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    Nails in health and disease

     

    NAILS IN HEALTH AND DISEASE. Introduction: The nails are present at the end of each finger tip on the dorsal surface. The main function of nail is protection and it also helps for a firm grip for holding articles. It consists of a strong relatively flexible keratinous nail plate originating from the nail matrix. Under the nail plate there is a soft tissue called nail bed. Between the skin and nail plate there is a nail fold or cuticle. Normal healthy nail is slight pink in colour and the surface is convex from side to side. Finger nails grow 1 cm in three months and toe nails take 24 months for the same. Importance of nails in disease diagnosis: The colour, appearance, shape and nature of the nails give some information about the general health and hygiene of a person . Nails are examined as a routine by all doctors to get some clues about underlying diseases. Just looking at nails we can makeout the hygiene of a person. The abnormal nail may be congenital or due to some diseases. The cause for changes in the nail extend from simple reasons to life threatening diseases. Hence the examination by a doctor is essential for diagnosis. Some abnormal findings with probable causes are discussed here for general awareness. 1) Hygiene:- We can make out an unhygienic nail very easily. Deposition of dirt under the distal end of nail plate can make a chance for ingestion of pathogens while eating. If nail cutting is not done properly it can result in worm troubles in children. When the worms crawl in the anal orifice children will scratch which lodges the ova of worms under the nails and will be taken in while eating. Prominent nail can also complicate a skin disease by habitual scratching. Sharp nails in small kids cause small wounds when they do feet kicking or hand waving. 2) Colour of the nails:- a) Nails become pale in anaemia. b) Opaque white discolouration(leuconychia) is seen in chronic renal failure and nephrotic syndrome. c) Whitening is also seen in hypoalbuminaemia as in cirrhosis and kidney disorders. d) Drugs like sulpha group, anti malarial and antibiotics ect can produce discolouration in the nails. e) Fungal infection causes black discolouration. f) In pseudomonas infection nails become black or green. g) Nail bed infarction occures in vasculitis especially in SLE and polyarteritis. h) Red dots are seen in nails due to splinter haemorrhages in subacute bacterial endo carditis, rheumatoid arthritis, trauma, collagen vascular diseases. i) Blunt injury produces haemorrhage and causes blue/black discolouration. j) Nails become brown in kidney diseases and in decreased adrenal activity. k) In wilsons disease blue colour in semicircle appears in the nail. l) When the blood supply decreases nail become yellow. In jaundice and psoriasis also nail become yellowish. m) In yellow nail syndrome all nails become yellowish with pleural effusion. 3) Shape of nails:- a) Clubbing: Here tissues at the base of nails are thickened and the angle between the nail base and the skin is obliterated. The nail becomes more convex and the finger tip becomes bulbous and looks like an end of a drumstick. When the condition becomes worse the nail looks like a parrot beak. Causes of clubbing:- Congenital Injuries Severe chronic cyanosis Lung diseases like empyema, bronchiactesis, carcinoma of bronchus and pulmonary tuberculosis. Abdominal diseases like crohn's disease, polyposis of colon, ulcerative colitis, liver cirrhosis ect... Heart diseases like fallot's tetralogy, subacute bacterial endocarditis and ect.. b) Koilonychia:- Here the nails become concave like a spoon. This condition is seen in iron deficiency anaemia. In this condition the nails become thin, soft and brittle. The normal convexity will be replaced by concavity. c) Longitudinal ridging is seen in raynaud's disease. d) Cuticle becomes ragged in dermatomyositis. e) Nail fold telangiectasia is a sign in dermatomyositis, systemic sclerosis and SLE. 4) Structure and consistancy:- a) Fungal infection of nail causes discolouration, deformity, hypertrophy and abnormal brittleness. b) Thimble pitting of nail is charecteristic of psoriasis, acute eczema and alopecia aereata. c) The inflamation of cuticle or nail fold is called paronychia. d) Onycholysis is the seperation of nail bed seen in psoriasis, infection and after taking tetracyclines. e) Destruction of nail is seen in lichen planus, epidermolysis bullosa. f) Missing nail is seen in nail patella syndrome. It is a hereditary disease. g) Nails become brittle in raynauds disease and gangrene. h) Falling of nail is seen in fungal infection, psoriasis and thyroid diseases. 5) Growth:- Reduction in blood supply affects the growth of nails. Nail growth is also affected in severe ilness. when the disease disappears the growth starts again resulting in formation of transverse ridges. These lines are called Beau's lines and are healpful to date the onset of illness.

