Dr. Ezra M. Hunt says: “The capacity of the alcohols for impairment of functions and the initiation and promotion of organic lesions in vital parts, is unsurpassed by any record in the whole range of medicine. The facts as to this are so indisputable, and so far granted by the profession, as to be no longer debatable . Changes in stomach and liver, in kidneys and lungs, in the blood-vessels to the minutest capillary, and in the blood to the smallest red and white blood disc disturbances of secretion, fibroid and fatty degenerations in almost every organ, impairment of muscular power, impressions so profound on both nervous systems as to be often toxic these, and such as these, are the oft manifested results. And these are not confined to those called intemperate.”
Professor Youmans says: “It is evident that, so far from being the conservator of health, alcohol is an active and powerful cause of disease, interfering, as it does, with the respiration, the circulation and the nutrition; now, is any other result possible?”
Dr. F.R. Lees says: “That alcohol should contribute to the fattening process under certain conditions, and produce in drinkers fatty degeneration of the blood, follows, as a matter of course, since, on the one hand, we have an agent that retains waste matter by lowering the nutritive and excretory functions, and on the other, a direct poisoner of the vesicles of the vital stream.”
Dr. Henry Monroe says: “There is no kind of tissue, whether healthy or morbid, that may not undergo fatty degeneration; and there is no organic disease so troublesome to the medical man, or so difficult of cure. If, by the aid of the microscope, we examine a very fine section of muscle taken from a person in good health, we find the muscles firm, elastic and of a bright red color, made up of parallel fibres, with beautiful crossings or striae; but, if we similarly examine the muscle of a man who leads an idle, sedentary life, and indulges in intoxicating drinks, we detect, at once, a pale, flabby, inelastic, oily appearance. Alcoholic narcotization appears to produce this peculiar conditions of the tissues more than any other agent with which we are acquainted. ‘Three-quarters of the chronic illness which the medical man has to treat,’ says Dr. Chambers, ‘are occasioned by this disease.’ The eminent French analytical chemist, Lecanu, found as much as one hundred and seventeen parts of fat in one thousand parts of a drunkard’s blood, the highest estimate of the quantity in health being eight and one-quarter parts, while the ordinary quantity is not more than two or three parts, so that the blood of the drunkard contains forty times in excess of the ordinary quantity.”
Dr. Hammond, who has written, in partial defense of alcohol as containing a food power, says: “When I say that it, of all other causes, is most prolific in exciting derangements of the brain, the spinal cord and the nerves, I make a statement which my own experience shows to be correct.”
Another eminent physician says of alcohol: “It substitutes suppuration for growth. It helps time to produce the effects of age; and, in a word, is the genius of degeneration.”
Dr. Monroe, from whom “Alcohol, taken in small quantities, or largely diluted, as in the form of beer, causes the stomach gradually to lose its tone, and makes it dependent upon artificial stimulus. Atony, or want of tone of the stomach, gradually supervenes, and incurable disorder of health results. Should a dose of alcoholic drink be taken daily, the heart will very often become hypertrophied, or enlarged throughout. Indeed, it is painful to witness how many persons are actually laboring under disease of the heart, owing chiefly to the use of alcoholic liquors.”
Dr. T.K. Chambers, physician to the Prince of Wales, says: “Alcohol is really the most ungenerous diet there is. It impoverishes the blood, and there is no surer road to that degeneration of muscular fibre so much to be feared; and in heart disease it is more especially hurtful, by quickening the beat, causing capillary congestion and irregular circulation, and thus mechanically inducing dilatation.”
Sir Henry Thompson, a distinguished surgeon, says: “Don’t take your daily wine under any pretext of its doing you good. Take it frankly as a luxury one which must be paid for, by some persons very lightly, by some at a high price, but always to be paid for. And, mostly, some loss of health, or of mental power, or of calmness of temper, or of judgment, is the price.”
