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In order to make a thorough investigation of the iris-signs, it is first necessary to consider which type of sign. We distinguish three kinds of signs in the iris:

1. Unnatural colourings.

2. White, dark and black signs—chiefly as dots, radiating lines or ‘wisps’.

3. Circular signs—called ‘Contraction rings’.

1. The unnatural colourings have their basis in the circulatory fluids of the body. These circulatory fluids (blood and lymph) are affected by external and internal influences, as through medication, or autointoxication, and changes due to uric acid or biliary disturbances. These pathological changes in the lymph are revealed not only by the skin and mucous membranes, but show also in the iris and the sclera, as is evident in jaundice. There are also the deposits in tissues, as may occur in rheumatism and gout.

2. Special attention is given to the white, dark and black signs of the iris which are generally radiating in direction, and which constitute the first consideration in the recognition of disease conditions. White signs may also indicate unnatural substances, as with uric-acid crystalline deposits, arteriosclerosis, etc.

The next signs to investigate are the inflammation-signs. These appear with acute diseases, and either disappear on recovery, or become darker and darker with the transition to the chronic phase, and ultimately change to black signs with the direct loss of tissue-substance in the organs concerned.

White signs mean: Over-stimulation, increased activity, heightened rhythm (e.g. peristaltic), and irritation of the nerve-fibres.

Dark signs mean: Insufficient stimulation, diminished activity, atony, atrophy, loss of substance: the iris shows loss of colour, thus becoming darker, and with the final destruction of nerve fibres and tissue cells ultimately registers as black signs.

When there is destruction of the nerve-plexus of an organ, how is it that neither the connection nor the result is visible in the iris? It is functionless, and hence useless. In the same way, we can find a plausible explanation for the white healing-signs surrounding the black signs in the iris which indicate loss of substance. It suggests that there is increased functional activity in the tissues adjacent to the nerve plexus —exactly the same in the organ as in the iris. Either the healthy fibres assume the functions of the destroyed nerve pathways, or alternatively initiate a reparative activity by laying down new tissue (scar-tissue) and promoting fibrosis.

In the same way, one can explain the traumatic-lesion signs found in the iris—frequently showing a characteristic shape, i.e. according as whether caused by a blunt or pointed object. It then shows not the form of the instrument but the shape of the injury, as for example the

destroyed tissue and nerve cells.

There are also the so-called ‘lacunae’—small or large open spaces in the iris, which are more easily visible, the more plentiful their surroundings of interweaving thick vascular trunks. These (lacunae) lie between the delicate reticular ramifications of the nerve bundles and indicate functional weaknesses. The ramifications also suggest a weakened organism. The ‘lacunae’ usually appear in the iris in large numbers, if present at all.

3. Contraction rings. Circular signs, called Cramp rings (Nerve rings) which appear as shorter or longer segments of arc, are found only in the ciliary zone. These ‘ring-furrows’ are usually lighter or darker than the remainder of the iris and arise in connection with conditions of continued spasm. Considerable difference of opinion exists as to their origin.

Schnabel ascribes to a slackening or spasm of the sphincters or dilators of the ciliary muscles. Thiel believes that through the continuous regular pull of all the dilator fibres, or at least of a sector of the iris-diaphragm, functioning in the same way as the pupillary margin, that concentric arcs would be formed by circular folds.

Now it is surely remarkable that these rings are found only in the ciliary zone, usually in arcs of smaller or greater length, and this is highly suggestive when it is also observed that not more than four such arcs are to be found running parallel. Surely, it must be considered that the

arc-shape makes it fairly improbable that the radiating fibres of the pupillary dilators could form these rings.

With close observation of the ciliary zone in the normal iris we find three concentric interruptions faintly signified. How do these arise? According to the opinion of Frau Pastor Madaus, they arise in the true nerve fibre. Dr. Andogsky states that these enter the iris in radial bundles. Thereafter they immediately lose their radial direction and turn parallel to the ciliary border, thus forming the first ring, and thereafter sending several thick radial branches towards the pupillary margin with a number of smaller branching distributions.

