The meaning of the symbols of dreams/ seen in a dream.


Catarrh

A condition in which the mucous membranes of the nose and breathing passages are inflamed, often chronically... catarrh

Colitis

Inflammation of the colon... colitis

Cystitis

Inflammation of a bladder, especially the urinary bladder... cystitis

Cancer

Malignant neoplasm. Uncontrolled cell growth with local invasion and/or distant spread.... cancer

Cholesterol

A fatty substance produced predominantly by the liver, and necessary for building cell membranes, insulating the CNS, covering fats for blood transport, forming bile acids, oiling the skin and making steroid hormones. Blood cholesterols are not derived from food (digestion breaks them down) but are intentionally synthesized by the liver, in response to seeming need. Elevated cholesterols are the result of certain types of stress or metabolic imbalances, and the liver makes more than the tissues need. Although not a direct cause, high consumption of fats and proteins will convince the liver to kick into a fat/protein or anabolic stance...THEN it may oversecrete cholesterols, perhaps thinking you are putting food away for the winter.... cholesterol

Colic

A severe spasmodic griping pain... colic

Conjunctivitis

Inflammation of the conjunctiva... conjunctivitis

Cachexia

Depressed habit of mind... cachexia

Camphor

See Alcanfor.... camphor

Carbuncle

An infection of the skin and subcutaneous tissue by Staphylococcus aureus... carbuncle

Carcinoma

A malignant epithelial tumour eventually becoming fatal... carcinoma

Cardiac Arrest

Absence of a palpable pulse, and thus of circula tion of blood around the body by the heart contraction. The cause may be asystole or ventricular fibrillation.... cardiac arrest

Cataract

Opacity in the crystalline lens of the eye which may be partial or complete... cataract

Celery

See Apio.... celery

Chamomile

See Manzanilla.... chamomile

Chemotherapy

The use of chemicals/pharmaceuticals to treat disease.... chemotherapy

Cholecystitis

Inflammation of the gall bladder and ducts, sometimes from the presence of passing stones, sometimes following fasting or anorexia, sometimes because of a spreading intestinal tract infection....sometimes just because you eat three avocado sandwiches before going to bed.... cholecystitis

Cholera

A severe infectious epidemic disease due to Vibrio cholerae... cholera

Cirrhosis

Progressive fibrous tissue overgrowth in an organ... cirrhosis

Collagen

The fibrous insoluble structural protein that forms almost a third of our total body protein and holds everything together. Too much collagen is what makes a steak tough.... collagen

Colostomy

A temporary or permanent opening in the colon and the abdominal wall to allow faeces to pass out before reaching the anus.... colostomy

Coma

The state of complete loss of consciousness... coma

Congestion

Thick and boggy tissues, usually resulting from excess inflammation, or irritation that is unremitting. It is characterized by the accumulation of an excess volume of fluid, with impairment of venous and lymphatic drainage, and the buildup of unremoved cellular waste products.... congestion

Constipation

A condition in which a person infrequently passes hard FAECES (stools). Patients sometimes complain of straining, a feeling of incomplete evacuation of faeces, and abdominal or perianal discomfort. A healthy individual usually opens his or her bowels once daily but the frequency may vary, perhaps twice daily or once only every two or three days. Constipation is generally de?ned as fewer than three bowel openings a week. Healthy people may have occasional bouts of constipation, usually re?ecting a temporary change in diet or the result of taking drugs – for example, CODEINE – or any serious condition resulting in immobility, especially in elderly people.

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

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

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

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

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

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

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

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

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

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

Corn

(Hominy) See also Flour, Vegetable oils, Wheat cereals.

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

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

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

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

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

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

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

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

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

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

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

Croup

Any condition caused by respiratory obstruction... croup

Basal Cell Carcinoma

A generally slow growing malignant epithelial tumour, which has potential to invade and metastasise, especially if untreated.... basal cell carcinoma

Biliary Colic

See CHOLECYSTITIS, CHOLECYSTALGIA, etc.... biliary colic

Cabbage

See Repollo.... cabbage

Cactus

(American) Resembling the spiny plant Caktus... cactus

Caffeine

A white crystalline substance obtained from co?ee, of which it is the active principle. Its main actions are as a cerebral stimulant, a cardiac stimulant, and a diuretic. It is a constituent of many tablets for the relief of headache, usually combined with aspirin and paracetamol, but its pain-killing properties are controversial. One unusual use is in treating apnoeic attacks in premature babies (see APNOEA).... caffeine

Calcium

The metallic element present in chalk and other forms of lime. The chief preparations used in medicine are calcium carbonate (chalk), calcium chloride, calcium gluconate, calcium hydroxide (slaked lime), liquor of calcium hydroxide (lime-water), calcium lactate, and calcium phosphate. Calcium gluconate is freely soluble in water and is used in conditions in which calcium should be given by injection.

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

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

Calculus

A concretion formed in any part of the body usually compounds of salts of organic or inorganic acids... calculus

Calyx

The outer set of sterile, floral leaves; the green, clasping base of a flower.... calyx

Cancrum Oris

Cancrum oris, also called noma, is a gangrenous ulcer about the mouth which affects sickly children, especially after some severe disease such as measles. It is due to the growth of bacteria in the tissues.... cancrum oris

Candida

A yeast-like fungus which comprises part of the normal flora of the gut but which can cause candidiasis (which includes oral and vaginal thrush) usually as an overgrowth syndrome in diabetics, the immunologicallycompromised, or as a result of the use of broad spectrum antibiotics (e.g. tetracyclines) and the contraceptive pill.... candida

Candidiasis

Generally, a disorder caused by Candida (Monilia) albicans. This is a common yeast-like fungus found in the mouth. vagina. and rectum, as well as on the outside skin. It is a common cause of thrush in infants and vaginal yeast infections. In recent years much attention has been given to the increased numbers of people with candidiasis in the upper and lower intestinal tract. This condition is now known to occur as a result of extended antibiotic therapy and anti-inflammatory treatment. Most anti­inflammatory drugs are really immunosuppressants, and the normal, stable competition between fungus and bacteria is altered by the antibiotic use; this rather benign and common skin and mucosal fungus can then move deeply into the body. Although both therapies are of major importance in managing disease, they are often prescribed or requested trivially, and both are centerpieces to the increased reliance on procedural medicine (surgery). The drug industry is paralyzed by the cost of marketing new drugs, whereas surgical procedures need far easier peer and FDA acceptance. Procedural medicine normally needs antibiotic AND anti-inflammatory therapy.... candidiasis

Capsule

A term used in several senses in medicine. It is applied to a soluble case, usually of gelatine, for enclosing small doses of unpleasant medicine.

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

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

Carcinoma In Situ

The ?rst stage of CARCINOMA in which the malignant tumour is present only in the EPITHELIUM, and when surgical excision of the local growth, with its pathological status con?rmed in the laboratory, should ensure a cure.... carcinoma in situ

Cardiac

Relating to the heart... cardiac

Carrier

An insurer; an underwriter of risk, who finances health care. Also refers to any organization which underwrites or administers life, health or other insurance programmes.... carrier

Case Control Study

A study that starts with the identification of persons with the disease (or other outcome variable) of interest, and a suitable control (comparison, reference) group of persons without the disease. The relationship of an attribute to the disease is examined by comparing the diseased and non-diseased with regard to how frequently the attribute is present or, if quantitative, the level of the attribute, in each of the groups.... case control study

Catalepsy

A physical condition in which part or all of the body becomes rigid. It is characterised by the adoption of strange – often statue-like – poses (CATATONIA), which may pass o? within a few minutes or may last for several hours (rarely, days). Typically brought on by a sudden mental trauma, catalepsy may occur with prolonged depression or some other serious MENTAL ILLNESS, and occasionally with EPILEPSY. Successful treatment must depend upon due recognition of all precipitating factors and circumstances.... catalepsy

Cataplexy

A condition marked by abrupt attacks of muscular weakness... cataplexy

Cathartic

Having the power of cleaning the bowels-purgative... cathartic

Cellulitis

In?ammation taking place in cellular tissue, and usually referring to infection in the subcutaneous tissue. A related word, cellulite, which has no medical meaning, is used in the slimming business to refer to excess fatty tissue in the arms, buttocks and thighs. (See ABSCESS; ERYSIPELAS.)... cellulitis

Central Nervous System

A collective term for the brain, spinal cord, their nerves, and the sensory end organs. More broadly, this can even include the neurotransmitting hormones instigated by the CNS that control the chemical nervous system, the endocrine glands.... central nervous system

Cephalic

A remedy for disorders of the head... cephalic

Chancroid

Tropical sexually transmitted disease caused by Haemophilus ducreyi . Also known as “Soft sore”. It is characterised by soft, extremely painful ulcers on the genitals and enlarged inguinal lymph nodes (“buboes”).... chancroid

Chicory

Cichorium intybus

Description: This plant grows up to 1.8 meters tall. It has leaves clustered at the base of the stem and some leaves on the stem. The base leaves resemble those of the dandelion. The flowers are sky blue and stay open only on sunny days. Chicory has a milky juice.

Habitat and Distribution: Look for chicory in old fields, waste areas, weedy lots, and along roads. It is a native of Europe and Asia, but is also found in Africa and most of North America where it grows as a weed.

Edible Parts: All parts are edible. Eat the young leaves as a salad or boil to eat as a vegetable. Cook the roots as a vegetable. For use as a coffee substitute, roast the roots until they are dark brown and then pulverize them.... chicory

Chiropody

See “podiatry”.... chiropody

Childbirth

See PREGNANCY AND LABOUR.... childbirth

Chloasma

This is an increase in the melanin pigment of the skin as a result of hormonal stimulation. It is commonly seen in pregnancy and sometimes in women on the contraceptive pill. It mainly affects the face.... chloasma

Chloroquine

A 4-aminoquinoline drug commonly used for treating malaria. Resistence is widespread in Plasmodium falciparum.... chloroquine

Cholangitis

Inflammation of of only bile ducts. This word and the next three describe conditions that may be, subjectively, all the same.... cholangitis

Chorea

A neuromuscular condition, with twitching and spastic muscle control.... chorea

Chronic

A disease or imbalance of long, slow duration, showing little overall change and characterized by periods of remission interspersed with acute episodes. The opposite of acute.... chronic

Chronic Fatigue Syndrome

(CFS) is a recently designated semi-disease, often attributed to EBV (the Epstein-Barr virus) or CMV (Cytomegalovirus) infections, characterized by FUOs (Fevers of Unknown Origin) and resulting in the patient suffering FLS (Feels Like Shit). In most of us, the microorganisms involved in CFS usually provoke nothing more than a head cold; in some individuals, however, they induce a long, grinding, and debilitating disorder, characterized by exhaustion, depression, periodic fevers...a crazy-quilt of symptoms that frustrates both the sufferer and the sometimes skeptical physician. MCS (Multiple Chemical Sensitivities) are another syndrome that is often lumped with CFS, and they may often be two faces of the same condition. I am not using all these acronyms to mock the conditions, but as an irony. There is too much (Acronym Safety Syndrome) in medicine, reducing complex and frustrating conditions to insider’s techno-babble, somehow therein trivializing otherwise complex, painful and crazy-making problems. The widest use of acronyms (AIDS, HIV, CFS, MCS, MS etc.) seems to be for diseases hardest to treat, least responsive to procedural medicine, and most depressing to discuss with patients or survivors.... chronic fatigue syndrome

Cinnamon

See Canela.... cinnamon

Cinchona

Cinchona spp.

Rubiaceae

San: Cinchona, Kunayanah

Hin: Kunain Mal: Cinchona, Quoina

Tam: Cinchona

Importance: Cinchona, known as Quinine, Peruvian or Crown bark tree is famous for the antimalarial drug ‘quinine’ obtained from the bark of the plant. The term cinchona is believed to be derived from the countess of cinchon who was cured of malaria by treating with the bark of the plant in 1638. Cinchona bark has been valued as a febrifuge by the Indians of south and central America for a long time. Over 35 alkaloids have been isolated from the plant; the most important among them being quinine, quinidine, cinchonine and cinchonidine. These alkaloids exist mainly as salts of quinic, quinovic and cinchotannic acids. The cultivated bark contains 7-10% total alkaloids of which about 70% is quinine. Similarly 60% of the total alkaloids of root bark is quinine. Quinine is isolated from the total alkaloids of the bark as quinine sulphate. Commercial preparations contain cinchonidine and dihydroquinine. They are useful for the treatment of malarial fever, pneumonia, influenza, cold, whooping couphs, septicaemia, typhoid, amoebic dysentery, pin worms, lumbago, sciatica, intercostal neuralgia, bronchial neuritis and internal hemorrhoids. They are also used as anesthetic and contraceptive. Besides, they are used in insecticide compositions for the preservation of fur, feathers, wool, felts and textiles. Over doses of these alkaloids may lead to deafness, blindness, weakness, paralysis and finally collapse, either comatose or deleterious. Quinidine sulphate is cardiac depressant and is used for curing arterial fibrillation.

Distribution: Cinchona is native to tropical South America. It is grown in Bolivia, Peru, Costa Rica, Ecuador, Columbia, Indonesia, Tanzania, Kenya, Zaire and Sri Lanka. It was introduced in 1808 in Guatemala,1860 in India, 1918 in Uganda, 1927 in Philippines and in 1942 in Costa Rica. Roy Markham introduced the plant to India. The first plantation was raised in Nilgiris and later on in Darjeeling of West Bengal. The value of the tree was learnt by Jessuit priests who introduced the bark to Europe. It first appeared in London pharmacopoeia in 1677 (Husain, 1993).

Botany: The quinine plant belongs to the family Rubiaceae and genus Cinchona which comprises over 40 species. Among these a dozen are medicinally important. The commonly cultivated species are C. calisaya Wedd., C. ledgeriana Moens, C. officinalis Linn., C. succirubra Pav. ex Kl., C. lancifolia and C. pubescens. Cinchona species have the chromosome number 2n=68. C. officinalis Linn. is most common in India. It is an evergreen tree reaching a height of 10-15m. Leaves are opposite, elliptical, ovate- lanceolate, entire and glabrous. Flowers are reddish-brown in short cymbiform, compound cymes, terminal and axillary; calyx tubular, 5-toothed, obconical, subtomentose, sub-campanulate, acute, triangular, dentate, hairy; corolla tube 5 lobed, densely silky with white depressed hairs, slightly pentagonal; stamens 5; style round, stigma submersed. Fruit is capsule ovoid-oblong; seeds elliptic, winged margin octraceous, crinulate-dentate (Biswas and Chopra, 1982).

Agrotechnology: The plant widely grows in tropical regions having an average minimum temperature of 14 C. Mountain slopes in the humid tropical areas with well distributed annual rainfall of 1500-1950mm are ideal for its cultivation. Well drained virgin and fertile forest soils with pH 4.5-6.5 are best suited for its growth. It does not tolerate waterlogging. Cinchona is propagated through seeds and vegetative means. Most of the commercial plantations are raised by seeds. Vegetative techniques such as grafting, budding and softwood cuttings are employed in countries like India, Sri Lanka, Java and Guatemala. Cinchona succirubra is commonly used as root stock in the case of grafting and budding. Hormonal treatment induces better rooting. Seedlings are first raised in nursery under shade. Raised seedbeds of convenient size are prepared, well decomposed compost or manure is applied , seeds are broadcasted uniformly at 2g/m2, covered with a thin layer of sand and irrigated. Seeds germinate in 10-20 days. Seedlings are transplanted into polythene bags after 3 months. These can be transplanted into the field after 1 year at 1-2m spacing. Trees are thinned after third year for extracting bark , leaving 50% of the trees at the end of the fifth year. The crop is damaged by a number of fungal diseases like damping of caused by Rhizoctoria solani, tip blight by Phytophthora parasatica, collar rot by Sclerotiun rolfsii, root rot by Phytophthora cinnamomi, Armillaria mellea and Pythium vexans. Field sanitation, seed treatment with organo mercurial fungicide, burning of infected plant parts and spraying 1% Bordeaux mixture are recommended for the control of the diseases (Crandall, 1954). Harvesting can be done in one or two phases. In one case, the complete tree is uprooted, after 8-10 years when the alkaloid yield is maximum. In another case, the tree is cut about 30cm from the ground for bark after 6-7 years so that fresh sprouts come up from the stem to yield a second crop which is harvested with the under ground roots after 6-7 years. Both the stem and root are cut into convenient pieces, bark is separated, dried in shade, graded, packed and traded. Bark yield is 9000-16000kg/ha (Husain, 1993).

Properties and activity: Over 35 alkaloids have been isolated from Cinchona bark, the most important among them are quinine, quinidine, cinchonine, cinchonidine, cinchophyllamine and idocinchophyllamine. There is considerable variation in alkaloid content ranging from 4% to 20%. However, 6-8% yield is obtained from commercial plantations. The non alkaloidal constituents present in the bark are bitter glycosides, -quinovin, cinchofulvic, cinchotannic and quinic acids, a bitter essential oil possessing the odour of the bark and a red coloring matter. The seed contains 6.13% fixed oil. Quinine and its derivatives are bitter, astringent, acrid, thermogenic, febrifuge, oxytocic, anodyne, anti-bacterial, anthelmintic, digestive, depurative, constipating, anti pyretic, cardiotonic, antiinflammatory, expectorant and calcifacient (Warrier et al, 1994; Bhakuni and Jain, 1995).... cinchona

Claustrophobia

Morbid fear of being in a con?ned space, or the fear experienced while in it. Claustrophobia may develop because of a previous unpleasant experience in a con?ned space. COGNITIVE BEHAVIOUR THERAPY may help patients whose daily lives are seriously affected by this disorder.... claustrophobia

Clinical Trial

A controlled research study of the safety and effectiveness of drugs, devices or techniques that occurs in four phases, starting with the enrolment of a small number of people, to the later stages in which thousands of people are involved prior to approval by the licensing authorities (for example, the Food and Drug Administration).... clinical trial

Coeliac Disease

Around one in 100 people suffers from coeliac disease, a condition in which the small INTESTINE fails to digest and absorb food, but many have no or few symptoms and remain undiagnosed. The intestinal lining is permanently sensitive to the protein gliadin (an insoluble and potentially toxic PEPTIDE protein) which is contained in GLUTEN, a constituent of the germ of wheat, barley and rye. As bread or other grain-based foods are a regular part of most people’s diet, the constant presence of gluten in the intestine of sufferers of coeliac disease causes atrophy of the digestive and absorptive cells of the intestine. Children are usually diagnosed when they develop symptoms such as vomiting, diarrhoea, lethargy, ANAEMIA, swollen abdomen and pale, frothy, foul-smelling faeces with failure to thrive. The diagnosis is usually made by a positive blood antibody test such as antiendomysial antibodies. However, because there may be an occasional false positive result, the ‘gold standard’ is to obtain a biopsy of the JEJUNUM through a tiny metal capsule that can be swallowed, a specimen taken, and the capsule retrieved. Though coeliac disease was long thought to occur in childhood, a second peak of the disorder has recently been identi?ed among people in their 50s.

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

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

Colostrum

The first breast milk after birth, containing minerals and white blood cells. This is followed gradually by true milk.... colostrum

Communicable Disease

An illness due to a specific infectious agent or its toxic products which arises through transmission of that agent or its products from a reservoir to a susceptible host - either directly, through the agencyof an intermediate plant or animal host, vector, or the inanimate environment.... communicable disease

Complement

A large body of blood proteins (over 20), initiated in the liver, and intimately involved in nearly all aspects of immunity and nonspecific resistance. They form two types of self-mediated cascade reactions to antigens, antibody-antigen complexes, dead tissue and the like, and are almost solely able to initiate the rupture and killing of bacteria. The protein strings they form around foreign substances are the main “hooks” used for absorption by macrophages as they digest and clean up.... complement

Complex

A group of closely related species once thought to be a single species.... complex

Compliance

A measure of the extent to which persons undergo an assigned treatment or regimen, e.g. taking drugs, undergoing a medical or surgical procedure, following an exercise regimen, or abstaining from smoking.... compliance

Compress

Compress is the name given to a pad of linen or ?annel wrung out of water and bound to the body. It is generally wrung out of cold water, and may be covered with a piece of waterproof material. It is used to subdue pain or in?ammation. A hot compress is generally called a FOMENTATION.... compress

Conjunctiva

The mucus membrane which covers the underside of the eyelids and the front surfaces of the eyeball.... conjunctiva

Connective Tissue

Sometimes called ?brous tissue, this is one of the most abundant tissues in the body, holding together the body’s many di?erent structures. Connective tissue comprises a matrix of substances called mucopolysaccharides in which are embedded various specialist tissues and cells. These include elastic (yellow), collagenous (white) and reticular ?bres as well as macrophages (see MACROPHAGE) and MAST CELLS. Assembled in di?ering proportions, this provides structures with varying functions: bone, cartilage, tendons, ligaments and fatty and elastic tissues. Collagenous connective tissue binds the muscles together and provides the substance of skin. It is also laid down in wound repair, forming the scar tissue. Contracting with time, connective tissue becomes denser, causing the puckering that is typical in serious wounds or burns. (See ADHESION; SCAR; WOUNDS.)... connective tissue

Consent

See “informed consent”.... consent

Copper

Copper is an essential nutrient for humans, and all tissues in the human body contain traces of it. The total amount in the adult body is 100– 150 mg. Many essential enzyme systems are dependent on traces of copper; on the other hand, there is no evidence that dietary de?ciency of copper ever occurs in humans. Infants are born with an ample store, and the normal diet for an adult contains around 2 mg of copper a day. It is used in medicine as the two salts, sulphate of copper (blue stone) and nitrate of copper. The former is, in small doses, a powerful astringent, and in larger doses an irritant. Both are caustics when applied externally. Externally, either is used to rub on unhealthy ulcers and growths to stimulate the granulation tissue to more rapid healing.... copper

Coriander

(Greek) A romantic woman; resembling the spice Coryander, Coriender, Coryender... coriander

Corpus Luteum

A temporary endocrine gland formed at ovulation from part of the former egg follicle, and the source of progesterone. See PROGESTERONE, ESTROGEN, MENOPAUSE... corpus luteum

Cortisone

An early corticosteroid drug (see CORTICOSTEROIDS), now obsolete and replaced by PREDNISOLONE and HYDROCORTISONE.... cortisone

Coryza

Coryza is the technical name for a ‘cold in the head’ (see COLD, COMMON).... coryza

Counselling

Interaction offering an opportunity for a person to explore, discover and clarify ways of living with greater well-being, usually in a one-to-one discussion with a trained counsellor.... counselling

Cramp

See MUSCLES, DISORDERS OF.... cramp

Cream

The oily or fatty part of milk from which butter is prepared. Various medicinal preparations are known also as cream – for example, cold cream, which is a simple ointment containing rosewater, beeswax, borax, and almond oil scented with oil of rose.... cream

Creatinine

It is the waste product of creatine, an enzyme found in large amounts throughout the tissues, and mainly excreted in the urine. The parent compound creatine enables the body to use the “blue flame” of anaerobic combustion (as opposed to the yellow flame of oxidation). Elevated creatinine in the blood may be an early symptom of kidney disease.... creatinine

Cutaneous

... cutaneous

Cystic Fibrosis

This is the most common serious genetic disease in Caucasian children, with an incidence of about one per 2,500 births, and more than 6,000 patients in the UK (30,000 in the USA). It is an autosomal recessive disorder of the mucus-secreting glands of the lungs, the pancreas, the mouth, and the gastrointestinal tract, as well as the sweat glands of the skin. The defective gene is sited on chromosome 7 which encodes for a protein, cystic ?brosis transmembrane conductance regulator (CFTR). Individuals who inherit the gene only on one set of chromosomes can, however, carry the defect into successive generations. Where parents have a child with cystic ?brosis, they have a one-infour chance of subsequent children having the disease. They should seek GENETIC COUNSELLING.

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

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

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

Cytology

Study of cells removed from surface of organs (exfoliated cells) for the purpose of diagnosing cancer; e.g., Papanicolaou smear.... cytology

Health Centre

A centre that may carry out promotive, protective, preventive, diagnostic, curative and rehabilitative health care activities for ambulant people.... health centre

Intermediate Care

A short period of intensive rehabilitation and treatment to enable people to return home following hospitalization or to prevent admission to hospital or residential care.... intermediate care

Intermittent Claudication

A condition occurring in middle-aged and elderly people, which is characterised by pain in the legs after walking a certain distance. The pain is relieved by resting for a short time. It is due to arteriosclerosis (see ARTERIES, DISEASES OF) of the arteries to the leg, which results in inadequate blood supply to the muscles. Drugs usually have little e?ect in easing the pain, but useful preventive measures are to stop smoking, reduce weight (if overweight), and to take as much exercise as possible within the limits imposed by the pain.... intermittent claudication

Primary Care

Basic or general health care focused on the point at which a patient ideally first seeks assistance from the medical care system. It is the basis for referrals to secondary and tertiary level care.... primary care

Cyst

An abnormal sac-like swelling covered by a supporting membrane containing fluid of different consistencies which cannot escape into the general circulation.

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

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

Hydatid. Caused by parasitic infection (Thuja).

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

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

Cervical. Chaparral tea douche.

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

Birth Control

See CONTRACEPTION.... birth control

Blood Clot

A blood clot arises when blood comes into contact with a foreign surface – for example, damaged blood vessels – or when tissue factors are released from damaged tissue. An initial plug of PLATELETS is converted to a de?nitive clot by the deposition of FIBRIN, which is formed by the clotting cascade and erythrocytes. (See COAGULATION.)... blood clot

Blood Count

The number of each of the cellular components per litre of blood. It may be calculated using a microscope or by an automated process.... blood count

Cachet

An oval capsule that encloses a dose of unpleasant medicine.... cachet

Caecum

The dilated ?rst part of the large intestine lying in the right lower corner of the abdomen.The small intestine and the appendix open into it, and it is continued upwards through the right ?ank as the ascending colon.... caecum

Caesarean Section

The operation used to deliver a baby through its mother’s abdominal wall. It is performed when the risks to mother or child of vaginal delivery are thought to outweigh the problems associated with operative delivery. One of the most common reasons for Caesarean section is ‘disproportion’ between the size of the fetal head and the maternal pelvis. The need for a Caesarean should be assessed anew in each pregnancy; a woman who has had a Caesarean section in the past will not automatically need to have one for subsequent deliveries. Caesarean-section rates vary dramatically from hospital to hospital, and especially between countries, emphasising that the criteria for operative delivery are not universally agreed. The current rate in the UK is about 23 per cent, and in the USA, about 28 per cent. The rate has shown a steady rise in all countries over the last decade. Fear of litigation by patients is one reason for this rise, as is the uncertainty that can arise from abnormalities seen on fetal monitoring during labour. Recent research suggesting that vaginal delivery is becoming more hazardous as the age of motherhood rises may increase the pressure from women to have a Caesarean section – as well as pressure from obstetricians.

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

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

Caisson Disease

See COMPRESSED AIR ILLNESS.... caisson disease

Calamine

A mild astringent used, as calamine lotion, to soothe and protect the skin in many conditions such as eczema and urticaria.... calamine

Calamus

Luck, Healing, Money, Protection... calamus

Calcaneus

The heel-bone or os calcis, and the largest bone in the foot.... calcaneus

Calciferol

This is an outdated term for ergocaliciferol or vitamin D2 (see APPENDIX 5: VITAMINS).... calciferol

Calcinosis

Abnormal deposition of CALCIUM in the body tissue.... calcinosis

Calcitonin

A hormone, produced by the THYROID GLAND, which is involved in the metabolism of bone. Acting to lower concentrations of CALCIUM and PHOSPHATES in the blood, calcitonin is given by injection in the treatment of some patients with HYPERCALCAEMIA (especially when associated with malignant disease). In severe cases of PAGET’S DISEASE OF BONE it is used mainly for pain relief, but also relieves some of the neurological complications such as deafness.... calcitonin

Calorie

A unit of energy. Two units are called by this name. The small calorie, or gram calorie, is the amount of heat required to raise one gram of water one degree centigrade in temperature.

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

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

Campylobacter

A species of bacterium found in farm and pet animals, from which it can be transmitted to humans, in whom it is a major cause of bacterial FOOD POISONING: outbreaks of infection have followed drinking unpasteurised milk from infected cows and eating undercooked meat and poultry. It causes diarrhoea.

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

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

Cannula

A tube for insertion into the body, designed to ?t tightly round a trocar – a sharp, pointed instrument which is withdrawn from the cannula after insertion, so that ?uid may run out through the latter.... cannula

Cannabis

Psychoactive substances obtained from Cannabis sativa or Indian hemp, they are the oldest euphoriants. Also called marijuana, these substances do not usually result in physical DEPENDENCE but chronic abuse leads to passivity, apathy and inertia. Acute adverse effects include transient panic reactions and toxic psychoses. The panic reactions are characterised by anxiety, helplessness and loss of control and may be accompanied by ?orid paranoid thoughts and hallucinations. The toxic psychoses are characterised by the sudden onset of confusion and visual hallucinations. Even at lower doses, cannabis products can precipitate functional psychoses in vulnerable individuals. The acute physical manifestations of short-term cannabis abuse are conjunctival su?usion and tachycardia.

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

Captopril

An ACE-inhibitor drug introduced for the treatment of patients with severe HYPERTENSION. It acts by lowering the concentration in the blood of angiotensin II which is one of the factors responsible for high blood pressure. (See ANGIOTENSIN; RENIN.)... captopril

Carbamazepine

An anticonvulsant drug used to treat most types of EPILEPSY, including simple and complex partial seizures and tonic-clonic seizures secondary to a focal discharge. Monitoring of concentrations in the blood may be of help in ?nding the most e?ective dose. Carbamazepine has generally fewer side-effects than other antiepileptic drugs; even so, it should be started at a low dose and increased incrementally. The drug is also used to treat TRIGEMINAL NEURALGIA and other types of nerve pain, as well as pain from a PHANTOM LIMB. DEPRESSION resistant to LITHIUM CARBONATE may also bene?t from carbamazepine.... carbamazepine

Carbimazole

One of the most widely used drugs in the treatment of HYPERTHYROIDISM. It acts by interferring with the synthesis of thyroid hormone in the thyroid gland.... carbimazole

Carcinogen

A chemical or other agent that has been implicated in causing cancer.... carcinogen

Carcinogenesis

Carcinogenesis is the means or method whereby the changes responsible for the induction of CANCER are brought about.... carcinogenesis

Carcinomatosis

The spread of cancer cells from their original site of growth to other tissues in the body. Such a spread of cancer, which takes place mainly via blood and lymph vessels, is usually fatal. CHEMOTHERAPY and RADIOTHERAPY may, however, check the spread or sometimes destroy the cancerous growth.... carcinomatosis

Cardiac Cycle

The various sequential movements of the heart that comprise the rhythmic relaxation and expansion of the heart muscles as ?rst the atria contract and force the blood into the ventricles (diastole), which then contract (systole) to pump the blood round the body. (See ELECTROCARDIOGRAM (ECG).)

Cardiac Disease

See HEART, DISEASES OF.... cardiac cycle

Cardiac Output

The volume of blood pumped out per minute by the ventricles of the heart. It is one measure of the heart’s e?ciency. At rest, the heart of a healthy adult will pump between 2.5 and 4.5 litres of blood every minute. Exercise will raise this to as much as 30 litres a minute but, if this ?gure is low, it suggests that the heart muscle may be diseased or that the person has suffered severe blood loss.... cardiac output

Cardiology

That branch of medical science devoted to the study of the diseases of the heart.... cardiology

Cardiomyopathy

A general term covering primary disease of the heart muscle. (See HEART, DISEASES OF.)... cardiomyopathy

Cardiopulmonary Bypass

A procedure in which the body’s circulation of blood is kept going when the heart is intentionally stopped to enable heart surgery to be carried out. A HEART-LUNG MACHINE substitutes for the heart’s pumping action and the blood is oxygenated at the same time.... cardiopulmonary bypass

Cardiotonic

Keeping the heart functioning normally... cardiotonic

Cardioversion

Cardioversion, or DEFIBRILLATION, is indicated in patients with ventricular ?brillation or tachycardia, fast or irregular heartbeat, if other treatments have failed. A general anaesthetic is given if the patient is conscious, following which a carefully timed direct-current shock is applied to the patient’s chest wall using a DEFIBRILLATOR. The patient’s ECG rhythm should then be monitored and anticoagulants considered, as the risk of EMBOLISM is increased.... cardioversion

Carminative

Drug causing the release of stomach or intestinal gas... carminative

Carotene

A colouring matter of carrots, other plants, butter and yolk of egg, carotene is the precursor of vitamin A, which is formed from carotene in the liver. (See VITAMIN and APPENDIX 5: VITAMINS.)... carotene

Carpus

The Latin term for the WRIST, composed of eight small bones ?rmly joined together with ligaments, but capable of a certain amount of sliding movement over one another.... carpus

Cartilage

A hard but pliant substance forming parts of the skeleton – for example, the cartilages of the ribs, of the larynx and of the ears. Microscopically, cartilage is found to consist of cells arranged in twos or in rows, and embedded in a ground-glass-like material devoid of blood vessels and nerves. The end of every long bone has a smooth layer of hyaline cartilage on it where it forms a joint with other bones (articular cartilage), and in young persons up to about the age of 16 there is a plate of cartilage (epiphyseal cartilage) running right across the bone about 12 mm (half an inch) from each end. The latter, by constantly thickening and changing into bone, causes the increase in length of the bone. (See also BONE.) In some situations there is found a combination of cartilage and ?brous tissue, as in the discs between the vertebrae of the spine. This ?bro-cartilage, as it is known, combines the pliability of ?brous tissue with the elasticity of cartilage. (For cartilages of the knee, see KNEE.)... cartilage

Cascara Sagrada

Rhamnus purshiana. N.O. Rhamnaceae.

Synonym: Sacred Bark, Chittem Bark.

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

furrowed-longitudinally, purplish-brown in colour. Inner surface longitudinally

striated, transversely wrinkled. Fracture pale brown, or dark brown when older.

Persistently bitter taste, leather-like odour.

Older bark is preferred, younger sometimes griping. Part used ? Bark.

Action: Tonic laxative.

In habitual constipation due to sluggishness and atony of the lower bowel, and for digestive disorders generally. Doses for chronic constipation, firstly 1/2 to 1 teaspoonful at bedtime, afterwards 5-10 drops before each meal, of the fluid extract.... cascara sagrada

Catabolism

The breakdown by the body of complex substances to form simpler ones, a process that is accompanied by the release of energy. Among the substances catabolised are nutrients, such as CARBOHYDRATE and PROTEIN in food, and in storage in the body – for example, GLYCOGEN.... catabolism

Castration

This is literally de?ned as ‘deprivation of the power of generation’. In practical terms this involves surgical removal of both OVARIES, or both testicles (see TESTICLE). Such an operation is most commonly associated with the treatment of malignant lesions. In women who have reached the menopause, bilateral oophorectomy is routinely performed during HYSTERECTOMY, especially in cases of uterine carcinoma, and is usually performed when removing an ovarian tumour or malignant cyst. It is essential that the surgeon discusses with a woman before an operation when it might prove bene?cial to remove her ovaries in addition to carrying out the main procedure. In men, orchidectomy is routine for testicular tumours, and is sometimes carried out when treating prostatic cancer.... castration

Catatonia

A condition in which an individual takes up odd postures, often accompanied by muteness or semi-coma. The arms and legs may be moved passively by someone else into positions that the sufferer then holds for many hours. Catatonia occurs in SCHIZOPHRENIA. It may also be associated with organic brain disease such as encephalitis lethargica (see ENCEPHALITIS), tumours and carbon monoxide intoxication.... catatonia

Catecholamines

Hormones released by the body under any stressful reaction, or after envenomation (eg Irukandji), that affect the circulatory system, often increasing heart rate and blood pressure.... catecholamines

Causalgia

A severe burning pain in a limb in which the sympathetic and somatic nerves have been damaged.... causalgia

Cayenne

Capsicum minimum. N.O. Solanaceae.

Synonym: African Pepper, Bird Pepper, Guinea Pepper and Chillies.

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

Features ? The oblong-conical shaped pods are fiery to the taste, and the numerous seeds contain a large amount of oil, which has a similar effect on the palate. The fruit itself, however, differs widely in size, colour and strength. The yellowish-red product of Sierra Leone is the most pungent, the long, bright red type from Japan being much milder.

(Capsicum annum is cultivated in Hungary, and fed to canaries in order to improve the appearance of the plumage. Known as "tasteless Cayenne," this is quite free from pungency.)

Part used ? Dried, ripe fruit. Used for medicinal and culinary purposes.

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

As a pure stimulant, the administration of Cayenne produces a natural warmth and uniform circulation, and in dyspepsia and flatulence the carminative effect is especially noticeable. As a diaphoretic it may be used whenever it is desired to open the pores and bring about increased perspiration.

Capsicum is a constituent of many of the herbal compounds, including the well-known composition powders, Thomson's formula for which will be found in the appropriate section of this book. The dose of the powdered fruit is 5-20 grains.

Coffin is a champion of the virtues of Capsicum, one of his reasons being that, unlike most of the stimulants of allopathy, it is not a narcotic.... cayenne

Celandine

Chelidonium majus. N.O. Papaveraceae.

Synonym: Garden Celandine, Greater Celandine.

Habitat: Uncultivated places, and close to old walls.

