Medical Glossary

Amenorrhoea an absence of menstruation which is normal before puberty, during pregnancy and while breast-feeding is being carried out and following the menopause. Primary amenorrhoea describes the situation where the menstrual periods do not begin at puberty. This occurs if there is a chromosome abnormality (such as Turner's syndrome) or if some reproductive organs are absent. It can also occur where there is a failure or imbalance in the secretion of hormones. In secondary amenorrhoea, the menstrual periods stop when they would normally be expected to be present. There are a variety of causes including hormone deficiency, disorders of the hypothalamus, psychological and environmental stress-es, during starvation, anorexia nervosa or depression.

Arthritis inflammation of the joints or spine, the symptoms of which are pain and swelling, restriction of movement, redness and warmth of the skin. There are many different causes of arthritis including osteoarthritis, rheumatoid arthritis, tuberculosis and rheumatic fever.

Asthma a condition characterized by breathing difficulties caused by narrowing ofthe airways (bronchi) ofthe lung. It is a distressing condition with breathlessness and a paroxysmal wheezing cough and the extent to which the bronchi narrow varies considerably. Asthma may occur at any age but usually begins in early childhood, and is a hypersensitive response that can be brought on by exposure to a variety of allergens, exercise, stress or infections. An asthma sufferer may have other hypersensitive conditions such as eczema and hay fever, and it may be prevalent within a family. It may or may not be possible for a person to avoid the allergen(s) responsible for an asthma attack. Treatment involves the use of drugs to dilate the airways (bronchodilators) and also inhaled corticosteroids.

Atheroma a degenerative condition of the arteries. The inner and middle coats of the arterial walls become scarred and fatty deposits (cholesterol) are built up at these sites. The blood circulation is impaired and it may lead to such problems as angina pectoris, stroke and heart attack. The condition is associated with the western lifestyle, i.e. lack of exercise, smoking, obesity and too high an intake of animal fats.

Atrophy wasting of a body part due to lack of use, malnutrition or as a result of ageing. The ovaries of women atrophy after the menopause and muscular atrophy accompanies certain diseases.

Boil (or furuncle) a skin infection in a hair follicle or gland that produces inflammation and pus. The infection is often due to the bacterium Staphylococcus, but healing is generally quick upon release of the pus or administration of antibiotics. Frequent occurrence of boils is usually investigated to ensure the patient is not suffering from diabetes mellitus.

Bronchitis occurring in two forms, acute and chronic, bronchitis is the inflammation of the bronchi. Bacteria or viruses cause the acute form that is typified by the symptoms of the common cold initially, but develops with painful coughing, wheezing, throat and chest pains and the production of purulent (pus-containing) mucus. If the infection spreads to the bronchioles (bronchiolitis) the consequences are even more serious as the body is deprived of oxygen. Antibiotics and expectorants can relieve the symptoms.

Chronic bronchitis is identified by an excessive production of mucus and may be due to recurrence of the acute form. It is a common cause of death among the elderly and there are several parameters of direct consequence to its cause: excessive smoking of cigarettes; cold, damp climate; obesity; respiratory infections. Damage to the bronchi and other complications may occur giving rise to constant breathless-ness. Bronchodilator drugs are ineffective in treatment of the chronic form.

Bruises injuries of, and leakage of blood into, the subcutaneous tissues, but without an open wound. In the simplest case minute vessels rupture and blood occupies the skin in the immediate area. A larger injury may be accompanied by swelling. A bruise begins as blue/ black in colour, followed by brown and yellow as the blood pigment is reabsorbed.

Burns burns and scalds show similar symptoms and require similar treatment, the former being caused by dry heat, the latter moist heat. Burns may also be due to electric currents and chemicals. Formerly burns were categorized by degrees (a system developed by Dupuytres, a French surgeon) but are now either superficial, where sufficient tissue remains to ensure skin regrows, or deep where grafting will be necessary.

Severe injuries can prove dangerous because of shock due to fluid loss at the burn. For minor burns and scalds, treatment involves holding the affected area under cold water. In more severe cases antiseptic dressings are normally applied and in very severe cases hospitalization is required. Morphine is usually administered to combat the pain. If the burns exceed nine per cent then a transfusion is required.