         
    Piles

     

    BRIEF IDEA ABOUT PILES (Hemorrhoids) What is piles ? Dilatation of radicles of rectal veins within the anal canal is called piles. The medical term for piles is hemorrhoidspared to arteries veins are weak due to thin walls and hence any backpressure in the veins can make them tortuous. There are three rectal veins namely superior, middle and inferior rectal veins. Any obstructions or increase of pressure in these veins can predispose piles. Depending upon the situation there are two types of piles. 1) External piles. 2) Internal piles. 1) External piles:- This type of piles is seen outside the anal opening and is covered by skin. It is black or brown in colour. This type of piles is very painful due to rich nerve supply in this area. 2) Internal piles:- It is inside the anal canal and internal to the anal orifice. It is covered by mucous membrane and is red or purple in colour. These piles are painless. Some times internal and external piles occure in same individual. Factors responsible for piles:-- 1) This is a familial disease. 2) Piles is seen only in animals maintain an erect posture. This is due to congestion in the rectal veins due to the effect of gravity. 3) It is common in individuals having chronic constipation. Those who have a habit of visiting the toilet due to frequent urge for stool may develop piles in future. 4) Piles is common in those who take excess of chicken, prawns, spicy food ect. Those who take vegetables and fibrous food are rarely affected. 5) Some ladies get piles during pregnancy due to compression of rectal veins by the uterus. 6) Cancerous lesions in the rectum can obstruct blood flow and result in piles. Signs and symptoms of piles:-- 1) Pain:- Pain is common in external piles which will be worse while straining at stool. 2) Bleeding:- Bleeding comes in splashes while pressing for stool. Bleeding may be profuse in some cases. 3) Protruding mass:- In external piles the swelling can be felt around the anal orifice. In case of internal piles initially it can not be felt. When the disease progresses the piles protrude during stool and will go inside automatically. When the condition becomes worse the protruded piles will not go back in to the anus. 4) In some cases there will be discharge of mucus with itching around the anal orifice. Complications of piles:-- 1,Infection: The infection can spread to deep veins resulting in septicaemia. 2,Fibrosis: Here the piles become fibrosed with hardening of anal orifice. 3,Thrombosis: Here the blood inside the piles will form clots and can obstruct blood flow. 4,Gangrene: Here the tissues in the piles and nearby skin die due to lack of blood supply. 5,Suppuration: When the piles suppurate it can produce abscess with discharge of pus. Treatment of piles:-- Initially it is treated on the basis of symptoms. Constipation should be treated. If there is anaemia iron should be give. Homoeopathic medicines can give good results. If medicinal treatment is not giving any result the following can be tried. 1) The thrombosed external pile is excised under local anaesthesia. 2) Sclerosant injection therapy can reduce the size of piles. 3) Rubber band ligation around the neck of piles is useful in some cases. 4) Cryosurgery is very effective. 5) Anal dilatation can reduce constipation and pain. 6) Haemorrhoidectomy is the surgical removal of piles. How to prevent piles? 1) Eat plenty of fruits and vegetables. 2) Take fibrous food. 3) Avoid excess intake of meat, prawns, crabs ect. 4) Keep a regular timing for food. 6) Drink sufficient quantity of water. 7) Keep a regularity in bowel habits. 8) Take treatment for constipation.

         
    Prostate cancer

     