Features ? This straggling, well-branched plant, which belongs to the poppy family, is not related either medicinally or botanically to Pilewort, which latter is commonly known as the Small or Lesser Celandine. This apparent confusion probably arose from some imagined superficial resemblance. The hairy stem of our present subject reaches a height of two feet, and exudes a saffron-yellow juice when fresh. The pinnate leaves are also slightly hairy, green above and greyish underneath, and are six to twelve inches long by two to three inches wide. The root tapers, and the yellow- flowers appear in May and June singly at the end of three or four smaller stalks given off from the end of a main flower stalk. The taste is bitter and caustic, the smell disagreeable.

Part used ? Herb.

Action: Alterative, diuretic and cathartic.

The infusion of 1 ounce to 1 pint of boiling water is taken in wineglassful doses three times daily, as part of the treatment for jaundice, eczema, and scrofulous diseases. The infusion is also helpful when applied directly to abrasions and bruises, and the fresh juice makes a useful application for corns and warts.

Culpeper knew of the virtues of Celandine in jaundice, and refers to it thus ? "The herb or roots boiled in white wine and drunk, a few Aniseeds being boiled therewith, openeth obstructions of the liver and gall, helpeth the yellow jaundice."... celandine

Cell

The smallest unit of living material that can function independently.... cell

Centaury

Erythraea centaurium. N.O. Gentianaceae.

Synonym: Century, Feverwort.

Habitat: Dry pastures.

Features ? Stem up to one foot high. Leaves opposite, lanceolate-ovate, three to five longitudinal ribs, smooth, entire at margins. Flowers (July and August) pink, twisted anthers. Whole plant bitter to the taste.

Part used ? Herb.

Action: Stomachic, bitter tonic.

In dyspepsia. Also jaundice, together with Bayberry bark. Three or four wineglass doses daily of the 1 ounce to 1 pint infusion.

R. L. Hool recommends equal parts of Centaury and Raspberry leaves in a similar infusion and dosage to above as a tonic for delicate and elderly people. He considers that Centaury "acts particularly upon the heart as a general strengthener." Coffin stresses its value in jaundice.... centaury

Cerebellar Ataxia

Uncoordinated movements, including an unsteady gait, caused by damage to or disease of the cerebellum (see BRAIN). Brain tumours, MULTIPLE SCLEROSIS (MS) and stroke can result in ataxia – as can excessive consumption of alcohol, and degeneration of the cerebellum as a result of an inherited disease. A?ected victims may have slurred speech, hand tremors and nystagmus (see under EYE, DISORDERS OF).... cerebellar ataxia

Cerebral Palsy

The term used to describe a group of conditions characterised by varying degrees of paralysis and originating in infancy or early childhood. In some 80 per cent of cases this takes the form of spastic paralysis (muscle sti?ness), hence the now obsolete lay description of sufferers as ‘spastics’. The incidence is believed to be around 2 or 2·5 per 1,000 of the childhood community. In the majority of cases the abnormality dates from well before birth: among the factors are some genetic malformation of the brain, a congenital defect of the brain, or some adverse e?ect on the fetal brain as by infection during pregnancy. Among the factors during birth that may be responsible is prolonged lack of oxygen such as can occur during a di?cult labour; this may be the cause in up to 15 per cent of cases. In some 10–15 per cent of cases the condition is acquired after birth, when it may be due to KERNICTERUS, infection of the brain, cerebral thrombosis or embolism, or trauma. Acute illness in infancy, such as meningitis, may result in cerebral palsy.

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

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

Cerumen

The name for the wax-like secretion found in the external ear.... cerumen

Cerebrospinal Fluid

The ?uid within the ventricles of the brain and bathing its surface and that of the spinal cord. Normally a clear, colourless ?uid, its pressure when an individual is lying on one side is 50 to 150 mm water. A LUMBAR PUNCTURE should not be done if the intracranial pressure is raised (see HYDROCEPHALUS).

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

Cervical

Cervical means anything pertaining to the neck, or to the neck of the womb.... cervical

Cervicitis

In?ammation of the cervix uteri or neck of the womb.... cervicitis

Cetrimide

Also known as cetavlon, cetrimide is the o?cial name for a mixture of alkyl ammonium bromides. It is a potent antiseptic, and as a 1 per cent solution is used for cleaning and disinfecting wounds, and in the ?rst-aid treatment of burns. As it is also a detergent, it is particularly useful for cleaning the skin, and also for cleansing and disinfecting greasy and infected bowls and baths.... cetrimide

Chagas’ Disease

A zoonotic protozoan disease endemic to parts of Latin America and caused by Trypanosmoma cruzi with reduviid (Triatomid or assassin) bugs as the vectors.... chagas’ disease

Chalazion

See EYE, DISORDERS OF.... chalazion

Chancre

The primary lesion of SYPHILIS.... chancre

Chest

The chest, or THORAX, is the upper part of the trunk. It is enclosed by the breastbone (sternum) and the 12 ribs which join the sternum by way of cartilages and are attached to the spine behind. At the top of the thorax, the opening in between the ?rst ribs admits the windpipe (TRACHEA), the gullet (OESOPHAGUS) and the large blood vessels. The bottom of the thorax is separated from the abdomen below by the muscular DIAPHRAGM which is the main muscle of breathing. Other muscles of respiration, the intercostal muscles, lie in between the ribs. Overlying the ribs are layers of muscle and soft tissue including the breast tissue.

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

Chestnut

Castanea sativa

Description: The European chestnut is usually a large tree, up to 18 meters in height.

Habitat and Distribution: In temperate regions, the chestnut is found in both hardwood and coniferous forests. In the tropics, it is found in semievergreen seasonal forests. They are found over all of middle and south Europe and across middle Asia to China and Japan. They are relatively abundant along the edge of meadows and as a forest tree. The European chestnut is one of the most common varieties. Wild chestnuts in Asia belong to the related chestnut species.

Edible Parts: Chestnuts are highly useful as survival food. Ripe nuts are usually picked in autumn, although unripe nuts picked while green may also be used for food. Perhaps the easiest way to prepare them is to roast the ripe nuts in embers. Cooked this way, they are quite tasty, and you can eat large quantities. Another way is to boil the kernels after removing the outer shell. After being boiled until fairly soft, you can mash the nuts like potatoes.... chestnut

Chickenpox

Also known as varicella. An acute, contagious disease predominantly of children – although it may occur at any age – characterised by fever and an eruption on the skin. The name, chickenpox, is said to be derived from the resemblance of the eruption to boiled chickpeas.

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

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

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

Chickweed

Stellaria media. N.O. Caryophyllaceae.

Synonym: Star-weed, Star duckweed.

Habitat: Waste places, roadsides.

Features ? Stem weak, straggling, freely branched; line of white hairs along one side only, changing direction at each pair of leaves. Leaves small, ovate, sessile above, flat stalks lower. Flowers white, very small, petals deeply cleft, singly on axils of upper leaves. Taste slightly salty.

Part used ? Herb.

Action: Demulcent, emollient, pectoral.

Inflammation of the respiratory organs and internal membranes generally. One ounce of herb in 1 1/2 pints of water simmered down to 1 pint. Dose, wineglassful every two or three hours. Used externally as a poultice for inflamed surfaces, boils, burns and skin eruptions.... chickweed

Child Abuse

This traditional term covers the neglect, physical injury, emotional trauma and sexual abuse of a child. Professional sta? responsible for the care and well-being of children now refer to physical injury as ‘non-accidental injury’. Child abuse may be caused by parents, relatives or carers. In England around 35,000 children are on local-authority social-service department child-protection registers – that is, are regarded as having been abused or at risk of abuse. Physical abuse or non-accidental injury is the most easily recognised form; victims of sexual abuse may not reveal their experiences until adulthood, and often not at all. Where child abuse is suspected, health, social-care and educational professionals have a duty to report the case to the local authority under the terms of the Children Act. The authority has a duty to investigate and this may mean admitting a child to hospital or to local-authority care. Abuse may be the result of impulsive action by adults or it may be premeditated: for example, the continued sexual exploitation of a child over several years. Premeditated physical assault is rare but is liable to cause serious injury to a child and requires urgent action when identi?ed. Adults will go to some lengths to cover up persistent abuse. The child’s interests are paramount but the parents may well be under severe stress and also require sympathetic handling.

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

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

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

Chlamydia

A genus of intracellular Gram negative bacteria including Chlamydia trachomatis, C. pneumoniae and C. psittaci.... chlamydia

Chlorambucil

One of several ALKYLATING AGENTS widely used in cancer chemotherapy, chlorambucil is an oral drug commonly used to treat chronic lymphocytic LEUKEMIA, non-Hodgkin’s lymphomas, Hodgkin’s disease (see LYMPHOMA) and ovarian cancer (see OVARIES, DISEASES OF). Apart from suppression of bone-marrow activity, side-effects are few.... chlorambucil

Chloramphenicol

An antibiotic derived from a soil organism, Streptomyces venezuelae. It is also prepared synthetically. A potent broad-spectrum antibiotic, chloramphenicol may, however, cause serious side-effects such as aplastic ANAEMIA, peripheral NEURITIS, optic neuritis and, in neonates, abdominal distension and circulatory collapse. The drug should therefore be reserved for the treatment of life-threatening infections such as Haemophilus in?uenzae, SEPTICAEMIA or MENINGITIS, typhoid fever (see ENTERIC FEVER) and TYPHUS FEVER, when the causative organism proves resistant to other drugs. However, because it is inexpensive, it is used widely in developing countries. This antibiotic is available as drops for use in eye and ear infection, where safety is not a problem.... chloramphenicol

Chlordiazepoxide

A widely used anti-anxiety drug. (See TRANQUILLISERS; BENZODIAZEPINES.)... chlordiazepoxide

Chlorhexidine

An antiseptic which has a bacteriostatic action against many bacteria.... chlorhexidine

Chlorine

See SODIUM HYPOCHLORITE.... chlorine

Chloroform

A chemical used for immobilising mosquitoes to facilitate their handling. It is toxic and should be used with extreme care.... chloroform

Chlorophyll

The green colouring matter of plants. Its main use is as a colouring agent, principally for soaps, oils and fats. It is also being found of value as a deodorant dressing to remove, or diminish, the unpleasant odour of heavily infected sores and wounds.... chlorophyll

Chlorpromazine

Chlorpromazine is chemically related to the antihistamine drug, PROMETHAZINE HYDROCHLORIDE. One of the ?rst antipsychotic drugs to be marketed, it is used extensively in psychiatry on account of its action in calming psychotic activity without producing undue general depression or clouding of consciousness. The drug is used particularly in SCHIZOPHRENIA and mania. It carries a risk of contact sensitisation, so should be handled with care, and the drug has a wide range of side-effects.... chlorpromazine

Cholagogue

A drug which causes increased flow of bile into the intestine... cholagogue

Cholangiocarcinoma

A cancer in the bile ducts of the liver associated with opisthorchiasis. See Opisthorchiasis.... cholangiocarcinoma

Cholangiography

The process whereby the bile ducts (see BILE DUCT) and the gall-bladder (see LIVER) are rendered radio-opaque and therefore visible on an X-ray ?lm.... cholangiography

Cholecystectomy

Removal of the gall-bladder (see LIVER) by operation.... cholecystectomy

Choking

Choking is the process which results from an obstruction to breathing situated in the larynx (see AIR PASSAGES). It may occur as the result of disease causing swelling round the glottis (the entrance to the larynx), or of some nervous disorders that interfere with the regulation of the muscles which open and shut the larynx. Generally, however, it is due to the irritation of a piece of food or other substance introduced by the mouth, which provokes coughing but only partly interferes with breathing. As the mucous membrane lining the upper part of the latter is especially sensitive, coughing results in order to expel the cause of irritation. At the same time, if the foreign body is of any size, lividity of the face appears, due to partial su?ocation (see ASPHYXIA).

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

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

Cholecystography

The process whereby the gall-bladder (see LIVER) is rendered radio-opaque and therefore visisble on an X-ray ?lm.... cholecystography

Cholecystokinin

The hormone (see HORMONES) released from the lining membrane of the DUODENUM when food is taken, and which initiates emptying of the gall-bladder (see LIVER).... cholecystokinin

Cholelithiasis

Having gall stones.... cholelithiasis

Choleretic

The term applied to a drug that stimulates the ?ow of BILE.... choleretic

Cholestasis

A reduction or stoppage in the ?ow of BILE into the intestine caused either by a blockage such as a stone in the BILE DUCT or by liver disease disturbing the production of bile. The ?rst type is called extrahepatic biliary obstruction and the second, intrahepatic cholestasis. The patient develops jaundice and itching and passes dark urine and pale faeces. Cholestasis may occasionally occur during pregnancy.... cholestasis

Cholestyramine

A drug of value in the treatment of the PRURITUS, or itching, which occurs in association with JAUNDICE. It does this by ‘binding’ the bile salts in the gut and so preventing their being reabsorbed into the bloodstream, where their excess in jaundice is responsible for the itching. It reduces the level of cholesterol and triglycerides in the blood and thereby, like clo?brate and STATINS, helping to reduce the incidence of coronary artery heart disease. (See HEART, DISEASES OF; HYPERLIPIDAEMIA.)... cholestyramine

Cholinergic

Pertaining to functions primarily controlled by the parasympathetic nervous system. See PARASYMPATHETIC... cholinergic

Chondroma

A TUMOUR composed in part of cartilage.... chondroma

Choriocarcinoma

A form of cancer affecting the CHORION, in the treatment of which particularly impressive results are being obtained from the use of methotrexate.... choriocarcinoma

Chorion

This is the more external of the two fetal membranes. (See PLACENTA.)... chorion

Choroid

See EYE.... choroid

Choroid Plexus

An extensive web of blood vessels occurring in the ventricles of the BRAIN and producing the CEREBROSPINAL FLUID.... choroid plexus

Choroiditis

See UVEITIS.... choroiditis

Christmas Disease

A hereditary disorder of blood coagulation which can only be distinguished from HAEMOPHILIA by laboratory tests. It is so-called after the surname of the ?rst case reported in this country. About one in every ten patients clinically diagnosed as haemophiliac has in fact Christmas disease. It is due to lack in the blood of Factor IX (see COAGULATION).... christmas disease

Cilia

Tiny hair-like cells that beat together, `wafting’, like a field of corn. They have the specialised function of moving substances (eg. food) across an area. Cilia also serve as organs of locomotion for ciliate protozoa.... cilia

Ciliary Body

That part of the EYE that connects the iris and the choroid. The ciliary ring is next to the choroid; the ciliary processes comprise many ridges behind the iris, to which the lens’s suspensory ligament is attached; and the ciliary muscle contracts to change the curvature of the lens and so adjust the accommodation of the eye.... ciliary body

Cimetidine

Cimetidine is a drug (known as an H2 receptor antagonist) that is widely used in the treatment of PEPTIC ULCER. It acts by reducing the hyperacidity of the gastric juice by antagonising histamine receptors in the stomach.... cimetidine

Cisplatin

A toxic drug with an alkylating action that gives it useful anti-tumour properties, especially against solid tumours such as ovarian and testicular cancers (see CYTOTOXIC).... cisplatin

Circumcision

A surgical procedure to remove the prepuce of the PENIS in males and a part or all of the external genitalia in females (see below). Circumcision is mainly done for religious or ethnic reasons; there is virtually no medical or surgical reason for the procedure. (The PREPUCE is not normally retractable in infancy, so this is not an indication for the operation – by the age of four the prepuce is retractable in most boys.) Americans are more enthusiastic about circumcision, and the reason o?ered is that cancer of the penis occurs only when a foreskin is present. This is however a rare disease. In the uncircumcised adult there is an increased transmission of herpes and cytomegaloviruses during the reproductive years, but this can be reduced by adequate cleansing. PHIMOSIS (restricted opening of the foreskin) is sometimes an indication for circumcision but can also be dealt with by division of adhesions between the foreskin and glans under local anesthetic. Haemorrhage, infection and meatal stenosis are rare complications of circumcision.

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

Claudication

A cramp-like pain that occurs in the legs on walking. It may cause the sufferer to limp or, if severe, stop him or her from walking. The usual cause is narrowing or blockage of the arteries in the legs due to ATHEROSCLEROSIS: smoking is a contributary factor. Intermittent claudication occurs when a person has to stop every so often to let the pain – caused by the build-up of waste products in the muscles – to subside. The condition may be improved by exercise, for example, for an hour a day (resting when the pain starts). Pentoxifylline, a vasodilator, may help, as may CALCIUM-CHANNEL BLOCKERS. Patients must avoid all tobacco products.... claudication

Clavicle

The bone which runs from the upper end of the breastbone towards the tip of the shoulder across the root of the neck. It supports the upper limb, keeps it out from the side, and gives breadth to the shoulders. The bone is shaped like an ‘f’ with two curves, which give it increased strength. It is, however, liable to be broken by falls on the hand or on the shoulder, and is the most frequently fractured bone in the body. (See BONE, DISORDERS OF.)... clavicle

Claw-foot

Claw-foot, or PES CAVUS, is a familial deformity of the foot characterised by an abnormally high arch of the foot accompanied by shortening of the foot, clawing of the toes, and inversion, or turning inwards, of the foot and heel. Its main e?ect is to impair the resilience of the foot resulting in a sti? gait and aching pain. Milder cases are treated with special shoes ?tted with a sponge rubber insole. More severe cases may require surgical treatment.... claw-foot

Claw-hand

A (contraction) deformity of the hand and ?ngers, especially of the ring and little ?ngers. The condition is generally due to paralysis of the ULNAR NERVE. A somewhat similar condition is produced by contraction of the ?brous tissues in the palm of the hand, partly due to rheumatic changes and partly to injury caused by the constant pressure of a tool against the palm of the hand. (See DUPUYTREN’S CONTRACTURE.)... claw-hand

Climacteric

This was a word originally applied to the end of certain epochs or stages in the life of an individual, at which some great change was supposed to take place. (See also MENOPAUSE.)... climacteric

Clindamycin

An antibiotic used in the treatment of serious infections. It is active against gram-positive cocci, including penicillin-resistant staphylococci (see STAPHYLOCOCCUS) and also many anaerobes (see ANAEROBE), especially Bacteroides fragilis. It is recommended for staphylococcal bone and joint infections such as OSTEOMYELITIS and intra-abdominal sepsis, as well as ENDOCARDITIS prophylaxis. Clindamycin has only limited use because of its adverse effects; patients should discontinue immediately if diarrhoea or colitis develops.... clindamycin

Clinical Governance

A framework through which health organizations are accountable for continuously improving the quality of their services and safeguarding high standards of care.... clinical governance

Clitoris

A small, sensitive organ comprising erectile tissue at the top of the female genitalia where the labial folds meet below the pubic bone. Clitoral tissue extends into the anterior roof of the vagina. During sexual excitement the clitoris enlarges and hardens and may be the focus of orgasm. (See CIRCUMCISION.)... clitoris

Clomipramine

One of the tricyclic ANTIDEPRESSANT DRUGS.)... clomipramine

Clonazepam

A drug to treat EPILEPSY, including STATUS EPILEPTICUS, and MYOCLONUS. (See also TRANQUILLISERS.)... clonazepam

Clone

A group of cells genetically identical to each other that have arisen from one cell by asexual reproduction (see CLONING).... clone

Clonic

Smooth muscle spasms or colic that alternate rhythmically with a rest state...like birthing contraction or waves of nausea.... clonic

Clonidine

A drug used for HYPERTENSION, MIGRAINE, GILLES DE LA TOURETTE’S SYNDROME, and menopausal ?ushing. It can cause drowsiness so caution is needed when driving or using machinery.... clonidine

Clonus

A succession of intermittent muscular relaxations and contractions usually resulting from a sustained stretching stimulus. An example is the clonus stimulated in the calf muscle by maintaining sustained upward pressure on the sole of the foot. The condition is often a sign of disease in the brain or spinal cord.... clonus

Clostridium

The genus, or variety, of micro-organisms that produce spores which enable them to survive under adverse conditions. They normally grow in soil, water and decomposing plant and animal matter, where they play an important part in the process of PUTREFACTION. Among the important members of the group, or genus, are Clostridium welchii, Cl. septicum and Cl. oedematiens, the causes of gas gangrene (see GANGRENE); Cl. tetani, the cause of TETANUS; and Cl. botulinum, the cause of BOTULISM.... clostridium

Clotrimazole

A drug of the IMIDAZOLES group used to treat fungal infections of the skin and vagina.... clotrimazole

Clove

(French) Resembling the spice; a nail... clove

Club-foot

See TALIPES.... club-foot

Clubbing

The term applied to the thickening and broadening of the ?ngertips – and, less commonly, the tips of the toes – that occurs in certain chronic diseases of the lungs and heart. It is due to interstitial OEDEMA especially at the nail bed, leading to a loss of the acute angle between the nail and the skin of the ?nger. Clubbing is associated with lung cancer, EMPYEMA, BRONCHIECTASIS and congenital cyanotic heart disease.... clubbing

Cocaine

Coca leaves are obtained from two South American plants, Erythroxylum coca and Erythroxylum truxillense, and contain an alkaloid, cocaine. Cocaine has marked effects as a stimulant, and, locally applied, as an anaesthetic by paralysing nerves of sensation. The dried leaves have been used from time immemorial by the South American Indians, who chew them mixed with a little lime. Their e?ect is to dull the mucous surfaces of mouth and stomach, with which the saliva, produced by chewing them, comes into contact – thus blunting, for long periods, all feeling of hunger. The cocaine, being absorbed, stimulates the central nervous system so that all sense of fatigue and breathlessness vanishes for a time. It was by the use of coca that the Indian post-runners of South America were able to achieve their extraordinary feats of endurance. The continued use of the drug, however, results in emaciation, loss of memory, sleeplessness and general breakdown. DEPENDENCE on cocaine or a derivative, ‘crack’, is now a serious social problem in many countries.

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

Coccyx

The lower end of the SPINAL COLUMN, resembling a bird’s beak and consisting of four fused nodules of bone; these represent vertebrae and correspond to the tail in lower animals. Above the coccyx lies a much larger bone, the SACRUM, and together they form the back wall of the PELVIS, which protects the organs in the lower ABDOMEN.... coccyx

Cochlea

That part of the inner ear concerned with hearing. (See EAR.)... cochlea

Codeine

One of the active principles of OPIUM, codeine is an analgesic (see ANALGESICS) which in the form of codeine phosphate is used to suppress persistent coughs and to relieve pain such as headaches and musculoskeletal discomfort. Side-effects include constipation, nausea and sleepiness. Dependence is rare.... codeine

Coconut

Cocos nucifera

Description: This tree has a single, narrow, tall trunk with a cluster of very large leaves at the top. Each leaf may be over 6 meters long with over 100 pairs of leaflets.

Habitat and Distribution: Coconut palms are found throughout the tropics. They are most abundant near coastal regions.

Edible Parts: The nut is a valuable source of food. The milk of the young coconut is rich in sugar and vitamins and is an excellent source of liquid. The nut meat is also nutritious but is rich in oil. To preserve the meat, spread it in the sun until it is completely dry.

Other Uses: Use coconut oil to cook and to protect metal objects from corrosion. Also use the oil to treat saltwater sores, sunburn, and dry skin. Use the oil in improvised torches. Use the tree trunk as building material and the leaves as thatch. Hollow out the large stump for use as a food container. The coconut husks are good flotation devices and the husk’s fibers are used to weave ropes and other items. Use the gauzelike fibers at the leaf bases as strainers or use them to weave a bug net or to make a pad to use on wounds. The husk makes a good abrasive. Dried husk fiber is an excellent tinder. A smoldering husk helps to repel mosquitoes. Smoke caused by dripping coconut oil in a fire also repels mosquitoes. To render coconut oil, put the coconut meat in the sun, heat it over a slow fire, or boil it in a pot of water. Coconuts washed out to sea are a good source of fresh liquid for the sea survivor.... coconut

Coffee

See Café.... coffee

Cohort Study

An observational study in which outcomes in a group of participants that received an intervention are compared with outcomes in a similar group (i.e. the cohort) of participants, either contemporary or historical, that did not receive the intervention. In an adjusted (or matched) cohort study, investigators identify (or make statistical adjustments to provide) a cohort group that has characteristics (e.g. age, gender, disease severity) that are as similar as possible to the group that experienced the intervention.... cohort study

Coitus

Coitus is sexual intercourse.

Coitus interruptus (see CONTRACEPTION).... coitus

Colchicine

A drug used to treat GOUT in the acute stage. Its use is limited by the development of toxicity at higher doses, but in patients with heart failure it may be preferable to NON-STEROIDAL ANTIINFLAMMATORY DRUGS (NSAIDS), which tend to cause ?uid retention. Colchicine can be given to patients receiving ANTICOAGULANTS. The drug does have side-effects on the gastrointestinal system.... colchicine

Colectomy

The operation for removing the COLON.... colectomy

Collagen Diseases

A group of diseases affecting CONNECTIVE TISSUE. The term is really outdated since there is no evidence that collagen is primarily involved. Fibrinoid NECROSIS and VASCULITIS are two ‘characteristics’, and autoimmunity reaction may occur in the connective tissue. The latter affects blood vessels and causes secondary damage in the connective tissue. Such conditions are sometimes described as collagen vascular diseases, examples being RHEUMATOID ARTHRITIS, SYSTEMIC LUPUS ERYTHEMATOSUS (SLE), and SCLERODERMA.... collagen diseases

Colloid

Gooey substances, usually proteins and starches, whose molecules can hold large amounts of a solvent (usually water) without dissolving. In lifeforms, virtually all fluids are held suspended in protein or starch colloids (hydrogels). (Examples: cell protoplasm, lime Jell-O.)... colloid

Colon

The ?rst part of the large INTESTINE.... colon

Colour Blindness

See VISION – Defective colour vision.... colour blindness

Colposcopy

The method of examining the VAGINA and CERVIX UTERI by means of the binocular instrument known as the colposcope. It is used to screen for cancer of the cervix and in investigation of child sexual abuse.... colposcopy

Coltsfoot

Tussilago farfara. N.O. Compositae.

Synonym: Also recognised as Coughwort and Horsehoof, the name Coltsfoot is from the shape of the leaf, which is supposed to resemble a colt's foot.

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

Features ? Springing erect from the ground to a height of about eight inches, the stem is entirely covered with small brown scales and a loose cottony down. The angular, long-stalked, toothed leaves are about four inches, green above with long white hairs underneath. Large, daisy type, bright yellow flowers appear, one to each

stalk, from February to April, long before the leaf growth. The taste is mucilaginous and rather astringent, the odour scarcely noticeable.

Part used ? Leaves.

Action: Expectorant and demulcent.

Coltsfoot leaves are used in a decoction of 1 ounce to 1 1/2 pints of water, simmered down to 1 pint, which is taken in teacupful doses. Its expectorant and demulcent action is of great help in cough remedies when in conjunction with pectorals such as Horehound. The leaves also form a useful constituent of asthma and whooping-cough medicines, and are smoked as a relief against asthma, bronchitis and catarrh.

These same uses were known centuries ago, as witness Culpeper ? "The dry leaves are best for those that have thin rheums, and distillations upon the lungs, causing a cough, for which also the dried leaves taken as tobacco, or the root, is very good."... coltsfoot

Comfrey

Symphytum officinale. N.O. Boraginaceae.

Synonym: Knitbone, Nipbone.

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

Features ? The hairy stem is two to three feet high, freely branched, rough and angular. Egg-shaped to lance-shaped leaves, with wavy edges, hug the stem above, the lower ones having long stalks ; they are all large and hairy. The plant produces yellowish, bluish, or purplish-white flowers in May and June, all on the same side of the stem. The root is brownish-black, deeply wrinkled, greyish and horny internally. The taste is mucilaginous and sweetish, and the dried herb has an odour resembling that of tea.

Part used ? Root and leaves.

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

The action of Comfrey is similar to that of Marsh Mallow, and consequently it is a popular cough remedy. It is also used as a fomentation in strained and inflammatory conditions of the muscles, and will promote suppuration of boils and other skin eruptions. A decoction is made by boiling 1/2 to 1 ounce of the crushed root in 1 quart of water,

reducing to 1 1/2 pints, and is taken in wineglass doses.

Coffin tells us the root of the plant is also "a good tonic medicine, and acts friendly on the stomach; very useful in cases where, from maltreatment, the mouth, the throat and stomach have become sore."... comfrey

Commensal

Micro-organisms which live in or on the body

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

Community Health

The combination of sciences, skills and beliefs directed towards the maintenance and improvement of the health of all the people through collective or social actions. The programmes, services and institutions involved emphasize the prevention of disease and the health needs of the population as a whole. Community health activities change with changing technology and social values, but the goals remain the same.... community health

Conception

Conception signi?es the complex set of changes which occur in the OVUM and in the body of the mother at the beginning of pregnancy. The precise moment of conception is that at which the male element, or spermatozoon, and the female element, or ovum, fuse together. Only one-third of these conceptions survive to birth, whilst 15 per cent are cut short by spontaneous abortion or stillbirth. The remainder – over one-half – are lost very early during pregnancy without trace. (See also FETUS.)... conception

Condom

A thin rubber or plastic sheath placed over the erect PENIS before sexual intercourse. It is the most e?ective type of barrier contraception and is also valuable in preventing the transfer between sexual partners of pathogenic organisms such as gonococci, which cause GONORRHOEA, and human immuno-de?ciency virus, which may lead to AIDS (see AIDS/HIV). Sheaths are most e?ective when properly used and with spermicides.

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

Cone

(1) A light-sensitive cell in the retina of the EYE that can also distinguish colours. The other type of light-sensitive cell is called a rod. There are around six million cones in the human retina and these are thought to comprise three types that are sensitive to the three primary colours of red, blue, and green.

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

Confidentiality

Privacy in the context of privileged communication (such as patient-doctor consultations) and medical records is safeguarded.... confidentiality

Congenital

Congenital deformities, diseases, etc. are those which are either present at birth, or which, being transmitted direct from the parents, show themselves some time after birth.... congenital

Congenital Adrenal Hyperplasia

See ADRENOGENITAL SYNDROME and GENETIC DISORDERS.... congenital adrenal hyperplasia

Consolidation

A concentration of control by a few organizations over other existing organizations through consolidation of facility assets that already exist. Acquisitions, mergers, alliances and formation of contractual networks are examples of consolidation.... consolidation

Consumption

Pulmonary tuberculosis... consumption

Contact Lenses

Contact lenses are lenses worn in contact with the EYE, behind the eyelids and in front of the cornea. They may be worn for cosmetic, optical or therapeutic reasons. The commonest reason for wear is cosmetic, many short-sighted people preferring to wear contact lenses instead of glasses. Optical reasons for contact-lens wear include cataract surgery (usually unilateral extraction) and the considerable improvement in overall standard of vision experienced by very short-sighted people when wearing contact lenses instead of glasses. Therapeutic lenses are those used in the treatment of eye disease: ‘bandage lenses’ are used in certain corneal diseases; contact lenses can be soaked in a particular drug and then put on the eye so that the drug slowly leaks out on to the eye. Contact lenses may be hard, soft or gas permeable. Hard lenses are more optically accurate (because they are rigid), cheaper and more durable than soft. The main advantage of soft lenses is that they are more comfortable to wear. Gas-permeable lenses are so-called because they are more permeable to oxygen than other lenses, thus allowing more oxygen to reach the cornea.

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

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

Continuity Of Care

The provision of barrier-free access to the necessary range of health care services over any given period of time, with the level of care varying according to individual needs.... continuity of care

Contracture

The permanent shortening of a muscle or of ?brous tissue. Contraction is the name given to the temporary shortening of a muscle.... contracture

Contraindication

A clinical symptom, circumstance, condition indicating that the use of an otherwise advisable intervention would be inappropriate. A contraindication may be absolute or relative. An absolute contraindication is a situation which makes a particular treatment or procedure absolutely inadvisable. A relative contraindication is a condition which makes a particular treatment or procedure somewhat inadvisable, but does not rule it out (for example, X-rays in pregnancy).... contraindication

Contrast Medium

A material that is used to increase the visibility of the body’s tissues and organs during RADIOGRAPHY. A common example is the use of barium which is given by mouth or as an enema to show up the alimentary tract.... contrast medium

Contraception

A means of avoiding pregnancy despite sexual activity. There is no ideal contraceptive, and the choice of method depends on balancing considerations of safety, e?ectiveness and acceptability. The best choice for any couple will depend on their ages and personal circumstances and may well vary with time. Contraceptive techniques can be classi?ed in various ways, but one of the most useful is into ‘barrier’ and ‘non-barrier’ methods.

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

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

SPERMICIDAL GELS, CREAMS, PESSARIES, ETC.

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

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

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

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

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

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

Contusion

An injury to tissue that does not break the skin... contusion

Convulsion

A violent involuntary contraction of the skeletal musculature... convulsion

Conversion Disorder

A psychological disorder, also called hysterical conversion, in which the affected individual presents with striking neurological symptoms – such as weakness, paralysis, sensory disturbances or memory loss – for which no organic cause can be identi?ed. Up to 4 per cent of patients attending neurological outpatient clinics have been estimated as having conversion disorders. The disorder remains controversial, with theories about its cause unsupported by controlled research results. In clinical practice the physician’s experience and intuition are major factors in diagnosis. It has been suggested that the physical symptoms represent guilt about a physical or emotional assault on someone else. Treatment using a COGNITIVE BEHAVIOUR approach may help those with conversion disorders.... conversion disorder

Cordotomy

The surgical operation of cutting the anterolateral tracts of the SPINAL CORD to relieve otherwise intractable pain. It is also sometimes known as tractotomy.... cordotomy

Cornea

See EYE.... cornea

Corneal Graft

Also known as keratoplasty. If the cornea (see EYE) becomes damaged or diseased and vision is impaired, it can be removed and replaced by a corneal graft. The graft is taken from the cornea of a human donor. Some of the indications for corneal grafting include keratoconus (conicalshaped cornea), corneal dystrophies, severe corneal scarring following HERPES SIMPLEX, and alkali burns or other injury. Because the graft is a foreign protein, there is a danger that the recipient’s immune system may set up a reaction causing rejection of the graft. Rejection results in OEDEMA of the graft with subsequent poor vision. Once a corneal graft has been taken from a donor, it should be used as quickly as possible. Corneas can be stored for days in tissue-culture medium at low temperature. A small number of grafts are autografts in which a patient’s cornea is repositioned.

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

Coronary Thrombosis

See HEART, DISEASES OF.... coronary thrombosis

Coroner

An independent legal o?cer of the Crown who is responsible for deciding whether to hold a POST-MORTEM EXAMINATION and an inquest in cases of sudden or unexpected or unnatural death. He or she presides over an inquest, if held – sometimes with the help of a jury. Coroners are usually lawyers or doctors (some are double-quali?ed) who have been quali?ed for at least ?ve years. In Scotland the coroner is known as the procurator ?scal.... coroner

Corpuscle

Corpuscle means a small body. (See BLOOD.)... corpuscle

Cortex

The tissues that form the outer part of an organ and which are positioned just below the capsule or outer membrane. Examples are the cerebal cortex of the BRAIN and the renal cortex of the KIDNEYS.... cortex

Corticosteroids

Natural steroid hormones or synthetic analogues, usually taken for suppressing inflammation (and immunity) and therefore having cortisone-like functions, or taken as analogues to adrenocortical androgen...or even testosterone, in order to impress the other gym members, make varsity by your junior year or to join the WWF and get newbie-mangled for two years by The Hangman or even the Hulkster Himself. Then, if your gonads don’t fall off and your back holds up you get promoted to Good Guy, have your chance to Take A Name and finally wear your chosen costume...a spandex violet nurse’s uniform.... corticosteroids

Cortisol

Another name for HYDROCORTISONE.... cortisol

Costalgia

Pain in the ribs.... costalgia

Cough

A natural re?ex reaction to irritation of the AIR PASSAGES and LUNGS. Air is drawn into the air passages with the GLOTTIS wide open. The inhaled air is blown out against the closed glottis, which, as the pressure builds up, suddenly opens, expelling the air – at an estimated speed of 960 kilometres (600 miles) an hour. This explosive exhalation expels harmful substances from the respiratory tract. Causes of coughing include infection – for example, BRONCHITIS or PNEUMONIA; in?ammation of the respiratory tract associated with ASTHMA; and exposure to irritant agents such as chemical fumes or smoke (see also CROUP).

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

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

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

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

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

Counterirritant

An agent that causes local inflammation of an area... counterirritant

Cowpox

Cowpox is a disease affecting the udders of cows, on which it produces vesicles (see VESICLE; PAPULE). It is communicable to humans, and there has for centuries been a tradition that persons who have caught this disease from cows do not suffer afterwards from SMALLPOX. This formed the basis for Jenner’s experiments on VACCINATION.... cowpox

Cowslip

Primula veris. N.O. Primulaceae.

Synonym: Herb Peter, Paigles, Palsywort.

Habitat: Moist pastures and open places.

Features ? Round, downy stem rising well above the leaves, which lie, rosette-like, on the ground. Leaves grow from the root, stalkless, undivided, velvety appearance similar to primrose leaves, but shorter and rounder. Yellow, tubular flowers bunch together on one stalk, each flower emerging from the same point, outer blossoms drooping.

Part used ? Corolla.

Action: Antispasmodic, sedative.