After which, the larger nerve branches which have traversed approximately a third of the distance to the midway of the total width, again turn parallel to the border and conjoin to form arcs—the second ring. From these, radiating branches project to form a new line of arcs close to the iris-wreath: the third ring. We thus have three concentric contracting rings of iris nerves.

If we apply our understanding of the origin of the white and black radial signs to the nerve rings, then it follows that their bright or dark appearance must be related to conditions of

over-stimulation or deficient stimulation. The arc formation of which the individual rings consist readily explains the appearance of partial rings. If we find a region of the body as localised in the iris so marked, we may certainly assume that these rings give definite indication of disturbance in such parts.

Whether such are always associated with painful attacks—spasms—I cannot confirm, since one frequently finds that there is no history of such conditions. From my observations it appears that cramp-like conditions exist in the bodily organs corresponding to the iris region where the nerve rings show an interruption.

In dealing with ‘nerve-rings’ we must also consider the zone in which they are found. If registering in the Blood-zone, then they indicate disturbances of circulation in the large blood vessels and lymph channels. If found in the other zones—muscular, skeletal, skin—then disturbances exist in those tissues.

During the last twenty years, the incidence of these nerve rings has increased ten to fifteen times. I attribute this to the calcium deficiency arising from the bad nutrition of the war years.

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A hot bath is a great help at period time, not only because it keeps us sweet smelling, but because heat eases pain. As in everything else, we are all highly individual in the amount of heat we need. One woman’s hot bath will feel lukewarm to another. In Victorian times women used to be told that they couldn’t take a bath or wash their hair when they had a period, otherwise they’d catch cold and end up with pneumonia. Although we tend to mock such an idea today, it was actually sensible advice at the time it was given. In those days most bathrooms were unheated, hair was long and difficult to dry, and ordinary people’s homes did not have central heating. Now that most of us can keep our homes adequately warm, and dry ourselves and our hair thoroughly and quickly, there’s no reason why we shouldn’t bath as often as we like — providing we have a warm bathroom and the necessary supply of hot water.

A hot water bottle is a cheap form of warmth and there’s nothing to beat its comfort, especially when it can be applied quickly to a localized pain, like the one you feel low down in your abdomen, or in the small of your back. Some women make themselves into a hot water bottle sandwich, with bottles back and front. They find the double source of heat eases a lot of pain away. Many say the heat also helps them to relax. On the other hand there are some who find that direct heat is too exhausting to help them much, more evidence of how different we all are in the things we like and the things we need.

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At any given moment, different parts of the body are at different temperatures. Moreover, normal temperatures vary as much as one or two degrees Centigrade over the course of a day even when a child is healthy. A rectal temperature of 37.7 °C or less, an oral temperature of 37.7°C or below, and an armpit temperature, though the least accurate, of 36.7°C or less are all considered normal.

Despite these variations, all thermometers are marked to indicate 37°C as normal. A rectal thermometer differs from an oral one only in having a more rugged bulb. (The most practical instrument for home use is a stubby bulb thermometer, which can be used to take a child’s temperature in any of the preferred ways.)

For the most reliable readings at any age, the rectal thermometer is recommended, although it takes a little longer for the temperature to register.

No one can accurately estimate the degree of a fever by touch. If your child feels warm or appears ill, you must use a thermometer to register the accurate temperature that you and your doctor need to know in order to treat the child.

Before using the thermometer, shake it down to be certain the mercury column is below 37°C and the bulb is intact. Then spread the child’s buttocks with the thumb and forefinger of one hand so the anal opening is clearly visible. Lubricate the bulb with petroleum jelly and insert it gently into the center of the anus. The child should feel no pain or discomfort. (Only the bulb portion of the thermometer needs to be inserted for the two to three minutes required to obtain an accurate reading.)

To take a baby’s temperature, place the child face down on a solid surface and put the heel of your hand firmly on the lower back. An unwilling toddler can be firmly clasped between your thighs and bent forward over your leg so that you can take the temperature.