    PROSTATE CANCER Introduction:- Prostate is a glandular organ present only in males. It surrounds the neck of bladder & the first part of urethra and condributes a secretion to the semen. The gland is conical in shape and measures 3 cm in vertical diameter and 4 cm in transverse diameter. It has got five lobes anterior, posterior, two lateral and a median lobe. Since the first part of the urethra pass through it any lesion in the prostate will produce difficulty in passing urine. Diseases of the prostate gland:- 1) Prostatitis:- This is the inflamation of the prostate gland due to bacterial infection. 2) Benign enlargement of the prostate:- This is a non cancerous tumour of the prostate seen after the age of 50. 3,Cancer of the prostate:-This is the 4th most common cause of death from malignant diseases in males. Cancer of the prostate. Cancer of the prostate is directly linked with the male sex hormones(androgens).If the levels of sex hormone increases the growth rate of cancer also increases. It is found that after the removel of testes there is marked reduction in the size of tumour. Site of tumour:- Prostate cancer is seen mainly in the posterior lobe. Non cancerous enlargement is seen in other lobes. Changes in the gland in cancer:- The gland becomes hard with irregular surface with loss of normal lobulation. Histologically prostate cancer is an adeno carcinoma(cancer of the epithelial cells in the gland) Growth :- Growth rate is very fast in prostate cancer. The tumour compresses the urethra and produce difficulty in urination. Spread of tumour:- Metastasis in cancer of prostate is very early. 1) Local spread:- From the posterior lobe the cancer cells go to the lateral lobes and seminal vesicles. Tumour cells also move to the neck and base of the urinary bladder. 2) Lymphatic spread:- Through the lymph vessels cancer cells reach the internal and external illiac group of lymph nodes. From there cells move to retroperitonial(Behind the peritonium) and mediastinal lymph nodes(in the chest) 3) Spread through the blood:- Spread of cancer cells takeplace through the periprostatic venous plexus and reaches the vertebral veins while coughing and sneezing and finally enders the vertebral bodies of the lumbar vertebrae. Signs and symptoms of prostate cancer:-- Signs and symptoms depend upon the stage of the cancer. The following symptoms may be seen. 1) No symptoms:- Tumour is small and only in the posterior lobe. This is diagnosed accidentely. 2) Slight difficulty in urination:- Here the tumour is enlarged and urethra is slightly compressed. Shortly there will be frequent urge for urination with difficult urination. 3) When the tumour spread to all nearby areas including neck of bladder and urethra there will be painful urination with bleeding. Urine comes drop by drop. 4) Retention of urine:- When the urethra is completely compressed there will be retention of urine. This can lead to hydronephrosis, renal failure ect. In this condition patient may get convulsions due to renal failure and finally coma. 5) Signs of metastasis:- Some patients come with the signs and symptoms of metastasis. a) Lumbo sacral pain due to spread of cancer cells to lumbar and sacral vertebrae. b) Fracture of spine due to cancerous growth in the spine. c) Swelling, pain and fluid collection in the abdomen due to lesion in the abdomen. d) Respiratory complaints due to cancer of mediastinal lymphnodes and lungs. e) General weakness due to spread of cancer to different parts of the body. f) Anaemia due to involment of bone marrow and increased destruction of RBCs. Clinical examination :- Includes per rectal examination to feel the prostate gland, palpation of abdomen to feel the swelling in kidneys and any tumours. Patient is examined from head to foot to find out any lesions. Investigations:- 1) Complete blood investigations;- RBC, WBC, Platlets, ESR, bleeding time, clotting time ect. 2) Urine analysis:- Microscopic examination to detect pus cells, occult blood, casts, Crystals ect. 3) Renal function tests:- Blood urea level, serum creatinine level, electrolyte level ect. 4) Serum acid phosphatase:- Increased in cancer of prostate. 5) x-ray of the spine:- To detect any tumour or fracture. 6) Ultra sonography;- Gives idea about prostate, bladder, kidney ect. 7) C T scan:- More detailed information about organs and tumour. 8) MRI of the spine:- Gives detailed information about spine, disc and nearby soft tissues. 9) Lymphangiography:- Gives idea about lymphatic spread of cancer. 10) Biopsy to confirm cancer:- Biopsy is taken from the tumour and is send for histopathological examination under the microscope. This will detect the presence of cancer cells. Treatment:- 1) If there is retention of urine catheterisation is needed. 2) Dialysis if kidney failure. 3) If there is coma monitoring of all vital functions along with parentral nutrition and electolyte supply. 4) Specific treatment is prostatectomy(removal of prostate) Partial prostatectomy :- Here only the affected lobe is removed. Radical prostatectomy :- Total removal of prostate along with nearby lymphnodes. 5, Hormone therapy :- Stilbestrol is given to reduce tumour growth. Since this treatement increases the chance for cardiovascular disease phosphorylated diethyle stilbesterol is used nowadays. 6) Chemotherapy:-Drugs like cyclophosphamide, cisoplatim ect are given. 7) Radiotherapy is also done for some cases. 8) Homoeopathy:- Homoeopathic drugs like carcinocin, conium, sabal, crotalus, thuja, iodum, selinium, staphysagria, sulphur ect can be given according to symptoms. Constitutional homoeopathic medicine will give great relief and can increase the life span. 9) Yoga and meditation is also healpful.

         
    The growth and power of appetite

     

    THE GROWTH AND POWER OF APPETITE. One fact attendant on habitual drinking stands out so prominently that none can call it in question. It is that of the steady growth of appetite. There are exceptions, as in the action of nearly every rule; but the almost invariable result of the habit we have mentioned, is, as we have said, a steady growth of appetite for the stimulant imbibed. That this is in consequence of certain morbid changes in the physical condition produced by the alcohol itself, will hardly be questioned by any one who has made himself acquainted with the various functional and organic derangements which invariably follow the continued introduction of this substance into the body.

    But it is to the fact itself, not to its cause, that we now wish to direct your attention. The man who is satisfied at first with a single glass of wine at dinner, finds, after awhile, that appetite asks for a little more; and, in time, a second glass is conceded. The increase of desire may be very slow, but it goes on surely until, in the end, a whole bottle will scarcely suffice, with far too many, to meet its imperious demands. It is the same in regard to the use of every other form of alcoholic drink. Now, there are men so constituted that they are able, for a long series of years, or even for a whole lifetime, to hold this appetite within a certain limit of indulgence.

    To say "So far, and no farther." They suffer ultimately from physical ailments, which surely follow the prolonged contact of alcoholic poison with the delicate structures of the body, many of a painful character, and shorten the term of their natural lives; but still they are able to drink without an increase of appetite so great as to reach an overmastering degree. They do not become abandoned drunkards.