Dr. Charles Jewett says: “The late Prof. Parks, of England, in his great work on Hygiene, has effectually disposed of the notion, long and very generally entertained, that alcohol is a valuable prophylactic where a bad climate, bad water and other conditions unfavorable to health, exist; and an unfortunate experiment with the article, in the Union army, on the banks of the Chickahominy, in the year 1863, proved conclusively that, instead of guarding the human constitution against the influence of agencies hostile to health, its use gives to them additional force. The medical history of the British army in India teaches the same lesson.”
But why present farther testimony? Is not the evidence complete? To the man who values good health; who would not lay the foundation for disease and suffering in his later years, we need not offer a single additional argument in favor of entire abstinence from alcoholic drinks. He will eschew them as poisons.
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.
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:-
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..
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.
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.
Food poisoning is an acute gastroenteritis caused by the consumption of a food material or a drink which contains the pathogenic micro organism or their toxins or poisonous chemicals.Food poisoning is common in hostels,hotels,communal feedings, and festivel seasons.
A group of persons will be affected with same type of symptoms ,and they give a history of consumption of a common food before few hours.
Types of food poisoning
1) Bacterial food poisoning:
Here the micro organisms called bacteria are responsible.The food material may contain the pathogenic bacteriae or their toxin and will be ingested along with the food.
2) Non bacterial food poisoning:
Due to the presence of toxic chemicals like fertilizers,insectisides,heavy metals and ect.
Since bacterial food poisoning is common it is discussed here.
Bacterial food poisoning:
All bacteria are not harmful.There are some pathogenic bacteria which secrete toxins and cause clinical manifestations.These organisms enter the human body through food articles or drinks.
How food poisoning occures:
1) Presence of bacteria in the water.
2) The raw materials for the food may contain toxins.
3) Premises where the food is prepared may contain micro organisms or toxins.
4) Food handlers may have some infectious diseases.
5) Some animals like dogs,rats may contaminate the food.
6) If prepared food is kept in the room temperature for a long time and heated again can make a chance for food poisoning.
7) Purposely some body mixing toxins in the food.
Some common bacterial food poisonings.
1) Salmonella food poisoning:
There are three different varieties of salmonella bacteria.(salmonella typhimurium,salmonella cholera suis,salmonella enteritidis) These bacteria are present in milk, milk products and eggs. Symptoms of this food poisoning include nausea, vomiting and diarrhoea. Fever is also common.
This is the dangerous type of food poisoning caused by clostridium botulinum. The spores of these organisms are seen in the soil and enters the human body through pickles and canned fish ect.Compared to other food poisonings here vomiting and diarrhoea are rare Mainly the nervous system is affected.The symptoms starts with double vision,numbness with weakness.Later there will be paralysis with cardiac and respiratory failure ending in death.
3) Staphylococcal food poisoning:
It is caused by staphylo coccus aureus. These organisms usually cause skin troubles like boils and eruptions.It causes mastitis in cow.Through the milk and milk products it enders and causes gastroenteritis.There will be vomiting,abdominal cramps with diarrhoea.
4) Closteridium food poisoning:
This is caused by closteridium perfringens.They are present in stool,soil and water. They enter the body through,meat,meat dishes and egg ect.If food articles are cooked and kept in room temperature for a long time and heated again before eating can result this food poisoning.Symptoms include vomiting ,diarrhoea and abdominal cramps.
5) Bacillus cereus:
The spores of these organisms can survive cooking and causes enteritis. Diarrhoea and vomiting is common in this infection.
How to investigate food poisoning?
1) Examine each and every person affected.
2) Water sample should be tested.
3) Kitchen, store room and food samples should be examined.
4) The cook and food handlers should be questioned and examined.
5) Samples of vomitus and stool of all victims should be tested to identify the bacteria.
How to prevent food poisoning:-
1) Only purified water should be used.
2) Hygiene should be maintained by all persons keeping contact with food.
3) Workers should use masks, cap and gloves during cooking and serving.
4) Sick individuals should not come in contact with food materials.
5) Kitchen and premises should be neat and clean.
5) Vessels should be washed with soap and hot water.
6) Should not keep the prepared food for a long time in room temperature.
7) All food materials should be kept in closed containers.
8) Animals like dog, cat, rat ect should not come in contact with food materials.