In the reduction of involuntary spasmodic movements, restlessness and similar symptoms. Used also in insomnia. The usual herbal infusion is taken in tablespoonfuls as required.

Both cowslip and primrose were at one time prescribed for rheumatism, gout and paralysis, but their value in these diseases has long since been disproved.... cowslip

Cradle Cap

Crusta lactea, or cradle cap as it is technically known, is a form of SEBORRHOEA of the scalp which is not uncommon in nursing infants. It usually responds to a daily shampoo with cetrimide solution. Warm olive oil gently massaged into the scalp and left overnight, after which the scales can be washed o?, also helps with the condition.... cradle cap

Cranial Nerves

Cranial nerves are those arising from the BRAIN.... cranial nerves

Craniotomy

The removal of part of the SKULL to provide surgical access for an operation on the BRAIN. This may be to obtain a BIOPSY, to remove a tumour or to drain an infection or a blood clot. Following the operation the bone is replaced, along with the membranes, muscle and skin.... craniotomy

Cranium

The part of the skull enclosing the brain as distinguished from the face.... cranium

Crepitus

Crepitus means a grating sound. It is found in cases of fractured bones when the ends rub together; also, in cases of severe chronic arthritis, by the rubbing together of the dried internal surfaces of the joints.... crepitus

Cretinism

An out-of-date name for congenital HYPOTHYROIDISM, a disease caused by defective thyroid function in fetal life or early in infancy.... cretinism

Crisis

Crisis is a word used with several distinct meanings. (1) The traditional meaning is that of a rapid loss of fever and return to comparative health in certain acute diseases. For example, PNEUMONIA, if allowed to run its natural course, ends by a crisis usually on the eighth day, the temperature falling in 24 hours to normal, the pulse and breathing becoming slow and regular and the patient passing from a partly delirious state into natural sleep. In this sense of the word, the opposite of crisis is lysis: for example, in typhoid fever (see ENTERIC FEVER), where the patient slowly improves during a period of a week or more, without any sudden change. (2) A current use of the word crisis, and still more frequently of critical, is to signify a dangerous state of illness in which it is uncertain whether the sufferer will recover or not.... crisis

Cruciate Ligaments

Two strong ligaments in the interior of the knee-joint, which cross one another like the limbs of the letter X. They are so attached as to become taut when the lower limb is straightened, and they prevent over-extension or bending forwards at the knee. The cruciate ligaments are sometimes strained or torn as a result of sporting injuries or vehicular accidents; surgery may be needed to repair the damage, but the knee will be permanently weakened.... cruciate ligaments

Crush Syndrome

A condition in which kidney failure occurs in patients who have been the victims of severe crushing accidents (see also KIDNEYS). The fundamental injury is damage to muscle. The limb swells. The blood volume falls. Blood UREA rises; there is also a rise in the POTASSIUM content of the blood. Urgent treatment in an intensive therapy unit is required and renal dialysis may well be necessary. The patient may survive; or die with renal failure. Post-mortem examination shows degeneration of the tubules of the kidney, and the presence in them of pigment casts.... crush syndrome

Cryopreservation

Maintenance at very low temperatures of the viability of tissues or organs that have been excised from the body.... cryopreservation

Cryosurgery

The use of cold in surgery. Its advantages include little associated pain, little or no bleeding, and excellent healing with little or no scar formation. Hence its relatively wide use in eye surgery, some abdominal surgery, skin cancers and treatment of HAEMORRHOIDS. The coolants used include liquid nitrogen with which temperatures as low as ?196 °C can be obtained, carbon dioxide (?78 °C) and nitrous oxide (?88 °C).... cryosurgery

Cryotherapy

The treatment of disease by refrigeration. The two main forms in which it is now used are HYPOTHERMIA and refrigeration ANAESTHESIA.... cryotherapy

Cryptococcosis

Cryptococcosis is a rare disease due to infection with a yeast known as Cryptococcus neoformans. Around 5–10 cases are diagnosed annually in the United Kingdom. It usually involves the lungs in the ?rst instance, but may spread to the MENINGES and other parts of the body, including the skin. As a rule, the disease responds well to treatment with AMPHOTERICIN B, clotrimazole, and ?ucytosine.... cryptococcosis

Cryptococcus

A capsulate yeast which can infect humans. Can give rise to a cry ptococcoma in the lung and maylead to cryptococcal meningitis. One species with two subspecies recognised, Cryptococcus neoformans neoformans in which human infection is associated with pigeon droppings and C. neoformans gattii associated with Red River Gums.... cryptococcus

Cryptorchidism

An undescended testis (see TESTICLE). The testes normally descend into the scrotum during the seventh month of gestation; until then, the testis is an abdominal organ. If the testes do not descend before the ?rst year of life, they usually remain undescended until puberty – and even then, descent is not achieved in some instances. Fertility is impaired when one testis is affected and is usually absent in the bilateral cases. The incidence of undescended testis in full-term children at birth is 3·5 per cent, falling to less than 2 per cent at one month and 0·7 per cent at one year. Because of the high risk of infertility, undescended testes should be brought down as early as possible and at the latest by the age of two. Sometimes medical treatment with HUMAN CHORIONIC GONADOTROPHIN is helpful but frequently surgical interference is necessary. This is the operation of orchidopexy.... cryptorchidism

Culture

The learned, shared and transmitted values, beliefs, norms and lifetime practices of a particular group that guides thinking, decisions and actions in patterned ways.... culture

Cumin

Protection, Fidelity, Exorcism ... cumin

Curette

A spoon-shaped instrument with a cutting edge, used for scooping out the contents of any body cavity – for example, the uterus – or for removing certain skin lesions, such as verrucae.... curette

Cuticle

See SKIN.... cuticle

Cyanocobalamin

The name given by the British Pharmacopoeia Commission to vitamin B12, found to be an e?ective substitute for liver in the treatment of pernicious ANAEMIA. It has now been replaced by HYDROXOCOBALAMIN as the standard treatment for this condition (see also COBALAMINS).... cyanocobalamin

Cyanosis

A condition in which the skin – usually of the face and extremities – takes on a bluish tinge. It accompanies states in which the blood is not properly oxygenated in the lungs, and appears earliest through the nails, on the lips, on the tips of the ears, and over the cheeks. It may be due to blockage of the air passages, or to disease in the lungs, or to a feeble circulation, as in heart disease. (See CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD); METHAEMOGLOBINAEMIA.)... cyanosis

Cyclophosphamide

A derivative of NITROGEN MUSTARDS used to treat various forms of malignant disease, including HODGKIN’S DISEASE and chronic lymphocytic LEUKAEMIA. (See also ALKYLATING AGENTS; CYTOTOXIC.)... cyclophosphamide

Cycloplegia

Paralysis of the ciliary muscle of the EYE, which results in the loss of the power of ACCOMMODATION in the eye.... cycloplegia

Cyclothymia

The state characterised by extreme swings of mood from elation to depression, and vice versa. (See also MANIC DEPRESSION; MENTAL ILLNESS.)... cyclothymia

Cypress

Longevity, Healing, Comfort, Protection... cypress

Cystectomy

The surgical excision of the bladder (see URINARY BLADDER). When this is done – usually to treat cancer of the bladder – an alternative means of collecting urine from the KIDNEYS must be arranged. The URETERS of the kidney can be transplanted into a loop of bowel which is brought to the surface of the abdomen to form a STOMA that exits into an externally worn pouch. The latest surgical technique is to fashion a substitute bladder from a section of intestine and to implant the ureters into it, thus allowing the patient to void urine through the urethra as normal.... cystectomy

Cystometry

A technique for measuring the pressure in the URINARY BLADDER as part of a URODYNAMIC investigation to assess the functioning of the bladder.... cystometry

Cysticercosis

This disease rarely occurs except in Central Europe, Ethiopia, South Africa, and part of Asia. It results from ova (eggs) being swallowed or regurgitated into the stomach from an adult pork tapeworm in the intestine. In the stomach the larvae escape from the eggs and are absorbed. They are carried in the blood to various parts of the body, most commonly the subcutaneous tissue and skeletal muscle, where they develop and form cysticerci. When super?cial, they may be felt under the skin as small pea-like bodies. Although they cause no symptoms here, cysts may also develop in the brain. Five years later the larvae die, and the brain-tissue reaction may result in epileptic ?ts, obscure neurological disorders, and personality changes. The cysts calcify at this stage, though to a greater degree in the muscles than the brain, allowing them to be seen radiologically. Epilepsy starting in adult life, in anyone who has previously lived in an endemic area, should suggest the possibility of cysticercosis. (See also TAENIASIS.)

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

Dermoid Cyst

See CYSTS.... dermoid cyst

Dilatation And Curettage

Commonly referred to as D and C, a gynaecological operation to scrape away the lining of the UTERUS (ENDOMETRIUM). The procedure may be used to diagnose and treat heavy bleeding from the womb (ENDOMETRIOSIS) as well as other uterine disorders. It can be used to terminate a pregnancy or to clean out the uterus after a partial miscarriage. D and C is increasingly being replaced with a LASER technique using a hysteroscope – a type of ENDOSCOPE.... dilatation and curettage

Febrile Convulsion

Convulsion occurring in a child aged six months to six years with a high temperature in which the limbs twitch; he or she may lose consciousness. The condition is common, with one child in 20 suffering from it. It is a result of immature homeostatic control (see HOMEOSTASIS) and is not usually serious, occurring generally during an infection such as measles or tonsillitis. The brain and nervous system are normal in most cases. Treatment is tepid sponging and attention to the underlying cause, with the child placed in the recovery position. It is important to rule out more serious illness, such as MENINGITIS, if the child seems particularly ill.... febrile convulsion

Genetic Counselling

The procedure whereby advice is given about the risks of a genetic disorder and the various options that are open to the individual at risk. This may often involve establishing the diagnosis in the family, as this would be a prerequisite before giving any detailed advice. Risks can be calculated from simple Mendelian inheritance (see MENDELISM) in many genetic disorders. However, in many disorders with a genetic element, such as cleft lip or palate (see CLEFT PALATE), the risk of recurrence is obtained from population studies. Risks include not only the likelihood of having a child who is congenitally affected by a disorder, but also, for adults, that of being vulnerable to an adult-onset disease.

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

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

Genetic Code

The message set out sequentially along the human CHROMOSOMES. The human gene map is being constructed through the work of the international, collaborative HUMAN GENOME project; so far, only part of the code has been translated and this is the part that occurs in the GENES. Genes are responsible for the PROTEIN synthesis of the cell (see CELLS): they instruct the cell how to make a particular polypeptide chain for a particular protein.

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

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

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

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

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

Germ Cell

Those embryonic cells with the potential to develop into ova (see OVUM) or spermatozoa (see SPERMATOZOON).... germ cell

Human Chorionic Gonadotrophin

A glycoprotein hormone secreted by the PLACENTA in early pregnancy, and stimulating the CORPUS LUTEUM within the ovary (see OVARIES) to secrete OESTROGENS, PROGESTERONE, and relaxin. The hormone is essential for the maintenance of pregnancy up to about 6–8 weeks of gestation. A RADIOIMMUNOASSAY can be used to detect its presence, and pregnancy can be diagnosed as early as six days after conception by testing for it in the urine. Some tumours also secrete human chorionic gonadotrophin, particularly HYDATIDIFORM MOLE, which produces large amounts.... human chorionic gonadotrophin

Informed Consent

A patient’s/client’s explicit agreement to the care and treatment to be provided, based on full information on his or her condition/diagnosis, the existing options for treatment and the possible beneficial and adverse effects of those options.... informed consent

Oedipus Complex

A description used by psychoanalysts of the subconscious attraction of a child for its parent of the opposite sex. This is accompanied by a wish to get rid of the parent of the same sex. The origin of the phrase lies in the Greek story in which Oedipus kills his father without realising who he is, then marries his mother. It has been suggested that the arrest of psychological development at the Oedipal stage may cause NEUROSIS and sexual dysfunction.... oedipus complex

Molluscum Contagiosum

Common papular eruption of the skin caused by a virus. Most common in children, it is highly contagious and often transmitted in swimming pools and sauna baths. Mollusca are often multiple and persistent in children with atopic eczema (see DERMATITIS), and epidemics may occur in boarding schools. The typical molluscum is 2–3 mm in diameter, skincoloured and translucent, with a dimpled centre. The armpits and adjacent chest, upper inner thighs and genital areas are common sites in young children. In adults the infection is usually transmitted sexually and affects the pubic area and lower belly. Mollusca eventually disappear spontaneously, but cure can be expedited by curettage (removal with a CURETTE) under surface anaesthesia.... molluscum contagiosum

Pes Cavus

Known popularly as claw-foot, this is a deformity in which the foot has an abnormally high arch and the tips of the toes are turned under.

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

Renal Cell Carcinoma

See HYPERNEPHROMA.... renal cell carcinoma

Sebaceous Cyst

A misnomer applied to epidermoid cysts of the skin whose contents are kerateous not sebaceous. The common ‘wen’ of the scalp arises from follicular epithelium and is similar.... sebaceous cyst

Secondary Care

Specialist care provided on an ambulatory or inpatient basis, usually following a referral from primary care.... secondary care

Sensory Cortex

See BRAIN.... sensory cortex

Slapped Cheek Syndrome

See ERYTHEMA – Erythema infectiosum.... slapped cheek syndrome

Snellen Chart

The most commonly used chart for testing the acuity of distant VISION. The chart comprises rows of capital letters, with the letters in each row being smaller than those in the one above. The top line of large letters can be seen by a normally sighted person standing 60 metres away. The subject under test sits 6 metres from the screen and, if he or she can read the 6-metre line of letters, his or her visual acuity is normal at 6/6.... snellen chart

Spermatic Cord

This comprises the VAS DEFERENS, nerves and blood vessels, and it runs from the cavity of the ABDOMEN to the TESTICLE in the SCROTUM.... spermatic cord

Squamous Cell Carcinoma

Malignant tumour of squamous epithelium of skin, which generally spreads and metastasises.... squamous cell carcinoma

Spinal Cord

This is the lower portion of the CENTRAL NERVOUS SYSTEM which is situated within the SPINAL COLUMN. Above, it forms the direct continuation of the medulla oblongata, this part of the BRAIN changing its name to spinal cord at the foramen magnum, the large opening in the base of the skull through which it passes into the spinal canal. Below, the spinal cord extends to about the upper border of the second lumbar vertebra, where it tapers o? into a ?ne thread, known as the ?lum terminale, that is attached to the coccyx at the lower end of the spine. The spinal cord is thus considerably shorter than the spinal column, being only 37– 45 cm (15–18 inches) in length, and weighing around 30 grams.

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

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

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

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

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

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

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

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

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

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

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

Stem Cell

Stem CELLS develop a few days after an egg (ovum) is fertilised by a spermatozoon and starts developing to form an EMBRYO. These master cells are crucial to the development of a normal embryo. They contain a specialised ENZYME that gives them the facility to divide inde?nitely, developing into the many di?erent specialised cells that comprise the various tissues in the body – for example, skin, blood, muscle, glands or nerves.

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

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

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

Tertiary Care

The provision of highly specialized services in ambulatory and hospital settings.... tertiary care

Umbilical Cord

The ?eshy tube containing two arteries and a vein through which the mother supplies the FETUS with oxygen and nutrients. The cord, which is up to 60 cm long, ceases to function after birth and is clamped and cut about 2·5 cm from the infant’s abdominal wall. The stump shrivels and falls o? within two weeks, leaving a scar which forms the UMBILICUS. (See also PREGNANCY AND LABOUR.)... umbilical cord

Vena Cava

The name of either of the two large vessels that open into the right atrium of the HEART. (See VEINS.)... vena cava

Thyroid Cancer

A rare disease that accounts for around 1 per cent of all cancers, cancer of the THYROID GLAND usually presents as an isolated hard nodule in the neck. The rate at which the nodule grows depends upon the patient’s age and type of cancer cell. Pain is not usually a feature, but the increasing size may result in the tumour pressing on vital structures in the neck – for example, the nerves controlling the LARYNX (resulting in hoarseness) and the PHARYNX (causing di?culty in swallowing). If more than one nodule is present, they are likely to be benign, not malignant. Treatment is by surgical removal after which the patient will need to take THYROXINE for the rest of his or her life. Radioactive iodine is usually given after surgery to destroy any residual cancerous cells. If treated early, the outlook is good.... thyroid cancer

X Chromosome

One of two SEX CHROMOSOMES. Every normal female body cell has a pair of X chromosomes. Men have only one X chromosome and this is paired with a Y chromosome. The sex cells in men and women each have one X and one Y chromosome. Certain diseases are linked to the presence of an X chromosome: these include HAEMOPHILIA (see GENETIC DISORDERS). (See also GENES.)... x chromosome

Ulcerative Colitis

Chronic in?ammation of the lining of the COLON and RECTUM. The disease affects around 50 people per 100,000; it is predominantly a disease of young and middle-aged adults.

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

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

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

Y Chromosome

One of two SEX CHROMOSOMES that is present in every male body cell where it is paired with an X CHROMOSOME. The sex or germ cells in women as well as men contain one X and one Y chromosome (see also GENES).... y chromosome

Whooping-cough

Whooping-cough, or pertussis, is a respiratory-tract infection caused by Bordetella pertussis and spread by droplets. It may occur at all ages, but around 90 per cent of cases are children aged under ?ve. Most common during the winter months, it tends to occur in epidemics (see EPIDEMIC), with periods of increased prevalence occurring every three to four years. It is a noti?able disease (see NOTIFIABLE DISEASES). The routine vaccination of infants with TRIPLE VACCINE (see also VACCINE; IMMUNISATION), which includes the vaccine against whooping-cough, has drastically reduced the incidence of this potentially dangerous infection. In the 1990s over 90 per cent of children in England had been vaccinated against whooping-cough by their second birthday. In an epidemic of whooping-cough, which extended from the last quarter of 1977 to mid-1979, 102,500 cases of whooping-cough were noti?ed in the United Kingdom, with 36 deaths. This was the biggest outbreak since 1957 and its size was partly attributed to the fall in vaccination acceptance rates because of media reports suggesting that pertussis vaccination was potentially dangerous and ine?ective. In 2002, 105 cases were noti?ed in England.

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

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

Cobalt

Trace element essential to life.

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

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

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

Giant Cell Arteritis

See: ARTERITIS. ... giant cell arteritis

Cervix

Erosion of. A gynaecological problem of infection of the cervical crypts with a reddened area from the cervical os to the vaginal surface of the cervix. Cervicitis may be due to chemical irrigations and contraceptive creams or to the mechanical irritation of pessaries.

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

Alternatives (also for cervicitis).

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

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

Douche: German Chamomile tea, or Lapacho tea.

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

Diet. Lacto-vegetarian.

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

Minerals. Iron, Zinc.

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

Chiropractic

A system of skeletal manipulation to restore balance and normality in cases of structural derangement. A feature is their “high velocity: low amplitude thrust.” A number of herbal lotions and massage oils assist the Chiropractor to relax muscles and prepare tissues for manipulation. See: ROSEMARY AND ALMOND OIL. STIFF NECK SALVE, GOLDEN FIRE.

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

Chromium

Trace element. Essential to human life. RDA 0.05 to 0.2mg. Key element in the glucose tolerance factor. Required by the pancreas to combat stress and to control blood sugar. The key metal in the glucose tolerance factor (GTF) known for its role in maintaining the correct balance of blood sugar. Low levels place pregnant mothers at risk.

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

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

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

Cold Sore

See: HERPES SIMPLEX.

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

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

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

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

Differential diagnosis: gallstones, menstrual difficulties, kidney stone.

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

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

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

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

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

Traditional German combination. Ginger, Gentian, Turkey Rhubarb.

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

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

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

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

Concussion

Loss of brain function with unconsciousness. Cause: head injury or violent spinal jarring as when falling on the base of the spine.

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

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

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

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

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

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

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

Crohn’s Disease

Chronic inflammation and ulceration of the gut, especially the terminal ileum from changes in the gut blood vessels. Commences with ulceration which deepens, becomes fibrotic and leads to stricture. Defective immune system. Resistance low. May be associated with eye conditions and Vitamin B12 deficiency.

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

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

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

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

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

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

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

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

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

Ispaghula seeds. 2-4 teaspoons thrice daily.

Tea Tree oil Suppositories. Insertion at night.

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

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

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

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

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

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

Cushing’s Syndrome

A glandular disorder occurring mostly in females, aged 30 to 50.

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

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

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

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

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

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

Dupuytren’s Contracture

The Thatcher Finger. Fibrosis of the palm of the hand leading to deformity. Inability to straighten the ring and little finger due to fixed flexion. A tightened sinew. High serum fat levels are present, the disease affecting men from the age of 20 and women after the menopause.

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

Treatment. Directed towards prevention. Same as for HYPERLIPIDAEMIA.

DWARF BEAN. See: FRENCH BEAN.

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

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

Uses: Dropsy, kidney and bladder torpor, rheumatism.

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

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

Preparations: Thrice daily.

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

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

Acorus Calamus

Linn.

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

Ayurvedic: Vatsanaabha (related sp.).

Folk: Tilia Kachnaag, Dudhia.

Action: Nervine tonic.

Air-dried roots of the plant are reported to contain 1% indaconitine.... acorus calamus

Aids-related Complex

A variety of chronic symptoms and physical findings that occur in some persons who are infected with HIV, but do not meet the Centres for Disease Control’s definition of AIDS. Symptoms may include chronic swollen glands, recurrent fevers, unintentional weight loss, chronic diarrhoea, lethargy, minor alterations of the immune system (less severe than those that occur in AIDS), and oral thrush. ARC may or may not develop into AIDS.... aids-related complex

Alimentary Canal

See GASTROINTESTINAL TRACT.... alimentary canal

Antenatal Care

The protocol which doctors and midwives follow to ensure that the pregnant mother and her FETUS are kept in good health, and that the pregnancy and birth have a satisfactory outcome. The pregnant mother is seen regularly at a clinic where, for example, her blood pressure is checked, the growth and development of her child-to-be are carefully assessed, and any problem or potential problems dealt with. Most antenatal care deals with normal pregnancies and is supervised by general practitioners and midwives in primary-care clinics. If any serious problems are identi?ed, the mother can be referred to specialists’ clinics in hospitals. (See PREGNANCY AND LABOUR.)... antenatal care

Assisted Conception

(Further information about the subject and the terms used can be found at http:// www.hfea.gov.uk/glossary)

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

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

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

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

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

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

Birth Canal

The passage that extends from the neck of the womb (UTERUS), known as the CERVIX UTERI, to the opening of the VAGINA. The baby passes along this passage during childbirth.... birth canal

Blood Corpuscle

See ERYTHROCYTES and LEUCOCYTES.... blood corpuscle

Branchial Cyst

A cyst arising in the neck from remnants of the embryological branchial clefts. They are usually ?uid-?lled and will therefore transilluminate.... branchial cyst

Cadaver

A dead body.... cadaver

Cade

(American) A precocious young woman

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

Cadmium

A metallic element which, when molten, gives o? fumes that can cause serious irritation of the lungs if inhaled.... cadmium

Cadmium Poisoning

Cadmium poisoning is a recognised hazard in certain industrial processes, such as the manufacture of alloys, cadmium plating and glass blowing. Sewage sludge, which is used as fertiliser, may be contaminated by cadmium from industrial sources; such cadmium could be taken up into vegetable crops and cadmium levels in sewage are carefully monitored.

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

Caesium-137

An arti?cially produced radioactive element that is used in RADIOTHERAPY treatment.... caesium-137

Calcicosis

Calcicosis is a traditional term applied to disease of the lung caused by the inhalation of marble dust by marble-cutters.... calcicosis

Calcium-channel Blockers

Calcium-channel blockers inhibit the inward ?ow of calcium through the specialised slow channels of cardiac and arterial smooth-muscle cells. By thus relaxing the smooth muscle, they have important applications in the treatment of HYPERTENSION and ANGINA PECTORIS. Various types of calcium-channel blockers are available in the United Kingdom; these di?er in their sites of action, leading to notable di?erences in their therapeutic effects. All the drugs are rapidly and completely absorbed, but extensive ?rst-pass metabolism in the liver reduces bioavailability to around one-?fth. Their hypotensive e?ect is additive with that of beta blockers (see BETA-ADRENOCEPTOR-BLOCKING DRUGS); the two should, therefore, be used together with great caution – if at all. Calcium-channel blockers are particularly useful when beta blockers are contraindicated, for example in asthmatics. However, they should be prescribed for hypertension only when THIAZIDES and beta blockers have failed, are contraindicated or not tolerated.

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

Calculi

The general name given to concretions in, for example, the URINARY BLADDER, KIDNEYS or gall-bladder (see LIVER).... calculi

Caldicott Guardian

A senior health professional in all NHS trusts, whose responsibility it is to preserve the con?dentiality of patient information.... caldicott guardian

Calliper

A two-pronged instrument with pointed ends, for the measurement of diameters, such as that of the pelvis in obstetrics.... calliper

Callus

The new tissue formed around the ends of a broken bone. (See BONE, DISORDERS OF.)... callus

Calmative

Sedative... calmative

Caloric Test

A test for vestibular function (see EAR). It is performed by irrigating the external auditory meatus of the ear with alternate cold and hot water. This usually stimulates the vestibular apparatus, causing nystagmus (see DIABETES MELLITUS – Diabetic eye disease). If the vestibular apparatus is affected by disease, the response may be absent or reduced.... caloric test

Calumba

Jateorhiza calumba. N.O. Menispermaceae.

Synonym: Cocculus palmatus, Colombo.

Habitat: Ceylon.

Features ? Root bark thick, greyish-brown outside, transverse section yellowish, vascular bundles in radiating lines. Fracture short and mealy. Very bitter and mucilaginous in taste.

Part used ? Root.

Action: Tonic, febrifuge.

As a bitter tonic without astringency, in weakness of stomach function and indigestion generally. The infusion of 1 ounce of the powdered root to 1 pint of cold water is taken in two tablespoonful doses three or four times daily.

For bowel flatulence, U.S. Dispensatory gives ? 1/2 ounce each powdered Calumba and Ginger, 1 drachm Senna, infused in 1 pint boiling water. Dose, wineglassful three times daily.... calumba

Canaliculus

Canaliculus means a small channel, and is applied to (a) the minute passage leading from the lacrimal pore on each eyelid to the lacrimal sac on the side of the nose; (b) any one of the minute canals in bone.... canaliculus

Cancellous

A term applied to loose bony tissues as found in the ends of the long bones.... cancellous

Canthus

The name applied to the angle at either end of the aperture between the eyelids.... canthus

Capd

Chronic ambulatory peritoneal dialysis – an outpatient technique for treating failure of the KIDNEYS. (See HAEMODIALYSIS.)... capd

Capillaries

The minute vessels which join the ends of the arteries to venules, the tiny commencement of veins. Their walls consist of a single layer of ?ne, ?at, transparent cells, bound together at the edges, and the vessels form a meshwork all through the tissues of the body, bathing the latter in blood with only the thin capillary wall interposed, through which gases and ?uids readily pass. These vessels are less than 0·025 mm in width.... capillaries

Caput Succedaneum

Usually shortened by obstetricians to ‘caput’, this is the temporary swelling which is sometimes found on the head of the newborn infant. It is due to OEDEMA in and around the scalp, caused by pressure on the head as the child is born. It is of no signi?cance and quickly disappears spontaneously.... caput succedaneum

Carbaryl

A pesticide used to kill head and crab lice (see PEDICULOSIS). Available as a lotion, some of which contains alcohol (not recommended for use on crab lice), the substance may irritate skin and should not be used near damaged skin, eyes or ears.... carbaryl

Carbohydrate

The term applied to an organic substance in which the hydrogen and oxygen are usually in the proportion to form water. Carbohydrates are all, chemically considered, derivatives of simple forms of sugar and are classi?ed as monosaccharides (e.g. glucose), disaccharides

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

Carbolic Acid

Carbolic acid, or phenol, was the precursor of all ANTISEPTICS. It paralyses and then destroys most forms of life, particularly organisms such as bacteria. It has been superseded by less penetrative and harmful antiseptics.... carbolic acid

Carbon

A non-metallic element, the compounds of which are found in all living tissues and which is a constituent (as carbon dioxide) of air exhaled from the LUNGS. Two isotopes of carbon, 11C and 14C, are used in medicine. Carbon-11 is used in positron-emission tomography (see PET SCANNING); carbon-14 is used as a tracer element in studying various aspects of METABOLISM.... carbon

Carbonic Anhydrase Inhibitor

A drug that curbs the action of an ENZYME in the blood controlling the production of carbonic acid or bicarbonate from CARBON DIOXIDE (CO2). Called carbonic anhydrase, the enzyme is present in ERYTHROCYTES and it has a key part in maintaining the acid-base balance in the blood. Inhibiting drugs include ACETAZOLAMIDE and DORZOLAMIDE, and these are used as weak DIURETICS to reduce the increased intraocular pressure in ocular hypertension or open-angle GLAUCOMA (see EYE, DISORDERS OF).... carbonic anhydrase inhibitor

Carcinogens

Agents, such as tobacco smoke, certain chemicals, asbestos ?bres and high-dose radiation, that have the property of causing CANCER.... carcinogens

Cardamon

Lust, Love... cardamon

Cardia

Cardia is a term applied to the upper opening of the stomach into which the oesophagus empties. The cardia lies immediately behind the heart.... cardia

Cardiac Glycosides

Drugs whose main actions are to increase the force of myocardial contraction and reduce the conductivity of the nerve ?bres in the atrioventricular node of the heart. They are useful in treating supraventricular tachycardias (rapid heart rhythm) and some forms of heart failure. Glycosides are a traditional group of cardiac drugs, originally derived from the leaves of foxglove plants and used as digitalis. The active principle has long been synthesised and used as DIGOXIN. They are potentaially toxic and their use, especially during initial treatment, should be monitored. Side-effects include ANOREXIA, nausea, vomiting, diarrhoea and abdominal pain; drowsiness, confusion and DEPRESSION may occur. An abnormally slow heart rate may develop. The glycosides should be used with special care in the elderly who are sometimes particularly susceptible to their toxic effects.... cardiac glycosides

Cardiac Massage

The procedure used to restart the action of the heart if it is suddenly arrested. In many cases the arrested heart can be made to start beating again by rhythmic compression of the chest wall. This is done by placing the patient on a hard surface – a table or the ?oor – and then placing the heel of the hand over the lower part of the sternum and compressing the chest wall ?rmly, but not too forcibly, at the rate of 60–80 times a minute. At the same time arti?cial respiration must be started by the mouth-tomouth method. (See APPENDIX 1: BASIC FIRST AID.) Open heart massage is sometimes undertaken if an arrest occurs during a chest operation – the heart being directly handled by the resuscitator.... cardiac massage

Cardiac Muscle

The muscle, unique to the heart, which comprises the walls of the atria and ventricles. It consists of long broadening cells (?bres) with special physiological characteristics which enable them to keep contracting and expanding inde?nitely.... cardiac muscle

Cardiac Neurosis

Obsessional fear about the state of the heart. It tends to occur after a heart attack and may result in the patient’s experiencing the symptoms of another attack.... cardiac neurosis

Cardiac Tamponade

Compression of the heart due to abnormal accumulation of ?uid within the ?brous covering of the heart (PERICARDIUM). The result is irregular rhythm and death if the ?uid is not removed.... cardiac tamponade

Cardiomegaly

Enlargement of the heart (see HEART, DISEASES OF).... cardiomegaly

Cardioplegia

A procedure whereby the heart is stopped by reducing its temperature (hypothermia), by injecting the muscle with a solution of salts or by electrostimulation. This enables surgeons to operate safely on the heart.... cardioplegia

Cardiovascular System

This refers to the whole circulatory system: the heart, the systemic circulation (the arteries and veins of the body) and the pulmonary circulation (the arteries and veins of the lungs). Blood circulates throughout the cardiovascular system bringing oxygen and nutrients to the tissues and removing carbon dioxide and other waste products.... cardiovascular system

Caries

See TEETH, DISORDERS OF.... caries

Carina

(Latin) Little darling Carena, Carinna, Carrina, Cariana, Carin, Carine, Caren, Carinen, Caron, Carren, Carron, Carrin, Caryn, Caryna, Carynn, Careena, Cariena, Careina, Careana... carina

Carminatives

Preparations to relieve FLATULENCE, and any resulting griping, by the bringing up of wind, or ERUCTATION. Their essential constituent is an aromatic volatile oil, usually of vegetable extraction.... carminatives

Carnation

(Latin) Resembling the flower; becoming flesh... carnation

Carneous Mole

An ovum which has died in the early months of pregnancy. It usually requires no treatment and evacuates itself.... carneous mole

Carotid Body

A small reddish-brown structure measuring 5–7 × 2·5–4 millimetres, situated one on each side of the neck, where the carotid artery divides into the internal and external carotid arteries. Its main function is in controlling breathing so that an adequate supply of oxygen is maintained to the tissues of the body. Oxygen levels are controlled by a re?ex operating between the carotid body and the respiratory centre in the brain.... carotid body

Carpal Tunnel Syndrome

A condition characterised by attacks of pain and tingling in the ?rst three or four ?ngers of one or both hands. The attacks usually occur at night. Carpal tunnel syndrome is caused by pressure on the median nerve as it passes under the strong ligament that lies across the front of the wrist. The condition may respond to use of a night splint on the hand; otherwise a corticosteroid injection under the ligament may help. If not, pressure is relieved by surgical division of the compressing ligament.... carpal tunnel syndrome

Carrot

See Zanahoria.... carrot

Carob

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

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

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

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

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

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

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

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

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

Caruncle

Any small ?eshy eminence, whether normal or abnormal.... caruncle

Case Fatality Rate

The number of fatal cases of specific disease, divided by total number of known cases and it is usually expressed as percent. Case fatality is one index of disease severity and is of more interest in acute than in chronic disease.... case fatality rate

Caseation

A process which takes place in the tissues in TUBERCULOSIS and some other chronic diseases. The central part of a diseased area, instead of changing into pus and so forming an ABSCESS, changes to a ?rm cheese-like mass which may next be absorbed or may be converted into a calcareous deposit and ?brous tissue, and so healing results in the formation of a scar.... caseation

Casein

That part of milk which forms cheese or curds. It is produced by the union of a substance, caseinogen, dissolved in the milk, with lime salts also dissolved in the milk – the union being produced by the action of rennin, a ferment from the stomach of the calf. The same change occurs in the human stomach as the ?rst step in the digestion of milk, and therefore when milk is vomited curdled it merely shows that digestion has begun.... casein

Cashew

See Cajuil.... cashew

Casilda

(Latin / Spanish) Of the home / a warrior woman

Casildah, Cassilda, Casylda, Cassylda... casilda

Cassia

(Greek / Latin) Of the spice tree / feminine form of Cassius; one who is hollow; empty

Cassea, Cassiah, Casseah... cassia

Catchment Area

A geographic area defined and served by a health programme or institution, such as a hospital or community health centre, which is delineated on the basis of such factors as population distribution, natural geographic boundaries, and transportation accessibility. By definition, all residents of the area needing the services of the programme are usually eligible for them, although eligibility may also depend on additional criteria.... catchment area

Castor

Ricinus communis

Euphorbiaceae

San: Erandah, Pancangulah;

Hin: Erandi, Erand;

Ben: Bherenda;

Mal: Avanakku;

Tam: Amanakku, Kootaimuttu, Amanakkam Ceti;

Kan: Haralu, Manda, Oudla;

Tel: Erandamu, Amudamu

Importance: Castor is a perennial evergreen shrub. The Sanskrit name erandah describes the property of the drug to dispel diseases. It is considered as a reputed remedy for all kinds of rheumatic affections. They are useful in gastropathy such as gulma, amadosa, constipation, inflammations, fever, ascitis, strangury, bronchitis, cough, leprosy, skin diseases, vitiated conditions of vata, colic, coxalgia and lumbago. The leaves are useful in burns, nyctalopia, strangury and for bathing and fermentation and vitiated conditions of vata, especially in rheumatoid arthritis, urodynia and arthralgia. Flowers are useful in urodynia and arthralgia and glandular tumours. Seeds are useful in dyspepsia and for preparing a poultice to treat arthralgia. The oil from seeds is a very effective purgative for all ailments caused by vata and kapha. It is also recommended for scrotocele, ascites, intermittent fever, gulma, colonitis, lumbago, coxalgia and coxitis (Warrier et al, 1996). Oil is also used for soap making. Fresh leaves are used by nursing mothers in the Canary Island as an external application to increase the flow of milk. Castor oil is an excellent solvent of pure alkaloids and as such solutions of atropine, cocaine, etc. is used in ophthalmic surgery. It is also dropped into the eye to remove the after-irritation caused by the removal of foreign bodies.

Distribution: It is a native of N. E. tropical Africa. It is found throughout India, cultivated and found wild upto 2400m.

Botany: Ricinus communis Linn. belongs to the family Euphorbiaceae. It is a monoecious evergreen shrub growing upto 4m. Leaves are alternate, palmatifid, 6-10 lobed, each 1- nerved with many lateral nerves and peltate. Lobes are lanceolate, thinly pubescent below, margin serrate and apex acuminate. Paniculate racemes are terminal with male flowers below, female ones above. Perianth is cupular, splitting into 3-5 lobes, laceolate, valvate, margin inrolled and acuminate. Filaments of stamen are connate and repeatedly branched with divergent anther cells. Sepals are 5, sub-equal, lanceolate, valvate and acute. Ovary is globose, echinate, 3-locular with 3 ovules and pendulous. Styles are 3, stout, papillose, stigmatiferous. Capsules are 3-lobed and prickly with oblong seeds having smooth testa and marbled, shiny and carunculate. R. bronze King and R. africanus are two good garden varieties which are known as Italian and East Indian Castors, respectively (Mathew, 1983, Grieve and Leyel, 1992).