    No man safe who drinks. ---------------------- But no man who begins the use of alcohol in any form can tell what, in the end, is going to be its effect on his body or mind. Thousands and tens of thousands, once wholly unconscious of danger from this source, go down yearly into drunkards' graves. There is no standard by which any one can measure the latent evil forces in his inherited nature. He may have from ancestors, near or remote, an unhealthy moral tendency, or physical diathesis, to which the peculiarly disturbing influence of alcohol will give the morbid condition in which it will find its disastrous life. That such results follow the use of alcohol in a large number of cases, is now a well-known fact in the history of inebriation. The subject of alcoholism, with the mental and moral causes leading thereto, have attracted a great deal of earnest attention. Physicians, superintendents of inebriate and lunatic asylums, prison-keepers, legislators and philanthropists have been observing and studying its many sad and terrible phases, and recording results and opinions. While differences are held on some points, as, for instance, whether drunkenness is a disease for which, after it has been established, the individual ceases to be responsible, and should be subject to restraint and treatment, as for lunacy or fever; a crime to be punished; or a sin to be repented of and healed by the Physician of souls, all agree that there is an inherited or acquired mental and nervous condition with many, which renders any use of alcohol exceedingly dangerous. The point we wish to make with you is, that no man can possibly know, until he has used alcoholic drinks for a certain period of time, whether he has or has not this hereditary or acquired physical or mental condition; and that, if it should exist, a discovery of the fact may come too late. Dr. D. G. Dodge, late Superintendent of the New York State Inebriate Asylum, speaking of the causes leading to intemperance, after stating his belief that it is a transmissible disease, like "scrofula, gout or consumption," says: "There are men who have an organization, which may be termed an alcoholic idiosyncrasy; with them the latent desire for stimulants, if indulged, soon leads to habits of intemperance, and eventually to a morbid appetite, which has all the characteristics of a diseased condition of the system, which the patient, unassisted, is powerless to relieve since the weakness of the will that led to the disease obstructs its removal. "Again, we find in another class of persons, those who have had healthy parents, and have been educated and accustomed to good social influences, moral and social, but whose temperament and physical constitution are such, that, when they once indulge in the use of stimulants, which they find pleasurable, they continue to habitually indulge till they cease to be moderate, and become excessive drinkers. A depraved appetite is established, that leads them on slowly, but surely, to destruction."

         
    Tongue in disease diagnosis

     

    TONGUE IN DISEASE DIAGNOSIS: Introduction: Tongue is a muscular organ associated with the function of deglutition, taste and speech. It acts as an easily accessible organ for the assessment of health of an individual and shows the state of hydration of the body. It is said that tongue is the mirror of the gastrointestinal system and any abnormal functioning of the stomach and intestines will be reflected on the tongue. Some characteristic changes occur in the tongue in some particular diseases. That is why the examination of the tongue is very essential and will give some clues for diagnosis. All doctors examine the tongue and they consider the changes in size, shape,,colour, moisture, coating, nature of papillae and movements ect. Appearance of tongue in some abnormal conditions:- 1) Movements of the tongue:- a) In one sided paralysis of the body(hemiplegia)tongue moves towards the parylised side when protruded. b) Tremulus movement of the tongue is seen in diseases like thyrotoxicosis, delirium tremens and parkinsonisum. Tremor is also seen in nervous patients. c) In progressive bulbar palsy there will be wasting and paralysis of the tongue with fibrillation. Eventually the tongue gets shrivelled and lies functionless in the floor of the mouth. This condition is associated with dribbling of saliva and loss of speech. d) In chorea(involuntary rhythmic movements) the patient may not be able to keep the protruded tongue in rest, it will be moving involuntarily. 2) Moistness of the tongue:- The moistness of the tongue gives some indication about the state of hydration of the body. Water volume depletion leads to peripheral circulatory failure characterised by weakness, thirst, restlessness, anorexia, nausea, vomiting, dry and parched tongue. Dryness of the tongue is seen in following conditions. a) Diarrhoea b) Later stages of severe illness c) Advanced uraemia d) Hypovolumic shock e) Heat exhaustion f) Hyponatraemia g) Acute intestinal obstruction h) Starvation i) Prlonged fasting. 3) Change in colour of tongue:- a) Central cyanosis:- Cyanosis is the bluish discolouration of the mucus membrane due to decrease in the amount of oxygen in the blood. This is seen in heart failure, respiratory failure and in anoxia. In cyanosis tongue, lips ect becomes pale bluish. b) Jaundice:- This is the yellowish discolouration of all mucus surfaces of the body (including tongue)due to increase of bilirubin in the blood. Jaundice is seen in hepatitis, bile duct obstruction, increased destruction of RBCs and ect... c) Advanced uremia:- This is the increase of urea and other nitrogenous waste products in the blood due to kidney failure. Here the tongue become brown in colour. d) Keto acidosis:- This is the acidosis with accumulation of ketone bodies seen mainly in diabetes mellitus. Here the tongue become brown with a typical ketone smell from the mouth. e) Riboflavin deficiency:- Deficiency of this vitamin (vitamin B2) produces megenta colour of the tongue with soreness and fissures of lips. f) Niacin deficiency:- Deficiency of niacin (vitamin B3)and some other B complex vitamins results in bright scarlet or beefy red tongue. g) Anaemia:- It is the decrease in haemoglobin percentage of the blood. In severe anaemia tongue becomes pale. 4) Coating on the tongue:- a) Bad breath:- The main cause for bad breath is formation of a pasty coating(bio film) on the tongue which lodges thousands of anaerobic bacteria resulting in the production of offenssive gases. Those who complain about bad breath may have thick coating on the posterior part of the tongue. b) Typhoid fever:- In typhoid fever tongue becomes white coared like a fur. c) Candidiasis;- It is a fungal infection which affects the mucus surfaces of the body. On the tongue there will be sloughing white lesions. d) In diabetes and hypoadrenalism there will be sloughing white lesions. e) Secondary syphilis:- Syphilis is a sexually transmitted diseased caused by trepenoma pallidum infection. In secondary stage of this disease we can see mucous patches which are painless, smooth white glystening opalescent plaques which can not be scraped off easily. f) Leokoplakia:- Here white keratotic patches are seen on the tongue and oral cavity. This is a precancerous condition. g) AIDS:- In these patients hairy leukoplakia is seen. h) Peritonitis:- It is the inflammation of the peritonium(inner covering of abdominal cavity which also covers the intestines and keep them in position) in this condition there is white furring of the tongue. i) Acute illness:- Furring is also seen in some acute diseases. 5) Papillae:- These are small projections on the rongue associated with taste. There are different type of papillae on the healthy tongue. In some diseases there are some abnormal changes which are following. a) Hairy tongue:- This condition is due to elongation of filiform papillae seen in poor oral hygeine, general debility and indigestion. b) Geographic tongue:- Here irregular red and white patches appear on the tongue. These lesions looks like a geographic map. The excact cause is not known. c) Median rhomboid glossitis:- In this condition there is smooth nodular red area in the posterior mid line of the tongue. This is a congenital condition. d) Nutritional deficiency:- In nutrional deficiency there is glossitis(inflammation of tongue) leading to papillary hypertrophy followed by atrophy. e) Benign migratory glossitis:- It is an inflamatory condition of the tongue where multiple annular areas of desquamation of papillae appear on the tongue which shift from area to area in few days. f) Thiamine and riboflavin deficiency:- Deficiency of these vitamins cause hypertrophied filiform and fungiform papillae. g) Niacin and iron deficiency:- In this condition there is atrophy of papillae. Smooth tongue is encountered in iron deficiency. h) Vitamin A deficiency:- This causes furrowed tongue. i) In nutritional megaloblastic anaemia tongue becomes smooth. j) Folic acid deficiency:- Here macrocytic megaloblastic anaemia with glossitis is seen. k) Cyano coblamine deficiency:- Here glossitis with macrocytic megaloblastic anaemia and peripheral neuropathy is encountered. l) Scarlet fever;- In this streptococcal infection there is bright red papillae standing out of a thick white fur, later the white coat disappear leaving enlarged papillae on the bright red surface and is called strawberry tongue. 6) Ulcers on the tongue:-- a) Apthous ulcer:- These are round painful ulcers appear in stressed individuals frequently. May be associated with food allergy. Usual sites are tongue, lips, oral mucosa and ect. b) Herpes simplex:- It is an acute vesicular eruptions produced by herpes simplex virus. When these vesicles rupture it forms ulcers. c) Ulcer in cancer:- Cancerous ulcers are having everted edges with hard base. Bleeding is also seen. Cancer of the tongue is common in tobacco chewers. d) Syphilitic ulcers:- Syphilitic fissures are longitudinal in direction. In primary syphilis extra genital chancre is seen on the tongue. In secondary syphilis multiple shallow ulcers are seen on the under surface and sides of the tongue. In tertiary syphilis gumma may be seen on the midline of the dorsum of the tongue. e) Dental ulcers:- These ulcers are produced by sharp edges of carious teeth.