Although less reliable, an oral temperature reading is sufficient and can be taken in a child who is old enough to hold the bulb of the thermometer under the tongue with the mouth closed for three minutes. (If the thermometer breaks and the child accidentally swallows the mercury in the thermometer, don’t fret. Thermometers contain elemental mercury, which is a nonpoisonous and harmless form of the metal.)

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Symptom: A surface skin wound that is longer and wider than it is deep

Home care: Wash the wound with soap and water and look carefully for embedded dirt or any other foreign matter.

Stop bleeding by covering the wound with gauze and applying gentle pressure.

If there’s no dirt in the wound, apply a non-stinging antiseptic, cover the abrasion, and keep it covered until completely healed.

If necessary, scrub gently to remove embedded dirt. Liberally apply antibiotic ointment to help keep the scab flexible. Keep the area covered.

Precautions

-    Do not treat at home any abrasion that involves the full thickness of the skin; take the child to the doctor.

-    If dirt is left in an abrasion, it may cause infection or become sealed under the skin.

-    An abrasion on an area such as a joint that is subject to constant movement should be swabbed periodically with ointment to prevent cracking.

-    An abrasion that bleeds evenly over its entire surface requires medical attention.

-    Keep your child’s tetanus immunization up to date.

An abrasion is a shallow break in the skin caused by an injury. Abrasions are distinguished from cuts and lacerations in that they are not as deep as they are long or wide. Abrasions are, certainly, the most common and least dangerous injuries sustained by children. Most abrasions do not involve the loss of full thickness of skin and heal with little or no scarring. However, any embedded dirt, sand or gravel may be permanently sealed under the skin if it’s not removed before the abrasion heals.

Signs and symptoms

Abrasions are easy to identify. As long as the full thickness of the skin has not been injured, the entire surface of the abrasion will bleed unevenly and some large and small areas will not bleed at all. When the surface of an abrasion does not bleed uniformly, it is classified as a first-or second-degree abrasion and can be treated at home. A third-degree abrasion bleeds uniformly over its entire surface and must be seen by a doctor because it could leave a scar.

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Why do some children having insulin get lumps or swellings at the injection spots?

Repeated injections of insulin at the one spot cause the fat at that spot to swell up and cause a lump. Children who develop lumps or swellings have usually done so because they have got a favourite spot which they use all the time, perhaps because it is less painful after repeated injections at one area. Lumps of this sort can be avoided by moving the injection site from leg to leg and to different places each day. If a lump has developed it will disappear again provided no more injections are put into that area. These swellings are sometimes called ‘insulin tumours’ but they are harmless and are not growths or real tumours.

Is there anything wrong with injecting insulin into the swellings at injection sites? They hurt less.

It is better to avoid injection sites that have become swollen, even if they are less painful. If you keep injecting there, the swelling may get larger and become embarrassing. The longer you inject into a lump, the longer it will stay swollen. Sometimes insulin injected into a swelling is absorbed less well, so that you may get erratic diabetic control.

Repeated injections into a swelling can increase the risk of an infection developing there, though this is unlikely.

Why can’t I take a bit more insulin and have sugary things in my diet?

Theoretically it should perhaps be possible to do this, balancing your taste for food with an increased amount of insulin. In practice it often just does not work out and the reason for this is that it is difficult to judge each day when you give your injection how much food you are likely to have that day. Also insulin injected beneath the skin works slowly and evenly over a period of hours and cannot cope with a sudden surge of glucose through the system that would follow something like a big piece of cake or can of ordinary soft drink.

Can young people with diabetes have tablets instead of insulin?

In general, no. Almost all children with diabetes require insulin. Tablets occasionally may be added to assist the action of insulin but can’t be given successfully instead of insulin. Some children, in the first few months of their life with diabetes, do respond to tablets, but no form of tablet treatment available at present is suitable for children in the long run.

What would happen if I did not have my insulin injection one morning?

If you missed having an injection for one day you would obviously develop high blood glucose levels and you might become very thirsty and pass excessive quantities of urine, much the same way as you probably did when you first got ill with diabetes. If you did forget your insulin and you realized this during the day you should consult your doctor at once, as he will probably advise you to have a supplementary dose of quick acting insulin to replace some of the insulin you missed. If you do this no harm will be done. If you do not it may take a few days to get re-stabilized.

