I was completely immobile last week – constant fevers, aches, even a bit delirious, and this week I came back to work even though on Monday and Tuesday especially I was still suffering – I was managing through the day then getting home and having fevers and totally uncomfortable sleepless nights still.

I got desperate and was looking for any natural therapies on the internet that could help me and stumbled accross a wonderful Hydrotherapy technique: Warming Socks.

Basically you make sure your feet are really warm, then you soak a normal pair of socks in cold water, ring them out well and put them on, then immediately put some thicker woollen socks over them and go to bed. The water almost immediately turns your body temperature and in the morning the socks are completely dry.

I’ve been doing it for the last couple of nights (the ritual of wrapping your little feet up before bed is very comforting too!) and have had lovely calm, rested sleep. I was on the mend anyway, but I do think they helped.

And it’s just a lovely free naturopathic technique.

The RLHH has been part of the Health Service for 150 years. It provides 40,000 homeopathic appointments per year for patients who would otherwise have no access to homeopathic treatment. In 2005, 67% of GPs and 85% of practices in it’s Primary Care Trust, referred patients to the hospital. The hospital provides effective and most importantly, COST-EFFECTIVE treatments.

We ask for an investigation into why the PCTs in Brent, Hammersmith and Fulham, Harrow, Hillingdon, Islington and Kensington and Chelsea have cancelled their contracts with the hospital or plan to cancel them this year. It is our concern that these cancelled contracts and directives from PCTs to stop referrals to the RLHH, must result in a perceived lowered patient demand, and that this self-fulfilling prophecy will then be used as the rationale for the hospital’s closure. Furthermore we assert these cancellations make no sense whatsoever if cost-effectiveness is a yardstick by which treatments are to be measured.

SIGN THE PETITION TODAY >>

http://petitions.pm.gov.uk/SavetheRLHH/

New evidence correlates short-term recovery of brain structure, metabolism, and function in abstinent alcoholics.

Bartsch and colleagues used automated structural brain imaging, proton MR spectroscopy, and neuropsychological testing to assess whether abstinence in alcoholics leads to brain repair. Within a few days after alcohol withdrawal and 6 to 7 weeks later, they evaluated 15 patients with DSM-IV defined primary alcohol dependence. A group of 10 normal subjects served as controls. Notably, the alcoholics did not smoke heavily, and none required medication to treat symptoms of alcohol withdrawal.

From the first to the second evaluation, alcoholics exhibited a nearly 2% increase in total brain volume (compared with no change among controls), with region-specific increases in the superior cerebellar vermis, the perimesencephalic and periventricular regions, and the frontomesial and fronto-orbital edges. Increased brain volume correlated significantly with increases in cerebellar and frontomesial levels of choline, but not with N-acetylaspartate (NAA) levels. In contrast, improved performance on a test of attention was significantly associated with increases in frontomesial NAA levels. Measures of brain water levels did not change over time.

Comment: Although longitudinal studies have demonstrated short-term recovery of brain structure, metabolism, and function in abstinent alcoholics, this is the first to combine all three measures. The metabolic data suggest that increases in brain volume were due to white matter repair rather than to increases in brain hydration. The patient population may have had a less severe form of alcoholism than is typical, because detoxification was not associated with significant symptoms of withdrawal and metabolic measures did not differ at baseline from those in the control population. This study adds to a growing body of evidence that the brain undergoes significant repair during abstinence, particularly in less severe forms of alcoholism. It is noteworthy that volume increases were observed in several brain areas that are selectively affected in Wernicke encephalopathy, a disorder of thiamine deficiency that occurs most commonly in alcoholics. Hence, it remains possible that improved nutrition as well as sobriety contributes to brain repair following abstinence.

Michael E. Charness, MD

Dr. Charness is Professor of Neurology, Harvard Medical School; Associate Chief, Department of Neurology, Brigham and Women’s Hospital; and Chief of Staff, Veterans Affairs Boston Healthcare System.

Published in Journal Watch Neurology March 20, 2007

Citation(s):

Bartsch AJ et al. Manifestations of early brain recovery associated with abstinence from alcoholism. Brain 2007 Jan; 130:36-47.