Calculus stones formed within the body, particularly in the urinary tract (gravel) or gall bladder (see gallstones). They are formed from mineral salts, e.g. calcium oxalate and they generally cause pain as they may block the ureter or bile ducts. Treatment is by removing or crushing the stone surgically, by drugs and diet (in gallstones a low fat diet eases pain and prevents formation of more stones) and also by the use of herbal remedies.

Cancer a widely-used term describing any form of malignant tumour. Characteristically, there is an uncontrolled and abnormal growth of cancer cells that invade surrounding tissues and destroy them. Cancer cells may spread throughout the body via the blood stream or lymphatic system, a process known as metastasis, and set up secondary growths elsewhere. There are known to be a number of different causes of cancer including cigarette smoking, radiation, ultraviolet light, some viruses and possibly the presence of cancer genes (oncogenes). Treatment depends upon the site of the cancer but involves radiotherapy, chemotherapy and surgery, and survival rates in affected people are showing encouraging improvements.

Chilblain a round, itchy inflammation of the skin that usually occurs on the toes or fingers during cold weather, and is caused by a localized deficiency in the circulation. Chilblains may sometimes be an indication of poor health or inadequate clothing and nutrition. Keeping the feet and hands warm, paying attention to the diet and exercise to improve the circulation help to prevent chilblains.

Cholera an infection of the small intestine caused by the bacterium Vibrio cholerae. It varies in degree from very mild cases to extremely severe illness and death. The disease originated in Asia but spread widely during the nineteenth century when there were great cholera epidemics in Britain and elsewhere. During epidemics of cholera, the death rate is over fifty per cent and these occur in conditions of poor sanitation and overcrowding. The disease is spread through contamination of drinking water by faeces of those affected by the disease, and also by flies landing on infected material and then crawling on food. Epidemics are rare in conditions of good sanitation but when cholera is detected, extreme attention has to be paid to hygiene in1 eluding treatment and scrupulous disposal of the body waste of the infected person. The incubation period for cholera is one to five days and then a person suffers from severe vomiting and diarrhoea (known as "cholera diarrhoea" or "rice water stools"). This results in severe dehydration and death may follow within twenty four hours. Treatment involves bed rest and the taking by mouth of salt solutions, or these may need to be given intravenously. Tetracycline or other sulphonamide drugs are given to kill the bacteria. The death rate is low (five per cent) in those given proper and prompt treatment but the risk is greater in children and the elderly. Vaccination against cholera can be given but it is only effective for about six months.

Chorea a disorder of the nervous system characterized by the involuntary, jerky movements of the muscles mainly of the face, shoulders and hips. Sydenham's chorea or St. Vitus' dance is a disease that mainly affects children and is associated with acute rheumatism. About one third of affected children develop rheumatism elsewhere in the body, often involving the heart, and the disease is more common in girls than in boys. If the heart is affected there may be problems in later life but treatment consists of rest and the giving of mild sedatives. The condition usually recovers over a period of a few months. Huntington's chorea is an inherited condition that does not appear until after the age of forty and is accompanied by dementia. Senile chorea afflicts some elderly people but there is no dementia.

Cirrhosis a disease of the liver in which fibrous tissue resembling scar tissue is produced as a result of damage and death to the cells. The liver becomes yellow-coloured and nodular in appearance, and there are various types of the disease including alcoholic cirrhosis and postnecrotic cirrhosis caused by viral hepatitis. The cause of the cirrhosis is not always found (cryptogenic cirrhosis) but the progress of the condition can be halted if this can be identified and removed. This particularly is applicable in alcoholic cirrhosis where the consumption of alcohol has to cease.

Cold (common cold) widespread and mild infection of the upper respiratory tract caused by a virus. There is inflammation of the mucous membranes and symptoms include feverish-ness, coughing, sneezing, runny nose, sore throat, headache and sometimes face ache due to catarrh in the sinuses. The disease is spread by coughing and sneezing and treatment is by means of bed rest and the taking of mild analgesics.

Conjunctivitis inflammation of the mucous membrane (conjunctiva) that lines the inside of the eyelid and covers the front of the eye. The eyes become pink and watery and the condition is usually caused by an infection that may be bacterial, viral or the micro-organism Chlamydia may be responsible. Treatment depends upon cause but a number of drugs are used often in the form of eyedrops.