Agrotechnology: Castor is cultivated both in the plains and the hills. As it has deep root system it is hardy and capable of resisting drought. It does not withstand waterlogging and frost. It requires hard dry climate for proper development of fruits and seeds. It requires a well- drained soil, preferably sandy loam or loamy sand. High soil fertility is of less importance as compared to the good physical condition of the soil. It cannot tolerate alkalinity. It is generally grown in red loamy soils, black soils and alluvial soils. The plant is seed propagated. The seed rate required is 5-12 kg/ha (pure crop) and 3 kg/ha (mixed crop). Seeds are to be sown on a hot bed early in March. When the plants come up individual plant is to be planted in a separate pot filled with light soil and plunged into a fresh hot bed. The young plants are to be kept in glass houses till early June where they are hardened and kept out. The suitable season of growing is kharif season. The crop is usually sown in April and planting is done in early July. The land is to be ploughed 2-3 times with the onset of rains and is repeated after rain. The spacing recommended is 60X90cm in case of pure crop but it is seldom cultivated pure. It is usually grown mixed with crops such as jowar, arhar, chilly, groundnut, cowpea, cotton, etc. 10-15t FYM/ha and 50kg N, 50kg P2O5 and 20kg K2O/ha will be sufficient. Addition of neem cake is beneficial as it increases oil content. There should be sufficient moisture in the field at the time of sowing. A month after planting, weeding and earthing up is to be done. The plant is attacked by hairy caterpillar, castor semi - looper, castor seed caterpillar, etc. which can be managed by integrated pest management measures. The leaf blight disease occurring in castor can be controlled by spraying with Bordeaux mixture 2-3 times at 15 days interval. Harvesting of ripe fruits can be done from the end of November till the end of February. The fruit branches are picked when they are still green to avoid splitting and scattering of the seeds. The pods are to be heaped up in the sun to dry. Then the seeds are to be beaten with stick and winnowed. Roots, leaves, flowers, seeds and oil constitute the economic parts. The average yield is 500-600kg/ha (Thakur, 1990).

Properties and activity: The beancoat yielded lupeol and 30-norlupan-3 -ol-20-one. Roots, stems and leaves contain several amino acids. Flowers gave apigenin, chlorogenin, rutin, coumarin and hyperoside. Castor oil is constituted by several fatty acids (Husain et al, 1992). Seed coat contained 1. 50-1. 62% lipids and higher amounts of phosphatides and non-saponifiable matter than seed kernel. Fresh leaves protected against liver injury induced by carbon tetra chloride in rats while cold aqueous extract provided partial protection (Rastogi et al, 1991). Root and stem is antiprotozoal and anticancerous. Root, stem and seed are diuretic. The roots are sweet, acrid, astringent, thermogenic, carminative, purgative, galactagogue, sudorific, expectorant and depurative. Leaves are diuretic, anthelmintic and galactagogue. Seeds are acrid, thermogenic, digestive, cathartic and aphrodisiac. Oil is bitter, acrid, sweet, antipyretic, thermogenic and viscous (Warrier et al, 1996). Castor oil forms a clean, light- coloured soap, which dries and hardens well and is free from smell. The oil varies much in activity. The East Indian is the more active, but the Italian has the least taste. Castor oil is an excellent solvent of pure alkaloids. The oil furnishes sebacic acid and caprylic acid. It is the most valuable laxative in medicines. It acts in about 5 hours, affecting the entire length of the bowel, but not increasing the flow of bile, except in very large doses. The mode of its action is unknown. The oil will purge when rubbed into the skin (Grieve and Leyel, 1992).... castor

Catgut

A traditional absorbable SUTURE used in surgery for tying cut arteries and stitching wounds. Consisting of twisted COLLAGEN (from sheep or cattle intestines), catgut is absorbed by phagocytes (see under PHAGOCYTE) over a variable period. There are two types: plain, and chromatised or chromic. Synthetic absorbable sutures cause less reaction, have a predictable absorption period and are more e?ective.... catgut

Cauda

A tail or a tail-like structure. For example, the cauda equina (‘horse’s tail’) is a collection of nerve roots arising from the lumbar, sacral and coccygeal spinal nerves. The resulting bundle, fancifully resembling a horse’s tail, runs down inside the spinal column until the individual ?bres leave through their respective openings.... cauda

Caul

The piece of AMNION which sometimes covers a child when he or she is born.... caul

Cavernous Breathing

A peculiar quality of the respiratory sounds heard on AUSCULTATION over a cavity in the lung.... cavernous breathing

Cavernous Sinus

A channel for venous blood placed either side of the sphenoid bone at the base of the SKULL behind the eye sockets. Blood drains into it from the eye, the nose, the brain and part of the cheek, and leaves via the internal jugular and facial veins. Sometimes the sinus becomes blocked by a blood clot (thrombus), usually a complication of a nearby bacterial infection. A potentially serious condition, it should be treated with thrombolysis and antibiotics.... cavernous sinus

Cellulose

A carbohydrate substance forming the skeleton of most plant structures. It is colourless, transparent, insoluble in water and is practically unaffected by digestion. In vegetable foods it therefore adds to the bulk, but it is of no value as a food-stu?. It is found in practically a pure state in cotton-wool.... cellulose

Cement

See TEETH.... cement

Census

The enumeration of an entire population, usually with details being recorded on residence, age, sex, occupation, ethnic group, marital status, birth history and relationship to head of household.... census

Central Venous Pressure

The pressure of blood within the right atrium of the HEART as measured by a catheter and manometer.... central venous pressure

Cera

(French) A colorful woman Cerah, Cerrah, Cerra... cera

Cerebrovascular Accident

See STROKE.... cerebrovascular accident

Certification

The process by which a government or nongovernmental agency or association evaluates and recognizes an individual, institution or educational programme as meeting predetermined standards. One so recognized is said to be “certified”. It is essentially synonymous with accreditation, except that certification is usually applied to individuals and accreditation to institutions. Certification programmes are generally nongovernmental and do not exclude the uncertified from practice, as do licensure programmes.... certification

Cervical Smear

This screening test detects abnormal changes in the cells of the cervix (see CERVIX UTERI), enabling an affected woman to have early treatment. The National Health Service has arrangements to check women regularly. A woman’s ?rst test should be within six months of her ?rst experience of intercourse and thereafter at three-yearly intervals for the rest of her life. The test is simple, with some cells being scraped o? the cervix with a spatula and the tissue then being examined microscopically.... cervical smear

Cervical Vertebrae

The seven bones of the top end of the backbone that form the neck. The ?rst cervical vertebra is the atlas and this articulates with the base of the skull. The axis is the second vertebra, which contains a shaft of bone that allows the atlas to rotate on it, thus permitting the head to turn. (See SPINAL COLUMN.)... cervical vertebrae

Cervical Cancer

Cancer of the cervix – the neck of the womb – is one of the most common cancers affecting women throughout the world. In some areas its incidence is increasing. This cancer has clearly identi?able precancerous stages with abnormal changes occurring in the cells on the surface of the cervix: these changes can be detected by a CERVICAL SMEAR test. Early cancer can be cured by diathermy, laser treatment, electrocoagulation or cryosurgery. If the disease has spread into the body of the cervix or beyond, more extensive surgery and possibly radiotherapy may be needed. The cure rate is 95 per cent if treated in the early stages but may fall as low as 10 per cent in some severe cases. Around 3,000 patients are diagnosed as having cervical cancer every year in the United Kingdom, and around 1,500 die from it. Latest ?gures in England show that the incidence rates have fallen to under 11 per 100,000 women, while death rates fell by more than 40 per cent during the 1990s. The sexual behaviour of a woman and her male partners in?uences the chances of getting this cancer; the earlier a woman has sexual intercourse, and the more partners she has, the greater is the risk of developing the disease.... cervical cancer

Chamomile Tea

Chamomile is a popular herb that’s used in teas worldwide. Chamomile soothes the stomach and relieves bloating and indigestion. Chamomile also calms the mind and helps people relax and deal better with their stresses. Some people are allergic to chamomile and should avoid taking the tea. People who find it hard to go to sleep should drink a cup of chamomile tea before going to bed. Chamomile is known to fight insomnia by relaxing the body and the mind, enabling the person to fall asleep naturally.... chamomile tea

Chapped Hands

Chapped hands occur in cold weather, when reduced sweat and sebaceous activity leads to decreased natural protection of the skin. Prolonged immersion in soapy water, followed by exposure to cold air, results in cracking of the skin.

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

Charcoal

Activated charcoal is a ?nely powdered material with a huge surface area (1,000 m2/g) prepared from vegetable matter by carbonisation. It is capable of binding a variety of drugs and chemicals and is used in the treatment of poisoning as a method of gastric decontamination. It is not systemically absorbed. It is also used occasionally for ?atulence and as a deodorant for skin ulcers.... charcoal

Cheilosis

In?ammation of the lips. It is common at the angles of the lips (angular stomatitis), usually as a consequence of sagging facial muscles or ill-?tting dentures producing folds at the corners of the mouth which retain food debris and allow proliferation of bacteria and candida. Atopic eczema (see SKIN, DISEASES OF) is a common cause of cheilosis of the whole of the lips.... cheilosis

Cheiropompholyx

Pompholyx is an old name for vesicular eczema (see DERMATITIS) on the palms and ?ngers (cheiropompholyx) or soles of the feet (podopompholyx).... cheiropompholyx

Chelating Agents

Chelating agents are compounds that will render an ion (usually a metal) biologically inactive by incorporating it into an inner ring structure in the molecule. (Hence the name, from the Greek chele = claw.) When the complex formed in this way is harmless to the body and is excreted in the urine, such an agent is an e?ective way of ridding the body of toxic metals such as mercury. The main chelating agents are DIMERCAPROL, PENICILLAMINE, desferrioxamine and sodium calciumedetate, used for example, in iron poisoning.... chelating agents

Chemosis

Swelling of the conjunctiva of the EYE, usually caused by in?ammation from injury or infection.... chemosis

Chemotaxis

The ability of certain cells to attract or repel others.... chemotaxis

Chenodeoxycholic Acid

One of the bile acids (see BILE), used in the treatment of cholesterol gall-stones for patients with mild symptoms when other modern techniques are unsuitable. (See GALL-BLADDER, DISEASES OF.)... chenodeoxycholic acid

Cherry

(English) Resembling a fruit-bearing tree

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

Chiasma

This is an X-shaped crossing. The optic chiasma is where the nerve ?bres from the nasal half of each retina cross over the mid line to join the optic tract from the other side.... chiasma

Chigger

Another name for Trombicula autumnalis, popularly known as the harvest mite (see BITES AND STINGS).... chigger

Chilblain

Chilblain, or erythema pernio (see under ERYTHEMA), is an in?amed condition of the hands or feet, or occasionally of the ears, and should not be confused with cracked or CHAPPED HANDS. Most commonly found in childhood and old age, it may be associated with generally poor health, though there may also be a genetic predisposition. Prevention with good food, warm clothing, a warm environment, and regular exercise to maintain the circulation, is the best treatment.... chilblain

Chiretta

Swertia chirata. N.O. Gentianaceae.

Synonym: Brown Chirata, Chirayta, Griseb.

Habitat: Northern India.

Features ? Stem purplish-brown, cylindrical below, becoming quadrangular higher up, pithy, nearly quarter-inch thick. Leaves opposite, three to seven longitudinal ribs, entire. Fruit (capsule) one-celled, two valved. Extremely bitter taste.

Part used ? Whole plant.

Action: Bitter tonic.

In all cases where a tonic is indicated. With suitable hepatics and laxatives, sometimes forms part of prescriptions for liver complaints, dyspepsia and constipation.

Dose, two to four tablespoonfuls of 1/2 ounce to 1 pint infusion.... chiretta

Chloral Hydrate

This drug is now rarely used but chloral betaine (Welldorm) is occasionally used in the elderly and in newborns with ?ts or cerebral irritation after a di?cult delivery.... chloral hydrate

Chlorpropamide

An oral hypoglycaemic agent, chlorpropamide was for many years used to treat diabetes (see DIABETES MELLITUS). It has been largely superseded by more e?ective oral agents with fewer side-effects, such as gliclazide.... chlorpropamide

Chocolate

See Cacao.... chocolate

Cholagogues

Substances which increase the ?ow of BILE by stimulating evacuation of the gall-bladder (see LIVER). The great majority of these act only by increasing the activity of the digestive organs, and so producing a ?ow of bile already stored up in the gall-bladder. Substances which stimulate the liver to secrete more bile are known as CHOLERETIC.... cholagogues

Cholelithotomy

The removal of gall-stones from the gallbladder or bile ducts (see GALL-BLADDER, DISEASES OF), when CHOLECYSTECTOMY or LITHOTRIPSY are inappropriate or not possible. It involves a cholecystomy, an operation to open the gall-bladder.... cholelithotomy

Choline

One of the many constituents of the vitamin B complex. Lack of it in the experimental animal produces a fatty liver. It is found in egg-yolk, liver, and meat. The probable daily human requirement is 500 mg, an amount amply covered by the ordinary diet. Choline can be synthesised by the body (see APPENDIX 5: VITAMINS).... choline

Cholinesterase

An ENZYME that helps to break down the neurotransmitter compound ACETYLCHOLINE.... cholinesterase

Chorda

A nerve-?bre, tendon or cord.... chorda

Chromatin

The genetic material found in the nucleus of a cell. It consists of PROTEIN and deoxyribonucleic acid (DNA). During mitotic division of the cell, chromatin condenses into CHROMOSOMES.... chromatin

Chromoblastomycosis

A subcutaneous fungal disease caused by the dermatiacious fungi belonging to the genera Phialophora, Fonsecaea and Cladosporium.... chromoblastomycosis

Chromosomes

The rod-shaped bodies to be found in the nucleus of every cell in the body. They contain the GENES, or hereditary elements, which establish the characteristics of an individual. Composed of a long double-coiled ?lament of DNA, they occur in pairs – one from the maternal, the other from the paternal – and human beings possess 46, made up of 23 pairs. The number of chromosomes is speci?c for each species of animal. Each chromosone can duplicate an exact copy of itself between each cell division. (See GENETIC CODE; GENETICS; HEREDITY; MEIOSIS; SEX CHROMOSOMES.)... chromosomes

Chyle

The milky ?uid which is absorbed by the lymphatic vessels of the intestine. The absorbed portion consists of fats in very ?ne emulsion, like milk, so that these vessels receive the name of lacteals (L. lac, milk). This absorbed chyle mixes with the lymph and is discharged into the thoracic duct, a vessel, which passes up through the chest to open into the jugular vein on the left side of the neck, where the chyle mixes with the blood.... chyle

Chyluria

The passage of CHYLE in the urine. This results in the passing of a milky-looking urine. It is one of the manifestations of FILARIASIS, where it is due to obstruction of the LYMPHATICS by the causative parasite.... chyluria

Chyme

Partly digested food as it issues from the stomach into the intestine. It is very acid and grey in colour, containing salts and sugars in solution, and the animal food softened into a semi-liquid mass. It is next converted into CHYLE.... chyme

Chymotrypsin

An ENZYME produced by the PANCREAS which digests protein. It is used as an aid in operations for removal of a cataract (see ZONULOLYSIS), and also by inhalation to loosen and liquefy secretions in the windpipe and bronchi.... chymotrypsin

Circle Of Willis

A circle of arteries at the base of the brain, formed by the junction of the basilar, posterior cerebral, internal carotid and anterior cerebral arteries. Congenital defects may occur in these arteries and lead to the formation of aneurysm (see ANEURYSM).... circle of willis

Cinquefoil

Potentilla reptans. N.O. Rosaceae.

Synonym: Five-leaf-grass, Fivefinger.

Habitat: Meadows, pastures, waysides.

Features ? Stem long and creeping, rooting at joints, as the strawberry. Leaf stalks one to two inches long with five obovate leaflets, serrate, scattered hairs, veins prominent below. Flowers (June-September) bright yellow, five petals, solitary, on long stalks from stem as the leaves.

Part used ? Herb.

Action: Astringent.

Infusion of 1 ounce to 1 pint of water in wineglass doses for diarrhoea. Also as a gargle for relaxed throat. Externally, as an astringent skin lotion.... cinquefoil

Citric Acid

This is responsible for the sharp taste associated with citrus fruits, such as lemons and limes, and other fruits such as currants and raspberries. Although chemically di?erent from, it is similar in action and appearance to tartaric acid, obtained from grapes and other fruits, and similar to malic acid, found in apples and pears.... citric acid

Class

The total number of observations of a particular variable may be grouped according to convenient divisions of the variable range. A group so determined is called a class.... class

Cleft Palate

A ?ssure in the roof of the mouth (palate) and/ or the lip which is present at birth. It is found in varying degrees of severity in about one in 700 children. Modern plastic surgery can greatly improve the functioning of lips and palate and the appearance of the baby. Further cosmetic surgery later may not be necessary. The parent of the child who has cleft lip and/ or palate will be given detailed advice speci?c to his or her case. In general the team of specialists involved are the paediatrician, plastic surgeon, dentist or orthodontic specialist, and speech therapist. (See PALATE, MALFORMATIONS OF.)... cleft palate

Clinic

A facility, or part of one, devoted to diagnosis and treatment or rehabilitation of outpatients. See “outpatient services”; “ambulatory care”.... clinic

Clinical Audit

A MEDICAL AUDIT carried out by health professionals.... clinical audit

Cloaca

A common opening of the alimentary and reproductive systems of male nematodes, normally situated on the ventral side at the posterior end of the body.... cloaca

Clivers

Galium aparine. N.O. Rubiaceae.

Synonym: Cleavers, Goosegrass, Catchweed, Goosebill, Hayriffe.

Habitat: Among hedges and bushes.

Features ? Quadrangular stem, rough, weak but very lengthy, creeping up the hedges by little prickly hooks. Many side branches, always in pairs. Leaves small, lanceolate, in rings of six to nine round stem, with backward, bristly hairs at margins. Flowers white, very small, petals arranged like Maltese Cross ; few together on stalk rising from leaf ring. Fruit nearly globular, one-eighth inch diameter, also covered with hooked bristles. Saline taste.

Part used ? Herb.

Action: Diuretic, tonic, alterative.

Obstructions of urinary organs. Hot or cold infusion of 1 ounce to 1 pint in wineglass doses frequently. Clivers is similar in action to Gravelroot, the former causing a more copious watery flow, the latter a larger proportion of solid matter. The two herbs are frequently used together.... clivers

Cloning

Cloning – from the Greek klon, meaning a cutting such as is used to propagate plants – is essentially a form of asexual reproduction. The initial stages were ?rst successfully achieved in rabbits. In essence the technique consists of destroying the nucleus of the egg and replacing it with the nucleus from a body cell of the same species – either a male or a female. This provides the egg with a full complement of CHROMOSOMES and it starts to divide and grow just as it would if it had retained its nucleus and been fertilised with a spermatozoon. The vital di?erence is that the embryo resulting from this cloning process owes nothing genetically to the female egg. It is identical in every respect with the animal from which the introduced nucleus was obtained.

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

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

Clotting Time

See COAGULATION.... clotting time

Clover

(English) Resembling the meadow flower Claefer... clover

Clozapine

An antipsychotic drug used to treat schizophrenic patients (see SCHIZOPHRENIA) who have not responded to other treatments or who have suffered serious side-effects from them. Improvement is gradual and it may be several weeks before severe symptoms are relieved. The drug can cause AGRANULOCYTOSIS and so it is given under close hospital supervision.... clozapine

Club Moss

Protection, Power... club moss

Cluster

An aggregation of cases of a disease or other health-related condition which are closely grouped in time and place. The number of cases may or may not exceed the expected number; frequently the expected number is not known.... cluster

Cluster Headaches

A type of MIGRAINE occurring in clusters – that is, a patient may have an attack daily for several days and then none for weeks or months. The pain is on one side of the head, often centred over the eye. The pain is excruciatingly severe and often associated with tearing, nasal discharge and production of thick saliva from the same side of the mouth. It is treated either with drugs such as SUMATRIPTAN or by breathing 100 per cent oxygen.... cluster headaches

Cloves

Eugenia caryophyllata. N.O. Myrtaceae.

Synonym: Clavos.

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

Features ? Flower buds brown ; nail-shaped, calyx tube encloses ovary containing tiny ovules; four calyx teeth surrounded by unopened corolla consisting of four petals.

Part used ? Flower buds.

Action: Stimulant, aromatic, carminative.

Combined with more specific remedies in flatulence and other affections of the alimentary tract. Is an excellent carminative to reduce griping action of purgatives. Dose, 1 to 2 tablespoonfuls of the infusion.

Coffin holds that Cloves are the most powerful of all the carminatives.... cloves

Coarctation Of The Aorta

A narrowing of the AORTA in the vicinity of the insertion of the ductus arteriosus. It is a congenital abnormality but may not be discovered until well into childhood or adolescence. The diagnosis is easily made by discovering a major di?erence between the blood pressure in the arms and that of the legs. If untreated it leads to hypertension and heart failure, but satisfactory results are now obtained from surgical treatment, preferably in infancy. Paediatricians screen for coarctation by feeling for femoral pulses, which are absent or weak in this condition.... coarctation of the aorta

Coagulation

Coagulation of the blood is the process whereby bleeding (or haemorrhage) is normally arrested in the body. Blood starts to clot as soon as the skin (or other tissue) has been cut. Coagulation is part of the process of HAEMOSTASIS which is the arrest of bleeding from an injured or diseased blood vessel. Haemostasis depends on the combined activities of vascular, platelet (see PLATELETS) and PLASMA elements which are o?set by processes to restrict the accumulation of platelets and FIBRIN to the damaged area.

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

prothrombin + calcium + thromboplastin

thrombin + ?brinogen

?brin

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

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

Cocci

Spherical BACTERIA that cause a variety of infections. Staphylococci, streptococci and meningococci (see NEISSERIACEAE) are examples.... cocci

Coccydynia

The sensation of severe pain in the COCCYX.... coccydynia

Coco

Coconut (Cocos nucifera).

Plant Part Used: Fruit, oil.

Dominican Medicinal Uses: Fruit: milk, orally, for kidney infection, kidney stones, intestinal parasites, asthma; oil, orally, for asthma, cough, bronchitis and pulmonary infection.

Safety: Widely consumed and generally considered safe; potential for cross-reactivity in individuals with nut allergies

Laboratory & Preclinical Data: In vivo: hypolipidemic (flavonoids).

In vitro: anti-tumor (husk extract), antibacterial (plant extracts).

* See entry for Coco in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... coco

Coelioscopy

A method of viewing the interior of the abdomen in patients in whom a tumour or some other condition requiring operation may be present but cannot with certainty be diagnosed. The examination is carried out by making a minute opening under local anaesthesia, and inserting an ENDOSCOPE – a long ?exible instrument bearing an electric lamp and telescopic lenses like that for examining the bladder (CYSTOSCOPE) – into the abdominal cavity. Certain of the abdominal organs can then be directly inspected in turn.... coelioscopy

Cofactor

A factor other than the basic causative agent of a disease that increases the likelihood of developing that disease. Cofactors may include the presence of other microorganisms or psychological factors such as stress.... cofactor

Cognition

The mental processes by which a person acquires knowledge. Among these are reasoning, creative actions and solving problems.... cognition

Cohosh, Black

Cimicifuga racemosa. N.O. Ranunculaceae.

Synonym: Known also as Black Snakeroot.

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

Features ? Thick, hard and knotty, the root is bitter and acrid in taste, and gives off a rather nauseating smell.

Part used ? Rhizome and roots.

Action: Astringent, diuretic, emmenagogue and alterative.

The decoction of 1 ounce to 1 pint (reduced from 1 1/2 pints) of water, is administered in wineglassful doses. Its chief importance lies in the treatment of rheumatism, and the root figures frequently in herbal prescriptions for this complaint. In small doses it is useful in children's diarrhoea, and is reputed to be a remedy for St. Vitus' Dance (chorea), although its efficacy here is dubious.

Cimicifuga should be taken with care, as overdoses produce nausea and vomiting.... cohosh, black

Colchicum

The bulb of Colchicum autumnale, or meadow-sa?ron, has long been used as a remedy for GOUT. How it acts is not quite certain.

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

Cold, Common

An infection by any one of around 200 viruses, with about half the common-cold infections being caused by RHINOVIRUSES. Certain CORONAVIRUSES, ECHOVIRUSES and COXSACKIE VIRUSES are also culprits. The common cold – traditionally also called a chill – is one of several viral infections that cause respiratory symptoms and systemic illness. Others include PNEUMONIA and GASTROENTERITIS. Colds are commoner in winter, perhaps because people are more likely to be indoors in close contact with others.

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

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

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

Coliform Bacteria

Intestinal bacilli that are gram-negative, sugar-digesting, and both aerobic and anaerobic. They are usually from the family Enterobacteriaceae; Escherichia coli is the best known of the group.... coliform bacteria

Colistin

A POLYMYXIN antibiotic active against many gram-negative organisms, including Pseudomonas aeruginosa. It is not absorbed by mouth and therefore needs to be given by injection to obtain a systemic e?ect; this is rarely indicated, however, as it has serious adverse effects. Colistin is used by mouth in bowelsterilisation regimens before surgery in patients. It is given by inhalation of a nebulised solution as an adjunct to some standard antibiotic therapy, and is included in some topical preparations, chie?y for skin, eye and ear infections.... colistin

Collapse

See SHOCK.... collapse

Collar-bone

See CLAVICLE.... collar-bone

Colles’ Fracture

Colles’ fracture is a fracture of the lower end of the radius close to the wrist, caused usually by a fall forwards on the palm of the hand, in which the lower fragment is displaced backwards. (See BONE, DISORDERS OF.)... colles’ fracture

Collyrium

An eye-salve or eye-wash... collyrium

Coloboma

Coloboma simply means a defect, but its use is usually restricted to congenital defects of the eye. These may involve the lens, the iris, the retina or the eyelid.... coloboma

Colonic Irrigation

Washing out the large bowel with an ENEMA of water or other medication.... colonic irrigation

Colporrhaphy

An operation designed to strengthen the pelvic ?oor in cases of prolapse of the UTERUS. The surgeon excises redundant tissue from the front vaginal wall (anterior colporrhaphy) or from the rear wall (posterior colporrhaphy), thus narrowing the vagina and tightening the muscles.... colporrhaphy

Comminuted Fracture

See BONE, DISORDERS OF.... comminuted fracture

Commissure

Commissure means a joining, and is a term applied to strands of nerve ?bres which join one side of the brain to the other; to the band joining one optic nerve to the other; to the junctions of the lips at the corners of the mouth, etc.... commissure

Community Care

Services and support to help people with care needs to live as independently as possible in their communities.... community care

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

Community Nurses

A term that includes district nurses, health visitors, practice nurses and school nurses. While customarily based in a general practice or a health centre, they are independent health professionals contracted to the NHS (see NURSING).... community nurses

Community Paediatrician

Formerly entitled consultant paediatrician (community child health), these are specialists dealing with children with chronic problems not involving acute or hospital care. For example, they have a primary role in dealing with disabled children, children with special educational needs and abused children.... community paediatrician

Compatibility

The extent to which a person’s defence systems will accept invading foreign substances – for example, an injection of a drug, a blood transfusion or an organ transplant. When incompatibility occurs there is usually a rapid antibody attack on the invading antigen with a severe local or system reaction in the individual receiving the antigenic substance. (See IMMUNITY.)... compatibility

Compensation

In medical parlance, a term applied to the counterbalancing of some defect of structure or function by some other special bodily development. The body possesses a remarkable power of adapting itself even to serious defects, so that disability due to these passes o? after a time. The term is most often applied to the ability possessed by the heart to increase in size, and therefore in power, when the need for greater pumping action arises in consequence of a defective valve or some other abnormality in the circulation (see also HEART, DISEASES OF; CIRCULATORY SYSTEM OF THE BLOOD). A heart in this condition is, however, more liable to be prejudicially affected by strains and disease-processes, and the term ‘failure of compensation’ is applied to the symptoms that result when this power becomes temporarily insu?cient.

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

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

Complexion

See ACNE; SKIN, DISEASES OF; PHOTODERMATOSES.... complexion

Compressed Air Illness

Also known as caisson disease, this affects workers operating in compressed-air environments, such as underwater divers and workers in caissons (such as an ammunition wagon, a chest of explosive materials, or a strong case for keeping out the water while the foundations of a bridge are being built; derived from the French caisse, meaning case or chest). Its chief symptoms are pains in the joints and limbs (bends); pain in the stomach; headache and dizziness; and paralysis. Sudden death may occur. The condition is caused by the accumulation of bubbles of nitrogen in di?erent parts of the body, usually because of too-rapid decompression when the worker returns to normal atmospheric presure – a change that must be made gradually.... compressed air illness

Compression Syndrome

See MUSCLES, DISORDERS OF.... compression syndrome

Computed Tomography

Tomography is an X-ray examination technique in which only structures in a particular plane produce clearly focused images. Whole-body computed tomography was introduced in 1977 and has already made a major impact in the investigation and management of medical and surgical disease. The technique is particularly valuable where a mass distorts the contour of an organ (e.g. a pancreatic tumour – see PANCREAS, DISORDERS OF) or where a lesion has a density di?erent from that of surrounding tissue (e.g. a metastasis in the LIVER).

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

Condyle

A rounded prominence at the end of a bone: for example, the prominences at the outer and inner sides of the knee on the thigh-bone (or FEMUR). The projecting part of a condyle is sometimes known as an epicondyle, as in the case of the condyle at the lower end of the HUMERUS where the epicondyles form the prominences on the outer and inner side of the elbow.... condyle

Condyloma

A localised, rounded swelling of mucous membrane around the opening of the bowel, and the genital organs, sometimes known as ‘genital warts’ or ‘ano-genital warts’. There are two main forms: condyloma latum, which is syphilitic in origin; and condyloma accuminatum, which often occurs in association with sexually transmitted disease, but is only indirectly due to it, being primarily a virus infection.... condyloma

Confidence Interval

A range of values for a variable of interest, e.g. a rate, constructed so that this range has a specified probability of including the true value of the variable. The specified probability is called the confidence level, and the end points of the confidence interval are called the confidence limits.... confidence interval

Conjoined Twins

Identical twins who are united bodily but are possessed of separate personalities. Their frequency is not known, but it has been estimated that throughout the world, six or more conjoined twins are born every year who are capable of separation. The earliest case on record is that of the ‘Biddendon Maids’ who were born in England in 1100. The ‘Scottish Brothers’ lived for 28 years at the court of James III of Scotland. Perhaps the most famous conjoined twins, however, were Chang and Eng, who were born of Chinese parents in Siam in 1811. It was they who were responsible for the introduction of the term, ‘Siamese twins’, which still remains the popular name for ‘conjoined twins’. They were joined together at the lower end of the chest bone, and achieved fame by being shown in Barnum’s circus in the United States. They subsequently married English sisters and settled as farmers in North Carolina. They died in 1874.

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

Conscientious Objection

See ETHICS.... conscientious objection

Consciousness

The state of being aware of physical events or mental concepts. A conscious person is awake and responsive to his or her surroundings. (See also COMA; UNCONSCIOUS; ANAESTHESIA.)... consciousness

Consensus Development

Various forms of group judgement in which a group (or panel) of experts interacts in assessing an intervention and formulating findings by vote or other informal or formal means, involving such techniques as the nominal group and Delphi techniques.... consensus development

Conservative Treatment

Medical treatment which involves the minimum of active interference by the practitioner. For example, a disc lesion in the back might be treated by bed rest in contrast to surgical intervention to remove the damaged disc.... conservative treatment

Consultant

In Britain’s health service a consultant is the senior career post for a fully accredited specialist. He or she normally sees patients referred by general practitioners – hence the historical term ‘consultant’ – or emergency cases admitted direct to hospital. NHS consultants are also allowed to do a certain amount of private practice if they wish. After quali?cation and a two-year period of general supervised training, doctors enter onto a specialist training scheme, working in hospitals for 5–8 years before being accredited; many also do research or spend some time working abroad. All must pass dif?cult higher examinations. In 2004, the number of consultant hospital medical and dental sta? in Great Britain was 30,650 (some of these worked part-time, so the whole-time equivalent [w.t.e.] ?gure was 25,640). The total number of hospital medical and dental sta? was 86,996

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

Contact

A person or animal that has been in such association with an infected person or animal or a contaminated environment as to have had opportunity t o acquire the infection.... contact

Contagious

An infectious disease which is transmissible from one person to another. Sometimes used synonymously with “infectious”.... contagious

Continuous Positive Airways Pressure

A method for treating babies who suffer from alveolar collapse in the lung as a result of HYALINE MEMBRANE DISEASE (see also RESPIRATORY DISTRESS SYNDROME).... continuous positive airways pressure

Contraceptive

Any agent or device used to prevent conception... contraceptive

Contusions

A bruise, characterized by a trauma in which the skin is not broken but underlying blood vessels are busted, causing a deep or lateral hematoma, with disorganized blood and interstitial fluid buildup. see EXUDATE... contusions

Convalescence

The condition through which a person passes after having suffered from some acute disease, and before complete health and strength are regained.... convalescence

Convergence

(1) Inward turning of the eyes to focus on a near point, with the result that a single image is registered by both retinas.

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

Coomb’s Test

A sensitive test that detects ANTIBODIES to the body’s red cells (see ERYTHROCYTE). There are two methods: one – the direct method – identi?es those antibodies that are bound to the cells; the other, indirect, method identi?es those circulating unattached in the serum.... coomb’s test

Coprolalia

An inherited condition, usually beginning in childhood. It presents with motor tics and with irrepressible, explosive, occasionally obscene, verbal ejaculations. (See GILLES DE LA TOURETTE’S SYNDROME.)... coprolalia

Copulation

The act of coitus or sexual intercourse, when the man inserts his erect penis into the woman’s vagina and after a succession of thrusting movements ejaculates his semen.... copulation

Convulsions

Rapidly alternating contractions and relaxations of the muscles, causing irregular movements of the limbs or body generally, usually accompanied by unconsciousness.