• [Original article] (Subscription may be required)
• [Medline abstract] (Free)

= largest serous membrane of the body
(torso, map)
= Closed sac containing serous fluid
(serous fluid = watery fluid)

Supplied with many blood and lymph vessels

Barrier to local spread of infection

parietal layer: lines a cavity
visceral layer: surrounds organs

The organs are invaginated into the closed sac being at least partly covered
Greater ormentum

= fold enclosing the stomach.
It hangs in front like an apron
It stores fat

Middle layer: Muscle layer

Smooth, involuntary muscles

2 layers:
Circular muscle layer
Longitudinal muscle layer

In between:
Blood vessels, lymph vessels, a plexus
Myenteric or Auerbach’s plexus

= Network of sympathetic and
parasympathetic nerves

Movement

Contraction and relaxation in waves
= peristalsis

Moves food forward and mixes the food
Sphincters control movement

Sphincters

= increased numbers of circular muscle fibres

Act also as valves to prevent reflux

Submucosa

Connective tissue containing blood vessels, lymph vessels and nerves

Mucosa

mucous membrane
lamina propria
muscularis mucosa

Mucous membrane
In the intestinal tract: Columnar epithelial cells with mucus secreting goblet cells

Mucus lubricates and protects from digestive juices

Lamia propria
= Conncetive tissue with lymph tissue

Blood supply

The digestive organs are supplied form branches of the aorta.

Venous drainage

The portal vein drains the blood from the lower part of the oesophagus, the stomach, pancreas, small intestine, large intestine and part of the rectum.

Blood from the lower part of the rectum and the anal canal drains directly into the
iliac veins

Digestion: Mechanical and chemical conversion of food
into absorbable substances

Absorption: Substances passing through the walls in
the alimentary canal into the blood and
lymph stream.

Assimilation: Incorporation of nutritive material
into living tissue

Egestion (=elimination): Discharge of not absorbed
substances

Mouth
pharynx
oesophagus
stomach
small intestine
large intestine
rectum
anal canal

The digestive system

alimentary tract
accessory organs
digestive process

Accessory organs

3 pairs of salivary glands
pancreas
liver
biliary tract

Click here for a pdf of my study into Peptic Ulcers for my Semester I Assignment, March 2007.

“Sprains” – joints have a ligamentous binding system, much tougher than muscles. Ligaments prevent the joints from moving outside their natural physiological ranges. However, sometimes, trauma can force a joint beyond this natural range, and a ligament/s might become stretched or torn. This then leads to a natural instability of the joint in a particular axis of movement. E.g: Anterior cruciate ligament – remember D. Beckham.

Dislocation/Subluxations
When a joint surface actually becomes partially or fully separated from its neighbour, we consider it subluxed or even dislocated.
3 grades of subluxation, then dislocation; e.g. S/C joint, Shoulder joint

Cartilage damage
A common example of this is a torn articular disc in the knee (aka meniscus). Damaged cartilage has a terrible blood supply, and often requires removal by surgery. i.e. arthroscopy (key-hole surgery).

Joint swelling
Immediate swelling can be due to rupture of local blood vessels around a joint (especially knee and ankle).
A gradual swelling, post-trauma, could be due to an irritated synovial capsule. Excessive production of synovial fluid is often referred to as “water on the knee”.

Bursitis
Inflammation of the cushioning fatty sac/s that occur in the joints. Might be due to sudden shock trauma, infection or wear and tear.

Spinal Curves and Deformities

The typical spine has 4 curves, considered in a sagittal plane (front to back). When put together, the spine can be thought of as a flexible spring-like mechanism, enabling effective shock absorption and force distribution.

Considering the spine from a coronal view (plane from side to side), one can very often observe another form of curve. This might look like a gentle, single curve (‘C’ shaped), or multiple curves (‘S’ shaped). A curve in this plane is called a Scoliosis. This occurs naturally due to the imbalance of our everyday lives – e.g. right handed / wearing rucksack on one shoulder / leg length difference. When these curves become extreme, they can lead to various complaints, including back ache and “trapped nerves”.