Constipation the condition in which the bowels are opened too infrequently and the faeces become dry, hard and difficult and painful to pass. The frequency of normal bowel opening varies between people but when constipation becomes a problem, it is usually a result of inattention to this habit or to the diet. To correct the condition a change of lifestyle may be needed including taking more exercise, fluid and roughage in the diet, laxatives and enemas are also used to alleviate the condition. Constipation is also a symptom of the more serious condition of blockage of the bowel (by a tumour), but this is less common. Convulsions also known as fits, these are involuntary, alternate, rapid, muscular contractions and relaxations throwing the body and limbs into contortions. They are caused by a disturbance of brain function and in adults usually result from epilepsy. In babies and young children they occur quite commonly but, although alarming, are generally not serious. Causes include a high fever due to infection, brain diseases such as meningitis and breath-holding, that is quite common in infants and very young children. Convulsions are thought to be more common in the very young because the nervous system is immature. Unless they are caused by the presence of disease or infection that requires to be treated, they are rarely life-threatening.

Cramp prolonged and painful spasmodic muscular contraction that often occurs in the limbs but can affect certain internal organs. Cramp may result from a salt imbalance as in heat cramp. Working in high temperatures causes excessive sweating and consequent loss of salt. It can be corrected and prevented by an increase of the salt intake. Occupational cramp results from continual repetitive use of particular muscles, e.g. writer's cramp. Night cramp occurs during sleep and is especially common among elderly people, diabetics and pregnant women. The cause is not known.

Croup a group of diseases characterized by a swelling, partial obstruction and inflammation of the entrance to the larynx, occurring in young children. The breathing is harsh and strained producing a typical crowing sound, accompanied by coughing and feverishness. Diphtheria used to be the most common cause of croup but it now usually results from a viral infection of the respiratory tract (laryngo-tracheo bronchitis). The condition is relieved by inhaling steam and also by mild sedatives and/or pain killers. Rarely, the obstruction becomes dangerous and completely blocks the larynx in which case emergency tracheostomy or nasotracheal intubation may be required. Usually, the symptoms of croup subside and the child recovers, but then he or she may have a tendency towards attacks on future occasions.

Delirium a mental disorder typified by confusion, agitation, fear, anxiety, illusions and sometimes hallucinations. The causal cerebral disfunction may be due to deficient nutrition, stress, toxic poisoning or mental shock.

Depression a mental state of extreme sadness dominated by pessimism and in which normal behaviour patterns (sleep, appetite, etc.) are disturbed. Causes are varied: upsetting events, loss, etc. and treatment involves the use of therapy and drugs.

Diarrhoea increased frequency and looseness of bowel movement, involving the passage of unusually soft faeces. Diarrhoea can be caused by food poisoning, colitis, irritable bowel syndrome, dysentery, etc. A severe case will result in the loss of water and salts that must be replaced and anti-diarrhoeal drugs are used in certain circumstances.

Diphtheria a serious, infectious disease caused by the bacterium Corynebacterium diphthe-riae, and commonest in children. The infection causes a membranous lining on the throat that can interfere with breathing and eating. The toxin produced by the bacterium damages heart tissue and the central nervous system and it can be fatal if not treated. The infection is countered by injection of the antitoxin with penicillin or erythromycin taken to kill the bacterium. Diphtheria can be immunized against.

Dropsy old-fashioned name for oedema.

Dysentery an infection and ulceration of the lower part of the bowels that causes severe diarrhoea with the passage of mucus and blood. There are two forms of dysentery caused by different organisms. Amoebic dysentery is due to Entamoeba histolytica that is spread via infected food or water and occurs mainly in the tropics and sub-tropics. The appearance of symptoms may be delayed but in addition to diarrhoea there is indigestion, anaemia and weight loss. Drugs are used in treatment. Bacillary dysentery is caused by the bacterium Shigella and spreads by contact with a carrier or contaminated food. Symptoms appear from one to six days after infection and include diarrhoea, cramp, nausea, fever and the severity of the attack varies. Antibiotics may be given to kill the bacteria but recovery usually occurs within one to two weeks.