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

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

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

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

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

Corona

(Spanish) A crowned woman Coronna, Coronetta, Coronette, Carona, Coronete, Coronet, Coroneta... corona

Coronary

A term applied to several structures in the body encircling an organ in the manner of a crown. The coronary arteries are the arteries of supply to the HEART which arise from the aorta, just beyond the aortic valve, and through which the blood is delivered to the muscle of the heart. Disease of the coronary arteries is a very serious condition producing various abnormal forms of heart action and the disorder, ANGINA PECTORIS.... coronary

Coronary Angioplasty

A technique of dilating atheromatous obstructions (see ATHEROMA) in CORONARY ARTERIES by inserting a catheter with a balloon on the end into the affected artery (see also CATHETERS). It is passed through the blockage (guided by X-ray FLUOROSCOPY) and in?ated. The procedure can be carried out through a percutaneous route.... coronary angioplasty

Coronary Arteries

(See also HEART.) The right coronary artery arises from the right aortic sinus and passes into the right atrio-ventricular groove to supply the right ventricle, part of the intraventricular septum and the inferior part of the left ventricle. The left coronary artery arises from the left sinus and divides into an anterior descending branch which supplies the septum and the anterior and apical parts of the heart, and the circum?ex branch which passes into the left atrio-ventricular groove and supplies the lateral posterior surfaces of the heart. Small anastomoses exist between the coronary arteries and they have the potential of enlarging if the blood-?ow through a neighbouring coronary artery is compromised. Coronary artery disease is damage to the heart caused by the narrowing or blockage of these arteries. It commonly presents as ANGINA PECTORIS or acute myocardial infarction (see HEART, DISEASES OF).... coronary arteries

Correlation

Most generally, the degree to which one phenomenon or random variable is associated with, or can be predicted from, another. In statistics, correlation usually refers to the degree to which a linear predictive relationship exists between random variables, as measured by a correlation coefficient (q.v.). Correlation may be positive (but never larger than 1), i.e. both variables increase or decrease together; negative or inverse (but never smaller than -1), i.e. one variable increases when the other decreases; or zero, i.e. a change in one variable does not affect the other.... correlation

Corset

A support device worn around the trunk to help in the treatment of backache and spinal injuries or disorders.... corset

Corticotropin

Corticotropin is the British Pharmacopoeia name for the adrenocorticotrophic hormone of the PITUITARY GLAND, also known as ACTH. It is so-called because it stimulates the functions of the cortex of the suprarenal glands. This results, among other things, in an increased output of cortisone.... corticotropin

Corynebacterium

The genus of Gram positive bacilli including Corynebacterium diphtheriae, the cause of diphtheria in humans. Genus also includes C. minutissimum, the cause of erythrasma in humans and the diphtheroids which are commensal corynebacteria making up part of the human respiratory tract normal flora.... corynebacterium

Cost Of Illness

The personal cost of acute or chronic disease. The cost to the patient may be an economic, social or psychological cost or loss to himself, his family or community. The cost of illness may be reflected in absenteeism, productivity, response to treatment, peace of mind, quality of life, etc. It differs from health care costs in that this concept is restricted to the cost of providing services related to the delivery of health care, rather than the impact on the personal life of the patient. See “burden of disease”.... cost of illness

Cost

Actual expenses incurred to provide a health care product or service. Cost can be divided into a number of types including: average cost: The average cost per unit; equals the total cost divided by the units of production. avoided cost: Cost caused by a health problem that is avoided by a health care intervention. direct cost: Cost borne by the health care system, the community and families, e.g. diagnosis and treatment costs. A cost that is identifiable directly with a particular activity, service or product. fixed cost: Costs that, within a defined period, do not vary with the quantity produced, e.g. overhead costs of maintaining a building. incremental cost: The difference between marginal costs of alternative interventions. indirect cost: Cost which cannot be identified directly with a particular activity, service or product of the programme experiencing the cost. Indirect costs are usually apportioned among the programme’s services in proportion to each service’s share of direct costs. intangible cost: The cost of pain and suffering resulting from a disease, condition or intervention. marginal cost: The additional cost required to produce an additional unit of benefit (e.g. unit of health outcome). operating cost: In the health field, the financial requirements necessary to operate an activity that provides health services. These costs normally include costs of personnel, materials, overheads, depreciation and interest. opportunity cost: The benefit foregone, or value of opportunities lost, by engaging resources in a service. It is usually quantified by considering the benefit that would accrue by investing the same resources in the best alternative manner. recurrent cost: An item of expenditure that recurs year after year, such as the remuneration of health workers and other staff; the cost of food and other goods and services; the cost of vaccines, medicines, appliances and other supplies; the replacement of equipment; and the maintenance of buildings and equipment. tangible cost: Objective elements in the production of care, i.e. number of personnel, beds, consumables, technologies, staff qualifications. total cost: The sum of all costs incurred in producing a set quantity of service.... cost

Cost-benefit Analysis

The systematic comparison, in monetary terms, of all the costs and benefits of proposed alternative schemes with a view to determining: which scheme or combination of schemes will contribute most to the achievement of predetermined objectives at a fixed level of investment; or the magnitude of the benefit that can result from schemes requiring the minimum investment. The resources required per unit of benefit must be determined, account being taken of the fact that costs and benefits accrue with time. For example, the cost of establishing a home and community care programme might be compared with the total cost of building residential facilities. Cost-benefit analysis can also be applied to specific medical tests and treatments.... cost-benefit analysis

Costal

Anything pertaining to the ribs.... costal

Costus

Costus speciosus

Zingiberaceae

San: Pushkara, Kashmeera, Kemuka;

Hin: Kebu, Keyu, Kust;

Ben: Keu, Kura

Mal: Channakkizhangu, Channakoova;

Tam: Kostam; Mar: Penva;

Tel: Kashmeeramu

Importance: Costus is one of the plants which contains diosgenin in its rhizome. It is widely used as starting material in the commercial production of steroidal hormones. The rhizomes are useful in vitiated conditions of kapha and pitta, burning sensation, flatulence, constipation, helminthiases, leprosy, skin diseases, fever, hiccough, asthma, bronchitis, inflammation and aneamia. It is used to make sexual hormones and contraceptives (Warrier et al,1994).

Distribution: The plant is widely distributed in Asia and other tropical countries like India, Nepal, Pakistan, Sri Lanka and China. In India, it occurs mostly in Arunachal Pradesh, Meghalaya, Nagaland, Tamil Nadu, Assam, Tripura and Kerala.

Botany: Costus speciosus (Koenig.) Sm. belonging to the family Zingiberaceae consists of two varieties viz., var. nepalensis Rose., found only in Nepal and Arunachal Pradesh and var. argycophyllus Wall., having a wide distribution in India.

The plant is a succulent herb with long leafy spirally twisted stems, 2-3m in height and horizontal rhizomes. Leaves are simple, spirally arranged, oblanceolate or oblong, glabrous above, silky pubescent beneath with broad leaf sheaths. Flowers are white, large, fragrant, arranged in dense terminal spikes. Bracts are bright red. The single stamen present is perfect, lip large with incurved margins. Fruits are globose or ovoid capsules with obovoid or sub- globose seeds (Warrier et al,1994).

Agrotechnology: Costus can be raised under a wide range of agroclimatic conditions. It prefers sandy loam soil for good growth. Propagation is by rhizomes. The best season for planting is April- May. The seed rate recommended is 2-2.4t/ha. The spacing adopted is 50x50cm. After an initial ploughing FYM or poultry manure should be applied at the rate of 30t/ha and the field is to be ploughed again irrigated and prepared to obtain a fine seed bed. Furrows are opened and the rhizome pieces are placed horizontally at a depth of 8-10cm and covered with soil. Care is taken to place the eye buds facing upwards. After 70-75 days about 90-95% sprouting is obtained. Desiccation of the young sprouts have been observed in the hot summer months, necessitating liberal water supply during the period. As September-November is the period of maximum tuberization at least two irrigations should be given at that time. One during the sprouting period of the crop followed by two more keeps the crop fairly free of weeds. Application of 37t/ha of poultry manure and fertilizers, 60kg P2O5 and 40kg K2O /ha as a basal doze, along with 80kg N/ha applied in 3 equal split dozes will take care. Crop is harvested at the end of seven months. Harvesting includes 2 operations, cutting the aerial shoots and digging out the rhizomes. Cost of production of diosgenin ranges from Rs. 271-300/kg (Atal, et al,1982).

Properties and activity: Tubers and roots contain diosgenin, 5 -stigmast-9(11)-en-3 ol, sitosterol- -D- glucoside, dioscin, prosapogenins A and B of dioscin, gracillin and quinones. Various saponins, many new aliphatic esters and acids are reported from its rhizomes, seeds and roots. Seeds, in addition, contain - tocopherol. Saponins from seeds are hypotensive and spasmolytic. Rhizomes possess antifertility, anticholinestrase, antiinflammatory, stimulant, depurative and anthelmintic activities (Hussain et al, 1992).... costus

Cotton

(American) Resembling the comfortable fabric

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

Coverage

A measure of the extent to which the services rendered cover the potential need for those services in the community.... coverage

Coxa Vara

A condition in which the neck of the thighbone is bent so that the lower limbs are turned outwards and lameness results.... coxa vara

Coxalgia

Pain in the hip... coxalgia

Crab-louse

Another name for Pediculus pubis, a louse that infests the pubic region. (See PEDICULOSIS.)... crab-louse

Cradle

A cage which is placed over the legs of a patient in bed, in order to take the weight of the bedclothes o? the legs.... cradle

Cranberry

Vaccinium macrocarpon

Description: This plant has tiny leaves arranged alternately. Its stem creeps along the ground. Its fruits are red berries.

Habitat and Distribution: It only grows in open, sunny, wet areas in the colder regions of the Northern Hemisphere.

Edible Parts: The berries are very tart when eaten raw. Cook in a small amount of water and add sugar, if available, to make a jelly.

Other Uses: Cranberries may act as a diuretic. They are useful for treating urinary tract infections.... cranberry

Cramp Bark

Viburnum opulus. N.O. Caprifoliaceae.

Synonym: Guelder Rose, High Cranberry, Snowball Tree.

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

Features ? Very thin bark, greyish-brown outside with corky growths (lenticels), slight longitudinal crackings, laminate, light brown internally. Fracture forms flat splinters.

Part used ? Bark.

Action: Antispasmodic, nervine.

As the name indicates, in cramp and other involuntary spasmodic muscular contractions. The decoction of 1 ounce to 1 pint of water (simmered from 1 1/2 pints) is administered in 1-2 tablespoon doses.... cramp bark

Creatine

A nitrogenous substance, methyl-guanidineacetic acid. The adult human body contains about 120 grams – 98 per cent of which is in the muscles. Much of the creatine in muscles is combined with phosphoric acid as phosphocreatine, which plays an important part in the chemistry of muscular contraction.... creatine

Creatine Kinase

An ENZYME which is proving to be of value in the investigation and diagnosis of muscular dystrophy (see MUSCLES, DISORDERS OF – Myopathy), in which it is found in the blood in greatly increased amounts.... creatine kinase

Cranberries

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

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

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

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

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

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

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

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

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

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

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

Creatinine Clearance

A method of assessing the function of the kidney (see KIDNEYS) by comparing the amount of creatinine – a product of body metabolism which is normally excreted by the kidneys – in the blood with the amount appearing in the urine.... creatinine clearance

Creeping Eruption

Creeping eruption is a skin condition caused by the invasion of the skin by the larvae of various species of nematode worms. It owes its name to the fact that as the larva moves through and along the skin it leaves behind it a long creeping thin red line. (See STRONGYLOIDIASIS.)... creeping eruption

Crenation

Abnormal microscopic appearance of blood cells in which their usually smooth margins appear irregular. It usually occurs after a blood specimen has been stored for a long time, but may occasionally indicate a blood disorder.... crenation

Crohn’s Disease

Also called regional enteritis or regional ileitis, this is a nonspecific inflammatory disease of the upper and lower intestine that forms granulated lesions. It is usually a chronic condition, with acute episodes of diarrhea, abdominal pain, loss of appetite, and loss of weight. It may affect the stomach or colon, but the most common sites are the duodenum and the lowest part of the small intestine, the lower ileum. The standard treatment is, initially, anti-inflammatory drugs, with surgical resectioning often necessary. The disease is autoimmune, and sufferers share the same tissue type (HLA-B27) as those who acquire ankylosing spondylitis.... crohn’s disease

Cross-sectional Study

A study that measures the prevalence of health outcomes or determinants of health, or both and other variables of interest in a population at a point in time or over a short period.... cross-sectional study

Crotamiton

A topical cream used to treat pruritus (itch).... crotamiton

Crural

Crural means connected with the leg.... crural

Crutch Palsy

Crutch palsy is weakness or paralysis of muscles in the wrist and hand, due to pressure exerted by the CRUTCH head on the nerves that control the affected muscles. It usually occurs because the crutch is too long for the individual, and/or if he or she attempts too much walking. The nerve damage is temporary and symptoms disappear if the crutch is properly used or left aside for a time.... crutch palsy

Cryoprecipitate

When frozen plasma is allowed to thaw slowly at 4 °C, a proportion of the plasma protein remains undissolved in the cold thawed plasma and stays in this state until the plasma is warmed. It is this cold, insoluble precipitate that is known as cryoprecipitate. It can be recovered quite easily by centrifuging. Its value is that it is a rich source of factor VIII, which is used in the treatment of HAEMOPHILIA.... cryoprecipitate

Cucumber

Chastity, Healing, Fertility ... cucumber

Curry

(American) Resembling the spice Currey, Curri, Currie, Curree, Currea, Curreah... curry

Cuts

See WOUNDS.... cuts

Cyan

(English) Having blue-green eyes Cyann, Cyanne, Cyana, Cyanna, Cyanea, Cyaneah, Cyania, Cyaniah... cyan

Cybernetics

The science of communication and control in the animal and in the machine.... cybernetics

Cycloserine

An antibiotic derived from an actinomycete, used to treat certain infections of the genitourinary tract, and and in combination with other drugs to treat TUBERCULOSIS resistant to ?rst-line drugs.... cycloserine

Cyclotron

A machine in which positively charged atomic particles are so accelerated that they acquire energies equivalent to those produced by millions of volts. From the medical point of view, its interest is that it is a source of neutrons. (See RADIOTHERAPY.)... cyclotron

Cyesis

Another term for pregnancy (see PREGNANCY AND LABOUR).... cyesis

Cyproterone Acetate

An antiandrogen. It inhibits the effects of androgens (see ANDROGEN) at receptor level and is therefore useful in the treatment of prostate cancer (see PROSTATE, DISEASES OF), ACNE, HIRSUTISM in women and in the treatment of severe hypersexuality and sexual deviation in men. The drug can have serious side-effects. (See OESTROGENS.)... cyproterone acetate

Cystadenoma

Benign tumour of epithelial tissue forming cysts.... cystadenoma

Cystalgia

Pain in the urinary bladder... cystalgia

Cysteine

An amino acid containing SULPHUR that is an essential constituent of many of the body’s enzymes. (See AMINO ACIDS; ENZYME.)... cysteine

Cystic Duct

The tube that runs from the gall-bladder (see LIVER) and joins up with the hepatic duct (formed from the bile ducts) to form the common BILE DUCT. The BILE produced by the liver cells is drained through this system and enters the small intestine to help in the digestion of food.... cystic duct

Cysticercus

Larval stage of tapeworms belonging to the genus Taenia. Also known as bladderworms. The cysticercus of the Pork Tapeworm is called Cysticercus cellulosae and is the cause of human cysticercosis.... cysticercus

Cystorrhea

Mucous discharge from the bladder... cystorrhea

Cytarabine

An drug used mainly to induce remission of acute myeloblastic LEUKAEMIA. A potent suppressant of myeloblasts, its use requires monitoring by a HAEMATOLOGIST. (See CYTOTOXIC.)... cytarabine

Cyto

A pre?x meaning something connected with a cell or CELLS.... cyto

Cytogenetics

The study of the structure and functions of the cells of the body, with particular reference to the CHROMOSOMES.... cytogenetics

Cytokine

Also lymphokine, a broad term for a variety of proteins and neuropeptides that lymphocytes and macrophages use to communicate between themselves, often from long distances. They stimulate organization and antibody responses, seem to induce the bone marrow to proliferate the type of white blood cells needed for immediate resistance, and generate sophistication and fine tuning for an overall strategy of resistance. A lymphocyte FAX.... cytokine

Cytokines

A family of PROTEIN molecules that carry signals locally between cells. Cytokines are released by cells when activated by antigens (see ANTIGEN), behaving as enhancing mediators for immune response. These proteins include INTERLEUKINS (produced by LEUCOCYTES), lymphokines (produced by lymphocytes – see LYMPHOCYTE), INTERFERON, and tumour necrosis factor, one of whose many functions is killing tumour cells.... cytokines

Cytometer

An instrument for counting and measuring CELLS.... cytometer

Cytoplasm

The PROTOPLASM of the cell body. (See CELLS.)... cytoplasm

Cytotoxic Drugs

Chemicals used to kill cancerous cells. Most cytotoxic drugs also kill normal cells. There is a delicate balance between killing enough cancer cells and not so many normal cells.... cytotoxic drugs

Cytotoxic

Cytotoxic means destructive to living cells. Cytotoxic drugs possess anti-cancer properties but also have the potential to damage normal tissue. Their use is twofold: to eliminate a cancer and so prolong life; or to alleviate distressing symptoms, especially in patients whose prospects of a cure are poor. In many cases CHEMOTHERAPY with cytotoxic drugs is combined with surgery, RADIOTHERAPY or both. Chemotherapy may be used initially to reduce the size of the primary TUMOUR (a process called neoadjuvant therapy) before using radiotherapy or surgery to eliminate it. Cytotoxic drugs may also be used as adjuvant treatment to prevent or destroy secondary spread of the primary tumour that has either been removed by surgery or treated with radiotherapy. All chemotherapy causes side-effects: the ONCOLOGIST – a specialist in cancer treatment – has to strike a balance between hoped-for bene?ts and acceptable (for the patient) toxic effects, which include nausea and vomiting, BONE MARROW suppression, ALOPECIA (hair loss) and teratogenic effects (see TERATOGENESIS).

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

The cytotoxic drugs include:

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

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

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

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

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

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

Dental Caries

Decay of teeth... dental caries

Dreams

See SLEEP.... dreams

End-of-life Care

Care of older persons who are dying.... end-of-life care

Enteric-coated

A description of tablets covered in material that allows them to pass through the stomach and enter the intestine unaltered. Drugs coated in this way are those whose action is reduced or stopped by acid in the stomach.... enteric-coated

Ethics Committee

A committee that can have a number of roles in relation to ethics. For example, it may develop policy relative to the use and limitation of treatment; serve as a resource for individuals and their families regarding options for terminal illness; or assess research projects with respect to the appropriate application of ethical principles.... ethics committee

Ethyl Chloride

A ?ammable, colourless liquid that is extremely volatile, and rapidly produces freezing of a surface when sprayed upon it. Now occasionally used to deaden pain for small and short operations, ethyl chloride was once used as an inhalant general anaesthetic for brief operations, and to induce ANAESTHESIA in patients in whom the anaesthesia is subsequently to be maintained by some other anaesthetic such as nitrous oxide or ether.... ethyl chloride

Funnel Chest

See CHEST DEFORMITIES.... funnel chest

General Dental Council

A statutory body set up by the Dentists Act which maintains a register of dentists (see DENTAL SURGEON), promotes high standards of dental education, and oversees the professional conduct of dentists. Membership comprises elected and appointed dentists and appointed lay members. Like other councils responsible for registering health professionals, the General Dental Council now comes under the umbrella of the new Council for Regulatory Excellence, a statutory body. (See APPENDIX 7: STATUTORY ORGANISATIONS.)... general dental council

Haemopoietic Stem Cell

This is the basic cell from which all types of blood cells originate. Its appearance is believed to be similar to that of a LYMPHOCYTE.... haemopoietic stem cell

Health Care

Services provided to individuals or communities by health service providers for the purpose of promoting, maintaining, monitoring or restoring health.... health care

Glasgow Coma Scale

A method developed by two doctors in Glasgow that is used to assess the depth of COMA or unconsciousness suffered by an individual. The scale is split into three groups – eye opening, motor response, and verbal response – with the level of activity within each group given a score. A person’s total score is the sum of the numbers scored in each group, and this provides a reasonably objective assessment of the patient’s coma state – particularly useful when monitoring people who have suffered a head injury. (See also PERSISTENT VEGETATIVE STATE (PVS).)... glasgow coma scale

Goblet Cell

A columnar secretory cell occurring in the EPITHELIUM of the respiratory and intestinal tracts.

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

Green Chiretta

Andrographis paniculata

Acanthaceae

San: Bhunimbah, Kiratatiktah

Hin: Kakamegh, Kalpanath

Ben: Kalmegh

Mal: Nilaveppu, Kiriyattu Tam: Nilavempu Kan: Kreata

Importance: Kalmegh, the Great or Green Chiretta is a branched annual herb. It is useful in hyperdipsia, burning sensation, wounds, ulcers, chronic fever, malarial and intermittent fevers, inflammations, cough, bronchitis, skin diseases, leprosy, pruritis, intestinal worms, dyspepsia, flatulence, colic, diarrhoea, dysentery, haemorrhoids and vitiated conditions of pitta (Warrier et al, 1993). It is used to overcome sannipata type of fever, difficulty in breathing, hemopathy due to the morbidity of kapha and pitta, burning sensation, cough, oedema, thirst, skin diseases, fever, ulcer and worms. It is also useful in acidity and liver complaints (Aiyer and Kolammal, 1962). The important preparations using the drug are Tiktakagheta, Gorocandi gulika, Candanasava, Panchatiktam kasaya, etc. (Sivarajan et al, 1994). A preparation called “Alui” is prepared by mixing powdered cumin (Cuminium cyminum) and large cardamom (Amomum subulatum) in the juice of this plant and administered for the treatment of malaria (Thakur et al, 1989). It is also a rich source of minerals.

Distribution: The plant is distributed throughout the tropics. It is found in the plains of India from U.P to Assam, M.P., A.P, Tamil Nadu and Kerala, also cultivated in gardens.

Botany: Andrographis paniculata (Burm.f.) Wall ex.

Nees belongs to the family Acanthaceae. It is an erect branched annual herb, 0.3-0.9m in height with quadrangular branches. Leaves are simple, lanceolate, acute at both ends, glabrous, with 4-6 pairs of main nerves. Flowers are small, pale but blotched and spotted with brown and purple distant in lax spreading axillary and terminal racemes or panicles. Calyx-lobes are glandular pubescent with anthers bearded at the base. Fruits are linear capsules and acute at both ends. Seeds are numerous, yellowish brown and sub-quadrate (Warrier et al,1993).

Another species of Andrographis is A. echioides (Linn.) Nees. It is found in the warmer parts of India. The plant is a febrifuge and diuretic. It contains flavone-echiodinin and its glucoside-echioidin (Husain et al, 1992).

Agrotechnology: The best season of planting Andrographis is May-June. The field is to be ploughed well, mixed with compost or dried cowdung and seedbeds of length 3m, breadth 1/2m and 15cm height are to be taken at a distance of 3m. The plant is seed propagated. Seeds are to be soaked in water for 6 hours before sowing. Sowing is to be done at a spacing of 20cm. Seeds may germinate within 15-20 days. Two weedings, first at one month after planting and the second at 2 month after planting are to be carried out. Irrigation during summer months is beneficial. The plant is not attacked by any serious pests or diseases. Flowering commences from third month onwards. At this stage, plant are to be collected, tied into small bundles and sun-dried for 4-5 days. Whole plant is the economic part and the yield is about 1.25t dried plants/ha (Prasad et al, 1997).

Properties and activity: Leaves contain two bitter substances lactone “andrographolid” and “kalmeghin”. The ash contains sodium chloride and potassium salts. Plant is very rich in chlorophyte. Kalmeghin is the active principle that contains 0.6% alkaloid of the crude plant. The plant contains diterpenoids, andrographolide, 14-deoxy-11-oxo-andrographolide, 14-deoxy-11,12-dihydroandrographolide, 14-deoxy andrographolide and neoandrographolide (Allison et al, 1968). The roots give flavones-apigenin-7,4-dio-O-methyl ether, 5-hydroxy-7,8,2’,3’- tetramethoxyflavone, andrographin and panicolin and -sitosterol (Ali et al, 1972; Govindachari et al, 1969). Leaves contain homoandrographolide, andrographosterol and andrographone.

The plant is vulnerary, antipyretic, antiperiodic, anti-inflammatory, expectorant, depurative, sudorific, anthelmintic, digestive, stomachic, tonic, febrifuge and cholagogue. The plant is antifungal, antityphoid, hepatoprotective, antidiabetic and cholinergic. Shoot is antibacterial and leaf is hypotensive(Garcia et al, 1980). This is used for the inflammation of the respiratory tract. In China, researchers have isolated the andrographolide from which soluble derivative such as 14-deoxy-11, 12-dehydro-andrographolide which forms the subject of current pharmacological and clinical studies. Apigenin 7,4’-O-dimethyl ether isolated from A. paniculata exhibits dose dependent, antiulcer activity in shay rat, histamine induced ulcer in guinea pigs and aspirin induced ulcers in rats. A crude substance isolated from methanolic extract of leaves has shown hypotensive activity. Pre-treatment of rats with leaf (500mg/kg) or andrographolide (5mg/kg) orally prevented the carbon tetrachloride induced increase of blood serum levels of glutamate-oxaloacetate transaminase in liver and prevented hepatocellular membrane.... green chiretta

Heat Cramps

Painful cramps in the muscles occurring in workers, such as stokers, who labour in hot conditions. The cramps are the result of loss of salt in the sweat, and can be cured by giving the sufferer salty water to drink. (See also HEAT STROKE.)... heat cramps

Horse Chestnut

Money, Healing ... horse chestnut

Intensive Care

Advanced and highly specialized care provided to medical or surgical patients whose conditions are life-threatening and require comprehensive care and constant monitoring. It is usually administered in a specially equipped unit of a health care facility. It can also be administered at home under certain circumstances (dialysis, respirators, etc.).... intensive care

Interstitial Cells

Also called Leydig cells, these cells are scattered between the SEMINIFEROUS TUBULES of the testis (see TESTICLE). LUTEINISING HORMONE from the anterior PITUITARY GLAND stimulates the interstitial cells to produce androgens, or male hormones.... interstitial cells

Krebs Cycle

A series of key cellular chemical reactions starting and ending with oxaloacetic acid. Also called the citric acid or tricarboxylic acid cycle, it produces energy in the form of ADENOSINE TRIPHOSPHATE (ATP) and is the last stage in the biological oxidation of fats, proteins, and carbohydrates. Named after Sir Hans Krebs, a German biochemist working in England in 1900, who won the Nobel Prize for his discovery.... krebs cycle

Kupffer Cells

Star-shaped cells present in the blood-sinuses of the LIVER. They form part of the RETICULOENDOTHELIAL SYSTEM and are to a large extent responsible for the breakdown of HAEMOGLOBIN into the BILE pigments.... kupffer cells

Life Cycle

1 The entire course of a person’s life – from infancy to old age. 2 The genetically prescribed course followed by all living organisms, including humans.... life cycle

Managed Care

A health care delivery system which entails interventions to control the price, volume, delivery site and intensity of health services provided, the goal of which is to maximize the value of health benefits and the coordination of health care management for a covered population.... managed care

Mast Cells

These are a group of cells that line the capillaries of tissues that come in contact with the outside, like skin, sinuses, and lung mucosa. They, like their first cousin basophils, are produced in the red bone marrow and migrate to the appropriate tissues, where they stay. They bind IgE, supply the histamine and heparin response that gives you a healing inflammation, and cause allergies.... mast cells

Mid-life Crisis

A colloquial description of the feelings of anxiety and distress experienced by some individuals in early middle age. They realise that by 45 years of age they are no longer young, and men in particular try to turn the clock back by changing jobs, dressing trendily, taking up energetic or unusual sports or engaging in extramarital liaisons. Sometimes those in mid-life crises develop mild or even serious DEPRESSION. The feelings of anxiety and insecurity usually disappear with time but some people may bene?t from counselling.... mid-life crisis

Nerve Cell

See NEURON(E).... nerve cell

Oat Cell

A type of cell found in one highly malignant form of lung cancer. The cell is small and either oval or round. The nucleus stains darkly and the cytoplasm is sparse and di?cult to identify. Oat-cell, or small-cell, carcinoma of the bronchus is usually caused by smoking, and comprises around 30 per cent of all bronchial cancers. It responds to radiotherapy and chemotherapy but, because the growth has usually spread widely by the time it is diagnosed, the prognosis is poor. Results of surgery are unsatisfactory.... oat cell

Obsessive Compulsive Disorder

A mental-health problem which will be experienced at some time by up to 3 per cent of adults. The main feature is the occurrence of spontaneous intrusive thoughts that cause intense anxiety. Many of these thoughts prompt urges, or compulsions, to carry out particular actions in order to reduce the anxiety. One of the commonest obsessions is a fear of dirt and contamination that prompts compulsive cleaning or repeated and unnecessary handwashing. (See MENTAL ILLNESS.)... obsessive compulsive disorder

Medical Research Council

A statutory body in the United Kingdom that promotes the balanced development of medical and related biological research and aims to advance knowledge that will lead to improved health care. It employs its own research sta? in more than 40 research establishments. These include the National Institute for Medical Research, the Laboratory of Molecular Biology, and the Clinical Sciences Centre. Grants are provided so that individual scientists can do research which complements the research activities of hospitals and universities. There are several medical charities and foundations – for example, the Imperial Cancer Research Fund, the British Heart Foundation, the Nu?eld Laboratories and the Wellcome Trust which fund and foster medical research.... medical research council

Oral Contraceptive

A contraceptive taken by mouth (see CONTRACEPTION). It comprises one or more synthetic female hormones, usually an oestrogen (see OESTROGENS), which blocks normal OVULATION, and a progestogen which in?uences the PITUITARY GLAND and thus blocks normal control of the woman’s menstrual cycle (see MENSTRUATION). Progestogens also make the uterus less congenial for the fertilisation of an ovum by the sperm.... oral contraceptive

Pacinian Corpuscles

Pacinian corpuscles, or lamellated corpuscles, are minute bulbs at the ends of the nerves scattered through the SKIN and subcutaneous tissue, and forming one of the end-organs for sensation.... pacinian corpuscles

Packed Cell Volume

That fraction of the blood’s total volume made up of red cells. The packed cell volume is found by centrifuging blood in a tube and measuring the depth of the column of red cells as a fraction of the whole column of blood. (See also HAEMATOCRIT.)... packed cell volume

Palliative Care

The active total care offered to a person and that person’s family when it is recognized that the illness is no longer curable, in order to concentrate on the person’s quality of life and the alleviation of distressing symptoms. The focus of palliative care is neither to hasten nor postpone death. It provides relief from pain and other distressing symptoms and integrates the psychological and spiritual aspects of care. It offers a support system to help relatives and friends cope during an individual’s illness and with their bereavement.... palliative care

Percutaneous Transluminal Coronary Angioplasty

A treatment for a stenosed (restricted) coronary artery (see ARTERIES). A balloon-tipped catheter (see CATHETERS) is passed through an incision in the skin of the chest into the artery of the HEART that has developed stenosis (narrowing). The balloon is aligned with the stenosed section and then in?ated to dilate the coronary artery and allow the blood to ?ow more freely.... percutaneous transluminal coronary angioplasty

Nasal Congestion

The nose and nasal sinuses (see SINUS) produce up to a litre of MUCUS in 24 hours, most of which enters the stomach via the NASOPHARYNX. Changes in the nasal lining mucosa occur in response to changes in humidity and atmospheric temperature; these may cause severe congestion, as might an allergic reaction or nasal polyp.

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

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

Plasma Cells

These are cells that produce ANTIBODIES and occur in bone-forming tissue as well as the lining of the gastrointestinal tract and the lungs. The cells develop in LYMPH NODES, SPLEEN and BONE MARROW when T-lymphocytes (see IMMUNITY) are stimulated by antigens (see ANTIGEN) to produce the precursor cells from which plasma cells originate.... plasma cells

Pleural Cavity

The normally restricted space between the parietal and the visceral PLEURA, which slide over one another as the individual breathes in and out. If gas or ?uid are introduced as a result of injury or infection, the pleural surfaces are separated and the pleural space increases in volume. This usually causes breathing diffculties.... pleural cavity

Primary Care Trust

See GENERAL PRACTITIONER (GP)... primary care trust

Purkinje Cells

Large specialised nerve cells occurring in great numbers in the cortex (super?cial layer of grey matter) of the cerebellum of the BRAIN. They have a ?ask-shaped body, an AXON and branching tree-like extensions called dendrites, which extend towards the surface of the brain (see NEURON(E)).... purkinje cells

Qrs Complex

The section of an ELECTROCARDIOGRAM (ECG) that precedes the S-T segment and registers contraction of the VENTRICLE of the HEART.... qrs complex

Prickly Pear Cactus

Opuntia species

Description: This cactus has flat, padlike stems that are green. Many round, furry dots that contain sharp-pointed hairs cover these stems.

Habitat and Distribution: This cactus is found in arid and semiarid regions and in dry, sandy areas of wetter regions throughout most of the United States and Central and South America. Some species are planted in arid and semiarid regions of other parts of the world.

Edible Parts: All parts of the plant are edible. Peel the fruits and eat them fresh or crush them to prepare a refreshing drink. Avoid the tiny, pointed hairs. Roast the seeds and grind them to a flour.

CAUTION

Avoid any prickly pear cactus like plant with milky sap.

Other Uses: The pad is a good source of water. Peel it carefully to remove all sharp hairs before putting it in your mouth. You can also use the pads to promote healing. Split them and apply the pulp to wounds.... prickly pear cactus

Red Blood Cell

See ERYTHROCYTES; BLOOD.... red blood cell

Purging Croton

Croton tiglium

Euphorbiaceae

San: Jepalah, Dantibijah

Hin: Jamalgota

Ben: Jaypal Mal: Nirvalam

Tam: Nervalam, Sevalamkottai

Tel: Nepala

Importance: Purging croton or croton oil plant, a small evergreen tree with separate male and female flowers, is one among the seven poisons described in Ayurveda. The drug is well known for its drastic purgative property. The drug is found to be useful in ascites, anasarca, cold, cough, asthma, constipation, calculus, dropsy, fever and enlargement of the abdominal viscera. The seed paste is a good application for skin diseases, painful swellings and alopacia. The seed-oil is useful in chronic bronchitis, laryngeal affections, arthritis and lock jaw. Misraka-sneham is an important preparation using the drug (Nadkarni, 1954; Dey, 1980; Sharma, 1983).

Distribution: It is distributed throughout North India. It is cultivated in Assam, West Bengal and South India.

Botany: Croton tiglium Linn. belongs to the family Euphorbiaceae. It is a small evergreen tree, 4.5-6.0m in height with ash coloured smooth bark and young shoots sprinkled with stellate hairs. Leaves are oblong to ovate-lanceolate, obtuse or rounded at the 2-glanded box, acuminate, membraneous, yellowish green and minutely toothed. Flowers are small, unisexual, males on slender pedicels, females larger and on short thick pedicels. Fruits are ovoid or oblong trigonous capsules. Seeds are smooth, testa black and enclosing reddish brown oily endosperm (Warrier et al,1994). Other species belonging to the genus Croton are as follows:

C. aromaticus Linn. C. caudatus Geisel C. jouera Roxb.

C. malabaricus Bedd.

C. oblongifolius Roxb.

C. polyandrus Roxb. syn. Baliospermum montanum Muell-Arg.

C. reticulatus(Chopra et al, 1980)

Agrotechnology: The plant is propagated by seeds. Seeds are to be sown on seedbeds and about 2 months old seedlings are used for transplanting. Pits of size 50cm cube are to be taken at 3m spacing and filled with dried cowdung, sand and topsoil and formed into a mound. The seedlings are to be planted on these mounds. Irrigation during summer months is beneficial. Application of organic manure after every 6 months is desirable. Weeding is to be carried out one month after transplanting. The plant is not attacked by any serious pests or diseases. Fruits are formed at the end of first year. Fruits when ripen and start to crack are to be collected, dried in sun, then the outer shell is removed and again dried for one day before marketing (Prasad et al,1997).

Properties and activity: Oil contains phorbol myristate acetate (Husain et al, 1992). Seeds contain upto 20% protein and 30-50% lipids. Iso-guanine-D-ribose (crotoniside) and saccharose were isolated from the seeds. In fractionation of croton oil, liquid-liquid distribution procedures proved to be the separation tools of choice. The per hydrogenated parent hydrocarbon of phorbol is a perhydrocyclopropabenzulene called tigliane and phorbol is 1, 1a , 1b , 4, 4a, 7a , 7b, 8, 9, 9a-decahydro-4a , 7 , 9 , 9a - tetrahydroxy-3-(hydroxymethyl)-1, 1, 6, 8 tetramethyl-5-H-cyclopropa[3,4] benz [1.2-e]azulen-5- one. Phorbol, a tetracylic diterpene with a 5, 7, 6 and 3- membered ring has 6 oxygen functions. Phorbol accounts for 3.4% and 4- deoxy- 4 - phorbol for 0.29% of the weight of croton oil. Twenty- five phorbol-12, 13-diesters have been detected (Hecker et al, 1974). A toxin croton 1, mol. wt 72,000 has been isolated from the seeds (Lin et al, 1978).

Phorbol myristate acetate activates nitroblue tetrazolium reduction in human polymorphs. Seed and oil is purgative, rubefacient and anti-dote for snakebite. The seeds and oil are acrid, bitter, thermogenic, emollient, drastic purgative, digestive, carminative, anthelmintic, antiinflammatory, vermifuge, deterent, diaphoretic, expectorant, vesicant, irritant and rubefacient.... purging croton

Rotator Cuff

A musculo-tendinous structure that helps to stabilise the shoulder-joint. The cu? may be damaged as a result of a fall; complete rupture requires surgical treatment and intensive PHYSIOTHERAPY.... rotator cuff

Secondary Sexual Characteristics

The physical characteristics that develop during PUBERTY as the body matures sexually. Girls’ breasts and genitals increase in size, and, like boys, they grow pubic hair. Boys also grow facial hair, their voice breaks and their genitals grow to adult size.... secondary sexual characteristics

Sex Change

A major surgical operation, usually coupled with the appropriate hormone treatment (see HORMONES), to change a person’s anatomical sex. The operation is done on transsexual individuals or in those whose sexual organs are neither totally female nor male. Male-to-female sex change is the more common. Such operations should not be performed without rigorous physical and mental assessment of the individual, and should be accompanied by extensive counselling. Some subjects make a satisfactory adjustment to the change of anatomical sex, while others may suffer serious psychological problems. Hormone therapy may need to be continued for life.... sex change

Small-cell Carcinoma

See OAT CELL.... small-cell carcinoma

Sodium Chloride

The chemical name for common salt (see SODIUM).... sodium chloride

Staghorn Calculus

A branched renal stone formed in the image of the collecting system of the kidney (see KIDNEYS). It ?lls the calyces and pelvis and is commonly associated with an infection of the urine, particularly Proteus vulgaris. The calculus may lead to pyonephrosis and an ABSCESS of the kidney.... staghorn calculus

Sex Chromosomes

In humans there are 23 pairs of CHROMOSOMES. Male and female di?er in respect of one pair. In the nucleus of female cells, the two members of the pair are identical and are called X chromosomes. In the male nucleus there is one X chromosome paired with a dissimilar, di?erently sized chromosome called the Y chromosome. In the sex cells, after MEIOSIS, all cells in the female contain a single X chromosome. In the male, half will contain an X chromosome and half a Y chromosome. If a sperm with an X chromosome fertilises an ovum (which, as stated, must have an X chromosome) the o?spring will be female; if a sperm with a Y chromosome fertilises the ovum the o?spring will be male. It is the sex chromosomes which determine the sex of an individual.

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

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

Deletion Where a segment of a chromosome is lost.

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

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

Translocation Where chromosomes of different pairs exchange segments.