Cervical and Lumbar Disc Lesions

The spine contains 24 shock absorbing and separating discs.
These “Intervertebral Discs” bind the bodies of the vertebrae together, and provide cushioning for all spinal movement.
The discs have two elements:
Annulus fibrosus
Nucleus pulposus

Degrees of damage:

annular tear

disc prolapse (see above diagram)

disc herniation

When a disc bulges far enough out of its normal place, it may press on a nerve leading to pain and spasm,
This, if prolonged, can badly damage a nerve’s function ® neurological problems ensue e.g. sciatica.
With age, the toothpaste like fluid in the nucleus dries up. Hence, there is less danger of discal damage, as we get older.

Cauda Equina Syndrome

This very important and serious pathology occurs when a discal bulge or herniation becomes too large, below the level at which the spinal cord stops at L2/3, although there is the potential for similar problems to occur anywhere below T10. The nerves which spread out below this level supply much of the control for the abdominal and pelvic organs and lower extremeties.

Red flag symptoms include:

Severe bilateral leg pain
Weakness and paralysis of both legs
Saddle anaesthesia (numbness)
Urine retention

If any combination of these factors comes to light in a case history, it is important that the patient is referred immediately to hospital for an emergency MRI scan. They could be sitting on a paralysis timebomb!
Bone Pathologies

Osteoporosis – meaning “porous bone”

An animation about Osteoporosis can be seen here.

Thinning of bone from loss of mineral content, although bony architecture is retained.
After the age of 30, the body’s ability to retain calcium diminishes, while excretion rates remain the same. This reduction is because of the demand for minerals for bony remodeling
When bones reach critical thinness, fractures occur, either spontaneously or with minor trauma
The most important factor is ↓ oestrogen at the menopause (oestrogen suppresses bone resorption and improves calcium uptake in the gut).
Osteoporosis it the most common bone disease in older Caucasian women of northern European descent, who have inadequate dietary calcium and who lead sedentary lifestyles.

Risk factors include:
Smoking
High alcohol consumption
Poor diet
Sedentary lifestyle
Family history
Long term steroid use
Endocrine problems – e.g. inability to produce oestrogen

· Clues to Diagnosis:
Ø Pain is usually severe and localized to site of fracture
Ø Aggravated by increased sitting, standing or bending
Ø Relieved by lying on side with hips and knees flexed
Ø Rib or spinal deformities (e.g. scoliosis)
Ø Loss of height due to vertebral crumpling and fracture

Osteomalacia or “Rickets” in children

· This is a softening of bones due to failed mineralization in the bone matrix
· Caused by Vitamin D deficiency in adults
· This might be due to:
↓ ultraviolet rays
↓Vitamin D diet
Failure to absorb in gut
↓ receptor sites for the vitamin in the tissues

· Characterised by decalcification of bone, especially the spine, pelvis and Lower Extremities
· Bones bend, become flattened or otherwise deformed

· Signs and Symptoms include:
Severe back pain
Severe muscle weakness
Fracture

Paget’s Disease

A focal inflammatory condition of the skeleton, that produces disordered bone remodeling
New bone is larger, less compact, more vascular and more susceptible to fracture
M:W – 3:2
Most commonly seen in people under the age of 70
Cause is unknown, with possible genetic involvement
Signs and symptoms vary from person to person. Some have mild to no pain. Others have disabling pain and bones that are easily deformed and fracture.
Typically, the weight bearing bones and ribs are most affected
Pain is “aching, deep, boring, worse at night, and eases with activity”
Can potentially cause spinal stenosis, or a range of other neurological symptoms due to nerve compression
Predisposes sufferer to Fracture, Osteoarthritis and Osteosarcomas

Osteomyelitis

A bone infection, most often affecting first and second lumbar vertebrae, or growing regions of long bones of children.
Many causative factors:
diabetes
injection drug users
alcoholics
Immune–suppressed people.
· Bacterial infection (Staphylococcus aureus) can spread through any wound into the blood steam.
Symptoms:
Marked local tenderness over S.Ps., exquisitely sensitive to percussion.
Generalized, “non-specific backache”
Muscular guarding of paravertebral muscles and housings.
Severe night pain.