Dysmenorrhoea painful menstruation. There are two main types, primary and secondary. Primary or spasmodic dysmenorrhoea is extremely common, but is normally mild and short-lived in duration. In a small proportion of women, the pain is severe enough to cause partial or total debility. The pain generally occurs in the lower abdomen or back and is cramping, often coming in waves that is due to uterine contractions. It is associated with dizziness, nausea, vomiting, headache, fainting and pale complexion with obvious distress. Secondary or congestive dysmenorrhoea is pain with a congested ache and cramps in the lower abdomen. It is generally due to specific pelvic conditions, e.g. chronic pelvic infection, endometriosis, fibroid tumours and the presence of an interuterine contraceptive device (IUCD).

Eczema an inflammation of the skin that causes itching, a red rash and often small blisters that weep and become encrusted. This may be followed by the skin thickening and then peeling off in scales. There are several types of eczema, atopic being one of the most common. (Atopic is the hereditary tendency to form allergic reactions due to an antibody in the skin). A form of atopic eczema is infantile eczema that starts at three or four months and it is often the case that eczema, hay fever and asthma is found in the family history. However, many children improve markedly as they approach the age of ten or eleven. The treatment for such conditions usually involves the use of hydrocortisone and other steroid creams and ointments.

Epilepsy a neurological disorder involving convulsions, seizures and loss of consciousness. There are many possible causes or associations of epilepsy, including cerebral trauma, brain tumour, cerebral haemorrhage and metabolic imbalances as in hypoglycaemia. Usually an epileptic attack occurs without warning, with complete unconsciousness and some muscle contraction and spasms. Some drugs are used in treatment although little can be done during the fit itself.

Erysipelas an infectious disease, caused by Streptococcus pyogenes. It produces an inflammation of the skin with associated redness. Large areas of the body may be affected and other symptoms may include vesicles, fever and pain with a feeling of heat and a tingling sensation. In addition to being isolated, patients are given penicillin.

Fistula an abnormal opening between two hollow organs or between such an organ or gland and the exterior. These may arise during development so that a baby may be born with a fistula. Alternatively, they can be produced by injury, infection or as a complication following surgery. A common example is an anal fistula, that may develop if an abscess present in the rectum bursts and produces a communication through the surface of the skin. An operation is normally required to correct a fistula, but healing is further complicated in the case of an anal fistula because of the passage of waste material through the bowels.

Gallstones stones of vaiying composition, that form in the gall bladder. Their formation seems to be due to a change in bile composition rendering cholesterol less soluble. Stones may also form around a foreign body. There are three types of stone cholesterol, pigment and mixed, the latter being the most common. Calcium salts are usually found in varying proportions. Although gallstones may be present for years without symptoms, they can cause severe pain and may pass into the common bile duct to cause, by the resulting obstruction, jaundice.

Gleet discharge due to chronic gonorrhoea.

Gonorrhoea the most common venereal disease that is spread primarily by sexual intercourse but may be contracted through contact with infected discharge on clothing, towels, etc. The causative agent is the bacterium Neisseria gonorrhoeae and it affects the mucous membrane of the vagina, or in the male, the urethra. Symptoms develop approximately one week after infection and include pain on urinating with a discharge of pus. Inflammation of nearby organs may occur (testicle, prostate in men; uterus, Fallopian tubes and ovaries in women) and prolonged inflammation of the urethra may lead to formation of fibrous tissue causing stricture. Joints may also be affected and later complications include endocarditis, arthritis and conjunctivitis.

If a baby is born to a woman with the disease, the baby's eyes may become infected, until recently a major cause of blindness (called Ophthalmia neonatorum).Treatment is usually very effective through the administration of penicillin, sulphonamides or tetracycline.

Gout a disorder caused by an imbalance of uric acid in the body. Uric acid is normally excreted by the kidneys but sufferers of gout have an excess in their bloodstream that is deposited in joints as salts (urates) of the acid. This causes inflammation of the affected joints and painful gouty arthritis with destruction of the joints. The kidneys may also be damaged, with formation of stones. Deposits of the salts (called tophi) may reach the stage where they prohibit further use of the joints, causing hands and feet to be set in a particular position. Treatment of gout is through drugs that increase the excre-tion of the urate salts or slow their formation.

Gravel this name refers to small stones formed in the urinary tract. They normally are made up of calcareous material and crystalline matter and passage of stones from the kidneys is normally linked to severe pain and, possibly, the presence of blood in the urine.