9) Vegetables should be washed before cooking.
10) Meat should be fresh and should be purchased from recognised slaughter house.
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.
Causes of bad breath ?
Bad breath is a common health problem which greately affects the daytoday activities of somany people. The offenssive odor from the mouth is unpleasent to those who come in close contact with bad breathers. The problem will be doubled by psychological trauma leading to depression. The sufferers from this problem wil be isolated from the society. This can even lead to marital disharmony.
Literally speaking all humanbeings are badbreathres. Oral cavity contains millions of anaerobic bacteria like fusobacterium and actinomyces which acts on the protein of food materials and putrifies them. This process results in the formation of offenssive gases like hydrogen sulphide,methyl mescaptan,cadaverin,skatol,putrescine ect causing bad odor. If oral hygiene is not maintained properly all will suffer from bad breath. Most of us control this by regular brushing,tongue cleaning and gargling. Even after maintining cleanliness in the mouth some individuals suffer from offenssive smell due to various causes which has to be diagnosed and treated properly.
Some common causes of bad breath.
1) Poor oral hygiene:
If oral hygiene is not maintained properly the mouth becomes the seat for millions of bacteria which produce offenssive gases by degrading the food debris. Bad breath is severe in those who do not brush their teeth regularly and clean their mouth after every food. Snacks taken inbetween meals can also produce bad breath because of improper cleaning.
Badbreath is common in almost all people in the morning on waking. During sleep there is less production of saliva .Saliva has got some antibacterial properties which help to keep the mouth clean. Saliva conains oxygen molecules which is needed to make oral cavity aerobic. So the reduction in it’s quantity during sleep makes a favourable condition for anaerobic bacteria.
2) Food habits:
The main cause of bad smell is due to degradation of protein by the bacteria and hence all food products rich in protein favours bad breath. Meat,fish,milk products, eggs,cakes,nuts,pear and ect can cause bad breath. Some food articles can produce particular type of smell which may be unpleasent. Raw onion can produce typical bad smell. It is said that an apple a day keeps the doctor away,a raw onion a day keeps everybody away. Eating groundnuts can also produce bad smell. However if proper cleaning is done smell can be reduced irrespective of the nature of food. Irregularity in timing of food can also produce bad breath. Small food articles taken in between the meals can also produce bad smell.
There is formation of a thin sticky coating called biofilm on the tongue and oral mucosa. This coating is thick on the posterior aspect of the tongue where millions of gram negative bacteriae are seen .The thick coating on the tongue is always associated with badbreath. Even a thin biofilm can make anaerobic condition favourable for bacterial proliferation.
4) Dental caries:
This is a destructive process causing decalcification with distruction of enamel and dentine resulting in cavitisation of the tooth. These are produced mainly by the lactobacilli . Food particles are deposited inside these cavities and are putrified by the anaerobic bacteria producing bad smell. Normal brushing will not remove the food debris easily and hence they are putrified completely. Caries are common in schoolgoing children and in those who donot maintain proper oral hygiene .Calcium and vitamin deficiency can also predispose caries.
Gum is a mucus membrane with supporting connective tissue covering the tooth bearing borders of the jaw .The main function of gum is protection .Gingivitis is the inflammation of the gum .Due to various causes gum tissue get infected resulting in swelling,pain and discharge. If the condition become worse the infection spread towards peridontal area leading to continuous discharge called pyorrhoea. Some times the infection goes deep producing alveolar abscess with discharge of pus. Infection can even reach the bone causing osteomyelitis.All these conditions can produce offenssive smell.
6) Gum retraction:
When the gums retract from the teeth a gap is developed which will lodge food particles and cause bad breath.
7) Dental plaques and tartar deposits; Plaques and tartar is deposited mainly in the gaps between the teeth and gum. This will provide shelter for the food debris and bacteria causing bad breath.