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If you’re the kind of guy who has all kinds of extra memory on your computer or even a turbocharger on your riding lawn mower, you may be wondering, what’s the fuss about high blood pressure? Doesn’t higher pressure mean more power? And how in a man’s world could that ever be bad?

For one thing, high blood pressure makes you a prime candidate for a stroke, the third leading killer of men. In fact, the National Stroke Association says that between 40 and 90 percent of all stroke victims had high blood pressure before their strokes. “No question about it, high blood pressure leads the hit list,” says Ralph Sacco, M.D., director of the Northern Manhattan Stroke Study at Columbia-Presbyterian Medical Center in New York City and spokesperson for the National Stroke Association. What’s more, high blood pressure is the leading risk factor for congestive heart failure and has been linked to, among other things, heart disease, kidney disease, and an ominous-sounding problem called brain shrinkage.

If all this sounds fairly negative, you’re starting to get the picture. High blood pressure itself may not put you in a pine box – although about 40,000 Americans die from it each year – but it can sure help you along. “We’re talking about a problem that affects 50 million people,” says Eva Obarzanek, R.D., Ph.D., a research nutritionist at the National Heart, Lung, and Blood

Institute in Washington, D.C. “If we could lower people’s blood pressure, we could cut the number of serious diseases dramatically.”

A peek inside your cardiovascular system shows why.

Think of your heart as one incredibly well-built pump and your arteries, veins, and capillaries as a vast plumbing system of flexible, interconnected tubes carrying blood throughout your body. And when we say vast, we mean it: Stretched length-wise, the vessels of your circulatory system would measure an amazing 60,000 miles. In just one day, the average healthy adult heart pumps the equivalent of 2,100 gallons of blood.

The motor behind that movement is your heartbeat. For purposes of measuring the force your heart exerts, experts divide your heartbeat into two phases. When blood is squeezed out of your heart, that’s called your systolic pressure- the first number in your blood pressure equation. When your heart relaxes and refills with blood, that’s called diastolic pressure, the second number. A reading of 120/80 millimeters of mercury (120 over 80) is considered normal. Experts say that a reading above 140/90 should be of concern. And when your blood pressure is higher than 160/100, it’s definitely a problem, says Dr. Thomas Pickering of the Hypertension Center at New York Hospital.

Here’s where it gets weird. When that pressure rises higher than normal, the ever-protective lining of your arteries, called the endothelium, can’t keep plaque and other bits of blood debris from entering the vessel wall. The result: Before long, plaque starts to build up, clogging your arteries and blood vessels, says Dr. Robert DiBianco of Washington Adventist Hospital.

High blood pressure also strains your heart. Given the right stress- say, running or some other form of aerobic exercise -your heart will grow so that it can pump more blood. Not so when you have high blood pressure. Instead, your heart just gets thicker, which down the road can cause your heart to outgrow its blood supply. And this makes it more susceptible to narrowing of the arteries that supply blood to the heart, Dr. Pickering says.

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Smoking

Cigarette smoking is not only a risk factor for lung and cardiovascular disease. Chronic inflammation of the nasal passages and other components of the upper airway are more likely in smokers, having the same effect as other forms of upper respiratory tract obstruction. Smoking should be regarded as a risk factor for snoring.

Incidence

It wouldn’t be difficult to convince the average lay person that snoring is a common occurrence. We all know someone or have heard stories about someone who snores, but accurate estimates of the incidence of snoring are not easily established. Problems arise when we start asking questions about snoring. For a start, how do you get reliable information from people who sleep by themselves, and how do you classify the ones who snore “sometimes”? Despite these methodological problems, some impressive studies have been reported. A study in Italy involving about 6000 subjects showed that 20% of the selected population was habitual snorers with a further 15% being occasional snorers. A study in Toronto, Canada, collected data on 2629 subjects from a wide variety of ethnic and socioeconomic groups resulting in an overall snoring incidence of 42%. Detailed analysis of these and subsequent studies tells us a great deal about snoring in different age groups and the association with other medical complaints such as obesity, hypertension and heart disease. Several important trends emerge, particularly the higher incidence of snoring in males and the fact that we are more likely to snore as we get older.