Haemorrhoids (piles) varicose and inflamed veins around the lower end of the bowel situated in the wall of the anus. They are classified as internal, external and mixed depending upon whether they appear beyond the anus. They are commonly caused by constipation or diarrhoea, especially in middle and older age, and may be exacerbated by a sedentary life style. They may also occur as a result of childbearing. Symptoms of haemorrhoids are bleeding and pain, and treatment is by means of creams, injections and suppositories. Attention to diet (to treat constipation) and regular exercise are important, but in severe cases, surgery to remove the haemorrhoids may be necessary.

Hysteria a type of neurosis that is difficult to define and in which a range of symptoms may occur. These include paralysis, seizures and spasms of limbs, swelling of joints, mental disorders and amnesia. The person is vulnerable to suggestion. Two types are recognized, conversion hysteria that is characterized by physical symptoms and dissociative hysteria in which marked mental changes occur. Mass hysteria affects a group, especially those gathered together under conditions of emotional excitement. A number of people may suffer from giddiness, vomiting and fainting that runs through the whole crowd. Recovery occurs when those affected are separated from the others under calmer conditions. Treatment for hysteria is by means of psychotherapy, involving suggestion.

Influenza a highly infectious disease caused by virus that affects the respiratory tract. Symptoms include headache, weakness and fever, appetite loss and general aches and pains. Sometimes there is the complication of a lung infection that requires immediate treatment. There are three main strains of influenza virus, designated A, B and C. The viruses quickly produce new strains which is why an attack of one is unlikely to provide protection against a later bout of the disease. Epidemics occur periodically and in Britain virus A is responsible for the majority of outbreaks.

Jaundice a condition characterized by the unusual presence of bile pigment (bilirubin) in the blood. The bile produced in the liver passes into the blood instead of the intestines and because of this there is a yellowing of the skin and the whites of the eyes.

There are several types of jaundice: obstructive due to bile not reaching the intestine due to an obstruction e.g. a gallstone; haemolytic where red blood cells are destroyed by haemolysis; hepatocellular due to a liver disease such as hepatitis which results in the liver being unable to use the bilirubin. Neonatal jaundice is quite common in newborn infants when the liver is physiologically immature but it usually lasts only a few days. The infant can be exposed to blue light that converts bilirubin to biliverdin, another (harmless) bile pigment.

Laryngitis inflammation of the mucous membrane that lines the larynx and vocal cords. It is due to viral infection in the main, but also bacteria, chemical irritants, heavy smoking or excessive use of the voice. Acute laryngitis accompanies infections of the upper respiratory tract and the symptoms include pain, a cough, difficulty in swallowing. Chronic laryngitis may be due to recurrence of the acute form, but is often attributable to excessive smoking worsened by alcohol. Changes occurring in the vocal cords are more permanent and the symptoms are as for the acute form, but longer lasting.

Leucorrhea a discharge of white or yellow-coloured mucus from the vagina. It may be a normal condition, increasing before and after menstruation but a large discharge probably indicates an infection somewhere in the genital tract. A common cause is the infection called thrush but it may also be due to gonorrhoea in which case the treatment will differ.

Malaria an infectious disease caused by the presence of minute parasitic organisms of the genus Plasmodium in the blood. The disease is characterized by recurrent bouts of fever and anaemia, the interval between the attacks depending upon the species. The parasite is transmitted to man by the Anopheles mosquito, (common in sub-tropical and tropical regions) being present in the salivary glands and passed into the bloodstream of a person when the insect bites. Similarly, the parasite is ingested by the mosquito when it takes a blood meal from an infected person. Efforts to control malaria have centred on destruction of the mosquito and its breeding sites. Once injected into the blood, the organisms concentrate in the liver where they multiply and then re-enter the bloodstream destroying red blood cells. This releases the parasites causing shivering, fever, sweating and anaemia. The process is then repeated, with hours or days between attacks. Drugs are used both to prevent infection, although these may not be totally effective, and to cure the disease once present.

Nephritis inflammation of the kidney, that may be due to one of several causes. Types of nephritis include glomerulonephritis (when the glomerulus is affected), acute nephritis, hereditary nephritis, etc.