Tumours of bone

Benign tumours grow inside bones.
They cause pressure, deep pain, fracturing and the potential to change into malignant tumours
Malignant tumours of bone are usually “secondaries” from organs, especially breast, lungs, thyroid, kidneys and prostate.
“Primary” malignancies are called Osteosarcomas or Chondrosarcomas, depending on the type of tissue in which they develop.

Soft tissue Strains and Tears

A muscular strain is a common minor soft tissue injury.
A certain number of myofibrils are torn and broken, but the muscle as a whole is still in one piece.
Blood supply to muscle bellies is sufficient to provide good healing to the fibres. (this fibre damage and healing is the very same mechanism by which muscle bulk and strength is increased.)
A tear is more significant. If enough fibres are damaged that there is local separation of the tissue, then natural and complete healing cannot happen. In such cases, skeletal muscle tissues undergo fibrosis, and damaged tissue is replaced by fibrous connective tissue.

Muscular Pathologies

Duchenne Muscular Dystrophy (dystrophy = degeneration)

M.Ds are inherited muscle destroying diseases, which result in gradual, progressive atrophy (wasting) of skeletal muscles
Typically, it is the external mobiliser muscles that are most affected
Duchenne is almost exclusively found in boys (1:3500)
Common age of onset is 3-5 years old, and always <10
Mechanism of muscular breakdown is only hypothesised, but might be due to unwanted Calcium ions triggering an enzymal breakdown of muscle fibres

Signs and Symptoms
Walking development can be delayed, with clumsiness and a waddling gait
Proximal limb weakness
Most patients die before reaching 20 – often due to respiratory weakness and failure

The Muscular Dystrophy Campaign is the only UK charity focusing on all muscular dystrophies and allied disorders.

Myasthenia Gravis (myo = muscle; asthenia = weakness; gravis = serious)

”Autoimmune” disease, characterised by fluctuating fatigueable weakness caused by an abnormality at the neuromuscular junction, that partially blocks contraction.
Antibodies are directed at Ach receptors on the Motor End Plate in a synapse. They prevent Ach binding, and hence prevent the motor impulse being sent to fibres.
Muscle becomes increasingly weaker, until it ceases to function.
Most common in women, age 20-50
Muscles of face and neck are most commonly affected.
Initial symptoms include:
Difficulty swallowing
Weakness of eye muscles
Problems with chewing
Problems with talking
Death may result from failure of the respiratory muscles.
Steroidal drugs have been found to reduce the effects of the antibodies.

Fibromyalgia (algia = painful condition)

A group of non-articular disorders
M:W – 1:15
Typical age of onset between 25-50
A significant sign is pain that results from gentle pressure at specific “tender spots”.
Also, generalised tenderness and stiffness of muscles, tendons and ligaments
Caused or aggravated by:
Stress
Trauma
Exposure to damp or cold
Poor sleep

Definition: Pain on palpation must be present in at least 11 of the 18 points shown:-

Osteoarthritis (OA)

A degenerative wear and tear process in joints.
Weight bearing joints are typically the most affected
There are nearly always predisposing factors that accelerate the wearing process. E.g.
congenital ill-development
irregularity of jt. surfaces e.g. from fracture
internal derangements – e.g. torn meniscus
previous disease e.g. RA
Mal-alignment of a joint
Obesity and overweight.
Pathology of OA

Articular cartilage wears away, until the underlying bone is exposed.
| ↓
| Subchrondral bone becomes hard and glossy (eburnation)
| ↓
| Cysts and sclerosis occurs in bone surface.
|
→ Bone at margins hypertrophies, forming projecting spurs.

The spurs of bone are called Osteophytes.
Onset is gradual, with pain increasing imperceptibly over month to years. Movements become restricted.
Joints like the hip demonstrate deformity in later stages.
Not usually associated with inflammatory symptoms.
Diagnosis can be confirmed by X-Ray. Typical features looked for are:
Joint space narrowing
Subchondral Cysts in ends of bone
Osteophyte formation
Squaring of rounded joint surfaces

Rheumatic and Autoimmune Diseases 

Rheumatoid Arthritis (RA)

Affects 1% of people world wide, most of whom have a positive “Rheumatoid Factor” in their genetic make-up.
Peak occurrence is between 30–50
Unknown cause
It involves inflammation of synovium, potentially in all organs except the brain.