8) Ulcerative lesions& coatings:
Almost all ulcerative lesions of the mouth are associated with bad breath. These lesions may be caused by bacteria,viruses,food allergies or due to autoimmune disorders. Apthous ulcer is the commonest amoung ulcerative lesions. Others are herpes,fungal infections,vincents angina,infectious mononucleosis,scarlet fever,diphtheria,drug reactions and ect. Cancerous ulcers produce severe bad breath. All fungal infections produce white coating(candidiasis). Leucoplakia is a white thick patch on the mucus membrane of the mouth & tongue. It is considered as a precancerous condition. Offenssive breath is associated with these conditions.
9) Diseases of the salivary glands:
Saliva is very useful to supply oxygen to all parts of the oral cavity. Even a thin film of coating called biofilm can provide an anaerobic condition in the mouth. Saliva can wet these layers and make an aerobic condition which is unfavourable for the bacteria .Any condition which reduces the production of saliva can increase bacterial activity. Some times the salivary duct is obstructed by stones or tumors.Cancer of the salivary gland is associated with offenssive odor. In suppurative parotitis purulant dischrge in to the mouth causes bad breath.
Tonsils are a pair of lymphoid tissue situated in the lateral wall of oropharynx. Inflammation of the tonsil is called tonsillitis. Bad breath is seen in both acute and chronic tonsillitis. Quinsy or peritonsillar abscess can also produce bad breath.
11) Tonsillar plaques & tonsillar fluid:
If bad breath persists even after maintaining proper oral hygeine there is possibility of this condition. Serous fluid secreated from the folds of tonsil is very offenssive. Some patients complain that they hawk some cheesy materials from the throat;which are very offenssive in nature. These are formed inside the tonsillar crypts which contain thousands of bacteriae. In such conditions tonsillectomy gives noticiable relief from bad breath.
12) Pharyngitis& pharyngial abscess:
Pharynx is a fibromuscular tube which forms the upper part of the digestive & respiratory tract. Inflmmation of the pharynx is called pharyngitis, caused mainly by bacteria and viruses. Bad breath is present in pharyngitis along with other signs like cough and throat irritation. Abscesses in the wall of pharynx can also produce offenssive discharge of pus in to the throat.
Denture users may complain about bad smell due to lodgement of small food debris in between. Proper brushing may not be possible in denture users especially fixed dentures.
Tobacco chewing is associated with bad breath. The smell of tobacco itself is unpleasent for others. Tobacco can irritate the mucus membrane and cause ulcers and coatings. Gingivitis and pyorrhoea are common in tobacco chewers. Tartar is deposited on the teeth mainly near the gums. Tobacco chewers get gastric acidity with eructations. All these causes offenssive smell.
Smokers always have bad smell. It can also produce lesions in the mouth & lungs causing bad breath.Smoking increases carbon dioxide in the oral cavity & reduces oxygen level,causing a favourable condition for bacteria. Smoking reduses appetite & thirst hence acid peptic disease is common in chain smokers.
16) Lesions in the nose & ear:
Bad breath is occasionally seen in sinusitis(infection of para nasal sinuses). In case of post nasal dripping bad breath is common due to the presence of protein in the discharges. These proteins are degraded by the bacteria. Infection in the middle ear with discharge of pus in to the throat through the eustachian tube(passage from middle ear to the throat)can also cause offenssive odor. Chronic rhinitis(infection of mucus membrane of nose) and forign bodies in the nose can also produce bad smell in the expired air.
17) Diabetes mellitus:
Mostly all diabetic patients suffer from bad breath. Coated tongue,ulcers &coatings in the mouth ,increased sugar level in tissues ect are responsible for bad breath.Bacterial growth in diabetic patient is very faster than non diabetic individuals.
Bad breath is common in almost all fevers. Even an acute fever can produce bad breath. Severe bad breath is seen in typhoid .Other infectious diseases like Tuberculosis , AIDS ect produce bad smell.
19) Fasting & dehydration:
Dry mouth favours bacterial activity. So any condition which produce dryness in the mouth makes the breath offenssive. Eventhough the food particles are known to produce bad breath, fasting can also produce the same. Production of saliva is also reduced during fasting. Chewing and swallowing also helps to keep the mouth clean.