Treatment

The demand for a snoring cure is evidenced by a proliferation of commercially available devices which claim to reduce or eliminate the problem. The techniques are various: hypnosis, designer pillows, electronic snore detectors and mouth appliances. Rather than present an evaluation of every one of these devices, it is intended to give an overview of current modes of treatment based on our understanding of the mechanisms of snoring.

Weight control

For the “uncomplicated” snorer, there are several approaches not requiring medical supervision. Overweight snorers, for example, will always be advised to lose weight regardless of other measures taken. Weight loss seems an absurdly simple way to reduce snoring, to the extent that many snoring patients are disappointed, if not offended, by the suggestion that their weight has anything to do with their nocturnal symptoms. Some recent work suggests that loss of weight is effective not merely because fatty impediments to the airway are removed, but because the function of the muscles supporting and controlling the pharyngeal area is improved.

There may well be both structural and functional reasons why weight loss decreases the likelihood of airway collapse during sleep, but regardless of the mechanisms, the importance of weight loss cannot be overemphasized. Weight loss, like alcohol avoidance, can only be achieved with appropriate education of the patient and a degree of self discipline. Unfortunately there are no diets designed specifically to meet the needs of snorers. Weight loss will follow when fewer calories are ingested, which for most people means a reduction in sweet and fatty foods. Consultation with a dietician is strongly recommended.

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First appointment

When you arrive at the clinic, you will be asked a few general questions about your health, and then shown into a cubicle to undress to the waist. It is easier if you wear trousers or a skirt rather than a dress. An X-ray of each of your breasts will then be taken, as described on p. 13. You should tell the radiographer if you are concerned about a lump, as you can be recalled for a clinical examination even if your mammogram does not show any abnormality.

Once both breasts have been X-rayed, you will be able to get dressed again while you wait a few minutes for the films to be developed, and for the radiographer to make sure that they are technically adequate. If you are asked to have a repeat X-ray at this stage, it will be for technical reasons or because a clear picture of the whole area of interest has not been obtained. The radiographer will not have made any medical judgment of your X-rays – only a technical one.

Receiving the results

During the next couple of weeks you and/or your GP should receive one of the following letters.

1    You are likely to receive a letter telling you that the mammogram showed no abnormality and that you will be called again for screening in 3 years time. This may be phrased as ‘no significant abnormality’ to take account of the fact that there is no real ‘normal’ standard as all women’s breasts are different.

2     You may receive a letter asking you to return for another mammogram because your X-rays were technically of poor quality. This may be because you moved slightly while the X-ray was being taken, or the developed film may not show enough of the breast area and armpit.

3     You may receive a letter asking you to return to the clinic for another assessment. This is the case for about 1 woman in 14, and can be because the X-rayed area needs to be examined more closely. Although you are bound to feel concern if this happens, bear in mind that there are numerous changes that occur in the breast tissue with age, some of which are quite normal and some of which may seem abnormal but are harmless.

Of the women who are recalled for further breast screening, 9 out of 10 are found not to have cancer. Most of the breast changes apparent on mammograms are not associated with any form of malignancy. Because of the importance of the early detection of breast cancer for successful treatment, the doctor examining your X-rays will err on the side of caution, and any unusual change in the tissue, or sign of any breast disease, will be examined further.

It may be helpful, while you wait for your second appointment, to make a note of any questions you think of, however trivial they may seem. Any doctor should be happy to explain points which are unclear and to discuss anything you are worried about.

Second appointment

All breast clinics are different, and each will have its own way of doing tests and investigations.

If you are asked to attend a second clinic, more X-rays will probably be taken, possibly from different angles, of one or both breasts. You may then be examined by a doctor, who will feel your breasts for any palpable lump or thickening of the tissue. If the doctor is able to feel anything, you may be given an ultrasound examination, the results of which may be discussed with you by the doctor at this visit or a subsequent one.

