Tapping Health Dictionary

An aid to diagnosis practised by striking the patient’s body with the ?ngers, in such a way as to make it give out a note. It was introduced in 1761 by Leopold Auenbrugger (1722–1809) of Vienna, the son of an innkeeper, who derived the idea from the habit of his father tapping casks of wine to ascertain how much wine they contained. According to the degree of dullness or resonance of the note, an opinion can be formed as to the state of CONSOLIDATION of air-containing organs, the presence of abnormal cavities in organs, and the dimensions of solid and air-containing organs, which happen to lie next to one another. Still more valuable evidence is given by AUSCULTATION.... percussion

The puncture by hollow needle or TROCAR and CANNULA of any body cavity (e.g. abdominal, pleural, pericardial), for tapping or aspirating ?uid. (See ASPIRATION.)... paracentesis

A sign obtained from collections of ?uid by laying the ?ngers of one hand upon one side of the swelling, and, with those of the other, tapping or pressing suddenly on a distant point of the swelling. The ‘thrill’ communicated from one hand to the other through the ?uid is one of the most important signs of the presence of an ABSCESS, or of e?usion of ?uid into joints or into the peritoneal cavity (see PERITONEUM).... fluctuation

A collection of ?uid connected with the testis (see TESTICLE) or spermatic cord. When there is no obvious cause, it is classi?ed as primary: such hydrocoeles are usually large and tense, and are commonly found in middle-aged and younger men, presenting as a large, painless scrotal swelling. Congenital hydrocoeles may occur in infants, when they are often associated with a hernial sac (see HERNIA). Hydrocoele of the cord is rare. Secondary hydrocoele is generally smaller and lax; it is usually secondary to a tumour or in?ammation of the underlying testis or epididymis.

Treatment Congenital hydrocoeles usually disappear spontaneously and may be safely watched; surgery is only indicated when there is a hernia, or if the condition persists after the ?rst year. Hydrocoeles in adults should be tapped and the testis palpated to exclude primary lesions. Primary hydrocoeles may be managed by intermittent tapping, or, preferably, by surgical removal. Secondary hydrocoeles require treatment of the underlying condition.... hydrocoele

Commiphora mukul

Burseraceae

San: Gugulu, Mahisaksah, Koushikaha, Devadhupa

Hin: Gugal Mal:Gulgulu Tam,

Tel: Gukkulu

Kan: Guggul

Ben: Guggul

Importance: Indian bdellium is a small, armed, deciduous tree from the bark of which gets an aromatic gum resin, the ‘Guggul’ of commerce. It is a versatile indigenous drug claimed by ayurvedists to be highly effective in the treatment of rheumatism, obesity, neurological and urinary disorders, tonsillitis, arthritis and a few other diseases. The fumes from burning guggul are recommended in hay- fever, chronic bronchitis and phytises.

The price of guggulu gum has increased ten fold in ten years or so, indicating the increase in its use as well as decrease in natural plant stand. It has been listed as a threatened plant by Botanical Survey of India (Dalal, 1995) and is included in the Red Data Book (IUCN) and over exploited species in the country (Billare,1989).

Distribution: The center of origin of Commiphora spp. is believed to be Africa and Asia. It is a widely adapted plant well distributed in arid regions of Africa (Somalia, Kenya and Ethiopia in north east and Madagascar, Zimbabwe, Botswana, Zaire in south west Africa), Arabian peninsula (Yemen, Saudi Arabia and Oman). Different species of Commiphora are distributed in Rajasthan, Gujarat, Maharashtra and Karnataka states of India and Sind and Baluchistan provinces of Pakistan (Tajuddin et al, 1994). In India, the main commercial source of gum guggul is Rajasthan and Gujarat.

Botany: The genus Commiphora of family Burseraceae comprises about 185 species. Most of them occur in Africa, Saudi Arabia and adjoining countries. In India only four species have been reported. They are C. mukul(Hook. ex Stocks) Engl. syn. Balsamodendron mukul (Hook. ex Stocks), C. wightii (Arnott) Bhandari, C.stocksiana Engl., C. berryi and C.agallocha Engl.

In early studies about the flora of India, the ‘guggul’ plant was known as Commiphora mukul(Hook. ex Stocks) Engl. or Balsamodendron mukul (Hook. ex Stocks). It was renamed as C. roxburghii by Santapau in 1962. According to Bhandari the correct Latin name of the species is C. wightii(Arnott) Bhandari, since the specific name ‘wightii’ was published in 1839, prior to ‘roxburghi’ in 1848 (Dalal and Patel, 1995).

C. mukul is a small tree upto 3-4m height with spinescent branching. Stem is brownish or pale yellow with ash colored bark peeling off in flakes. Young parts are glandular and pubescent. Leaves are alternate, 1-3 foliate, obovate, leathery and serrate (sometimes only towards the apex). Lateral leaflets when present only less than half the size of the terminal ones. Flowers small, brownish red, with short pedicel seen in fascicles of 2-3. Calyx campanulate, glandular, hairy and 4-5 lobed. Corolla with brownish red, broadly linear petals reflexed at apex. Stamens 8-10, alternatively long and short. Ovary oblong, ovoid and stigma bifid. Fruit is a drupe and red when ripe, ovate in shape with 2-3 celled stones. The chromosome number 2n= 26 (Warrier et al, 1994; Tajuddin et al, 1994).