         
    Action of alcohol on internal organs

     

    ACTION OF ALCOHOL ON INTERNAL ORGANS. Action on the stomach. ---------------------- The action of alcohol on the stomach is extremely dangerous that it becomes unable to produce the natural digestive fluid in sufficient quantity and also fails to absorb the food which it may imperfectly digest. A condition marked by the sense of nausea emptiness, prostration and distention will always be faced by an alcoholic. This results in a loathing for food and is teased with a craving for more drink. Thus there is engendered a permanent disorder which is called dyspepsia. The disastrous forms of confirmed indigestion originate by this practice. How the liver gets affected. ---------------------------- The organic deteriorations caused by the continued use of alcohol are often of a fatal character. The organ which most frequently undergoes structural changes from alcohol, is the liver. Normally, the liver has the capacity to hold active substances in its cellular parts. In instances of poisoning by various poisonous compounds, we analyse liver as if it were the central depot of the foreign matter. It is practically the same in respect to alcohol. The liver of an alcoholic is never free from the influence of alcohol and it is too often saturated with it. The minute membranous or capsular structure of the liver gets affected, preventing proper dialysis and free secretion. The liver becomes large due to the dilatation of its vessels, the surcharge of fluid matter and the thickening of tissue. This follows contraction of membrane and shrinking of the whole organ in its cellular parts. Then the lower parts of the alcoholic becomes dropsical owing to the obstruction offered to the returning blood by the veins. The structure of the liver may be charged with fatty cells and undergo what is technically designated 'fatty liver'. How the Kidneys deteriorate. ---------------------------- The Kidneys also suffer due to the excessive consumption of alcohol. The vessels of Kidneys lose elasticity and power of contraction. The minute structures in them go through fatty modification. Albumin from the blood easily passes through their membranes. This results in the body losing its power as if it were being run out of blood gradually. Congestion of the lungs. ------------------------ Alcohol relaxes the vessels of the lungs easily as they are most exposed to the fluctuations of heat and cold. When subjected to the effects of a rapid variation in atmospheric temperature, they get readily congested. During severe winter seasons, the suddenly fatal congestions of lungs easily affects an alcoholic. Alcohol weakens the heart. -------------------------- Consumption of alcohol greatly affects the heart. The quality of the membraneous structures which cover and line the heart changes and are thickened, become cartilaginous or calcareous. Then the valves lose their suppleness and what is termed valvular disorder becomes permanent. The structure of the the coats of the great blood-vessel leading from the heart share in the same changes of structure so that the vessel loses its elasticity and its power to feed the heart by the recoil from its distention, after the heart, by its stroke, has filled it with blood. Again, the muscular structure of the heart fails owing to degenerative changes in its tissue. The elements of the muscular fibre are replaced by fatty cells or, if not so replaced, are themselves transferred into a modified muscular texture in which the power of contraction is greatly reduced. Those who suffer from these organic deteriorations of the central and governing organ of the circulation of the blood learn the fact so insidiously, it hardly breaks upon them until the mischief is far advanced. They are conscious of a central failure of power from slight causes such as overexertion, trouble, broken rest or too long abstinence from food. They feel what they call a 'sinking' but they know that wine or some other stimulant will at once relieve the sensation. Thus they seek to relieve it until at last they discover that the remedy fails. The jaded, overworked, faithful heart will bear no more. it has run its course and the governor of the blood-streams broken. The current either overflows into the tissues gradually damming up the courses or under some slight shock or excess of motion ceases wholly at the centre.