20) Bedridden patients:
Bedridden patients suffer from offenssive breath due to thick coating on the tongue. water intake is also limited in these patients. Regurgitation of food aggravates the condition. Since they talk less aeration in the oral cavity is reduced which favours anaerobic bacteria to become active.
21) Diseases of stomach & esophagus:
Eructation of gas and food produce unpleasent smell. Abnormality in the function of lower sphincter can allow the food to regurgitate upwards causing bad breath. Bad breath is also common in gastritis,gastric ulcer and cancer of stomach.
22) Intestinal diseases:
Bad breath is common in patients suffering from ulcerative lesions of intestine like ulcerative collitis..Other diseases are malabsorption syndrome intestinal tuberculosis, peritonitis ect.
23) Diseases of lungs:
Lung diseases like pneumonia, lung abscess,chronic bronchitis,bronchiectasis,tuberculosis, lung cancer ect can produce bad odor during expiration.
24) Liver disorders:
Liver diseases like hepatitis, cirrhosis,can cause bad breath.Gall bladder diseases with vomiting also causes unpleasent odor.
25) Psychiatric patients:
Bad breath is common in psychotic patients due to poor hygiene,irregular food habits,less water intake and ect.
26) Somatisation disorder:
This is a psychiatric disorder charecterised by the presence of a physical symptom that suggest a medical illness .These patients come with physical complaints like pain,nausea difficult respiration, bad smell ect. This condition is diagnosed after detailed examination of the patient with all investigations.Since this is a psychiatric disorder it has to be managed with a psychological approach.
[ THE POINTS MENTIONED IN THIS ARTICLE IS FOR GENERAL INFORMATION. ANY PERSON HAVING BAD BREATH SHOULD CONSULT A QUALIFIED DOCTOR ]
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.”
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:-
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 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.
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.
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.
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.
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.
I once had the unusual, though unhappy, opportunity of observing the same phenomenon in the brain structure of a man, who, in a paroxysm of alcoholic excitement, decapitated himself under the wheel of a railway carriage, and whose brain was instantaneously evolved from the skull by the crash. The brain itself, entire, was before me within three minutes after the death. It exhaled the odor of spirit most distinctly, and its membranes and minute structures were vascular in the extreme. It looked as if it had been recently injected with vermilion. The white matter of the cerebrum, studded with red points, could scarcely be distinguished, when it was incised, by its natural whiteness; and the pia-mater, or internal vascular membrane covering the brain, resembled a delicate web of coagulated red blood, so tensely were its fine vessels engorged.
I should add that this condition extended through both the larger and the smaller brain, the cerebrum and cerebellum, but was not so marked in the medulla or commencing portion of the spinal cord.
The spinal cord and nerves.
The action of alcohol continued beyond the first stage, the function of the spinal cord is influenced. Through this part of the nervous system we are accustomed, in health, to perform automatic acts of a mechanical kind, which proceed systematically even when we are thinking or speaking on other subjects. Thus a skilled workman will continue his mechanical work perfectly, while his mind is bent on some other subject; and thus we all perform various acts in a purely automatic way, without calling in the aid of the higher centres, except something more than ordinary occurs to demand their service, upon which we think before we perform. Under alcohol, as the spinal centres become influenced, these pure automatic acts cease to be correctly carried on. That the hand may reach any object, or the foot be correctly planted, the higher intellectual centre must be invoked to make the proceeding secure. There follows quickly upon this a deficient power of co-ordination of muscular movement. The nervous control of certain of the muscles is lost, and the nervous stimulus is more or less enfeebled. The muscles of the lower lip in the human subject usually fail first of all, then the muscles of the lower limbs, and it is worthy of remark that the extensor muscles give way earlier than the flexors. The muscles themselves, by this time, are also failing in power; they respond more feebly than is natural to the nervous stimulus; they, too, are coming under the depressing influence of the paralyzing agent, their structure is temporarily deranged, and their contractile power reduced.
This modification of the animal functions under alcohol, marks the second degree of its action. In young subjects, there is now, usually, vomiting with faintness, followed by gradual relief from the burden of the poison.
Effect on the brain centres.