A fine needle aspiration biopsy may be done to remove a small sample of cells, or a small piece of tissue may be taken from a suspicious lump in your breast at a separate appointment using a general anesthetic. The cells or tissue sample will have to be examined under a microscope, so another appointment may have to be made for you to receive the results and discuss them with the doctor.

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Scarlet fever

In 1900 scarlet fever was so virulent that three out of every 100 children who caught it died. By 1973 there were only three deaths in 11,000 cases in the UK. Certainly children are better able to withstand the effects of the organism today but scientists are also sure that the organism itself has changed in some way.

Tuberculosis

In 185513 per cent of all deaths were caused by ÒÂ, and once again the young suffered most. ÒÂ is a classical example of a disease falling in the mortality league long before specific cures were available. Less overcrowding, better food, better personal hygiene and sanatorium treatment-all helped to reduce the illness and death from ÒÂ long before the drugs to cure it were discovered. Since the early 1950s, with mass X-rays, drugs and BCG vaccinations, there has been a rapid fall in the number of cases and deaths. New cases today are confined almost entirely to very old men and certain immigrants. But even today when the disease is virtually eradicated it causes the loss of 2.3 million working days a year in the UK. Just think what things were like a century ago!

Poliomyelitis

About thirty years ago polio reached its peak incidence. In 1947, 7,984 cases were recorded and 10 per cent of these died. Between 1952 and 1954 nearly another 1,000 died of the disease and many more were left paralysed. Today there are about 12,000 people in the UK suffering from the after-effects of polio.

The first vaccine was introduced in 1957. The result is that in the years 1972-4 only twenty-two cases of polio were reported in the UK and none died. But because not everywhere in the world has a similar record on this disease it still makes sense to be vaccinated before going abroad to certain countries.

Smallpox

Once the scourge of whole populations, this disease is now officially extinct in the world.

Maternal mortality

We have seen how the outlook has improved for babies and young children but so too has that of mothers during pregnancy and childbirth. A century ago maternal mortality in childbirth was at epidemic proportions, and even as recently as 1935 between forty and forty-five women died for every 10,000 pregnancies. This totalled about 2,500 women every year.

The establishment of the Royal College of Obstetricians and Gynecologists, and the Midwives Act of 1936 helped raise professional standards, and the care of pregnant women and the confinement in hospitals under specialist care has reduced the maternal death figures to one in every 10,000 births. There are suggestions that even this can be improved upon.

The history of preventive medicine, then, is largely that of public health, but now the challenges are different. Certainly we have combated the infectious illnesses to the point where they no longer pose a fraction of the threat they once did, but today we face new threats from degenerative diseases such as cancers, stroke, and heart disease-the big single killer of Western man.

Can modern preventive medicine do tor these diseases what public health so successfully did for the infections? The problems today are fundamentally different. The last century’s illness epidemics were caused by poverty and shortage. This century’s are being caused by wealth and excess. No one much minds giving up poverty and shortage but persuading people to give up ‘the good life’ is much more difficult.

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The benefits of the external use of herbs are greatly under estimated. Our skin is able to absorb the healing properties without having negative side effects on the digestive organs, when strong medicinal herbs or high dosages are used

To stimulate and treat a particular organ such as the stomach, liver or bladder, one can use a folded towel dipped in hot water placed on the area to be treated. Place a rubber water bottle, almost filled with hot water, on the wet towel, then wrap a towel around the body. A blanket to cover the patient is used as protection against cold air. Electric blankets should never be used to maintain the body temperature. Herbal extracts are used in hot compresses to amplify the treatment. This is the most commonly used pack. For treatments you use the same herbal tea as for baths. A cloth is dipped in herbal tea, .and wrung out, then placed on the problem area. A dry towel (bigger than the wet one) is then wrapped around for insulation and as an air barrier. Socks or compresses of wet socks should be linen or cotton, covered with dry woollen socks a bit longer than the wet socks. When applying wet socks or wet compresses one should make sure that all of the body is carefully covered with a blanket as a protection against cold.

You may alter or add to herbal compresses vinegar, Kombucha, clay, urine or only cold, warm or hot water depending on the treatment. You can find more detailed information in the book Water Medicine by Harald Tietze .

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