         
    Alcohol has no food value

     

    ALCOHOL HAS NO FOOD VALUE. Alcohol has no food value and is exceedingly limited in its action as a remedial agent. Dr. Henry Monroe says, "every kind of substance employed by man as food consists of sugar, starch, oil and glutinous matter mingled together in various proportions. These are designed for the support of the animal frame.

    The glutinous principles of food fibrine, albumen and casein are employed to build up the structure while the oil, starch and sugar are chiefly used to generate heat in the body". Now it is clear that if alcohol is a food, it will be found to contain one or more of these substances. There must be in it either the nitrogenous elements found chiefly in meats, eggs, milk, vegetables and seeds, out of which animal tissue is built and waste repaired or the carbonaceous elements found in fat, starch and sugar, in the consumption of which heat and force are evolved.

    "The distinctness of these groups of foods," says Dr. Hunt, "and their relations to the tissue-producing and heat-evolving capacities of man, are so definite and so confirmed by experiments on animals and by manifold tests of scientific, physiological and clinical experience, that no attempt to discard the classification has prevailed. To draw so straight a line of demarcation as to limit the one entirely to tissue or cell production and the other to heat and force production through ordinary combustion and to deny any power of interchangeability under special demands or amid defective supply of one variety is, indeed, untenable. This does not in the least invalidate the fact that we are able to use these as ascertained landmarks". How these substances when taken into the body, are assimilated and how they generate force, are well known to the chemist and physiologist, who is able, in the light of well-ascertained laws, to determine whether alcohol does or does not possess a food value.

    For years, the ablest men in the medical profession have given this subject the most careful study, and have subjected alcohol to every known test and experiment, and the result is that it has been, by common consent, excluded from the class of tissue-building foods. "We have never," says Dr. Hunt, "seen but a single suggestion that it could so act, and this a promiscuous guess. One writer (Hammond) thinks it possible that it may 'somehow' enter into combination with the products of decay in tissues, and 'under certain circumstances might yield their nitrogen to the construction of new tissues.

    ' No parallel in organic chemistry, nor any evidence in animal chemistry, can be found to surround this guess with the areola of a possible hypothesis". Dr. Richardson says: "Alcohol contains no nitrogen; it has none of the qualities of structure-building foods; it is incapable of being transformed into any of them; it is, therefore, not a food in any sense of its being a constructive agent in building up the body." Dr. W. B. Carpenter says: "Alcohol cannot supply anything which is essential to the true nutrition of the tissues." Dr. Liebig says: "Beer, wine, spirits, etc., furnish no element capable of entering into the composition of the blood, muscular fibre, or any part which is the seat of the principle of life." Dr. Hammond, in his Tribune Lectures, in which he advocates the use of alcohol in certain cases, says: "It is not demonstrable that alcohol undergoes conversion into tissue.

    " Cameron, in his Manuel of Hygiene, says: "There is nothing in alcohol with which any part of the body can be nourished." Dr. E. Smith, F. R.S., says: "Alcohol is not a true food. It interferes with alimentation.