Agrotechnology: Guggal being a plant of arid zone thrives well in arid- subtropical to tropical climate.

The rainfall may average between 100mm and 500mm while air temperature may vary between 40 C in summer and 3 C during winter. Maximum relative humidity prevails during rainy season (83% in the morning and 48% in the evening).Wind velocity remains between 20-25 km/hour during the year is good. Though they prefer hard gypseous soil, they are found over sandy to silt loam soils, poor in organic matter but rich in several other minerals in arid tracks of western India (Tajuddin et al, 1994).

Plants are propagated both by vegetatively and seeds. Plants are best raised from stem cuttings from the semi woody (old) branch. For this purpose one metre long woody stem of 10mm thickness is selected and the cut end is treated with IBA or NAA and planted in a well manured nursery bed during June-July months; the beds should be given light irrigation periodically. The cuttings initiate sprouting in 10-15 days and grow into good green sprout in 10-12 months. These rooted plants are suitable for planting in the fields during the next rainy season. The cuttings give 80-94% sprouting usually. Air layering has also been successfully attempted and protocol for meristem culture is available in literature. Seed germination is very poor (5%) but seedling produce healthier plants which withstand high velocity winds.

The rooted cuttings are planted in a well laid-out fields during rainy season. Pits of size 0.5m cube are dug out at 3-4 m spacing in rows and given FYM and filler soil of the pit is treated with BHC (10%) or aldrin (5%) to protect the new plants from white ants damage. Fertilizer trials have shown little response except due to low level of N fertilization. Removal of side branches and low level of irrigation supports a good growth of these plants. The plantation does not require much weeding and hoeing. But the soil around the bushes be pulverised twice in a year to increase their growth and given urea or ammonium sulphate at 25- 50g per bush at a time and irrigated. Dalal et al (1989) reported that cercospora leaf spot was noticed on all the cultures. Bacterial leaf blight was also noticed to attack the cultures. A leaf eating caterpillar (Euproctis lanata Walker) attack guggal, though not seriously. White fly (Bemisia tabaci) is observed to suck sap of leaves and such leaves become yellowish and eventually drop. These can be effectively controlled by using suitable insecticide.

Stem or branch having maximum diameter of about 5cm at place of incision, irrespective of age is tapped. The necrotic patch on the bark is peeled off with a sharp knife and Bordeaux paste is applied to the exposed (peeled off) surface of the stem or branch. A prick chisel of about 3cm width is used to make bark- deep incisions and while incising the bark, the chisel is held at an acute angle so that scooped suspension present on the body of the chisel flows towards the blade of the chisel and a small quantity of suspension flows inside the incised bark. If tapping is successful, gum exudation ensures after about 15-20 days from the date of incision and continues for nearly 30-45 days. The exuded gum slides down the stem or branch, and eventually drops on the ground and gets soiled. A piece of polythene sheet can be pouched around the place of incision to collect gum. Alternatively, a polythene sheet can be spread on the ground to collect exuded gum. A maximum of about 500g of gum has been obtained from a plant (Dalal, 1995).

Post harvest technology: The best grade of guggul is collected from thick branches of tree. These lumps of guggul are translucent. Second grade guggul is usually mixed with bark, sand and is dull coloured guggul. Third grade guggul is usually collected from the ground which is mixed with sand, stones and other foreign matter. The final grading is done after getting cleansed material. Inferior grades are improved by sprinkling castor oil over the heaps of the guggul which impart it a shining appearance (Tajuddin et al, 1994).

Properties and activity: The gum resin contains guggul sterons Z and E, guggul sterols I-V, two diterpenoids- a terpene hydrocarbon named cembreneA and a diterpene alcohol- mukulol, -camphrone and cembrene, long chain aliphatic tetrols- octadecan-1,2,3,4-tetrol, eicosan-1,2,3,4-tetrol and nonadecan-1,2,3,4-tetrol. Major components from essential oil of gum resin are myrcene and dimyrcene. Plant without leaves, flowers and fruits contains myricyl alcohol, -sitosterol and fifteen aminoacids. Flowers contain quercetin and its glycosides as major flavonoid components, other constituents being ellagic acid and pelargonidin glucoside (Patil et al, 1972; Purushothaman and Chandrasekharan, 1976).

The gum resin is bitter, acrid, astringent, thermogenic, aromatic, expectorant, digestive, anthelmintic, antiinflammatory, anodyne, antiseptic, demulcent, carminative, emmenagogue, haematinic, diuretic, lithontriptic, rejuvenating and general tonic. Guggulipid is hypocholesteremic (Husain et al, 1992; Warrier et al, 1994).... indian bdellium

One of the simplest forms of activity of the nervous system. (For the mechanism upon which it depends, see NERVOUS SYSTEM; NEURON(E).) Re?ex acts are divided usually into three classes.