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

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

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

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

Subacute Combined Degeneration Of The Cord

A degenerative condition of the SPINAL CORD which most commonly occurs as a complication of PERNICIOUS ANAEMIA. The motor and sensory nerves in the cord are damaged, causing spasticity of the limbs and an unsteady gait. Treatment is with vitamin B12 (see APPENDIX 5: VITAMINS).... subacute combined degeneration of the cord

T-cell

A specialised white cell (lymphocyte) responsible for cell-mediated immunity. See also T-lymphocyte.... t-cell

Spinal Column

Also known as the spine, this forms an important part of the skeleton, acting both as the rigid pillar which supports the upper parts of the body and as a protection to the SPINAL CORD and nerves arising from it. The spinal column is built up of a number of bones placed one upon another, which, in consequence of having a slight degree of turning-movement, are known as the vertebrae. The possession of a spinal cord supported by a vertebral column distinguishes the higher animals from the lower types, and is why they are called vertebrates. Of the vertebrates, humans alone stand absolutely erect, and this erect carriage of the body gives to the skull and vertebral column certain distinctive characters.

The human backbone is about 70 cm (28

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

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

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

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

Target Cell

Abnormal ERYTHROCYTES which are large and ‘?oppy’ and have a ringed appearance, similar to that of a target, when stained and viewed under the microscope. This change from normal may occur with iron-de?ciency ANAEMIA, liver disease, a small SPLEEN, haemoglobinopathies (disorders of HAEMOGLOBIN), and THALASSAEMIA.

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

Swan-ganz Catheter

(See also CATHETERS.) A ?exible tube with a double lumen and a small balloon at its distal end. It is introduced into a vein in the arm and advanced until the end of the catheter is in the right atrium (see HEART). The balloon is then in?ated with air through one lumen and this enables the bloodstream to propel the catheter through the right ventricle to the pulmonary artery. The balloon is de?ated and the catheter can then record the pulmonary artery pressure. When the balloon is in?ated, the tip is isolated from the pulmonary artery and measures the left atrial pressure. These measurements are important in the management of patients with circulatory failure, as under these circumstances the central venous pressure or the right atrial pressure is an unreliable guide to ?uid-replacement.... swan-ganz catheter

Terminal Care

Medical and nursing care of persons in the terminal stage of an illness. See also “palliative care”.... terminal care

Thyroid Cartilage

The largest cartilage in the LARYNX and forms the prominence of the Adam’s apple in front of the neck.... thyroid cartilage

Vital Capacity

The amount of air that can be forcibly exhaled from the lungs after a deep inspiration. (See RESPIRATION.)... vital capacity

Vocal Cords

See LARYNGOSCOPE; LARYNX; VOICE AND SPEECH.... vocal cords

White Blood Cell

See LEUCOCYTES.... white blood cell

Vasomotor Centre

The description ‘vasomotor’ refers to control of the muscular walls of blood vessels, particularly ARTERIES, dilating or constricting their diameters. The vasomotor centre is a group of neurons (see NEURON(E)) in the MEDULLA OBLONGATA of the BRAIN; they receive messages from sensory receptors in the circulatory system, and engineer re?ex alterations in the heart rate and blood-vessel diameters in order to adjust the blood pressure. The centre also receives transmission from other parts of the brain enabling emotions – fear or anger – to in?uence blood pressure. The vasomotor centre operates through the vasomotor nerves of the SYMPATHETIC NERVOUS SYSTEM and the PARASYMPATHETIC NERVOUS SYSTEM.... vasomotor centre

Breast, Cyst

See: FIBROCYSTIC BREAST DISEASE. ... breast, cyst

Cardiogenic Shock

The result of myocardial infarction. Reduction in contractility and output of the heart.

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

Bronchitis, Chronic

The ‘English Disease’. The result of repeated attacks of the acute condition. Menace to the elderly when bronchi becomes thickened and narrowed. Inelastic walls secrete a thick purulent mucus of fetid odour which plugs tubes and arrests oxygen intake. Aggravated by cold and damp, hence the need of a warm house with warm bedroom. Causes are many: smoking, industrial pollution irritants, soot, fog, etc. Breathlessness and audible breathing sounds may present an alarming spectacle.

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

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

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

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

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

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

Topical. Same as for acute bronchitis.

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

Cajeput

Swamp tea tree. Melaleuca leucadendron L. French: Cajeputier. German: Kajeputbaum. Contains terpenoids. Oil.

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

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

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

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

Chervil

Sweet Cicely. Myrrhis odorata. Anthriscus cerefolium 1. Hoffin. German: Gartenkerbel. French: Cerfeuil musque?. Italian: Felce muschiata. Indian: Rigi-el-Ghurab. Part used: fresh or dried leaves.

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

Uses: Indigestion, high blood pressure.

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

Chlorosis

Simple iron-deficiency anaemia in teenagers; with sickly greenish grey or yellowish complexion.

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

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

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

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

Citronella

Cymbopogon winterianus, Jowitt. Leaves.

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

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

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

Corneal Ulcer

See: EYES, INFECTION. ... corneal ulcer

Counter Irritant

An agent which produces vaso-dilation of peripheral blood vessels by stimulating nerve-endings of the skin to generate irritation intended to relieve deep-seated pain. Arnica, Balm of Gilead, Black Mustard, Bryony (white), Cajuput (oil of), Camphor, Canada Balsam, Cayenne, Eucalyptus, Nutmeg (oil of), Sassafras, Thuja. ... counter irritant

Cubebs

Tailed pepper. Piper cubeba L. Constituents: lignans, gum resins, volatile oil.

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

Preparations: Thrice daily.

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

Carcinoid Syndrome

Flushing of the face and neck caused by an active malignant tumour in the stomach or intestines with secondary growths in the liver. Often accompanied by an explosive diarrhoea. The lesion is usually found in the ileum yet it may also appear in the bile duct, ovaries or bronchi. Other symptoms include low blood pressure, drastic reduction in weight due to loss of body fluids.

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

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

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

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

Cavernous Sinus Thrombosis

Thrombosis arising in the cavernous sinus of the sphenoid bone in the head.

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

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

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

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

Celery Seed

Apium graveolens, L. French: Ache. German: Sellerie. Spanish: Apio. Italian: Sedano. Indian: Chanoo Rhadodni. Chinese: Han-ch’in. Dried seeds.

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

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

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

Preparations: Thrice daily.

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

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

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

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

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

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

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

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

Not taken in pregnancy.

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

Cellulite

Not a medical term. Puffy skin from deposition of fat. “Orange peel skin”. Occurs chiefly in women as lumpy flesh on buttocks, thighs, stomach, knees and upper arm. Though not due to increased fluid in the tissues, it is sufficient to arrest the circulation. Constriction of capillaries causes toxic wastes to build up, forming nodules that lock away fat in the tissues. Hormone imbalance also suspected. Varicose veins may appear with cellulite from poorly supportive connective tissue. Usual cause: poor posture and unhealthy lifestyle.

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

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

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

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

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

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

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

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

Cerebral Thrombosis

Formation of a blood clot within vessels of the brain. May be due to atheroma or embolism causing a blockage resulting in hypoxia (oxygen deficiency).

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

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

Tablets/capsules. Ginkgo, Hawthorn, Prickly Ash.

Diet. See: DIET–HEART AND CIRCULATION.

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

Baker’s Cyst

A fluid-filled lump behind the knee. A Baker’s cyst is caused by increased pressure in the knee joint due to a buildup of fluid in a disorder such as rheumatoid arthritis. Most Baker’s cysts are painless, and some disappear spontaneously. Occasionally, a cyst may rupture, producing pain and swelling in the calf that can mimic a deep vein thrombosis (see thrombosis, deep vein). Diagnosis of a Baker’s cyst is confirmed by ultrasound scanning. Treatment is rarely needed.... baker’s cyst

Barrier Cream

A cream used to protect the skin against the effects of irritant substances and of excessive exposure to water. (See also sunscreens.)... barrier cream

B-cell

See lymphocyte.... b-cell

Chilblains

Spasm of surface blood vessels, with inflammation, due to exposure to cold. Thrombosis of vessels of the skin, with red itchy patches. Possible calcium deficiency. Vaso-dilators bring relief. Internal treatment to stimulate the circulation.

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

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

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

Friar’s balsam: soak cotton wool and apply.

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

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

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

Café Au Lait Spots

Patches of coffeecoloured skin that may occur anywhere on the body.

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

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

Calcification

The deposition of calcium salts in body tissues that is part of the normal process of bone and teeth formation and the healing of fractures.

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

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.

See entry: BAREFOOT DOCTOR’S MANUAL.

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

Calcipotriol

A derivative of vitamin D, used in topical preparations for treating the skin disorder psoriasis.... calcipotriol

Chromatography

A laboratory technique for identification of herbs and their constituents, taking advantage of the different rates at which molecules diffuse through an absorbent column to separate them.

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

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

Callosity

See callus, skin.... callosity

Capsulitis

Inflammation of a capsule around an organ or joint, for example as occurs in frozen shoulder.... capsulitis

Carbon Dioxide

(CO) A colourless, odourless gas. Carbon dioxide is present in small amounts in the air and is an important by-product of metabolism in cells. It is produced by the breakdown of substances such as carbohydrates and fats to produce energy, and is carried in the blood to the lungs and exhaled. Carbon dioxide helps to control the rate of respiration: when a person exercises, CO2 levels in the blood rise, causing the person to breathe more rapidly in order to expel carbon dioxide and to take in more oxygen.

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

Carbon Monoxide

(CO) A colourless, odourless, poisonous gas present in motor exhaust fumes and produced by inefficient burning of coal, gas, or oil.

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

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

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

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

Carbon Tetrachloride

(CCl) A colourless, poisonous, volatile chemical with a characteristic odour that is present in some home dry-cleaning fluids and industrial solvents. It can cause dizziness, confusion, and liver and kidney damage if it is inhaled or swallowed.... carbon tetrachloride

Cardiopulmonary Resuscitation

The administration of life-saving measures to a person who has suffered a cardiac arrest. A person in cardiac arrest is not breathing and has no detectable pulse or heartbeat. First, mouth-to-mouth resuscitation (see artificial respiration) is given; if this fails to restart breathing, repeated chest compressions, using the heel of

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

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

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

Cardiotocography

See fetal heart monitoring.... cardiotocography

Carotenaemia

A harmless condition in which the blood level of the orange pigment carotene, found in carrots and other vegetables, is excessively high. The condition may cause temporary yellowing of the skin.... carotenaemia

Cast

A rigid casing applied to a limb or other part of the body to hold a broken bone or dislocated joint in position as it heals.

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

Catharsis

A term meaning purification or cleansing.

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

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

Catheter

A flexible tube inserted into the body to drain or introduce fluids or carry out other functions. Catheters are commonly used to drain urine from the bladder (see catheterization, urinary). Other types are used to investigate the condition of the heart (see catheterization, cardiac), to widen obstructed blood vessels, or to control bleeding. (See also balloon catheter.)... catheter

Coronary Heart Disease

The cause of: coronary occlusion, coronary blockage, coronary thrombosis. A heart attack occurs when a coronary artery becomes blocked by swellings composed, among other things, of cholesterol. Such swellings may obstruct the flow of blood leading to a blood clot (thrombus). Cholesterol is a major cause of CHD.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Prevention: Vitamin E – 400iu daily.

Diet. See: DIET – HEART AND CIRCULATION.

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

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

Caudal

Relating to the lower end of the spine.

Caudal means “of the tail”.... caudal

Caustic

A term used for any substance that has a burning or corrosive action on body tissues or has a burning taste.

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

Cefaclor

A common antibiotic, one of the cephalosporin drugs.... cefaclor

Cefadroxil

A cephalosporin drug, used to treat bacterial infections.... cefadroxil

Cefalexin

A cephalosporin drug, used to treat bacterial infections.... cefalexin

Cefotaxime

A cephalosporin drug, used to treat bacterial infections.... cefotaxime

Cefuroxime

A cephalosporin drug, used to treat bacterial infections.... cefuroxime

Celecoxib

A COX-2 inhibitor drug (a type of nonsteroidal anti-inflammatory drug) used to relieve the pain and inflammation of rheumatoid arthritis

and osteoarthritis.

Side effects include nausea and diarrhoea.

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

Cell Division

The processes by which cells multiply. Mitosis is the most common form of cell division, giving rise todaughter cells identical to the parent cells.

Meiosis produces egg (see ovum) and sperm cells that differ from their parent cells in that they have only half the normal number of chromosomes.... cell division

Cystinuria

The presence of cystin in the urine, sometimes during pregnancy. Hereditary. A weakness of metabolism associated with increased urinary excretion of cystine – an amino acid – which leads to the formation of kidney stone. Its presence increases the risk of urinary tract infection, obstruction and the possibility of renal failure. Cases will require specialist hospital treatment, being necessary to screen urine at 3 to 6 months of pregnancy.

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

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

Cementum

Bone-like tissue surrounding the root of a tooth (see teeth).... cementum

Centrifuge

A machine that separates the different components of a body fluid for analysis.

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

Cephalhaematoma

An extensive, soft swelling on the scalp of a newborn infant, which is caused by bleeding into the space between the cranium and its fibrous covering due to pressure on the baby’s head during delivery.

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

Cephalopelvic Disproportion

A complication of childbirth (see childbirth, complications of) in which the mother’s pelvis is too narrow in proportion to the size of the baby’s head.... cephalopelvic disproportion

Cerebral Haemorrhage

Bleeding within the brain due to a ruptured blood vessel (see intracerebral haemorrhage; stroke).... cerebral haemorrhage

Cerebrovascular Disease

Any disease affecting an artery in, and supplying blood to, the brain: for example, atherosclerosis (narrowing of the arteries) or defects or weaknesses in arterial walls causing aneurysm (a balloon-like swelling in an artery).

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

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

Cervical Incompetence

Abnormal weakness of the cervix that can result in recurrent miscarriages. An incompetent cervix may gradually widen under the weight of the fetus from about the 12th week of pregnancy onwards, or may suddenly open during the second trimester. The condition is detected by an internal examination or by ultrasound scanning.

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

Cervical Intraepithelial Neoplasia

Also known as , abnormalities in the cells of the cervix which may become cancerous.

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

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

Heart Disease – Congenital

Heart disease arising from abnormal development. Some cases are hereditary, others due to drugs taken during pregnancy. Many owe their origin to illnesses of the mother such as German measles. Structural abnormalities of the heart take different forms but whatever the case, when under abnormal pressure and stress, all may derive some small benefit from the sustaining properties of Hawthorn berry and other phytomedicines.

Alternatives. To sustain.

Teas. Lime flowers, Motherwort, Buckwheat, Hawthorn.

Tablets/capsules. Hawthorn, Mistletoe, Motherwort.

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

Cetirizine

An antihistamine drug used to relieve the symptoms of conditions such as allergic rhinitis (hay fever) and urticaria.... cetirizine

Charcot’s Joint

A joint that is repeatedly damaged by injuries that have gone unnoticed because of loss of sensation in the joint (see neuropathic joint).... charcot’s joint

Cheilitis

Inflammation, cracking, and dryness of the lips that may be caused by ill-fitting dentures, a local infection, allergy to cosmetics, excessive sunbathing, or deficiency of riboflavin (vitamin B3).... cheilitis

Chigoe

A painful, itchy, pea-sized swelling caused by a sand flea that lives in sandy soil in Africa and tropical America.

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

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

Chlorphenamine

An antihistamine drug used to treat allergies such as allergic rhinitis (hay fever), allergic conjunctivitis, urticaria, and angioedema. It is also found in some cold remedies.... chlorphenamine

Cholecalciferol

An alternative name for colecalciferol, also known as vitamin D3 (see vitamin D).... cholecalciferol

Cholesteatoma

A rare but serious condition in which skin cells proliferate and grow inwards from the ear canal into the middle ear.

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

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

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

Blood Clotting

The process of blood solidification. Clotting is important in stemming bleeding from damaged blood vessels. However, unwanted blood clotting can occur inside major blood vessels and cause a myocardial infarction (heart attack) or stroke (see thrombosis).

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

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

Defects in blood clotting may result in bleeding disorders.

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

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

Breast Cancer

A cancerous tumour of the breast. The incidence is raised in women whose menstrual periods began at an early age and whose menopause was late; in those who had no children or had their first child later in life; in those with mothers or sisters who had breast cancer; and in those who are obese. The disease is also more common in countries in which the typical diet contains a lot of fat. One form of breast cancer has a genetic component; 2 genes called BRAC1 and BRAC2 have been identified and appear to be involved in this type of breast cancer.

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

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

Chondrosarcoma

A cancerous growth of cartilage occurring within or on the surface of large bones, causing pain and swelling.

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

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

Chordee

Abnormal curvature of the penis, usually downwards.

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

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

Capillary

Any of the vessels that carry blood between the smallest arteries, or arterioles, and the smallest veins, or venules (see circulatory system). Capillaries form a fine network throughout the body’s organs and tissues. Their thin walls are permeable and allow blood and cells to exchange constituents such as oxygen, glucose, carbon dioxide, and water (see respiration). Capillaries open and close to blood flow according to the requirements of different organs. The opening and closing of skin capillaries helps to regulate temperature.

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

Chronic Obstructive Pulmonary Disease

See pulmonary disease, chronic obstructive.... chronic obstructive pulmonary disease

Ciclosporin

An immunosuppressant drug used following transplant surgery. The drug reduces the risk of tissue rejection and the need for large doses of corticosteroid drugs. Ciclosporin may need to be taken indefinitely after a transplant. It is also used to treat rheumatoid arthritis and other autoimmune disorders. Because ciclosporin suppresses the immune system, it increases the susceptibility to infection. Swelling of the gums and increased hair growth are fairly common. Ciclosporin may also cause kidney damage, and regular monitoring of kidney function is required.... ciclosporin

Carotid Artery

Any of the main arteries of the neck and head. There are 2 common carotid arteries (left and right), each of which divides into 2 main branches (internal and external).

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

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

The condition often disappears without treatment.

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

Cerebellum

A region of the brain behind the brainstem concerned with maintaining posture and balance and coordinating movement.

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

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

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

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

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

Cerebrum

The largest and most developed part of the brain, the site of most conscious and intelligent activities. Its main components are 2 large cerebral hemispheres that grow out from the upper part of the brainstem. Their surface is made up of a series of folds called gyri, separated by fissures called sulci, with a deep longitudinal fissure separating the 2 hemispheres. The 4 main surface regions of each hemisphere – the frontal, parietal, temporal, and occipital lobes – are named after their overlying bones. Each hemisphere has a central cavity, called a ventricle, filled with cerebrospinal fluid. This is surrounded by an inner layer, consisting of clusters of nerve cells called the basal ganglia. A middle layer of “white matter” is composed mainly of nerve fibres, which carry information between specific areas of the cortex and between areas of the cortex, central brain, and the brainstem. A thick band of fibres

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

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

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

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

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

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

Ciprofloxacin

An antibacterial drug used mainly to treat infections of the respiratory, gastrointestinal, and urinary tracts.... ciprofloxacin

Citalopram

An antipressant drug.... citalopram

Clemastine

An antihistamine drug used to relieve the symptoms of allergies such as urticaria and allergic rhinitis (hay fever).

Clemastine can cause drowsiness.... clemastine

Chorionic Villus Sampling

A method of diagnosing genetic abnormalities in a fetus using a small sample of tissue taken from the chorionic villi at edge of the placenta. Because the cells have the same chromosome makeup as those in the fetus, they can be used to detect genetic abnormalities. Chorionic villus sampling (CVS) is usually performed in the first 3 months of pregnancy in women who are at a higher-than-normal risk of having a child with a chromosomal disorder, such as Down’s syndrome, or a genetic disease, such as thalassaemia. Chromosome analysis of the villi cells takes place in the laboratory. CVS slightly increases the risk of miscarriage. choroid A layer of tissue at the back of the eye, behind the retina. The choroid contains many blood vessels that supply nutrients and oxygen to the retinal cells and to surrounding tissues in the eye. choroiditis Inflammation of the choroid. It is often caused by infections such as toxocariasis or toxoplasmosis, more rarely by sarcoidosis, syphilis, and histoplasmosis. It sometimes has no obvious cause. Treatment includes corticosteroid drugs for the inflammation, and antibiotic drugs for any causative infection.... chorionic villus sampling

Clitoridectomy

An operation to remove the clitoris (see circumcision, female).... clitoridectomy

Clomifene

A drug used to treat female infertility caused by failure to ovulate. Minor side effects may include hot flushes, nausea, headache, breast tenderness, and blurred vision. Occasionally, ovarian cysts develop, but these shrink when the dose is reduced. Use of the drug may result in multiple births.... clomifene

Coal Tar

A thick, black, sticky substance distilled from coal.

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

Circulatory System

The heart and blood vessels, which together maintain a continuous flow of blood throughout the body. The system provides tissues with oxygen and nutrients, and carries away waste products. The circulatory system consists of 2 main parts: the systemic circulation, which supplies blood to the whole body apart from the lungs; and the pulmonary circulation to the lungs. Within the systemic circulation, there is a bypass (the portal circulation), which carries nutrient-rich blood from the stomach, intestine, and other digestive organs to the liver for processing, storage, or re-entry into general circulation.

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

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

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

Cobalamin

A cobalt-containing complex molecule, part of vitamin B12.... cobalamin

Cochlear Implant

A device used to treat profoundly deaf people who are not helped by hearing aids. A cochlear implant consists of tiny electrodes surgically implanted in the cochlea deep in the inner ear and a receiver that is embedded in the skull just behind and above the ear. A microphone, sound processor, and transmitter are worn externally. A cochlear implant does not restore normal hearing, but it enables patterns of sound to be detected. Combined with lip-reading, it may enable speech to be understood.... cochlear implant

Co-codamol

A compound analgesic drug containing paracetamol and codeine.... co-codamol

Coitus Interruptus

A method of contraception (see contraception, withdrawal method of) in which the male partner withdraws his penis from the vagina before ejaculation occurs. Coitus interruptus is unreliable because sperm can be released before orgasm occurs, and it may cause psychosexual dysfunction in men and women.... coitus interruptus

Colestyramine

A lipid-lowering drug used to treat some types of hyperlipidaemia. The drug is also used to treat diarrhoea due to excessive amounts of undigested fats in the faeces in disorders such as Crohn’s disease.... colestyramine

Colonoscopy

Examination of the inside of the colon by means of a flexible, fibre-optic viewing instrument called a colonoscope, which is introduced through the anus and guided along the colon.

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

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

Comedo

Another name for a blackhead.... comedo

Compartment Syndrome

A painful cramp due to compression of a group of muscles within a confined space. It may occur when muscles are enlarged due to intensive training or injury such as shin splints. Cramps induced by exercise usually disappear when exercise is stopped. Severe cases may require fasciotomy to improve blood flow and prevent development of a permanent contracture.... compartment syndrome

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

Complication

A condition resulting from a preceding disorder or from its treatment.... complication

Conditioning

The formation of a specific response to a specific stimulus.

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

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

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

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

Cone Biopsy

A surgical procedure in which a conical or cylindrical section of the lower part of the cervix is removed. A cone biopsy is performed after an abnormal cervical smear test result if the exact precancerous or cancerous area (see cervix, cancer of) cannot be identified by colposcopy.... cone biopsy

Confabulation

The use of a fictional story to make up for gaps in memory.

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

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

Conn’s Syndrome

A disorder caused by the secretion of excessive amounts of the hormone aldosterone by a noncancerous tumour of one of the adrenal glands. (See also aldosteronism.)... conn’s syndrome

Cooley’s Anaemia

See thalassaemia.... cooley’s anaemia

Copd

The abbreviation for chronic obstructive pulmonary disease (see pulmonary disease, chronic obstructive).... copd

Controlled Drug

One of a number of drugs subject to restricted use because of their potential for abuse. They include

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

Coronary Artery Disease

Narrowing of the coronary arteries, which supply blood to the heart, leading to damage or malfunction of the heart. The most common heart disorders due to coronary artery disease are angina pectoris and myocardial infarction (heart attack). The usual cause of narrowing of the arteries is atherosclerosis, in which fatty plaques develop on the artery linings. The vessel can become totally blocked if a blood clot forms or lodges in the narrowed area. Atherosclerosis has many interrelated causes including smoking, a high-fat diet, lack of exercise, being overweight, and raised blood cholesterol levels. Other factors include a genetic predisposition and diseases such as diabetes mellitus and hypertension.

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

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

Coronary Care Unit

A specialist ward for the care of acutely ill patients who may be suffering, or who have suffered, a myocardial infarction (heart attack) or another serious cardiovascular disorder.... coronary care unit

Craniopharyngioma

A rare, non-hormone-secreting tumour of the pituitary gland. Symptoms of a craniopharyngioma may include headaches, vomiting, and defective vision. If a craniopharyngioma develops in childhood, growth may become stunted and sexual development may not occur. Craniopharyngiomas are usually removed surgically. Untreated, they may cause permanent brain damage. craniosynostosis The premature closure of one or more of the joints (sutures) between the curved, flattened bones of the skull in infants. If all the joints are involved, the growing infant’s brain may be compressed and there is a risk of brain damage from pressure inside the skull. If the abnormality is localized, the head may be deformed. Craniosynostosis may occur before birth and, in some cases, is associated with other birth defects. It may also occur in an otherwise healthy baby, or in a baby affected by a disorder such as rickets. If the brain is compressed, an operation may be performed to separate the fused skull bones.... craniopharyngioma

Crepitation

A crackling sound in the lungs (heard through a stethoscope) caused by abnormal build-up of fluid.

(See also auscultation.)... crepitation

Cri Du Chat Syndrome

A rare, congenital condition of severe mental handicap, abnormal facial appearance, low birth weight, and short stature, which is characterized by a cat-like cry in infancy. The syndrome is caused by a chromosomal abnormality. There is no treatment. (See also genetic counselling.)... cri du chat syndrome

Crossbite

A type of malocclusion in which some or all of the lower front teeth overlap the upper front teeth.... crossbite

Cryptosporidiosis

A type of diarrhoeal infection caused by protozoa, which may be spread from person to person or from domestic animals to people. The disease causes watery diarrhoea and sometimes fever and abdominal pain. It is most common in children but also occurs in male homosexuals. Treatment, apart from rehydration therapy, is not usually needed except for people whose immune system is suppressed, in whom the infection may be much more severe.... cryptosporidiosis

Cupping

An ancient form of treatment, still used in folk healing in some countries, which draws blood to the surface by applying a small heated vessel to the skin.

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

Curare

An extract from the bark and juices of various trees that has been used for centuries by South American Indians as an arrow poison. Curare kills by causing muscle paralysis. Synthetic compounds related to curare are used to produce paralysis during surgery.... curare

Curettage

The use of a sharp-edged, spoon-shaped surgical instrument called a curette to scrape abnormal tissue, or tissue for analysis, from the lining of a body cavity or from the skin.... curettage

Cyanide

Any of a group of salts of hydrocyanic acid. Most are highly poisonous; inhalation or ingestion can rapidly lead to breathlessness, paralysis, and death.... cyanide

Cyclopenthiazide

A thiazide diuretic drug used to reduce oedema associated with heart failure, kidney disorders, cirrhosis of the liver, and premenstrual syndrome, and to treat hypertension.

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

Cyclosporin

An alternative spelling for ciclosporin.... cyclosporin

Cystocele

A swelling in the vagina that is formed where the bladder pushes against weakened tissues in the vaginal wall.

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

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

Pelvic floor exercises may relieve symptoms.

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

Cystoscopy

The examination of the urethra and bladder using a cystoscope inserted up the urethra. A cystoscope is a rigid metal or flexible fibre-optic viewing instrument, sometimes with a camera at the tip (see endoscopy). Cystoscopy is used to inspect the bladder for calculi, bladder tumours, and sites of bleeding and infection, and to obtain urine samples from the ureters to look for infection or tumour cells. Radiopaque dye may be injected into the ureters via the cystoscope during the X-ray procedure of retrograde pyelography (see urography).

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

Cystostomy

The surgical creation of a hole in the bladder usually performed to drain urine when the introduction of a catheter is inadvisable or impossible.... cystostomy

Cyte

A suffix that denotes a cell.

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

Cytomegalovirus

One of the most common herpes viruses, which causes infected cells to take on an enlarged appearance. Cytomegalovirus (CMV) infection may cause an illness resembling infectious mononucleosis, but usually produces no symptoms. People who have impaired immunity are more seriously infected. A pregnant woman can transmit the virus to her unborn child; this can cause birth defects and brain damage in the child.... cytomegalovirus

Disseminated Intravascular Coagulation

(DIC) A type of bleeding disorder in which abnormal clotting leads to depletion of coagulation factors in the blood; the consequence may be severe spontaneous bleeding.... disseminated intravascular coagulation

Emergency Contraception

See contraception, emergency.... emergency contraception

Endometrial Cancer

See uterus, cancer of.... endometrial cancer

Flail Chest

A type of chest injury that usually results from a traffic accident or from violence. In flail chest, several adjacent ribs are broken in more than one place, producing a piece of chest wall that moves in the opposite way to normal as the victim breathes. The injury may lead to respiratory failure and shock.

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

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

Germ Cell Tumour

A growth comprised of immature sperm cells in the male testis or of immature ova in the female ovary. A seminoma is one type of germ cell tumour (see testis, cancer of).... germ cell tumour

Hickman Catheter

A flexible plastic tube, also known as a skin-tunnelled catheter, that is passed through the chest and inserted into the subclavian vein, which leads to the heart. It is often used in people who have leukaemia or other cancers and need regular chemotherapy and blood tests. The catheter allows drugs to be injected directly into the bloodstream and blood samples to be obtained easily. The catheter is inserted, under local anaesthesia. It can remain in position for months; the external end is plugged when not in use.... hickman catheter

Inferiority Complex

A neurotic state of mind that develops because of repeated hurts or failures in the past. Inferiority complex arises from a conflict between the positive wish to be recognized as someone worthwhile and the haunting fear of frustration and failure. Attempts to compensate for the sense of worthlessness may take the form of aggression and violence, or an overzealous involvement in activities. (See also superiority complex.)... inferiority complex

Intrauterine Contraceptive Device

See IUD.... intrauterine contraceptive device

Mast Cell

A type of cell that plays an important part in allergy.

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

Meibomian Cyst

See chalazion.... meibomian cyst

Oculogyric Crisis

A state of gaze in which the eyes are fixed, usually upwards, for minutes or hours.

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

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

Ovarian Cyst

An abnormal, fluid-filled swelling in an ovary. Ovarian cysts are common and, in most cases, noncancerous. The most common type, a follicular cyst, is one in which the egg-producing follicle enlarges and fills with fluid. Cysts may also occur in the corpus luteum, a mass of tissue that forms from the follicle after ovulation. Other types include dermoid cysts and cancerous cysts (see ovary, cancer of).

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

Polymerase Chain Reaction

(PCR) A method of rapidly copying DNA sequences so that they can be analysed.... polymerase chain reaction

Postcoital Contraception

See contraception, emergency.... postcoital contraception

Root-canal Treatment

A dental procedure performed to save a tooth in which the pulp (see pulp, dental) has died or become untreatably diseased, usually as the result of extensive dental caries.

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

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

Sigmoid Colon

The S-shaped part of the colon, in the lower abdomen, extending from the brim of the pelvis, usually down to the 3rd segment of the sacrum. It is connected to the descending colon above, and the rectum below.... sigmoid colon

Sodium Cromoglicate

A drug given by inhaler to control mild asthma in children and allergic or exercise-induced asthma in adults; as a nasal spray to treat allergic rhinitis; in eye-drops for allergic conjunctivitis; and orally for food allergy.

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

Sydenham’s Chorea

A rare childhood disorder of the central nervous system that causes involuntary jerky movements of the head, face, limbs, and fingers. Voluntary movements are clumsy, and the limbs become floppy. The disorder usually follows an attack of rheumatic fever.

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

Volkmann’s Contracture

A disorder in which the wrist and fingers become permanently fixed in a bent position. It occurs because of an inadequate blood supply to the forearm muscles that control the wrist and fingers as a result of an injury. Initially, the fingers become cold, numb, and white or blue. Finger movements are weak and painful, and there is no pulse at the wrist. Unless treatment is started within a few hours, wrist and finger deformity develops.

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

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

Contagious Disease

originally, a disease transmitted only by direct physical contact: now usually taken to mean any *communicable disease.... contagious disease

Crypt

n. a small sac, follicle, or cavity; for example, the crypts of Lieberkühn (see Lieberkühn’s glands), which are intestinal glands.... crypt

Acacia Canescens

Grab.

Family: Mimosaceae.

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

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

Acacia Catechu

(Linn. f.) Willd.

Family: Mimosaceae.

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

English: Cutch tree, Catechu.

Ayurvedic: Khadira, Kadara, Somavalka, Gaayatri, Dantdhaavan, Kantaki, Raktasaara (heartwood extract).

Unani: Khair, Kaat, Katthaa (heartwood extract).

Siddha/Tamil: Karunkaali (bark), Kalippakku, Kadiram. Katthakkaambu, Kaasukkatti (heartwood extract).

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

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of dried pieces of heartwood in inflammations, skin diseases and urinary disorders, recommends its use as a blood purifier, in diseases caused by lipid disorders.

Cutch (the concentrated extract) contains tannins 2-20%, catechin 2533%, phlobatannins including cate- chutannic acid 20-50%; flavonoids including quercetin, quercitrin, fisetin; gums, resins, pigments. The gum from A. catechu is a good substitute for Gum arabic.

Seed extract—hypoglycaemic to normal albino rats, but not effective in diabetic rats. The saline extract of seeds shows leuco-agglutinating activity against leukaemic cells. It agglutinates white cells from patients with different types of leukaemia. The activity is inhibited by simple sugars. Root extract shows antibacterial and fungi- cidal activity.

The heartwood contains a hepato- protective principle—cyanidanol.

Astringent and antibacterial properties of catechu result from its high tannin content.

Gambrine in pale catechu shows hy- potensive effects.

Fisetin in black catechu and (+)- catechin in black and pale catechu may protect against liver damage; (+)- catechin is also thought to protect against experimentally induced ulcers in animals; (+)-catechin (cianidanol) is associated with fatal anaemia. Methyl- catechin, one of the major metabolites of (+)-catechin, inhibits the binding of monocytes to vascular endothelial cells; thus, the catechin found in catechu may reduce atherosclerosis. (Natural Medicines Comprehensive Database, 2007.)

Dosage: Heartwood—20-30 g for decoction. (API Vol. I.)... acacia catechu

Acacia Chundra

Willd.

Synonym: A. sundra DC.

Family: Mimosaceae.

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

English: Red Cutch.

Ayurvedic: Khadira (related sp.).

Siddha/Tamil: Katthakkaambu (heartwood extract).

Folk: Laal Khair.

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

The bark and leaves are used for ulcerated abscesses and toothache; wood for leucoderma.

EtOH (50%) extract—spermicidal and spasmolytic.... acacia chundra

Acacia Concinna

(Willd.) DC.

Synonym: A sinuata (Lour.) Merrill; A. rugata (Lamk.) Ham.

Family: Mimosaceae.

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

Ayurvedic: Saptalaa, Shitalaa, Saatalaa, Shrivalli, Kantvalli.

Unani: Shikaakaai, Kharunb Nabti.

Siddha/Tamil: Seekai, Sigakai.

Folk: Ban-Reethaa.

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

The bark yields a saponin which, on hydrolysis, yields lupeol, alpha- spinasterol and acacic acid lactone. Pods also yield saponins (20.8%). Sugars identified are glucose, arabinose and rhamnose.

The leaves contain alkaloids, nicotine and colycotomine, a triterpenoid saponin and oxalic, tartaric, citric, suc- cinic and ascorbic acids.

The bark saponins are spermicidal, also haemolytic and spasmolytic. A decoction of pods relieves biliousness and acts as a purgative.

The ethanolic extract of unripe pods yields a glycosidal fraction (0.28%) which exhibits anti-inflammatory activity. It also shows significant antibacterial activity.

The plant acts as an antiseptic agent for curing sores, gums and loose teeth.

The flowers are the source of Cassie perfume.

The main constituents of the flowers are benzyl, anisic, decylic and cuminic aldehydes, as well as traces of geraniol, farnesol and linalool.... acacia concinna

Achalasia Of The Cardia

A condition in which there is a failure to relax of the muscle ?bres around the opening of the gullet, or oesophagus, into the stomach. (See OESOPHAGUS, DISEASES OF.)... achalasia of the cardia

Acalypha Ciliata

Forsk

Family: Euphorbiaceae.

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

Ayurvedic: Kuppi (smaller var.).

Folk: Daadari (Gujarat).

Action: See A. indica.

Folk: Chinnivara.

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

Aconitum Chasmanthum

Stapf ex Holmes.

Family: Ranunculaceae.

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

English: Indian Napellus.

Ayurvedic: Visha, Shringika-Visha, Vatsanaabha (related sp.).

Folk: Mohri, Meethaa Zahar.

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

Napellus, equated with Aconitum napellus Linn., is indigenous to Central Europe (named after the Black sea port Aconis and known as Wolfsbane, Monkshood). Aconitum of homoeopathic medicine is an alkaloid obtained from the roots and stems of A. nepellus. Used as an analgesic and sedative. It contains terpenoids up to 1.2%, including aconitine and aconine.