Onset of symptoms usually involves symmetrical arthritis of hands and feet, morning stiffness and swelling. Gradually spreads through more proximal structures.
Other symptoms include:
Ø Eye problems – pain in eyes or dry eyes
Ø Subcutaneous nodules
Ø General malaise symptoms
Ø Neurological complications, especially due to erosion of the odontoid peg of C2, or the cruciate ligaments that supports this part of the neck
Ø Atlatoaxial subluxation and compression of the spinal cord ® quadriparesis.
Ø Kidney problems

Ankylosis Spondylistis (AS)

95% of patients carry HLA–B27 gene
Age of onset 20–45.
1/3 have a family history
M:W – 8:1

A sufferer presents with low back pain, possibly radiating into posterior thighs.
Stiffness and pain is marked in the mornings, and improves with activity.
Early on in the progression, the lumber lordosis becomes flattened and mobility is lost. Gradually, the thoracic kyphosis becomes restricted, and as the rib joints become affected, chest expansion is diminished.
Hip and heel pain are common. 20% suffer acute iritis.
90% of suffers have mild disease, settling in the 4th decade.
10% have severe spinal restriction, often with hip disease.

Reiter’s Disease

M:F – 15:1 This is possibly inaccurate.
Triggering factors are bacterial
Predisposing factor: 90% have HLA–B27 gene

Reiter’s refers to a triad of symptoms:
Ø Arthritis
Ø Urethritis
Ø Conjunctivitis.
½ improve over several months. The rest have repeated episodes over many years.

Psoriatic Arthritis

Peak age of onset is 30 – 50
5% of people with psoriasis develop arthritis – 90% of these have nail changes.
Further symptoms and signs include:
Asymmetrical hand and feet pain and/or swelling – all joints are susceptible.
Sausage toes
Heel pain
Peripheral symmetrical arthritis, distinguished from RA by psoriasis and lack of rheumatoid factor.

Crystal Arthropathy

Gout
Problems occur when the level of uric acid in the blood stream becomes too concentrated. Uric acid is derived from the breakdown of purine from nucleic acids. A small contribution comes from diet (see later).
Obesity and high alcohol consumption accelerate Sodium Urate production.
Sodium Urate levels are higher in men than women until the menopause, when they balance out. Hence, men are more likely to suffer (M:F – 8:1).
Mean age of onset is 40 in men, 70 in woman.
Urate slowly crystallises on cartilage surfaces, in people suffering from “hyperuricaemia”.
May be precipitated by trauma, illness, dietary or alcohol excess.

Acute Gout
Monoarticular, especially in base of the big toe.
Joint becomes red, swollen, very painful and shiny.
Can resolve in days with use of Nonsteroidal Anti-inflammatories (NSAIDS), and 2 weeks if untreated.
90% of sufferers have recurrent attacks.

Tophaceous Gout
After recurrent attacks, solid deposits may form in fingers, big toes, pinna of ear and olecranon of the elbow. These nodules shine white through overlying skin, which may ulcerate or become infected.
Untreated these “tophi” eventually destroy joints.
Gout often points to more serious problems:
alcohol abuse
obesity
artherosclerosis
hypertension (­B.P.)
Developmental Abnormalities

Achondroplasia

Caused by a genetic mutation in sperm.
Abnormal growth of cartilage at the start of life, especially of the long bones. This leads to the classic characteristic of dwarfism.

Osteogenesis imperfecta – aka – “Brittle Bone Syndrome”.

A congenital defect of osteoblasts (bone forming cells) and hence failure of ossification. This leads to easy bone fracture.

Spina Bifida (Occulta)

This is when there is a failure of enfolding of nerve elements in the spinal canal during early development.
In mild cases this might be failure of fusion of one or more verbal arches, in the lumbosacral area. (It can lead to neurological problems).
The far more serious cases are called “Spina Bifida Aperta.”

and

Study Guide 2

The Musculoskeletal System

Health and Disease
The World Health Organisation definition of Health is:“The state of complete physical, mental and social well-being.”
WHO 1998

It is also:

“Absence of Illness”
WHO 1998

In life, we must consider health from a realistic standpoint, although perhaps we should at least aspire to the ideal. A truly holistic approach to human health must consider:

Physical
Mental
Emotional
Social
Spiritual
Environmental factors. How many of these aspects can one person really affect?