The alcoholic spirit carried yet a further degree, the cerebral or brain centres become influenced; they are reduced in power, and the controlling influences of will and of judgment are lost. As these centres are unbalanced and thrown into chaos, the rational part of the nature of the man gives way before the emotional, passional or organic part. The reason is now off duty, or is fooling with duty, and all the mere animal instincts and sentiments are laid atrociously bare. The coward shows up more craven, the braggart more boastful, the cruel more merciless, the untruthful more false, the carnal more degraded. ‘ In vino veritas ‘ expresses, even, indeed, to physiological accuracy, the true condition. The reason, the emotions, the instincts, are all in a state of carnival, and in chaotic feebleness.
Finally, the action of the alcohol still extending, the superior brain centres are overpowered; the senses are beclouded, the voluntary muscular prostration is perfected, sensibility is lost, and the body lies a mere log, dead by all but one-fourth, on which alone its life hangs. The heart still remains true to its duty, and while it just lives it feeds the breathing power. And so the circulation and the respiration, in the otherwise inert mass, keeps the mass within the bare domain of life until the poison begins to pass away and the nervous centres to revive again. It is happy for the inebriate that, as a rule, the brain fails so long before the heart that he has neither the power nor the sense to continue his process of destruction up to the act of death of his circulation. Therefore he lives to die another day.
It is a non progressive neuromuscular disorder causing mild to severe disabilities throughout life.This condition is manifested as a group of persisting qualitative motor disorders which appear in young children due to damage to the brain during delivery or due to some pathological conditions in the intrauterine life.The neuroligical problems are multiple but non progressive in nature.Approximately 2 per 100 live birth is having this problem.This disease is having no hereditary tendency.
Causes of cerebral palsy:
1) Injury to the brain during delivery.
2) As a complication of forceps delivery.
3) Lack of oxygen supply to the baby during delivery.
4) Infections during delivery.
Signs and symptoms of cerebral palsy:–
The signs and symptoms may not be similar in all babies affected.Depending upon the damage to the brain there may be mild to severe lesions.
Mild cases:- 20% children will have mild disability.
Moderate cases:-50% cases are having moderate disability.The affected children require self help for assisting their impaired ambulation capacity.
Severe cases:-About 30% of the affected children are totally incapacited and bedridden and they allways need care from others.
Abnormal findings in cerebral palsy:-
1,Abnormal neonatal reflexes.
2,Stiffness of all muscles with awkward motion.
3,Extention of extremities on vertical suspension of the infant.
4,Scissoring of the lower limbs due to spasm of the adductor muscles of the thigh.
5,In severe cases the back bend backwards like and arch.
6,May have total or partial paralysis.
7,Arrest of neurological and behavioral developement.
8,Swallowing may be difficult in some cases.
9,Drooling of saliva.
10,Mild to severe mental retardations.
11,Abnormal movements are seen in some cases.
12,Tremors with typical movements.
13,If cerebellum is affected there will be loss of muscle tone with difficulty in walking.
14,Complete or partial loss of hearing.
15,Speech may be affected.
16,Squint and other visual problems may be associated.
17,Convulsions may be seen in some children.
Cerebral palsy is diagnosed by detailed clinical examination and by eliminating other similar diseases like brain tumour, progressive atrophy ect.All investigations like CT scan,MRI and routine investigations are needed to ruleout other diseases.
Management of carebral palsy:–
This includes proper nutrition and personal care. Symptomatic medicines are needed to reduce convulsions and muscle stiffness. Diazepam can reduce spasticity and athetosis.
Dantrolene sodium helps to relax skeletal muscles.
Here massage,exercise, hydrotherapy and ect are needed.Special training is given to train walking,swallowing and talking.The affected children are also trained to hold articles for routine activities.
Moral and social support should be given to these children.They should be send to special schools where special training can be given by trained staff.Mentally retarded children need special training.Depending up on the disabitity special instruments and machines are given for locomotion and to assist their daytoday activities.
This is given by occupational therapists.They train the disabled people to do some suitable works so that these people can have their own income.