    " Dr. T. K. Chambers says: "It is clear that we must cease to regard alcohol, as in any sense, a food". "Not detecting in this substance," says Dr. Hunt, "any tissue-making ingredients, nor in its breaking up any combinations, such as we are able to trace in the cell foods, nor any evidence either in the experience of physiologists or the trials of alimentarians, it is not wonderful that in it we should find neither the expectancy nor the realization of constructive power." Not finding in alcohol anything out of which the body can be built up or its waste supplied, it is next to be examined as to its heat-producing quality. Production of heat. ------------------ "The first usual test for a force-producing food," says Dr. Hunt, "and that to which other foods of that class respond, is the production of heat in the combination of oxygen therewith. This heat means vital force, and is, in no small degree, a measure of the comparative value of the so-called respiratory foods. If we examine the fats, the starches and the sugars, we can trace and estimate the processes by which they evolve heat and are changed into vital force, and can weigh the capacities of different foods. We find that the consumption of carbon by union with oxygen is the law, that heat is the product, and that the legitimate result is force, while the result of the union of the hydrogen of the foods with oxygen is water. If alcohol comes at all under this class of foods, we rightly expect to find some of the evidences which attach to the hydrocarbons." What, then, is the result of experiments in this direction? They have been conducted through long periods and with the greatest care, by men of the highest attainments in chemistry and physiology, and the result is given in these few words, by Dr. H. R. Wood, Jr., in his Materia Medica. "No one has been able to detect in the blood any of the ordinary results of its oxidation." That is, no one has been able to find that alcohol has undergone combustion, like fat, or starch, or sugar, and so given heat to the body. Alcohol and reduction of temperature. ------------------------------------ instead of increasing it; and it has even been used in fevers as an anti-pyretic. So uniform has been the testimony of physicians in Europe and America as to the cooling effects of alcohol, that Dr. Wood says, in his Materia Medica, "that it does not seem worth while to occupy space with a discussion of the subject." Liebermeister, one of the most learned contributors to Zeimssen's Cyclopaedia of the Practice of Medicine, 1875, says: "I long since convinced myself, by direct experiments, that alcohol, even in comparatively large doses, does not elevate the temperature of the body in either well or sick people." So well had this become known to Arctic voyagers, that, even before physiologists had demonstrated the fact that alcohol reduced, instead of increasing, the temperature of the body, they had learned that spirits lessened their power to withstand extreme cold. "In the Northern regions," says Edward Smith, "it was proved that the entire exclusion of spirits was necessary, in order to retain heat under these unfavorable conditions." Alcohol does not make you strong. -------------------------------- If alcohol does not contain tissue-building material, nor give heat to the body, it cannot possibly add to its strength. "Every kind of power an animal can generate," says Dr. G. Budd, F. R.S., "the mechanical power of the muscles, the chemical (or digestive) power of the stomach, the intellectual power of the brain accumulates through the nutrition of the organ on which it depends." Dr. F. R. Lees, of Edinburgh, after discussing the question, and educing evidence, remarks: "From the very nature of things, it will now be seen how impossible it is that alcohol can be strengthening food of either kind. Since it cannot become a part of the body, it cannot consequently contribute to its cohesive, organic strength, or fixed power; and, since it comes out of the body just as it went in, it cannot, by its decomposition, generate heat force." Sir Benjamin Brodie says: "Stimulants do not create nervous power; they merely enable you, as it were, to use up that which is left, and then they leave you more in need of rest than before." Baron Liebig, so far back as 1843, in his "Animal Chemistry," pointed out the fallacy of alcohol generating power. He says: "The circulation will appear accelerated at the expense of the force available for voluntary motion, but without the production of a greater amount of mechanical force." In his later "Letters," he again says: "Wine is quite superfluous to man, it is constantly followed by the expenditure of power" whereas, the real function of food is to give power. He adds: "These drinks promote the change of matter in the body, and are, consequently, attended by an inward loss of power, which ceases to be productive, because it is not employed in overcoming outward difficulties i. e., in working." In other words, this great chemist asserts that alcohol abstracts the power of the system from doing useful work in the field or workshop, in order to cleanse the house from the defilement of alcohol itself. The late Dr. W. Brinton, Physician to St. Thomas', in his great work on Dietetics, says: "Careful observation leaves little doubt that a moderate dose of beer or wine would, in most cases, at once diminish the maximum weight which a healthy person could lift. Mental acuteness, accuracy of perception and delicacy of the senses are all so far opposed by alcohol, as that the maximum efforts of each are incompatible with the ingestion of any moderate quantity of fermented liquid. A single glass will often suffice to take the edge off both mind and body, and to reduce their capacity to something below their perfection of work." Dr. F. R. Lees, F. S.A., writing on the subject of alcohol as a food, makes the following quotation from an essay on "Stimulating Drinks," published by Dr. H. R. Madden, as long ago as 1847: "Alcohol is not the natural stimulus to any of our organs, and hence, functions performed in consequence of its application, tend to debilitate the organ acted upon. Alcohol is incapable of being assimilated or converted into any organic proximate principle, and hence, cannot be considered nutritious. The strength experienced after the use of alcohol is not new strength added to the system, but is manifested by calling into exercise the nervous energy pre-existing. The ultimate exhausting effects of alcohol, owing to its stimulant properties, produce an unnatural susceptibility to morbid action in all the organs, and this, with the plethora superinduced, becomes a fertile source of disease. A person who habitually exerts himself to such an extent as to require the daily use of stimulants to ward off exhaustion, may be compared to a machine working under high pressure. He will become much more obnoxious to the causes of disease, and will certainly break down sooner than he would have done under more favorable circumstances. The more frequently alcohol is had recourse to for the purpose of overcoming feelings of debility, the more it will be required, and by constant repetition a period is at length reached when it cannot be foregone, unless reaction is simultaneously brought about by a temporary total change of the habits of life. Driven to the wall. ------------------ Not finding that alcohol possesses any direct alimentary value, the medical advocates of its use have been driven to the assumption that it is a kind of secondary food, in that it has the power to delay the metamorphosis of tissue. "By the metamorphosis of tissue is meant," says Dr. Hunt, "that change which is constantly going on in the system which involves a constant disintegration of material; a breaking up and avoiding of that which is no longer aliment, making room for that new supply which is to sustain life." Another medical writer, in referring to this metamorphosis, says: "The importance of this process to the maintenance of life is readily shown by the injurious effects which follow upon its disturbance. If the discharge of the excrementitious substances be in any way impeded or suspended, these substances accumulate either in the blood or tissues, or both. In consequence of this retention and accumulation they become poisonous, and rapidly produce a derangement of the vital functions. Their influence is principally exerted upon the nervous system, through which they produce most frequent irritability, disturbance of the special senses, delirium, insensibility, coma, and finally, death." "This description," remarks Dr. Hunt, "seems almost intended for alcohol." He then says: "To claim alcohol as a food because it delays the metamorphosis of tissue, is to claim that it in some way suspends the normal conduct of the laws of assimilation and nutrition, of waste and repair. A leading advocate of alcohol (Hammond) thus illustrates it: 'Alcohol retards the destruction of the tissues. By this destruction, force is generated, muscles contract, thoughts are developed, organs secrete and excrete.' In other words, alcohol interferes with all these. No wonder the author 'is not clear' how it does this, and we are not clear how such delayed metamorphosis recuperates. Not an originator of vital force. -------------------------------- which is not known to have any of the usual power of foods, and use it on the double assumption that it delays metamorphosis of tissue, and that such delay is conservative of health, is to pass outside of the bounds of science into the land of remote possibilities, and confer the title of adjuster upon an agent whose agency is itself doubtful. Having failed to identify alcohol as a nitrogenous or non-nitrogenous food, not having found it amenable to any of the evidences by which the food-force of aliments is generally measured, it will not do for us to talk of benefit by delay of regressive metamorphosis unless such process is accompanied with something evidential of the fact something scientifically descriptive of its mode of accomplishment in the case at hand, and unless it is shown to be practically desirable for alimentation. There can be no doubt that alcohol does cause defects in the processes of elimination which are natural to the healthy body and which even in disease are often conservative of health.