Homeostasis

Cells need relatively stable conditions to function effectively.
This stability is called homeostasis. (homeo = same, stasis = standing still)

Definition:
Homeostasis is a condition in which the body’s internal environment remains within certain physiological limits.

For instance, body fluids must be regulated – kept at correct volume and composition.

Fluid in cells – intracellular (intra = within)
Fluid outside cells – extracellular (extra = outside)
ECF between cells – intercellular (inter = between)
ECF in blood vessels – plasma

Oxygen, nutrients and ions are carried in fluid, moved into and out of cells and around the circulatory systems (blood and lymph). Always a constant amount.

Interstitial fluids surround cells – known as the body’s internal environment. If conditions here are maintained in a consistent way, homeostasis is achieved.

When homeostasis is disturbed, illness may result → death.

Stress (all forms) can have a major impact on homeostatic balance. E.g. poisoning, overexposure to extreme temperatures, severe infection, death of a spouse.
Generally, the body regulates change very well.

Example:
↑ exercise → ↑ O2 use ↑ CO2 production.
nervous element: ↑ circulation
↑ breathing rate
endocrine element: ↑ adrenaline

Feedback systems

An animation about Positive and Negative feedback can be seen here.

Negative feedback

These systems maintain conditions that require frequent monitoring and adjustment within physiological limits e.g. body temperature, blood pressure…

Example 1:
Blood pressure control.
Blood pressure is the force exerted by blood as it presses against walls of the blood vessels. If heart beat ↑, then pressure ↑ or blood volume ↑ → pressure ↑
Hence, somehow the body must bring the pressure back down…

Positive Feedback

In unusual circumstances, where fine-tuning of a situation is less important, the body sometimes needs to amplify controlled conditions. E.g. Labor contractions, initial blood clotting…
Example 2:
Labor contractions
The hormone oxytocin is released from the brain as a muscle contractor of the pregnant uterus.
Labor begins; uterus is stretched → brain responds by releasing ↑ oxytocin. → ↑ contractions and stretching… Until baby is born → feedback is shut off.

Cytology

A cell is a basic, living, structural and functional unit of the body. All cells come into being from pre-existing cells. Virtually all metabolic activities take place within cells.

Definitions:
Prokaryote cell – bacteria (with no nucleus)
Eukaryotes are organisms with complex cells, including nuclei

Living characteristics:
Metabolism

Catabolism – breakdown of large complex things into smaller, useful building blocks. E.g. protein → amino acids.
e.g. O2 and nutrients → cell respiration (chemical energy) → ATP produced.
Anabolism – energy used to build structural and functional body components.
e.g. Protein → muscle and bone.
Responsiveness – ability to detect and respond to changes.
Movement – bodily, tissue (digestive level), intracellular.
Growth with ↑ size and number of cells
Differentiation – unspecialised → specialised.
Specialised cells have structural and functional characteristics that differ from their “ancestors”
E.g. Red bone marrow cells → red and white blood cells with many different functions.
Reproduction – Formation of new cells for growth, repair, replacement or production of a new individual.

Cell Components

Cell Membrane

Cell Nucleus

Cytoplasm : Cytosol
o Ribosomes
o Endoplasmic Reticulum
o Golgi Complex
o Lysosomes
o Mitochondria
o The Cytoskeleton
o Centrosome

Cell Membranes

Membranes are flexible, shape-shifting barriers between cells, keeping certain things in and out.
The membrane is composed of lipids, steroids and proteins, with chains of carbohydrates attached to the outside. The majority is phospholipids that consist of a polar end (phosphate –hydrophilic) and two fatty acid chains (hydrophobic).

Proteins act as carrier molecules, as entry and exit points, and can control this entry and exit.
Proteins have individual shapes, and hence can act as identity features
They can be enzymes / hormone releases.
Tubules of the cytoskeleton will be anchored to the proteins as well.
Cell shapes are influenced by the contractility of the cell membrane →squamous, cuboidal or columnar.
Surface area / shape can be altered to enable distinctive functions. E.g. formation of microvilli by folding.