Toxic constituents of A. napellus are aconitine, mesaconitine, hypaconi- tine, 3-acetylacoitine, lappaconitine (diterpenoid-ester alkaloids), benza- conine, benzoylaconine.

Aconitine, mesaconitine and hyp- aconitine exert widespread effects on cardiac, neural and muscle tissue by activitating sodium channels. (Natural Medicines Comprehensive Database, 2007.)

Aconitine is absorbed through mucus membranes and the skin. (Francis Brinker.) It is a cardiotoxin and interacts with antiarrhythmics, antihypertensives, Digoxin/cardiac glycosides. (Sharon M. Herr.)

Dosage: Root—10-15 mg powder. (CCRAS.)... aconitum chasmanthum

Activity Coordinator

A trained staff member who is responsible for leisure activities in a health care programme. Activity coordinators develop programmes for people based on individual abilities and interests.... activity coordinator

Acute Care / Acute Health Care

Care that is generally provided for a short period of time to treat a new illness or a flare-up of an existing condition. This type of care may include treatment at home, short-term hospital stays, professional care, surgery, X-rays and scans, as well as emergency medical services.... acute care / acute health care

Adiantum Capillus-veneris

Linn.

Family: Adiantaceae.

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

English: American Maidenhair Fern, Venus Hair, Rock Fern.

Ayurvedic: Hansaraaja, Hansapadi (related sp.).

Unani: Parsiaavashaan.

Siddha/Tamil: Seruppadai.

Folk: Mubaaraka.

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

The fern contains flavonoid gluco- sides, including rutin, isoquercetin, as- tragalin, kaempferol; hydroxycinnam- ic acid esters; terpenoids, including adiantone.... adiantum capillus-veneris

Administrative Costs

Costs which are not attributable to the direct delivery of health services and are not direct clinical care or service costs.... administrative costs

Adrenal Cortex

The outer covering of the two adrenal glands that lie atop each kidney. Embryonically derived from gonad tissue, they make steroid hormones that control electrolytes, the management of fuels, the rate of anabolism, the general response to stress, and maintenance of nonspecific resistance.... adrenal cortex

Adult Care Home / Residential Facility

A residence which offers housing and personal care services to a number of residents. Services (such as meals, supervision and transportation) are usually provided by the owner or manager. Usually 24-hour professional health care is not provided on site. See also “assisted living facility”.... adult care home / residential facility

Adult Day Care

See “day care centre”.... adult day care

Advance Care Planning

Planning in advance for decisions that may have to be made prior to incapability or at the end of life. People may choose to do this planning formally, by means of advance directives, or informally, through discussions with family members, friends and health care and social service providers, or a combination of both methods.... advance care planning

After-care

Care provided to individuals after their release from institutional care.... after-care

Aged Care

Services provided to people deemed to be aged or elderly.... aged care

Aged Care Assessment Team

Multidisciplinary team of health professionals that is responsible for comprehensive assessments of the needs of older persons, including their suitability for hospital, home or institutional care.... aged care assessment team

Adina Cordifolia

Hook. f. ex Brandis

Family: Rubiaceae.

Habitat: Indigenous in deciduous forests all over India.

English: Yellow Teak, Saffron Teak.

Ayurvedic: Haridru, Haraduaa- kadamba, Gaur-kadamba, Girikadamba, Dhaaraakadam- ba, Pitadaaru, Kadambapushpa.

Siddha/Tamil: Manjakadambu.

Folk: Haladu, Kheta Kadam.

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

The heartwood contains indole alkaloids; bark 7.27-9.27% tannin. The leaves contain ursolic acid and querce- tin.... adina cordifolia

Agaricus Campestris

Linn.

Synonym: Psalliota campestris (Linn.) Fr.

Family: Agaricaceae.

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

English: Field mushroom, Edible mushroom.

Ayurvedic: Chhatraka, Bhuumi- chhatra.

Unani: Kammat.

Siddha: Venkodiveli.

Folk: Khumbi.

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

Extracts of A. campestris contain tyrosinase; lowered blood pressure of hypertensive animals when administered intravenously (exhibited no effect on normal animals).

Fungal enzyme preparations have been used in digestive diseases.

Field mushroom contains amylase, maltase, glycogenase, protease, cata- lase, tyrosinase, phosphomonoesteras- es, polyphosphatases, polyphenoloxi- dase and dehydropeptidases.... agaricus campestris

Ageratum Conyzoides

Linn.

Family: Asteraceae, Compositae.

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

English: Goat Weed, White Weed.

Ayurvedic: Dochunty, Uchunti, Sahadevi (related sp.).

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

The leaf is reported to contain stig- masterol (59.9%) and beta-sitosterol (26.7%) as major component of sterol faction. The dried flowering plant contains the pyrrolizidine alkaloids, lycop- samine and echinatine.

An aqueous extract of leaves is reported to show haemostatic activity. The plant extract exhibited muscle relaxant activity experimentally. The ethanolic extract (95%) of roots possesses anti-inflammatory and analgesic properties.

The aqueous extract of leaves exhibits antifungal and crude plant extract antibacterial properties.

... ageratum conyzoides

Allemanda Cathartica

Linn.

Family: Apocynaceae.

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

English: Golden Trumpet.

Folk: Zahari Sontakkaa. (Maharashtra).

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

The purgative property of the aqueous extract of leaves was confirmed pharmacologically in rats. The extract also showed antifungal activity against ringworm causing fungi. Flower extract inhibits fungal growth.

EtOH extract of roots showed in- vivo activity against P-388 leukaemia in mouse and in vitro against human carcinoma cells of nasopharynx (KB). The root contains antileukaemic iri- doid lactone, allamandin and two other iridoids, allamandicin and allamdin.

The stems and leaves contain beta- amyrin, beta-sitosterol and ursolic acid. Petals gave flavonoids—kaem- pferol and quercetin.... allemanda cathartica

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

Ambulatory Care

Health services provided on an outpatient basis in contrast to services provided in the home or to persons who are inpatients. While many inpatients may be ambulatory, the term ambulatory care usually implies the patient travels to a location to receive services and no overnight stay in hospital is required. Many surgeries and treatments are now provided on an outpatient basis, while previously they were considered reason for inpatient hospitalization.... ambulatory care

Allium Cepa

Linn.

Family: Liliaceae; Alliaceae.

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

English: Onion.

Ayurvedic: Palaandu, Durgandh.

Unani: Piyaaz.

Siddha/Tamil: Venkaayam.

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

Key application: For the prevention of atherosclerosis (German Commission E) and age-dependent changes in the blood vessels, and loss of appetite (WHO).

The official onion bulb of the Pharmacopoeia of the People's Republic of China is a different species, Allium macrostemon Bge., than that of the German Commission E monographs, A. cepa. Chinese onion is used for cough, dyspnoea, angina pectoris and dysentery.

Scallions or Spring Onion of Chinese medicine are equated with Allium fistulosum.

Onion bulbs contain a volatile oil with sulphurous constituents, including allylpropyldisulphide; sulphur- containing compounds, including al- licin, alliin; flavonoids; phenolic acids and sterols.

Hypoglycaemic activity of the onion is attributed to the allylpropyldisul- phide and allicin. Diphenylamine, isolated from mature bulbs, also exhibits potent antihyperglycaemic activity.

Alliin and allicin have an inhibitory effect on platelet aggregation. Antibiotic activity is due mainly to alli-cin.

Regular use of onion (50 g/day) reduces insulin requirement of a diabetic patient from 40 to 20 units a day.

Thiosulphinates, isolated from onion juice, exhibited antiasthmatic activity in vivo.

Dosage: Juice of bulb—10-20 ml. (CCRAS.)... allium cepa

Allspice Tea: A Tasty Choice

Allspice tea is well known for its healing properties and, it proved to be an important ingredient when cooking stews, soups but not only. Allspice Tea description The Allspice plant was discovered by Christopher Columbus on a Jamaican island, in 1494. The Spaniards called it “pimienta” (pepper) and started to use it widely when cooking. It is a small berry, tasting like a mixture of pepper, cloves, juniper, nutmeg and cinnamon. Nowadays, this plant is added to recipes and brewes in order to obtain a healing beverage. Due to its taste, Allspice is commonly used to flavor stews and soups. Rice dishes become tastier when this spice is added. Allspice tea is best known for its aid in digestive processes but not only. Allspice Tea brewing To prepare Allspice tea:
  • place 1 or 2 teaspoons of dried allspice fruit (or powder) in 1 cup of boiling water
  • steep them for 10 to 20 minutes
  • drink the tea (sugar or honey might be added)
Allspice Tea benefits Allspice tea is said to:
  • facilitate and promote good digestion
  • help bloating, belching and flatulence
  • help in preventing allergies
  • help lower blood sugar
  • help relieve toothache and muscle/joint pain
  • help uplift the mood and relax the body
Allspice Tea side effects Breastfeeding mothers and pregnant women must not take allspice in any form. Allspice tea may cause serious allergic reactions in hypersensitive individuals. It is contraindicated for those with chronic gastrointestinal conditions such as duodenal ulcers, reflux disease, spastic colitis, diverticulitis, disarticulates and ulcerative colitis. It should not be consumed by patients with cancer. Also, allspice tea should not be intaken by people with a high risk of cancer. Discovered by Christopher Columbus, allspice plant was firstused in cooking recipes and afterwards, the resulting beverage turned out to be a useful aid in treating several ailments. Allspice tea is a good choice to treat oneself and to strengthen the body.... allspice tea: a tasty choice

Amaranthus Caudatus

Linn.

Family: Amaranthaceae.

Habitat: Grown as vegetable in northern India.

English: Love-Lies-Bleeding, Tassel Flower.

Ayurvedic: Raam-daanaa (grain).

Siddha/Tamil: Pungikeerai, Siru- keerai.

Folk: Chuko.

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

In Western herbal medicine, LoveLies-Bleeding is equated with Amaranthus hypochondriacus, and is used for ulcers, diarrhoea, as well as inflammation of the mouth and throat.

Preliminary evidence suggests that Amaranth seed can reduce total cholesterol and LDL, while increasing HDL, but Amaranth muffins failed to reduce cholesterol levels in hypercholes- terolemic adults beyond the reduction achieved by low-fat diet. (Natural Medicines Comprehensive Database, 2007.)... amaranthus caudatus

Amoora Cucullata

Roxb.

Family: Meliaceae.

Habitat: Coastal forests of West Bengal and Andaman Islands.

Folk: Amur, Latmi, Natmi (Bengal).

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

Ancyclostoma Caninum

See eosinophilic enteritis.... ancyclostoma caninum

Anís Comino

See Hinojo. May also be comino (cumin; Cuminum cyminum) which is not included in this book.... anís comino

Anís De Cocinar

See Anís chiquito.... anís de cocinar

Amazing Health Benefits Of Carrots

1. Beta carotene: Carrots are a rich source of this powerful antioxidant, which, among other vital uses, can be converted into vitamin A in the body to help maintain healthy skin. 2. Digestion: Carrots increase saliva and supply essential minerals, vitamins and enzymes that aid in digestion. Eating carrots regularly may help prevent gastric ulcers and other digestive disorders. 3. Alkaline elements: Carrots are rich in alkaline elements, which purify and revitalize the blood while balancing the acid/alkaline ratio of the body. 4. Potassium: Carrots are a good source of potassium, which can help maintain healthy sodium levels in the body, thereby helping to reduce elevated blood pressure levels. 5. Dental Health: Carrots kill harmful germs in the mouth and help prevent tooth decay. 6. Wounds: Raw or grated carrots can be used to help heal wounds, cuts and inflammation. 7. Phytonutrients: Among the many beneficial phytochemicals that carrots contain is a phytonutrient called falcarinol, which may reduce the risk of colon cancer and help promote overall colon health. 8. Carotenoids: Carrots are rich in carotenoids, which our bodies can use to help regulate blood sugar. 9. Fiber: Carrots are high in soluble fiber, which may reduce cholesterol by binding the LDL form (the kind we don’t want) and increasing the HDL form (the kind our body needs) to help reduce blood clots and prevent heart disease. 10. Eyes, hair, nails and more! The nutrients in carrots can improve the health of your eyes, skin, hair, nails and more through helping to detoxify your system and build new cells! 11. Improves vision There’s some truth in the old wisdom that carrots are good for your eyes. Carrots are rich in beta-carotene, which is converted into vitamin A in the liver. Vitamin A is transformed in the retina, to rhodopsin, a purple pigment necessary for night vision. Beta-carotene has also been shown to protect against macular degeneration and senile cataracts. A study found that people who eat large amounts of beta-carotene had a 40 percent lower risk of macular degeneration than those who consumed little. 12. Helps prevent cancer Studies have shown carrots reduce the risk of lung cancer, breast cancer and colon cancer. Falcarinol is a natural pesticide produced by the carrot that protects its roots from fungal diseases. Carrots are one of the only common sources of this compound. A study showed 1/3 lower cancer risk by carrot-eating rats. 13. Slows down aging The high level of beta-carotene in carrots acts as an antioxidant to cell damage done to the body through regular metabolism. It help slows down the aging of cells. 14. Promotes healthier skin Vitamin A and antioxidants protect the skin from sun damage. Deficiencies of vitamin A cause dryness to the skin, hair and nails. Vitamin A prevents premature wrinkling, acne, dry skin, pigmentation, blemishes and uneven skin tone. 15. Helps prevent infection Carrots are known by herbalists to prevent infection. They can be used on cuts—shredded raw or boiled and mashed. 16. Promotes healthier skin (from the outside) Carrots are used as an inexpensive and very convenient facial mask. Just mix grated carrot with a bit of honey. See the full recipe here: carrot face mask. 17. Prevents heart disease Studies show that diets high in carotenoids are associated with a lower risk of heart disease. Carrots have not only beta-carotene but also alpha-carotene and lutein. The regular consumption of carrots also reduces cholesterol levels because the soluble fibers in carrots bind with bile acids. 18. Cleanses the body Vitamin A assists the liver in flushing out the toxins from the body. It reduces the bile and fat in the liver. The fiber present in carrots helps clean out the colon and hasten waste movement. 19. Protects teeth and gums It’s all in the crunch! Carrots clean your teeth and mouth. They scrape off plaque and food particles just like toothbrushes or toothpaste. Carrots stimulate gums and trigger a lot of saliva, which, being alkaline, balances out the acid-forming, cavity-forming bacteria. The minerals in carrots prevent tooth damage. 20. Prevents stroke From all the above benefits it’s no surprise that in a Harvard University study, people who ate five or more carrots a week were less likely to suffer a stroke than those who ate only one carrot a month or less.... amazing health benefits of carrots

Anís De Comer

See Anís chiquito.... anís de comer

Anna Christina

(Latin) A graceful Christian Anna Christina, Anna Kristina, Anna Chrystina, Anna Christeena, Anna Christyna, Anna Chrystyna, Ana Christina, Ana Kristina, Anna Christine, Anne Christine, Ana Christine, Anna Christie, Ana Christi... anna christina

Assisted Living Facility / Assisted Care Living Facility

Establishment which provides accommodation and care for older or disabled persons who cannot live independently but do not need nursing care. Residents are also provided with domestic assistance (meals, laundry, personal care).... assisted living facility / assisted care living facility

Astragalus Candolleanus

Royle.

Family: Fabaceae; Papilionaceae.

Habitat: The western Himalayas.

Ayurvedic: Rudanti, Rudravanti.

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

Dosage: Fruit—3-5 g powder. (CCRAS.)... astragalus candolleanus

Amorphophallus Campanulatus

(Roxb.) Blume ex Decne.

Family: Araceae.

Habitat: Native to tropical Asia; cultivated throughout India.

English: Elephant-foot Yam.

Ayurvedic: Suurana, Kanduula, Arshoghna, Kand-ayak, Kandala.

Unani: Zamin-qand, Zamikand.

Siddha/Tamil: Chenaikkizhangu. Kaathukarunai (wild var.)

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

Along with other therapeutic applications, The Ayurvedic Pharmacopoeia of India indicates the use of corm in prostatic hyperplasia.

(The corm is irritant due to the presence of calcium oxalate. It can be con- sumedafterit iswashedwell andboiled in tamarind water or butter milk.)

The corm contains an active di- astatic enzyme amylase, betulinic acid, tricontane, lupeol, stigmasterol, beta- sitosterol and its palmitate and glucose, galactose, rhamnose and xylose.

Intake of 3.6-7.2 g of konjac (Amor- phophallus konjac tuber) mannan for 90 days reduced the dose of insulin or hypoglycaemic drugs (in human clinical study). (Francis Brinker.)

Amorphophallus sylvatius Kunth. is equated with the wild var. of Suu- rana, used especially in the treatment of piles.

Dosage: Dried corm—2-10 g powder. (API Vol. III.) 3-5 g powder. (CCRAS.)... amorphophallus campanulatus

Amygdalus Communis

Linn.

Synonym: Prunus amygdalus Baill. A. communis var. dulcis (sweet almond).

A. communis var. amara (bitter almond).

Family: Rosaceae.

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

English: Almond

Ayurvedic: Vaataama, Vaataada.

Unani: Badaam, Loz.

Siddha/Tamil: Vaadumai.

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

Almond flour and almond butter are free from starch and used in foods for diabetics and for patients with peptic ulcers. Chief protein in kernels is globulin.... amygdalus communis

Anamirta Cocculus

(Linn.) Wight and Arn.

Synonym: A. paniculata Colebr.

Family: Menispermaceae.

Habitat: The Khasi Hills, Orissa and peninsular India.

English: Fish Berry, Levant Berry, Poison Berry, Crow Killer.

Ayurvedic: Kaakaadani, Kaakamaari.

Siddha/Tamil: Kaakkaikkollividai.

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

The leaves and fruit contain picro- toxin (up to 5%) and alkaloids. Pi- crotoxin (sesquiterpene glycoside) is a powerful poison and nerve stimulant. It is rarely taken internally. Coccu- lus (a tincture prepared from the powdered seeds of Cocculus indicus) is used internally as a homoeopathic medicine for convulsions, neurological disorders and psychosis-related fear.

Picrotoxin at 20 mg is toxic, and two to three berries are lethal. (Francis Brinker.)... anamirta cocculus

Ananas Comosus

(Linn.) Merrill

Family: Bromeliaceae.

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

English: Pineapple.

Ayurvedic: Anaanaasa, Bahunetra.

Unani: Anannaas.

Siddha/Tamil: Annanshippazham, Annasi.

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

Key application: Bromelain, the proteolytic enzyme, is used in acute postoperative and post-traumatic conditions of swellings, especially of the nasal and paranasal sinuses. (German Commission E.) In Europe, a patented tape that contains bromelain is used for debriding escharotic skin. (Internally, bromelain's bioavailability has been questioned.)... ananas comosus

Attendant Care

Personal care for people with disabilities in non-institutionalized settings generally by paid, non-family carers.... attendant care

Average Cost

See “cost”.... average cost

Average Daily Census

The average number of hospital beds occupied per day. This measure provides an estimate of the number of inpatients receiving care each day at a hospital.... average daily census

Avoidable Hospital Condition / Admission

A medical condition for which hospitalization could have been avoided if ambulatory care had been provided in a timely and efficient manner.... avoidable hospital condition / admission

Avoided Cost

See “cost”.... avoided cost

B-lymphocyte (or B-cell)

A type of white blood cell that circulates through the body and is able to detect the presence of the foreign agents. Once exposed to an antigen on the agent, these cells differentiate into plasma cells to produce antibody.... b-lymphocyte (or b-cell)

Angiotensin-convertingenzyme (ace) Inhibitors

The ENZYME that converts angiotensin I to angiotensin II (see ANGIOTENSIN) is called angiotensin-converting enzyme. Angiotensin II controls the blood pressure and is the most potent endogenous pressor substance produced in the body; angiotensin I has no such pressor activity. Inhibition of the enzyme that converts angiotensin I to angiotensin II will thus have marked effects on lowering the blood pressure, and ACE inhibitors have a valuable role in treating heart failure when thiazides and beta blockers cannot be used or fail to work, especially after myocardial infarction (see HEART, DISEASES OF). Captopril was the ?rst ACE inhibitor to be synthesised: it reduces peripheral resistance by causing arteriolar dilatation and thus lowers blood pressure. Other drugs such as enalapril, lisinopril, cilazapril, quinapril and ramipril have since been developed. Some kidney disorders increase the production of angiotensin II and so cause HYPERTENSION.... angiotensin-convertingenzyme (ace) inhibitors

Anís Chiquito

Anise, anise burnet-saxifrage (Pimpinella anisum).

Plant Part Used: Fruit (seed).

Dominican Medicinal Uses: The seeds are traditionally prepared as a decoction and taken orally for colic (in children and adults), common cold, empacho, flatulence, flu, gastrointestinal disorders, headache, indigestion, nervous tension, pasmo and stress.

Safety: The seeds are generally regarded as safe for human consumption in moderation and widely used as a culinary spice. Caution is advised if this herbal remedy is combined with anís de estrella due to potential contamination with a toxic look-alike (see entry for “Anís de estrella”).

Contraindications: Studies show conflicting recommendations regarding safety of internal use during pregnancy and lactation. Use of this herb in combination with anís de estrella is contraindicated in children (due to potential for contamination with the toxic look-alike Illicium anisatum (see “Anís de estrella”); however, anís chiquito is considered safe for children when used appropriately.

Drug interactions: Anticoagulants, NSAIDS, antiplatelet drugs, warfarin: Avoid use of anís chiquito if taking any of these medications due to potential risk of excessive bleeding as a result of interaction with coumarin derivatives.

Clinical Data: No clinical trials of the oral use of this herb have been identified in the available literature. One open clinical trial has evaluated the pediculicidal effects of anise oil in combination with other ingredients.

Laboratory & Preclinical Data: The following biological activities of this plant have been investigated in laboratory studies using in vitro or animal models: anticonvulsant, antidiuretic, antiflatulent, antifungal, antimicrobial, antispasmodic, estrogenic, expectorant, hypotensive, liver regeneration, muscle stimulant and mutagenic.

* See entry for Anís chiquito in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... anís chiquito

Anisochilus Carnosus

Wall.

Family: Labiatae; Lamiaceae.

Habitat: The western Himalayas, Central and southern India.

Folk: Karpuravalli (southern region).

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

The oil exhibits antihistaminic property in vitro on smooth muscles of the uterus and the intestines. It also possesses muscle-relaxant action; bactericidal and fungicidal properties. The leaves contain glucosides of luteolin and apigenin.... anisochilus carnosus

Areca Catechu

Linn.

Family: Palmae; Arecaceae.

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

English: Arecanut, Betel Nut.

Ayurvedic: Puuga, Puugi, Kramuka, Ghontaa, Guwaak, Ghorant.

Unani: Fufal, Chhaalia, Supaari.

Siddha/Tamil: Kottai Paakku, Kamugu.

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

Along with other therapeutic application, The Ayurvedic Pharmacopoeia of India indicates the use of dried ripe seed in leucorrhoea and vaginal laxity.

Arecanut contains several alkaloids belonging to pyridine group, the most important being arecoline (0.1-0.5%). Arecaidine, guvacine and isoguvacine are also present. Arecoline is an- thelmintic (in animals, not in humans). Arecaidine has no parasympa- thomimetic effects, but only stimulating properties; sedative in higher doses. Isoguvacine produces hypotension.

Contraindicated in asthma due to bronchoconstrictive effects of the alkaloid arecoline (human case reports). (Francis Brinker.)

Arecanut tannins (8.0-18.0%) are predominantly catechol tannins which closely resemble Mimosa bark tannins. Powdered nuts are prescribed in diarrhoea and urinary disorders. In combination with other astringent and styptic herbs, arecanut is used as a major constituent in confections of Indian medicine for gynaecological disorders.

Aqueous extract of the nut exhibits direct vasoconstriction and adrenaline potentiation in rats. Antimicrobial activity is due to polyphenolic fraction. Tannins potentiated the action of acetylcholine in ileum and uterus of rat and noradrenaline on seminal vesicle at low concentration.

Due to increased incidence of oral cancer associated with betel chewing, the use of arecanut as a masticatory is being discouraged.

Seeds are toxic at 8-10 g, fluid extract at 3.7 ml; and arecoline hydrobromide at 4.3-6.5 mg. (Francis Brinker.)

Dosage: Dried ripe fruit—1-2 g powder. (API Vol. I.)... areca catechu

Bacillus Cereus

A Gram positive saprophytic rod which grows on parboiled unrefrigerated rice and other food. It produces potent exotoxins which can cause food poisoning – especially in Chinese and other restaurants specialising in rice dishes. Food poisoning from this organism can cause an emetic syndrome (associated with vomiting) or a diarrhoeal syndrome.... bacillus cereus

Balantidium Coli

A ciliate protozoan of pigs which can infect humans causing balantidial dysentery.... balantidium coli

Asclepias Curassavica

Linn.

Family: Aristolochiaceae.

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

English: Asarbacca, Hazelwort, Wild Nard.

Unani: Asaaroon, Subul-e-Barri, Naardeen-Barri.

Folk: Tagar Ganthodaa.

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

The volatile oil (0.7-4%) consists of asarone up to 50%, asaraldehyde 2-3%, methyleugenol 15-20%, with bornyl acetate, terpenes and sesquiterpenes. Asarone and its beta-isomer is found to be carcinogenic in animals. The rhizome, in addition, contains caffeic acid derivatives and flavonoids.

A related sp., Asarum canadense L., indigenous to North America and China, contains a volatile oil (3.5-

Family: Asclepiadaceae.

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

English: Curassavian Swallow- Wort, West Indian Ipecacuanha, Blood-Flower.

Ayurvedic: Kaakanaasikaa (substitute).

Folk: Kaakatundi (Kashmir).

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

An alcoholic extract of the Indian plant has been reported to contain a number of cardenolides, including calactin, calotropin, calotropagenin, coroglaucigenin, uzarigenin, asclepin, its glucosides and uzarin. Asclepin, the chief active principle, is spasmogenic and a cardiac tonic, having longer duration of action than digoxin (96 h in cat, as opposed to the 72 h of digoxin). Calotropin exhibits cytotoxic activity.

Pleurisy root of the U.S. is equated with Asclepias tuberosa. It is used for cold, flu and bronchitis in Western herbal medicine.

Toxic principles of the herb include galitoxin and similar resins, and glu- cofrugoside (cardenolide). Toxicity is reduced by drying.... asclepias curassavica

Barrier Creams

Substances, usually silicone-based, applied to the skin before work to prevent damage by irritants. They are also used in medicine – for the prevention of bedsores and nappy rash, for example.... barrier creams

Biological Control

Use of natural, indigenous predators or organisms to control medically important insects.... biological control

Averrhoa Carambola

Linn.

Family: Oxalidaceae; Averrhoaceae.

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

English: Carambola, Star Fruit, Chinese Gooseberry.

Ayurvedic: Karmaranga.

Unani: Khamraq, Karmal.

Siddha/Tamil: Tamarattai.

Folk: Kamarakh.

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

The fruits are a fairly good source of iron but deficient in calcium. They also contain oxalic acid and potassium oxalate. The presence of fluorine is also reported. A wide variation of vitamin-C content (0.3-23.0 mg/100 g) is recorded from different places in India. Sugar (3.19%) consists mainly of glucose (1.63%).... averrhoa carambola

Barleria Cristata

Linn.

Family: Acanthaceae.

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

Ayurvedic: Sahachara, Shveta- Rakta-pushpa Saireyaka (white- and red-flowered var.).

Siddha/Tamil: Ottamulli.

Folk: Katsaraiyaa. Raktajhinti.

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

The roots contain anthraquinones; flowers gave apigenin, naringenin, quercetin and malvindin.... barleria cristata

Barley Tea May Fight Cancer

Barley tea is widely consumed due to its medicinal properties. It fights effectively against several types of cancer, due to its high content of antioxidants. Barley Tea description Barley is a self-pollinating annual plant, member of the grass family. It grows to a height of 1 to 4 feet, being able to withstand various growing conditions. It is found in grasslands, woodlands, disturbed habitats, roadsides and orchards. The grass of barley is acknowledged to be a source of fiber, vitamins, minerals, and amino acids and it also has a high content of antioxidants. In traditional Chinese medicine, Barley grass has been prescribed to fight diseases of the spleen or poor digestion. It has also been effectively used to treat depression or emotional imbalance. Barley tea is the resulting beverage from brewing the abovementioned plant. This is a very common and appreciated drink in many parts of Asia including Japan, China, Malaysia and Singapore. Barley tea is popular in Japanese and Korean cuisine: the barley grass is often roasted and then stewed in hot water. It is also intaken as a caffeine-free coffee substitute in American cuisine. It is traditionally used for detoxification, to improve digestion and for urinary tract infections. Barley Tea brewing Barley tea is available in loose grains, tea bags or already prepared tea drinks. It is usually made by briefly simmering roasted barley grains. The resulting beverage has a toasty taste, with slight bitter undertones. Barley tea is best consumed hot, though some report that room temperature and even cold barley water is still effective. Barley Tea benefits Studies conducted so far showed that Barley tea is effective in treating:
  • certain forms of cancer
  • digestion
  • prostate
  • sleep disorder
Barley tea is believed to help relieving early symptoms of colds, acting as a daily nutritional supplement and successfully cleansing the body of toxins. This tea may help improve blood sugar levels and also reduce bad cholesterol levels. Barley Tea side effects Barley tea is not recommended for nursing and pregnant women because it may stop lactation. Barley tea is a healthy alternative to caffeine drinks and people choose it daily to replace the first mentioned beverage.... barley tea may fight cancer

Board And Care Home

See “adult care home”.... board and care home

Bombax Ceiba

Linn.

See Salmalia malabarica Schott & Endl.... bombax ceiba

Brood Capsule

A small cyst attached to a germinal layer of the hydatid, containing many protoscolices.... brood capsule

Buccal Capsule

The thickening of the cuticular lining of buccal cavity; buccal capsule may be large, small, vestigial or absent. In some nematodes, the cuticle lining within the buccal capsule may be modified to be chitinous teeth or cutting plates as in Ancylostomatidae or a stylet as in Trichinelloidea.... buccal capsule

Belamcanda Chinensis

(L.) DC.

Family: Iridaceae.

Habitat: Introduced from China; cultivated all over India, up to an altitude of 1,800 m.

Folk: Surajkaanti (Assam), Dasbaha, Dasbichandi (Bengal).

Action: Rhizomes—expectorant, deobstruent, resolvent, used in tonsillitis, chest and liver complaints (antiviral against pneumonia).

Presence of alkaloids is reported from the plant, glucoside, belamcan- din from the roots. The leaves and flowers contain a glycoflavone. The seeds tested positive for leucoantho- cyanins.... belamcanda chinensis

Berberis Chitria

Lindl.

Synonym: B. aristata auct. Hook. f & Thoms.

Family: Berberidaceae.

Habitat: The Himalayas from Kashmir to Nepal, at altitudes of 1,500-2,400 m.

Ayurvedic: Daaruharidraa (var.).

Folk: Totaro, Kintodaa (Garhwal).

Action: Same as that of Berberis aristata.

The root and stem bark contain alkaloids (5 and 4.2% respectively, calculated as berberine.)

The alcoholic extract of the roots was found to be better antimicrobial agent than the aqueous extract. The alkaloid palmitine hydroxide possesses an- tispermatogenic properties. See B. aristata and B. vulgaris. Berberis ulicina Hook, known as Khicharmaa in Tibet, is also equated with Daaruharidraa.... berberis chitria

Black Cohosh Tea: Benefic In Menopause

Black Cohosh tea is recommended to people who want to prevent bone ailments or just to enhance their immune system. Black Cohosh Tea description Black Cohosh is a woodland plant, found in the New England region of the United States, as well as eastern Canada. Its roots and rhizomes are used for medicinal properties, particularly for female hormonal balance and arthritis. It also has acknowledged anti-inflammatory and antispasmodic properties. Black cohosh can be consumed as a fresh or dry root or as a supplement in liquid or tablet forms. The daily dosage should not exceed 80 mg Black cohosh in tablet form or 2 to 4 ml Black Cohosh tincture two to three times a day. Black Cohosh tea is the resulting beverage from brewing the abovementioned plant. Black Cohosh Tea brewing To make Black Cohosh tea, use the roots of the plant. Black Cohosh roots should be boiled for about 20 to 30 minutes in water. Strain it and drink it slowly. Black Cohosh Tea benefits Studies revealed Black Cohosh tea to be efficient in treating:
  • the symptoms of menopause and menstrual discomfort (hot flashes, mood swings and vaginal dryness)
  • infertility
  • rheumatism
  • cough
  • high cholesterol levels, as well as hardening of the arteries
  • osteoporosis
  • muscle aches
Black Cohosh side effects Black Cohosh tea is not recommended during pregnancy, as large doses may induce a miscarriage. An overdose can cause dizziness, nausea and increased perspiration. Also, Black Cohosh tea may cause gastrointestinal pain, diarrhea, vomiting and nausea. People intaking  this type of tea may experience dizziness, headaches, tremors and a slow heart rate. Individuals with an allergy to buttercup or crowfoot should avoid Black Cohosh tea because they are from the same plant family. People who are allergic to aspirin should not consume the tea because it contains small amounts of salicylic acid, the active ingredient in aspirin. Also people with a history of blood clots, seizures and high blood pressure should avoid Black Cohosh tea. Black Cohosh tea is known for its anti-inflammatory and antispasmodic action, being successfully used to treat women health issues such as menopause and menstrual discomfort.... black cohosh tea: benefic in menopause

Boneset Tea: A Cure-all

Boneset tea has the reputation of a very effective “cure-all”. It is highly recommended to people looking to enhance their immunity in a natural way. Boneset Tea description Boneset is a daisy, commonly found in the eastern part of North America, on roadsides and in wet ground. It has a long, hairy stem with white flower toppings. The flowers normally bloom during July to September. The plant gained its name from its traditional use of treating dengue or breakbone fever, a viral infection causing muscle pain so intense that patients feel their bones are on the verge of breaking. The plant has therapeutic properties which can be intaken through teas, tinctures and capsules. Boneset tea is the resulting beverage from brewing the abovementioned plant. Boneset Tea brewing To make Boneset tea:
  • place two to three teaspoons of dried boneset herbs (leaves, flowers or the stem) into a cup of boiling water
  • allow the mixture to steep for about 10 to 15 minutes
Boneset Tea has a very bitter taste. Honey or lemon can be added to the tea. Boneset Tea benefits Boneset tea has been successfully used to:
  • treat colds, coughs and ailments in the upper respiratory tract
  • help in the treatment of influenza, malaria and fever
  • help relieve migraine headache
  • relieve pain from arthritis and rheumatism
  • help in the treatment of jaundice
  • fight intestinal worms
Boneset Tea side effects Boneset tea is not recommended for long-term use because high doses of this plant may cause damage to the liver or to the kidney. It is recommended not to be taken for a longer period than two weeks. Overdose may be deadly. Pregnant women and children under 6 years should not consume Boneset tea. Boneset tea is a medicinal remedy that can treat ailments of the upper respiratory tract, influenza, migraines but not only.  ... boneset tea: a cure-all

Budgetary Control

The set of actions taken to ensure that spending is in line with budgeted amounts and the regulations for spending them.... budgetary control

Brassica Campestris

Linn. var.

rapa (L.) Hartm.

Family: Cruciferae; Brassicaceae.

Habitat: Cultivated as an oil-yielding crop.

English: Field Mustard, Turnip Rape.

Ayurvedic: Sarshapa, Siddhaartha.

Unani: Sarson.

Siddha/Tamil: Kadugu.

Action: Stimulant, diuretic, emetic, rubefacient, counter-irritant. Used externally for bronchitis and rheumatic pains (increases flow of blood to a specific area). Powdered seeds are used as a tea for colds, influenza and fever.

The seeds contain glycosinolates (the derivatives are responsible for tox- icity). The concentration of the major glucosinolate, gluco-napin, varies from 0.64 to 1.8% in the oil-free meal of Indian brassicas. The glucosinolates in rapeseed meal split upon enzymatic hydrolysis to produce glucose, potassium, hydrogen sulphate and a sulphur- containing compound which undergoes intramolecular rearrangement to give rise to the antinutritional factors, isothiocyanates or thiocyanates.

The volatile oil of mustard is given internally in colic; in overdoses it is highly poisonous and produces gastro- enteric inflammations. It is employed externally as a liniment for rheumatic pains.

Adulteration of mustard oil with argemone oil (Argemone mexicana is frequently found growing in brassica fields), by accident or by design, has led to the widespread epidemics of dropsy and glaucoma due to an alkaloid sanguinarine.

Black mustard contains sinigrin, which on hydrolysis by enzyme my- rosin, produces allyisothiocynate; the white mustard contains sinalbin, which produces p-hydroxybenzyl isothiocy- nate. Mucilage contains sinapine.