Neuralgia strictly, pain in some part or the whole of a nerve (without any physical change in the nerve) but used more widely to encompass pain following the course of a nerve or its branches, whatever the cause. Neuralgia often occurs at the same time each day and is frequently an agonizing pain. It occurs in several forms and is named accordingly, e.g. sciatica, trigeminal neuralgia (affecting the face) and intercostal neuralgia (affecting the ribs). Treatment often involves the application of ointments, and the taking ofpain-killing drugs. If such treatments do not bring relief, it is possible to freeze the nerve or destroy part of it by surgery.

Oedema an accumulation of fluid in the body, possibly beneath the skin or in cavities or organs. With an injury the swelling may be localized or more general as in cases of kidney or heart failure. Fluid can collect in the chest cavity, abdomen or lung (pulmonary oedema). The causes are numerous, e.g. cirrhosis of the liver, heart or kidney failure, starvation, acute nephritis, allergies or drugs. To alleviate the symptom, the root cause has to be removed. Subcutaneous oedema commonly occurs in women before menstruation, as swollen legs or ankles, but does subside if the legs are rested in a raised position.

Palsy the term used formerly for paralysis and retained for the names of some conditions.
Pleurisy (or pleuritis) inflammation of the pleura resulting in pain from deep breathing, and resulting shortness of breath. There is a typical frictional rub heard through a stethoscope. Pleurisy is often due to pneumonia in the adjacent lung and is always associated with disease in the lung, diaphragm, chest wall or abdomen e.g. tuberculosis, abscesses, bronchial carcinoma, etc.

Pneumonia a bacterial infection of the lungs resulting in inflammation and filling of the alveoli with pus and fluid. As a result the lung becomes solid and air cannot enter. The symptoms vary depending upon how much of the lung is unavailable for respiration, but commonly there will be chest pain, coughing, breathlessness, fever and possibly cyanosis. Pneumonia may be caused by several bacteria, viruses or fungi, but bacterial infection is commonest. Bronchopneumonia affects the bronchi and bronchioles; lobar pneumonia the whole lobes of the lung(s). Antibiotic treatment is usually effective although it helps to know which is the infecting organism, to provide the most specific treatment.

Prolapse a moving down of an organ or tissue from its normal position due to the supporting tissues weakening. This may happen to the lower end of the bowel (in children) or the uterus and vagina in women who have sustained some sort of injury during childbirth. In the latter case prolapse may result in the uterus itself showing on the outside. Surgery can shorten the supporting ligaments and narrow the vaginal opening.

Psoriasis a chronic skin disease for which the cause is unknown and the treatment is palliative. The affected skin appears as itchy, scaly red areas, starting usually around the elbows and knees. It often runs in families and may be associated with anxiety, commencing usually in childhood or adolescence. Treatment involves the use of ointments and creams Rheumatism a general term used to describe aches and pains in joints and muscles.

Rickets a disease affecting children that involves a deficiency of vitamin D. Vitamin D can be manufactured in the skin in the presence of sunlight but dietary sources are important especially where sunlight is lacking. The disease is characterized by soft bones that bend out of shape and cause deformities.

Bones are hardened by the deposition of calcium salts and this cannot happen in the absence of vitamin D. Treatment consists of giving vitamin D, usually in the form of calciferol, and ensuring that there is an adequate amount in the child's future diet. Vitamin D deficiency in adults causes the condition called osteomalacia.

Scarlet Fever an infectious disease, mainly of childhood, caused by the bacterium Streptococcus. Symptoms show after a few days and include sickness, sore throat, fever and a scarlet rash that may be widespread. Antibiotics are effective and also prevent any complications e.g. inflammation of the kidneys.

Sciatica pain in the sciatic nerve, and therefore felt in the back of the thigh, leg and foot. The commonest cause is a prolapsed intervertebral disc pressing on a nerve root, but it may also be due to ankylosing spondylitis and other conditions.

Scurvy a deficiency disease caused by a lack of vitamin C (ascorbic acid) due to a dietary lack of fruit and vegetables. Symptoms begin with swollen, bleeding gums and then subcutaneous bleeding, bleeding into joints, ulcers, anaemia and then fainting, diarrhoea and trouble with major organs. Untreated, it is fatal, but nowadays it is easily prevented, or cured should it arise, through correct diet or administration of the vitamin.