Super?cial re?exes comprise the sudden movements which result when the skin is brushed or pricked, such as the movement of the toes that results from stroking the sole of the foot.

Deep re?exes depend upon the state of mild contraction in which muscles are constantly maintained when at rest, and are obtained, as in the case of the knee-jerk (see below), by sharply tapping the tendon of the muscle in question.

Visceral re?exes are those connected with various organs, such as the narrowing of the pupil when a bright light is directed upon the EYE, and the contraction of the URINARY BLADDER when distended by urine.

Faults in these re?exes give valuable evidence as to the presence and site of neurological disorders. Thus, absence of the knee-jerk, when the patellar tendon is tapped, means some interference with the sensory nerve, nerve-cells, or motor nerve upon which the act depends – as, for example, in POLIOMYELITIS, or peripheral NEURITIS; whilst an exaggerated jerk implies that the controlling in?uence exerted by the BRAIN upon this re?ex mechanism has been cut o? – as, for example, by a tumour high up in the SPINAL CORD, or in the disease known as MULTIPLE SCLEROSIS (MS).... reflex action

A term applied to symptoms, and sensations, perceived only by the affected individual. For example, numbness is a purely subjective sensation, whilst the jerk given by the leg on tapping the tendon of the knee is an objective sign.... subjective

This occurs when URINE is produced by the kidneys but not voided by the bladder. It is generally less serious than ANURIA, in which urine is not produced.

Causes Neurological injury, such as trauma to the spinal cord, may cause bladder weakness, leading to retention, although this is rare. Obstruction to out?ow is more common: this may be acute and temporary, for example after childbirth or following surgery for piles (HAEMORRHOIDS); or chronic, for example, with prostatic enlargement (see PROSTATE GLAND). Commonly seen in elderly men, this leads to reduced bladder capacity, with partial emptying every few hours. Total retention is rare, but may result from a stricture, or narrowing, of the URETHRA (see also URETHRA, DISEASES OF AND INJURY TO) – usually the result of infection or injury – or to pressure from a large neighbouring tumour.

Retention is generally treated by regular use of a urethral catether (see CATHETERS), various types of which are available. Tapping of the bladder with a needle passed above the pubis is rarely necessary, but may occasionally be required in cases of severe stricture.... urine retention

A technique that enables sputum (phlegm) or other secretions to drain from a person’s lungs in order to clear them.

The person lies in a way that allows the secretions to drain by gravity into the trachea, from where they are coughed up.

Tapping the person’s chest with cupped hands can help to loosen sticky secretions.... postural drainage

twitching of the facial muscles elicited by stimulation of the facial nerve by tapping. This indicates muscular irritability, usually due to calcium depletion (see tetany). [F. Chvosteck (1835–84), Austrian surgeon]... chvosteck’s sign

an abnormal reflex elicited by lightly placing the index finger across the chin of the patient and tapping it with a tendon hammer while the jaw hangs loosely open. A brisk upward movement of the jaw indicates an upper *motor neuron disorder above the brainstem.... jaw-jerk reflex

The part of a medical consultation in which the doctor looks, feels, and listens to various parts of the patient’s body to assess the patient’s condition or to gather information to help make a diagnosis.

Most examinations include palpation, by which the doctor examines relevant parts of the body for signs such as swelling, tenderness, or enlargement of organs. In some cases, percussion of the chest, or other parts of the body, may be performed by tapping with the fingers and then listening to the sound produced. Auscultation may be used to listen to blood flow through arteries and sounds made by the heart and lungs. The doctor may take the pulse or blood pressure, examine the eyes and ears, and assess the strength and coordination of the muscles.... examination, physical

(knee jerk) reflex contraction of the quadriceps (thigh) muscle so that the leg kicks, elicited in a patient sitting with one knee crossed over the other by sharply tapping the tendon of the muscle below the kneecap. The reflex is mediated through nerves emanating from the third and fourth lumbar spinal levels (see spinal nerves). This is a test of the connection between the sensory nerves attached to stretch receptors in the muscle, the spinal cord, and the motor neurons running from the cord to the thigh muscle, all of which are involved in the reflex. The patellar reflex is reduced or absent when there is disease or damage of the spinal cord at or below the level of the reflex and exaggerated in disorders above the level of the reflex.... patellar reflex

flexion of the forearm (and sometimes also of the fingers) that occurs when the lower end of the radius is tapped. It is due to contraction of the brachioradialis muscle, which is stimulated by tapping its point of insertion in the radius.... radial reflex

a method for checking the regeneration of a nerve: usually used in patients with *carpal tunnel syndrome. Direct tapping over the sheath of the nerve elicits a distal tingling sensation (see paraesthesia), which indicates the beginning of regeneration. [J. Tinel (1879–1952), French neurosurgeon]... tinel’s sign

spasmodic contractions of muscles, especially the muscles of mastication, in response to nerve stimulation (e.g. by tapping). It is a characteristic sign of hypocalcaemia (see tetany). [A. Trousseau (1801–67), French physician]... trousseau’s sign