Hernia is an abnormal protrusion of internal organs through an abnormal opening in the wall of the cavity.A combination of increased pressure inside the body with weakness in the wall is responsible for this condition.In this condition internal organs or parts of organs are protruded out forming a swelling which will increase the size with coughing and lifting weight,and while passing stool and urine.In lying down position the swelling goes inside except in strangulated and irreducible hernia.
1, Weakness in the body wall:–
a) Congenital weakness.
b) Acquired weakness due to injuries,wasting of muscles,suppurative lesions in the wall and presence of weak natural openings,obesity,lack of exercise,repeated pregnancy.
c) Surgical operation with improper suturing or sepsis of operated site.
2) Increased pressure inside the body.
a) Chronic constipation.
b) Recurrent cough.
c) Weight lifting.
d) Stricture of urethra.
Common sites for hernia:–
Hernia can occure anywhere in the body.However there are some common sites for hernia.Due to the presence of hard bony covering chest wall is normally not affected.Hernia in the lower back is also rare due to spine and back muscles and tough ligaments and sheeths.The common site for hernia is abdominal wall.Compared to other parts the abdominal wall is weak due to the presence of some natural orifices.There are some areas wherein the abdominal muscles are weaker and thin and all these factors make a chance for herniation.The common sites for hernia are following.
a) Inguinal hernia:
Here the abdominal contents protrude through the inguinal canal (passage in the lower abdominal wall just above the inguinal ligament.It is seen on either side).This type is common in males.Initially the swelling comes only while straining and goes back while lying down. Later the large portion of intestine may come out which may not go back easily.
b) Femoral hernia:
This type of hernia is more in females.Here the abdominal contents pass through the femoral canal which is seen just below the junction between the thigh and lower abdominal wall(Inside the femoral triangle).The contents pass downwards and comes out through saphenous opening in the thigh and forms a swelling under the skin.
c) Umbilical hernia:
This is common in children.The umbilicus is the weaker part of the abdomen.The contents of the abdomen may protrude as a bulb like swelling while crying and defecating.
d) Incisional hernia:
These hernias are seen in operated sites. Due to improper suturing or sepsis the operated site becomes weak resulting in hernia.
e) Epigastric hernia:
Here the hearniation occures in the epigastrium. It is a rare type.
f) Lumbar hernia:
Here the hernia appear in the lumbar area on either side of the lumbar spine(in the lumbar triangle).This is also a rare type.
g) Obturator hernia:
This is a rare type of hernia. Here the contents pass through obturator foramen in the pelvic bone.
Complications of hernia:–
If the hernial orifice is narrow the abdominal contents may not go back easily, and later the blood flow to the herniated tissues may be blocked due to constricition.This can cause death of protruded intestine.
2) Intestinal obstruction:
This occures when the whole portion of the intestine is protruded in to the hernial sac. The narrow hernial orifice will block the passage of bowels.
3) Infection and peritonitis:
If there is strangulation with death of a portion of intestine there will be spread of infection to the abdomen resulting in peritonitis.
Treatment of hernia:–
Initial treatment: In the initial stages of hernia the following steps may be useful
1) Use of hernia belt:
Special types of hernia belts are available for each type of heania.This will prevent the protrusion and will reduce pain.
2) Constipation,recurrent cough,urinary obstruction ect should be treated.
3) Fat reduction will increase the strength of abdominal wall.
4) Abdominal exercises to increase the muscle tone.
5) Take plenty of leafy vegetables, fruits and fibrous diet for easy bowel movements.
6) Try other systems like Homoeopathy,Herbal medicine and ect
If no relief by the above steps consult a general surgeon for surgical management.
The following operations are done depending up on the type and nature of hernia.
1) Hertniotomy : In this operation the contents of hernial sac is pushed in to the abdomen and neck of the sac is ligated with transfixion ligature and the sac is cut off.
2) Herniorrhaphy: Here along with herniotomy the posterior wall is repaired.
3) Hernioplasty: This operation is done if herniotomy is not possible due to wide neck of the sac.Here the repair is done with the healp of non absorbable materials like tantalum gauze,polypropylene mesh or stainless steel mesh.