Smallpox a highly infectious viral disease that has nonetheless been eradicated. Infection results, after about two weeks, in a high fever, head and body aches and vomiting. Eventually red spots appear that change to water and then pus-filled vesicles that on drying out leave scars. The person stays infectious until all scabs are shed. Fever often returns, with delirium. Recovery is usual, but complications often ensue, e.g. pneumonia. The last naturally-occurring case was in 1977.

Stone another name for calculus.

strangury the desire to pass water, that can only be done in a few drops and with accompanying pain. It is symptomatic of an irritation of the base of the bladder by a stone, cancer at this site, or cystitis or prostatitis. syphilis an infectious, sexually-transmitted disease, caused by the bacterium Treponema pallidum that shows symptoms in three stages. Bacteria enter the body through mucous membranes during sexual intercourse and an ulcer appears in the first instance. Within a short time the lymph nodes locally and then all over the body enlarge and harden and this lasts several weeks.

Secondary symptoms appear about two months after infection and include fever, pains, enlarged lymph nodes and a faint rash that is usually noticed on the chest. The bacterium is found in enormous numbers in the primary sores and any skin lesions of the secondary stage. The final stage may not appear until many months or years after infection and comprises the formation of numerous tumourlike masses throughout the body (in skin, muscle, bone, brain, spinal cord and other organs such as the liver, stomach., etc.). This stage can cause serious damage to the heart, brain or spinal cord resulting in blindness, tabes dorsalis, and mental disability. Congenital syphilis is much rarer than the former, acquired, type. It is contracted by a developing foetus from the mother, across the placenta and symptoms show a few weeks after birth. Treatment of syphilis is with penicillin, but it should be administered early in the development of the disease.

Torpor a state of physical and mental sluggishness that accompanies various mental disorders, some kinds of poisoning and may be present in elderly people with arterial disease.

Tuberculosis a group of infections caused by the bacillus (bacterium) Mycobacterium tuberculosis of which pulmonary tuberculosis of the lungs (consumption or phthisis) is the best known form. The pulmonary disease is acquired through inhalation of air containing the organism from an infected person, or dust laden with bacteria. People infected in this way can show no symptoms but still be carriers. In the lungs, the infection causes formation of a primary tubercle that spreads to lymph nodes to form the primary complex.

The disease may wax and wane for years as the body's natural immune system acts against the infection. If the infection is severe, symptoms include fever, wasting, night sweats and the coughing up of blood. The bacteria may enter the blood stream and spread throughout the body setting up numerous tubercles in other tissues {Miliary tuberculosis). The organism may also be acquired by eating contaminated food, especially milk, in which case the production of a primary complex in abdominal lymph nodes can lead to peritonitis. Rarely, the infection is acquired via a cut from contact with an infected person or animal. Tuberculosis affects people throughout the world (about six thousand new cases each year in England and Wales). Many people acquire the infection and recover without suspecting its presence and the disease is curable with antibiotics, e.g. streptomycin. In addition, BCG vaccination as a preventive measure is given to children in the U.K., in addition to X-ray screening to detect carriers.

ulcer a break on the skin surface or on the mucous membrane lining within the body cavities that may be inflamed and fails to heal. Ulcers of the skin include bedsores and varicose ulcers (that are caused by defective circulation). Ulcers of the alimentary tract include duodenal ulcers, gastric ulcers and peptic ulcers. varicose veins veins that have become stretched, distended and twisted. The superficial veins in the legs are often affected although it may occur elsewhere. Causes include congenitally defective valves, obesity, pregnancy and also thrombophlebitis (inflammation of the wall of a vein with secondary thrombosis in the affected part of the vein). Elastic support is a common treatment although alternatives are sclerotherapy and phlebectomy.

Whooping Cough (pertussis) an infectious disease caused by the bacterium Bordetella pertussis. The mucous membranes lining the air passages are affected and after a one to two week incubation period, fever, catarrh and a cough develop. The cough then becomes paroxysmal with a number of short coughs punctuated with the 'whooping' drawing in of breath. Nosebleeds and vomiting may follow a paroxysm. After about two weeks the symptoms abate but a cough may continue for some weeks. Whooping cough is not usually serious and immunization reduces the severity of an attack. However, a child may be susceptible to pneumonia and tuberculosis during the disease.