         
    Back pain

     

    CAUSES OF LOW BACK PAIN. Low back pain is a usual symptom amoung the modern civilised people. It affects mainly the middle aged and young adults of both sexes. People who work on the chair with out exercise and those who carry heavy loads regularly are prone to get this complaint.

    We can hardly find a person who has not suffered from back pain atleast once in life. The causes of low backpain ranges from simple reasons like muscular strain to cancer of spine and hence backache should not be ignored. The pain is felt in lumbar and sacral region and may radiate to nearby sites.

    The following are some causes for backache. 1) Backache due to diseases in the back. 2) Backache due to gynaecological problems. 3) Backache due to problems in other parts of the body. 1) Backache due to diseases in the back:-- a) Injuries :- 1) Compression fracture of the vertebral column. 2) Rupture of intervertebral discs. 3) Injuries to ligaments and muscles of back. 4) Lumbosacral strain. 5) Intervertebral joint injuries. 6) Fracture of processes of vertebra. b) Functional backache due to imbalance:- 1) During pregnancy. 2) Pot belly. 3) Diseases of the hip joint. 4) Curvature in the spine due to congenital defect. 5) Short leg in one side. c) Backache due to inflammatory conditions:- 1) Infection of the bone due to bacteria. 2) Tuberculosis of the spine. 3) Arthritis. 4) Brucellosis. 5) Lumbago or fibrositis. 6) Inflamation of the muscles. 7) Anchylosing spondylitis. d) Backache due to degenerative diseases in the back. 1) Osteoarthritis. 2) Osteoporosis in old people. 3) Degenaration of the intervertebral disc. e) Tumour in the spine:-- 1) Primory tumour of the bones in the spine. 2) Metastatic tumours from other sites like prostate, lungs, kidneys, intestine ect. 2) Backache due to gynaecological problems:- a) After childbirth. b) After gynaecological operations. c) Prolapse of the uterus. d) Pelvic inflammatory diseases. e) Cancerous lesions of the pelvic organs. f) Endometriosis. 3) Backache due to problems in other parts of the body. a) Renal stones. b) Ureteric stone. c) Cancer of prostate. d) Pancreatitis. e) Biliary stones. f) Peptic ulcer. g) Inflammations of pelvic organs. h) Occlusion of aorta and illiac arteries. Investigation of a case of backache:- 1) Complete blood count. 2) Routine urine examination. 3) Ultrasonography of the abdomen and pelvis. 4) X-ray of the lumbar and sacral region. 5) MRI of the spine. 5) CT scan of abdomen and pelvic region. 6) Examination of rectum, prostate, genito urinary organs. Treatment of back ache:- 1) Removing the cause for backache. 2) Symptomatic treatement. 2) Back exercises. 3) Traction. 3) Yoga. 5) Surgery. 7) Homoeopathy.

         
     
         
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