Dosage: Seed—500 mg to 1 g paste. (API Vol. III.)... brassica campestris

Buckthorn Tea Against Constipation

Buckthorn tea is efficient in dealing with a large array of ailments such as constipation, intestinal worms, rheumatism, but not only. Buckthorn Tea description Buckthorn, or black alder, is a herb coming from the bark, the stems and the branches of the rhamnus frangula tree. Buckthorn is a herbal remedy for bowel disorders. Buckthorn is also used as a health tonic and was primary consumed for its “blood purifying” and diuretic properties. It can be found as capsules, liquid, tablet or tea form. Buckthorn tea is the resulting beverage from brewing the abovementioned plant. Buckthorn Tea brewing To prepare Buckthorn tea:
  • add one spoon of mashed buckthorn bark to a cup of boiling water
  • cover it for 15 minutes
  • boil it for another 15 minutes
  • filter the brew while it is still hot
  • drink it before bedtime
It is recommended not to consume this type of tea for more than a year. Buckthorn Tea benefits Buckthorn tea has been successfully used to:
  • assist in moving bowels and to relieve constipation (particularly those caused by insufficiency of bile)
  • help in treating liver disorders
  • treat rheumatism
  • purge intestinal worms
  • combat skin disorders associated with constipation (eczema, acne and psoriasis)
Buckthorn Tea side effects Consuming untreated fresh buckthorn irritates the protective mucosa lining in the stomach and may cause severe gastrointestinal irritations, spasms, vomiting, diarrhea and colic. Buckthorn tea should not be taken on a long-term basis. Pregnant or nursing women should consult a health care provider before using this type of tea. Buckthorn tea is largely used for its medicinal action against constipation and for treating the skin disorders associated with it. It can be taken as tea, capsules, liquid and tablet.... buckthorn tea against constipation

Bupleurum Tea: A Cure For The Liver

Bupleurum tea is largely known for its healing propertiesand its action against the growth and spreading of cancer cells. Bupleurum Tea description Bupleurum is a plant from the Apiaceae family, originating from Asia. The roots of Bupleurum are used in various healing mixtures throughout China and East Asia. Scientists have shown that this plant possesses anti-inflammatory constituents and may inhibit the growth of liver cancer cells. Both Japan and China medicinal industries use it in order to treat cancer and hepatitis. Bupleurum tea is the resulting beverage from brewing the abovementioned plant. Bupleurum Tea brewing Bupleurum tea can be prepared by combining dried and chopped bupleurum roots with hot water. After steeping the mixture for about 10 minutes, drink it slowly. Bupleurum herb can also be consumed as extracts and capsules. Buplerum Tea benefits Bupleurum tea has been successfully used to:
  • treat liver problems like hepatitis, cirrhosis and cancer
  • treat infections with fever
  • relieve chest congestion
  • treat indigestion
  • treat hemorrhoids
  • treat uterine and anal prolapse
  • treat diarrhea
  • help in overall efforts to treat HIV
Bupleurum Tea side effects Bupleurum tea is not recommended to pregnant and breastfeeding women. Bupleurum tea is a healthy beverage used efficiently to treat liver-related diseases. It has been also proven that this type of tea can fight free radicals, responsible for cancer cells growth, due to its content of antioxidants.... bupleurum tea: a cure for the liver

Cable

(American) Resembling a heavy rope; having great strength Cabel... cable

Cabot

(French) A fresh-faced beauty... cabot

Cabrina

(American) Form of Sabrina, meaning “a legendary princess” Cabrinah, Cabrinna, Cabreena, Cabriena, Cabreina, Cabryna, Cabrine, Cabryne, Cabreene, Cabrynna... cabrina

Cabriole

(French) An adorable girl Cabriolle, Cabrioll, Cabriol, Cabryole, Cabryolle, Cabryoll, Cabryol, Cabriola, Cabriolla, Cabryola, Cabryolla... cabriole

Caca

(Latin) In mythology, the sister of a giant and the original goddess of the hearth... caca

Butternut Bark Tea Is Good Against Constipation

Butternut Bark tea has a long history in healing ailments like constipation, but not only. It is said that native Americans discovered its medicinal properties and used the plant to treat toothaches. Butternut Bark Tea description Butternut, or white walnut or oilnut, is a small tree, commonly found in the Midwestern and Northeastern regions of the United States. It grows on hillsides or streambanks. The butternut tree is valued for its nuts as well as for the lumber. To treat toothaches, Native Americans used the oil of the butternut tree. Medicinally, only the inner bark of the root is used. Butternut Bark tea is the resulting beverage from brewing the abovementioned plant. Butternut Bark Tea brewing To prepare Butternut Bark tea:
  • boil a teaspoon of the bark in a cup of water
  • let it steep for 3 to 5 minutes
Butternut Bark tea can also be purchased in powdered form and taken with cold water. Butternut Bark Tea benefits Butternut Bark tea has been successfully used to:
  • relieve constipation
  • expel parasites
  • help in the treatment of gallbladder disorders
  • help in the treatment of hemorrhoids
  • help against certain skin diseases
  • protect the liver
  • cleanse the blood
  • cleanse the colon
Butternut Bark Tea side effects Butternut Bark tea intakingis not recommended in case of gallstones. Also, pregnant and nursing women should ask their doctor before consuming it. Butternut Bark tea is a natural remedy against constipation and parasites, being also useful in case of skin diseases.... butternut bark tea is good against constipation

Cacalia

(Latin) Resembling the flowering plant

Cacaliah, Cacalea, Cacaleah... cacalia

Cacao

Chocolate (Theobroma cacao).

Plant Part Used: Leaf, seeds.

Dominican Medicinal Uses: The seeds are traditionally prepared as a tea by decoction (i.e. hot chocolate) taken orally for fatigue and weakness. The leaf decoction is used for kidney and urinary tract disorders.

Safety: Chocolate is widely consumed and generally regarded as safe. No data on the safety of the leaf has been identified in the available literature.

Contraindications: Avoid use in individuals with a history of heart disorders (due to cardiac stimulant effects) or hypersensitivity (due to potential skin reactions or migraines).

Drug Interactions: Avoid concomitant use with phenelzine due to potential for high blood pressure. The following medications may inhibit caffeine metabolism or clearance: oral contraceptives, cimetidine, furafylline, verapamil, disulfiram, fluconoazole, mexiletine, phenylpropanolamine, numerous quinolone antibiotics (i.e. enoxacin, pipemidic acid, ciprofloxacin, norfloxacin), idrocilamide and methoxsalen.

Clinical Data: The following effects of the seed extract have been investigated in human clinical trials: anti-ulcer, antioxidant and decreased platelet function.

Laboratory & Preclinical Data: In animal studies the seed extract has shown anti-ulcer effects. In vitro the seed extracts and/or constituents have shown antibacterial, antioxidant, anti-tumor, cardio-protective, dopaminergic, immunomodulatory and red blood cell production stimulant effects.

* See entry for Cacao in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... cacao

Caccinia Crassifolia

O. Kuntze.

Synonym: C. glauca Savi.

Family: Boraginaceae.

Habitat: Native to Baluchistan. Available in Indian market as Gaozabaan.

Unani: Gaozabaan. (According to National Formulary of Unani Medicine, Borago officinalis Linn. and other species of Boraginaceae are used as Gaozabaan.)

Action: Leaf—diuretic, antiinflammatory, demulcent; used for strangury, asthma and cough.

The stems and leaves gave sapoge- nins—caccigenin, caccigenin lactone and 23-deoxycaccigenin; rutin and a saponin derived from caccigenin. The leaves also gave a glucoside, cac- cinin. Caccinin and its aglucone cac- cinetin (which is the dimethylallyl ester of caffeic acid) is diuretic; saponins exhibit anti-inflammatory activity.

Flowers contain pyrrolizidine alkaloid, the diester of retronecine. Ben- zoic acid has also been isolated from the flowers.... caccinia crassifolia

Cacia

(Greek) Form of Acacia, meaning “thorny tree; one who is naive”; form of Casey, meaning “a vigilant woman” Caciah, Cacea, Caceah... cacia

Caddy

(American) An alluring woman Caddi, Caddie, Caddey, Caddee, Caddea, Caddeah... caddy

Caden

(English) A battlemaiden Cadan, Cadin, Cadon... caden

Cadence

(Latin) Rhythmic and melodious; a musical woman

Cadena, Cadenza, Cadian, Cadienne, Cadianne, Cadiene, Caydence, Cadencia... cadence

Cadha

(Scottish) From the steep mountain Cadhah... cadha

Cadhla

(Irish) A beautiful woman Cadhlah... cadhla

Cadis

(Greek) A sparkling young girl Cadiss, Cadisse, Cadys, Cadyss, Cadysse... cadis

Cadaba Fruticosa

(L.) Druce.

Synonym: C. farinosa Forsk. C. indica Lam.

Family: Capparidaceae.

Habitat: Common in Punjab, Rajasthan, Gujarat, Madhya Pradesh and Tamil Nadu.

Siddha/Tamil: Kattagatti, Vilivi, Villi.

Folk: Kodhab.

Action: Root and leaves— deobstruent, emmenagogue; used for uterine obstructions.

The leaves and stem bark gave alkaloids, L-stachydrine and L-3-hydroxy- stachydrine. Presence of quercetin, isoorientin, hydroxybenzoic acid, sy- ringic acid, vanillic acid and 2-hydro- xy-4-methoxy benzoic acid has also been reported. The stembark contains an alkaloid cadabicine, and dry pods contain cadabalone.... cadaba fruticosa

Cadillo De Gato

Cockleburr (Xanthium strumarium).

Plant Part Used: Leaf, root.

Dominican Medicinal Uses: The leaf and root are traditionally prepared as a tea by decoction and taken orally for kidney, gallbladder, liver disorders and hepatitis.

Safety: No data on the safety of this plant has been identified in the available literature. Animal toxicity studies suggest that therapeutic use of this plant may be considered safe in moderation.

Laboratory & Preclinical Data: In animal studies the leaf extract has shown antitrypanosomal and cytotoxic effects and the fruit extract has exhibited CNS depressant and antidiabetic activity. In vitro, isolated plant constituents have shown anti-tumor, antimalarial and antimicrobial effects and the leaf extract has demonstrated cytotoxic effects.

* See entry for Cadillo de gato in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... cadillo de gato

Cadillo Tres Pies

Gingerbush (Pavonia spinifex).

Plant Part Used: Leaf, root.

Dominican Medicinal Uses: The leaf and root are traditionally prepared as a tea by decoction and administered orally for disorders of the kidney, gallbladder or liver, blood in the urine, hepatitis, sexually transmitted infections, uterine fibroids, tumors, cysts and menopausal hot flashes.

Safety: Insufficient information identified.

Contraindications: Unknown; insufficient information identified in the available literature.

Drug Interactions: Unknown; insufficient information identified in the available literature.

Laboratory & Preclinical Data: The chloroform extract of the plant has shown antibacterial activity in vitro.

* See entry for Cadillo de gato in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... cadillo tres pies

Cadwyn

(Welsh) A bright, strong chain Cadwynn, Cadwynne, Cadwin, Cadwinne, Cadwinn, Cadwen, Cadwenn, Cadwenne... cadwyn

Cady

(American) One who is pure; finding happiness in simplicity Cade, Cadee, Cadey, Cadi, Cadie, Cadye, Caidie, Cadyna, Cadea, Cadeah... cady

Cael

(Celtic) Of the victorious people Caele, Caell, Caelle... cael

Caeneus

(Greek) In mythology, a woman who became a man Caenis, Caenius... caeneus

Caesaria

(Greek) Feminine form of Caesar; an empress

Caesariah, Caesarea, Caesareah, Caezaria, Caezariah, Caezarea, Caezareah, Cesaria, Cesariah, Cesarea, Cesareah, Cesarina, Cesariena, Cesaryna, Cesareina, Cesareana, Cesareena, Cesarie, Cesari, Cesary, Cesarey, Cesaree, Cesareah, Cesarea... caesaria

Caethes

(Welsh) A slave girl... caethes

Cafell

(Welsh) A priestess who is an oracle Cafelle, Cafele, Cafel, Caffel... cafell

Caffaria

(Irish) One who is helmeted Caffarea, Caffara, Caffariah, Caffarea, Caffareah... caffaria

Cahira

(Irish) Feminine form of Cahir; a woman warrior

Cahirah, Caheera, Cahyra, Caheira, Cahiera, Caheerah, Cahyrah, Caheirah, Cahierah, Caheara, Cahearah... cahira

Caia

(Latin) One who rejoices Cai, Cais... caia

Caieta

(Latin) In mythology, the woman who nursed Aeneas... caieta

Cailin

(Gaelic) A young woman; a lass Caelan, Caelyn, Caileen, Cailyn, Caylin, Cailean, Caolan, Caelin... cailin

Caesalpinia Bonduc

(L.) Roxb. Dandy & Exell.

Synonym: C. bonducella Flem. C. crista Linn.

Family: Caesalpiniaceae.

Habitat: Throughout the hotter parts of India. Common in West Bengal and South India. Often grown as hedge plant.

English: Fever Nut, Bonduc Nut, Nikkar Nut.

Ayurvedic: Puutikaranja, Lataa- karanja, Kantaki Karanja, Karanjin, Kuberaakshi (seed).

Unani: Karanjwaa.

Siddha/Tamil: Kazharchikkaai.

Action: Seed—antiperiodic, antirheumatic. Roasted and used as an antidiabetic preparation. Leaf, bark and seed—febrifuge. Leaf and bark—emmenagogue, anthelmintic. Root—diuretic, anticalculous.

The seeds contain an alkaloid cae- salpinine; bitter principles such as bon- ducin; saponins; fixed oil.

The seed powder, dissolved in water, showed hypoglycaemic activity in alloxanized hyperglycaemic rabbits. Aqueous extract of the seeds produced similar effects in rats. The powder forms a household remedy for treatment of diabetes in Nicobar Islands. In Kangra, Himachal Pradesh, roots are used in intermittent fevers and diabetes.

In homoeopathy, the plant is considered an excellent remedy for chronic fever.

(Three plant species—Pongamia pinnata Pierre, Holoptelea integrifo- lia (Roxb.) Planch. and Caesalpinia bonduc (L.) Roxb. are being used as varieties of Karanja (because flowers impart colour to water). P. pinnata is a tree and is equated with Karanja, Naktamaala and Udakirya; H. integri- folia, also a tree, with Chirabilva, Puti- ka (bad smell) and Prakiryaa; and C. bonduc, a shrub, with Kantaki Karanja or Lataa Karanja.)

Dosage: Seed kernel—1-3 g powder. (CCRAS.)... caesalpinia bonduc

Caesalpinia Coriaria

(Jacq.) Willd.

Family: Caesalpiniaceae.

Habitat: Grows abundantly in South India, also cultivated in North-western India and West Bengal.

English: American Sumac, Divi-divi Plant.

Siddha/Tamil: Kodivelam.

Folk: Libi-dibi; Divi-divi.

Action: Bark—febrifuge, antiperi- odic. Pod—astringent (in piles). Fruit—semen coagulant.

All parts of the plant contain tannin, the maximum amount occurring in the pods (69.4%). The tannins from pods comprise pyrogallol type of hy- drolysable tannins and consists of gal- lotannin and ellagitannin. Divi-divi closely resembles myrobalans both in nature and contents of tannins. Seeds contain little or no tannin.

The plant is used for treating freckles. Leaves contain ellagic and gallic acids, catechol and tannins.

Ethanolic extract of the leaves showed antifungal activity.... caesalpinia coriaria

Caesalpinia Digyny

Rottl.

Family: Caesalpiniaceae.

Habitat: Bengal, Assam and Andamans up to 1,000 m.

English: Teri Pods.

Ayurvedic: Vaakeri.

Siddha/Tamil: Nunigatcha.

Action: Root—astringent and antipyretic, used in phthisis and scrofulous affections.

The roots gave a phenolic compound vakerin, identical with bergenin. The ethanol-water extract of roots inhibits the growth of Mycobacterium tuberculosis.

The pods contain 28% tannin (without seeds, more than 54%). The bark contains 28% tannin (without seeds, more than 54%). The tannin is pure gallo-tannin and gallic acid.

Dosage: Root—3-5 g powder. (CCRAS.)... caesalpinia digyny

Caesalpinia Pulcherrima

Sw.

Family: Caesalpiniaceae.

Habitat: Cultivated in gardens throughout India.

English: Barbados Pride, Peacock Flower.

Ayurvedic: Padangam, Ratnagandhi, Krishnachuudaa.

Siddha/Tamil: Mayirkonrai, Nalal.

Folk: Guleturaa, Sankeshwara.

Action: Leaves—laxative, antipyretic. Used in Eastern India as a substitute for senna. Dried and powdered leaves are used in erysipelas. Flowers—anthelmintic. Also used for cough and catarrh. Root—a decoction is prescribed in intermittent fevers. Bark— emmenagogue, abortifacient.

The plant contains a flavonoid, my- ricitroside. The leaves, flowers and fruits contain tannins, gums, resin, benzoic acid. Presence of cyanidin- 3,5-diglucoside is also reported from the flowers, hydrocyanic acid from the leaves. The root contains caesalpin type diterpenoids along with sitosterol.

The leaves have displayed anticancer activity in laboratory animals. A diter- penoid, isolated from the root, also showed anticancer activity.

In Pakistan, the leaf and flower extract exhibited activity against Grampositive bacteria.... caesalpinia pulcherrima

Cailleach

(Scottish) An old woman; in mythology, the mother of all Caillic... cailleach

Cain

(Hebrew) A spear huntress; in the Bible, murdered his brother Abel Caine, Cayn, Cayne, Caen, Caene... cain

Cainell

(Welsh) A beautiful young girl Cainelle, Cainele, Cainel, Caynell, Caynelle, Caynele, Caynel, Caenell, Caenel... cainell

Cainwen

(Welsh) A beautiful treasure Cainwenn, Cainwenne, Cainwin, Cainwinn, Cainwinne, Cainwyn, Cainwynn, Cainwynne, Caynwen, Caynwenn, Caynwenne, Caynwin, Caynwinne, Caynwinn, Caynwyn, Caynwynn, Caywynne... cainwen

Cairo

(African) From the city in Egypt... cairo

Caesalpinia Sappan

Linn.

Family: Caesalpiniaceae.

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

English: Sappan.

Ayurvedic: Pattanga, Patanga, Pattraanga, Raktasaara, Ranjana, Pataranjaka, Suranga, Kuchandana.

Unani: Bakam.

Siddha/Tamil: Patangam, Anaikun- trumani.

Folk: Patang.

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

The heartwood gave an anti-inflammatory principle brazilin; amyrin glu- coside, amino acids and carbohydrates. EtOH (50%) extract of stem exhibited semen coagulant activity Aqueous and chloroform extracts of the wood exhibited inhibitory action on cyclic AMP phosphodiesterase. The methanolic extract of the sappan lignan showed sleep-time-elongation effect in mice. Significant anti-hypercholes- terolaemic activity is attributed to ben- zilic compounds.

The oil exhibited antibacterial and antifungal activity.

Plant pigments find use in facials which are resistant to light, heat and water and are non-irritating.

Dosage: Heartwood—5-10 g (API Vol. IV.)... caesalpinia sappan

Café

Coffee (Coffea arabica).

Plant Part Used: Seed, leaf.

Dominican Medicinal Uses: The roasted seeds are traditionally brewed to prepare coffee and taken orally as a laxative, diuretic, stimulant, blood cleanser and for treating sexually transmitted infections or used as a mouthwash for toothache and inflammation of the mouth or gums. The seeds tinctured in alcohol are applied topically for arthritis and muscle pain. The leaves are typically prepared as a tea by infusion and taken orally for diarrhea, and may also be prepared as a bath for skin ailments.

Safety: The seeds and seed decoction are widely consumed and generally considered safe. One of the primary active constituents in coffee is caffeine. Potential adverse effects from excess coffee intake include diarrhea, insomnia, headache, heart palpitations, hyperacidity and stomach irritation. No data on the safety of the leaf in humans has been identified in the available literature. In animal studies, the leaf showed no evident signs of toxicity.

Contraindications: Excess caffeine consumption (including coffee) is not advised during pregnancy or lactation. Caution is advised in patients with renal dysfunction and hyperthyroidism. No data on the safety of the leaves in pregnancy, lactation or small children has been identified in the available literature.

Drug Interactions: Coffee may interfere with drug resorption. The following medications may inhibit caffeine metabolism or clearance: oral contraceptives, cimetidine, furafylline, verapamil, disulfiram, fluconoazole, mexiletine, phenylpropanolamine, numerous quinolone antibiotics (i.e. enoxacin, pipemidic acid, ciprofloxacin, norfloxacin), idrocilamide and methoxsalen.

Clinical Data: Caffeine has been investigated in human clinical trials for its cognitive enhancement effects, and coffee has been studied as a colonic stimulant and common cold treatment.

Laboratory & Preclinical Data: In animal studies, coffee has shown hypercholesterolemic effects, and in vitro it has shown antioxidant activity.

* See entry for Café in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... café

Cakusola

(African) One who has the heart of a lion

Cakusolah, Cakusolla, Cakusollah... cakusola

Cala

(Arabic) From the castle Calah... cala

Calabash

See Higüero.... calabash

Calabaza

See Auyama.... calabaza

Calais

(French) From the city in France... calais

Calamus Tenuis

Roxb.

Synonym: C. amarus Lour.

Family: Palmae; Arecaceae.

Habitat: The sub-Himalayan tract from Dehra Dun to Assam.

English: Bareilly Cane.

Ayurvedic: Vetra (var.) (Vetasa, Salix caprea Linn., is a different drug).

Action: See C. rotang.... calamus tenuis

Cajanus Cajan

(Linn.) Millsp.

Synonym: C. indicus Spreng.

Family: Papilionaceae; Fabaceae.

Habitat: Cultivated as pulse crop, chiefly in Madhya Pradesh, Bihar, Andhra Pradesh, Maharashtra, Uttar Pradesh and Karnataka.

English: Pigeon Pea, Red Gram.

Ayurvedic: Aadhaki, Tuvari, Tuvara, Shanapushpikaa.

Unani: Arhar.

Siddha/Tamil: Thuvarai.

Action: Green leaves are considered hypocholesterolaemic. Pulse shows cholesterol and phospholipid lowering effect (reported to cause flatulence). A paste of leaves with salt and water, is taken on an empty stomach for jaundice. Leaves are used in diseases of the mouth, and topically for treating measles and other eruptions.

The Ayurvedic Pharmacopoeia ofIn- dia indicated the use of the seed in lipid disorders and obesity; externally for promoting breast development, and attributed blood purifying properties to the root.

Amino acid analysis of the seed extract showed that phenylalanine (26.3% of the total amino acids) is responsible for about 70% of the anti- sickling potency of the seed extract.

Seeds also contain riboflavin and pyridoxine. Root bark contains isofla- vones, sterols, triterpenoids, flavones, anthraquinone derivatives. Plant also contains an isoflavone, cajanol.

The aqueous extract of leaves showed vasodilatory effect in experimental animals.

Unroasted nuts had hypoglycaemic effect in mice; roasted seeds, in contrast, had a hyperglycaemic effect. (Sharon M. Herr.)

Dosage: Root—2-6 g powder. (API Vol. III.)... cajanus cajan

Cajuil

Cashew (Anacardium occidentale).

Plant Part Used: Seed case, dried bark.

Dominican Medicinal Uses: Traditionally the dried bark or seed case is prepared as a decoction by boiling in water and taken orally for diarrhea in both children and adults.

Safety: The fresh seed case is a potent skin irritant and is considered poisonous although roasting neutralizes this toxin. The juice of the fruit-stem is widely consumed as a beverage and generally considered safe. The seeds are commonly eaten and considered safe as long as they are properly roasted and processed. No information on the safety of the dried seed case or bark has been identified in the available literature.

Laboratory & Preclinical Data: In animal studies, the nut extract in milk has demonstrated antiarthritic and antioxidant effects, and the aqueous plant extract has shown antidiabetic activity. Extracts of the bark have shown anti-inflammatory and hypoglycemic activity, and the nut shell oil and fruit stem juice have demonstrated antioxidant effects in vivo. In vitro, extracts of the plant or bark have exhibited antibacterial, antifungal, antileishmaniasis, tyrosinase inhibition and vasorelaxant activity.

* See entry for Cajuil in “Part 3: Dominican Medicinal Plant Profiles” of this book for more information, including references.... cajuil

Calaguala

Rabbit’s foot fern (Polypodium aureum).

Plant Part Used: Leaf (fern frond).

Dominican Medicinal Uses: The leaf is traditionally prepared as an infusion and taken orally for the common cold, flu and upper respiratory tract infections.

Safety: In a human clinical trial of the plant extract, no toxic or adverse effects were reported.

Contraindications: Insufficient information identified in the available literature.

Drug Interactions: Insufficient information identified in the available literature.

Clinical Data: The plant extract has been studied in one human clinical trial for its photoprotective effects and was recommended as a potential therapy.

Laboratory & Preclinical Data: Plant extracts have shown antiparasitic, anti-inflammatory, antioxidant, immunosuppressant effects in animal studies. Isolated constituents (calagualine) or plant extracts have shown anti-tumor, antiviral, immunomodulatory and leukotriene formation inhibition activity in vitro.... calaguala

Calamus Rotang

Linn.

Synonym: C. roxburghii Griff.

Family: Palmae; Arecaceae.

Habitat: Central and South India.

English: Rotang, Rattan, Chair Bottom Cane.

Ayurvedic: Vetra, Abhrapushpa.

Siddha/Tamil: Pirambu.

Action: Astringent, antidiarrhoeal, anti-inflammatory (used in chronic fevers, piles, abdominal tumours, strangury), antibilious, spasmolytic. Wood—vermifuge.

The plant is used in convulsions and cramps. The presence of a saponin in the stem, an alkaloid in the leaves and a flavonoid in the root is reported.... calamus rotang

Calamus Travancoricus

Bedd. ex Hook. f.

Family: Palmae; Arecaceae.

Habitat: Deccan peninsula, from Malabar to Travancore.

English: Cane.

Ayurvedic: Vetra.

Siddha/Tamil: Pirambu.

Action: Tender leaves are used in dyspepsia, biliousness and as an anthelmintic. See C. rotang.... calamus travancoricus

Calandra

(Greek) Resembling a songbird; a lark

Calendre, Calynda, Calinda, Calandria, Callyr, Calynda... calandra

Calantha

(Greek) Resembling a lovely flower

Calanthe, Calanthia, Calanthiah, Calantheah, Calanthea... calantha

Calatea

(Greek) A flowering woman Calateah, Calatia, Calatiah, Calatee, Calati, Calatie, Calaty, Calatey... calatea

Calamus Tea Is Good For Laryngitis

Calamus tea is a good remedy against a large array of ailments such as laryngitis, but not only. It has a good taste when drank and it can fight the desire for tobacco. Calamus Tea description Calamus is a perennial semi-aquatic plant that grows in wetlands. It is found in Europe, Russia, East and South Asia, and the United States and Canada. Its leaves and rhizomes have a strong scent, due to which Calamus is appreciated in the perfume industry. Calamus tea is the resulting beverage from brewing the abovementioned plant. Calamus Tea brewing To prepare Calamus tea:
  • pour a cup of boiling water on 2 teaspoonfuls of the calamus root
  • leave it to steep for about 10 to 15 minutes
Calamus tea is recommended to be drunk an hour before eating. Calamus Tea benefits Calamus tea has been successfully used to:
  • treat chest congestion
  • treat digestive problems (flatulence and bloating)
  • relieve stomach spasms
  • enhance the appetite
  • treat laryngitis
  • fight the desire for tobacco
  • fight fever
Calamus Tea side effects Calamus tea is not recommended to pregnant or nursing women. Calamus tea is a medicinal beverage efficient in dealing with stomach spasms, digestive problems and chest congestion.... calamus tea is good for laryngitis

Calcification

The deposition of CALCIUM salts in body tissues, normally BONE and TEETH, though abnormal deposits can occur in damaged muscles or the walls of arteries.... calcification

Calcio

Calcium; this powdered mineral is often added as a supplement to herbal and other medicinal preparations and is often used in the treatment of anemia.... calcio

Calcium Gluconate

A salt of the element CALCIUM used to treat de?ciency of the mineral or to prevent osteoporosis (see BONE, DISORDERS OF). Tablets can be obtained without a doctor’s prescription. It is used intravenously to treat low calcium levels causing symptoms in newborn babies.... calcium gluconate

Caldwell

(English) Of the cold well Caldwelle, Caldwele, Caldwel... caldwell

Cale

(Latin) A respected woman Cayl, Cayle, Cael, Caele, Cail, Caile... cale

Caledonia

(Latin) Woman of Scotland Caledoniah, Caledoniya, Caledona, Caledonya, Calydona... caledonia

Calefacient

A remedy which gives rise to a sensation of warmth... calefacient

Calendula Officinalis

Linn.

Family: Compositae; Asteraceae.

Habitat: Throughout India; wild in Punjab.

English: Pot-Marigold, Marigold; Calendula.

Unani: Zergul.

Siddha/Tamil: Thulvkka Saamanthi.

Action: Flowers—antiinflammatory, antiseptic, stimulant, antispasmodic, emmenagogue, antihaemorrhagic, styptic. Used in gastric and duodenal ulcers and dysmenorrhoea; externally for cuts, bruises, burns, scalds. Plant—antiprotozoal. Flower— antimicrobial. Essential oil— antibacterial.

Key application: In inflammation of the oral and pharyngeal mucosa, internally and externally. Externally, on poorly healing wounds, ul- cuscruris. (German Commission E, WHO, ESCOP.) Anti-inflammatory, vulnerary. (The British Herbal Pharmacopoeia.)

The flowers contain triterpenes, sterols, flavonoids, carotenes, bitter glycosides, resins, volatile oil, mucilage (do not contain tannins). Polysaccharides from flowers exhibited immuno- stimulating and antitumour activity in several in vitro test systems.

An alcoholic extract has been shown to have antitrichomonal activity.

Wound healing and antiinflammatory properties are attributed to Mn and carotene. An aqueous alcoholic extract of florets showed CNS inhibitory effect with marked sedative activity in experimental animals.

The extract of flower-heads exhibited estrogenic activity (reduces period pains and regulates menstrual bleeding).

Calephlone, the extract containing the total polyphenols of the inflorescence, has a marked cholagogic effect in rats and has been found helpful in the treatment of CCl4-induced hepatitis. A hypocholesterolaemic saponin has been extracted from the plant.

Dosage: Dried inflorescences powder—1-3 g (API Vol. II); fruit powder—1-2 g. (API Vol. IV.)... calendula officinalis

Calendula Tea Is Anti-bacterial

Calendula tea can be consumed for its healing properties as well as for its taste. It is efficient in treating a large array of diseases, being an important ingredient in the pharmaceutical industry. Calendula Tea description Calendula, or ‘marigold’, is an orange or yellow flower, originating from the northern Mediterranean countries. In Roman Catholic Church, calendulas are used in the events honoring the Virgin Mary. In households, marigold flavors and colors cereals, rice and soups. Nowadays, calendula is appreciated for its ornamental features.   Calendula tea is the resulting beverage from brewing the abovementioned plant. Calendula Tea brewing Calendula Tea is prepared by steeping dried calendula flowers in boiling water for about 5 minutes. After taking it out of the heat, strain it and drink it slowly. Calendula Tea benefits Calendula tea is successfully used as:
  • an anti-inflammation and anti-bacterial adjuvant
  • an immuno-stimulator
  • an ear infections aid
  • a conjunctivitis treatment
  • a collagen production stimulator
  • a sore throat and a mouth inflammation adjuvant
  • a gastrointestinal disorders treatment
  • a menstruation cycle regulator
  • a body detoxifier (after an operation)
  • a soothing skin treatment
  • a minor burns healer
  • a toothache mitigator
  • a flu adjuvant
Calendula Tea side effects As a topical treatment, Calendula tea should not be applied on open wounds. Also, allergic responses were noticed by people allergic to ragweed, chrysanthemums and other plants from the daisy or aster family. Calendula tea is best known for its anti-inflammatory and anti-bacterial properties, but also for its healing properties for gastrointestinal disorders.... calendula tea is anti-bacterial

Calia

(American) A known beauty Caliah, Calea, Caleah... calia

Calibration

Demonstrating that a measuring device produces results within the specified limits of those produce by a reference standard device over an appropriate rang of measurements... calibration

Calibre

A talking-book service which is available to all blind and handicapped people who can supply a doctor’s certi?cate con?rming that they are unable to read printed books in the normal way. Its catalogue contains more than 370 books for adults and more than 250 for children, and additions are being made at the rate of around three a week. Full details can be obtained from Calibre.

www.calibre.org.uk... calibre

Calida

(Spanish) A woman who is warm and loving

Calidah, Calyda, Caleeda, Caleida, Calieda, Caleda, Calydah, Caleedah, Caleidah, Caliedah, Caledah, Caleada, Caleadah... calida

California

(Spanish) From paradise; from the state of California Califia... california

Calise

(Greek) A gorgeous woman Calyse, Calice, Calyce... calise

Calista

(Greek) Form of Kallisto, meaning “the most beautiful” Calissa, Calisto, Callista, Calyssa, Calysta, Calixte, Colista, Collista, Colisto, Caliesta, Caleista, Caleasta, Caleesta... calista

Calla

(Greek) Resembling a lily; a beautiful woman Callah... calla

Callan

(Gaelic / German) One who is powerful in battle / a talkative woman Callen, Callon, Callyn, Calynn, Calan... callan

California Poppy Tea Against Insomnia

California Poppy tea is a natural remedy against insomnia. It is largely used for its healing properties against anxiety, too. California Poppy Tea description California poppy is an annual or perennial plant, originating from the Pacific coast. Its orange-yellow flowers flourish during spring and midsummer. North Americans used to consume this plant for stress-caused illnesses. Landscape artists appreciate California poppy plant for its beauty. California Poppy tea is the beverage resulting from brewing the abovementioned plant. California Poppy Tea brewing To prepare California Poppy tea, place the flowers, stems and leaves in boiling water for about 10 minutes. California Poppy Tea benefits California Poppy tea has been successfully used to:
  • fight insomnia by ushering in restful sleep
  • fight anxiety
  • fight headaches
  • fight toothaches and stomachaches
  • fight skin sores and ulcers
California Poppy Tea side effects Pregnant women and children should not consume California Poppy tea. California Poppy tea is a healthy beverage able to deal with a large array of diseases such as stomachaches and ulcers and it also proved to be helpful for skin sores.... california poppy tea against insomnia

Callida

(Latin) A fiery young girl Callidah, Callyda, Calleeda, Calleida, Callieda, Calleda, Callydah, Calleedah, Calleidah, Calliedah, Calledah, Calleada, Calleadah... callida

Callidora

(Greek) A beautiful gift Callidorah, Calidora, Callydora, Calydora, Callidorra... callidora

Calligenia

(Greek) Daughter born with beauty

Caligenia, Calligeniah, Caligeniah, Callygenia, Calygenia, Calligenea, Caligenea... calligenia

Calliope

(Greek) Form of Kalliope, meaning “having a beautiful voice”; in mythology, the muse of epic poetry Calliopee, Calliopy, Calliopi, Calliopie, Caliope, Caliopi, Caliopie, Caliopy, Calliopea, Calliopeah, Caliopea, Caliopeah, Caliopa... calliope

Calliper Splint

This is applied to a broken leg in such a way that in walking, the weight of the body is taken by the hip-bone and not by the foot.... calliper splint

Callisto

(Greek) Form of Kallisto, meaning “the most beautiful”; in mythology, a nymph who was changed into a she-bear Callista, Calisto, Calista, Calysta, Calysto, Callysto, Callysta, Calliste, Calleesto, Calleisto, Calleisto, Calleasto... callisto

Callosities

Areas of gross thickening of the epidermis in response to trauma. They usually occur on a foot due to bony deformity or ill-?tting footwear. (See CORNS AND BUNIONS.)... callosities

Calluna

(Latin) Resembling heather Callunah, Caluna, Calunna... calluna

Calophyllum Apetalum

Willd.

Callicarpa macrophylla Vahl.

Synonym: C. incana Roxb.

Family: Verbenaceae.

Habitat: Sub-Himalayan tracts, from Hazara eastwards to Assam, up to 1,500 m.

English: Perfumed Cherry.

Ayurvedic: Priyangu, Priyan- gukaa, Priyaka, Gandhphali, Gandhpriyangu, Phalini, Vanitaa, Kaantaa, Kaantaahvaa, Shyamaa, Anganaapriya.

Unani: Habb-ul-Mihlb (Prunus mahaleb Linn., Rosaceae).

Siddha/Tamil: Gnazhal, Chokkala. (Fruits of Aglaia roxburghiana Miq. are used as Priyangu.)

Action: Leaves—applied hot in rheumatic pains. Smoked to relieve headache. Seed—paste used in stomatitis. Wood—paste used in mouth and tongue sores. Seeds and roots—employed as stomachic. Bark—used in rheumatism and diseases of genitourinary tract. The Ayurvedic Pharmacopoeia of India indicated the use of the fruit in emesis and giddiness.

The seeds and leaves contain cal- literpenone and its monoacetate; the former also contain fatty acids, beta- sitosterol and its beta-D-glucoside.

Synonym: C. wightianum T. Anders.

Family: Guttiferae; Clusiaceae.

Habitat: The evergreen forests of Western Ghats up to 330 m.

Siddha/Tamil: Shirupinnai.

Action: Resin—antiphlogistic, anodyne. Seed oil—antileprotic.

The leaves, stem, bark and root contain friedelin. Leaves also contain canophyllol and a triterpene lactone; stem, beta-amyrin; bark, apetalic acid. Heartwood contains a clathrate named wightianone palmitic acid. Wood contains mesoinositol.... calophyllum apetalum

Calpurnia

(Latin) A woman of power Calpurniah, Calpurnea, Capurneah, Calpernia, Calpernea