Transmembrane transport

Passive (no energy needed)

Diffusion – high concentration to low concentration across a “concentration” gradient. It is consequence of random movement of particles.
Influenced by temperature, surface area, thickness of membrane, concentration gradient and size of molecules.

Osmosis – “diffusion” through a selectively permeable membrane – water can flow through following pressure gradient (high to low) but some of the solute might not pass.

An animation on how Osmosis works can be seen here.

Hypertonic = concentrated solutions
Hypotonic = dilute solutions

Filtration – selectively permeable membrane enables passage from high to low pressure. E.g. creation of glomerular filtrate due to blood pressure; kidney filtration – extraction of plasma and waste from water
Facilitated diffusion – same as diffusion but helped by specific carrier molecules.

Active (energy needed)

ATP (energy) used to pump sodium or calcium out of cells after muscle contraction

Bulk transport – phagocytosis (consider the enveloping style of the amoeba. Also, blood flow is considered “bulk transport”.
Cell organelles and the Nucleus

Nucleus

Spherical or oval. Largest structure in cell
Most cells are uninucleate, although some, like skeletal muscles, are multinucleate
Contains genes – control cellular structure and activities
Genes are arranged in single file along structures called chromosomes.

Ribosomes

Tiny granules that contain ribosomal RNA, and are the site of protein synthesis.
Some are free, and produce proteins for that cell’s use. Some are attached to the endoplasmic reticulum, and create proteins for “export”.
Think of these as the “workers” of the cell.

Endoplasmic Reticulum (ER)

A system of membrane-enclosed channels called cisterns.
Continuous with nuclear membrane.
Smooth (agranular) ER – no ribosomes
Rough (granular) ER – studded with ribosomes
Rough ER serves as storage area for proteins.
Smooth ER is site for fatty acid, phospholipids and steroid synthesis. Enzymes produced here can also detoxify chemicals e.g. alcohol, pesticides, carcinogen.
Consider this as the “factory production line” for most things

Golgi Complex

Located near nucleus. Extensive in “secreting” cells. Flattened, saucer-shaped sacs.
It processes, sorts, packages and delivers proteins and lipids to the plasma membrane.
It also forms lysosomes and secretory vesicles.
Consider this as the “postal service” for the cell.

Lysosomes

Formed in Golgi complex, these are membrane-enclosed vesicles containing over 40 kinds of digestive enzyme.
Their job is to break down molecules.
Interior of lysosome is pH 5 (100 times more acidic than pH 7 cytosol)
They digest bacteria etc that enter the cell. The waste products are then released into the cytosol, to be used as building blocks by the cell.
They also digest redundant organelles. (autophagy)

Mitochondria

The “Powerhouse” of the cell.
Main site for generation of ATP
Outer smooth layer
Inner membrane folded to create a large surface area for enzymes to attach to.
These are the source of cellular respiration, providing ATP as the product, to be used by the cell.
They can self-replicate, in response to cellular need for ATP

The cytoskeleton

A complex network of filamentous proteins (microtubules and filaments)
Responsible for movement of organelles and chemicals within the cell. Also supports and shapes cells.

Centrosome

Centre for organizing microtubules, and the formation of “mitotic spindle” in cell division

Cell destiny
A cell has 3 possible destinies:

remain active (e.g. Brain cells)
grow and divide
die

Division and death must be kept balanced.
Some cells have genetically programmed death – Apoptosis – caused by protein produced by the “cell-suicide” gene.
Phagocytes engulf and degrade the cellular remains

Necrosis is a pathological cell death, resulting from tissue injury – cells burst, their contents is dispersed and inflammation results.

Cell Division

Mitosis

Most cells in the body replicate by a process of doubling up their contents, and then splitting in two, dividing the contents out equally. Hence, where once there was one cell, now there are two, identical ones.

BBC Bitesize has a great section that explains Mitosis - visit it here.

Meiosis

The process by which sex cells reproduce. Through a complex series of doubling and dividing, one cell with diploid chromosomes becomes 4 daughter cells with haploid chromosomes (see Tortora pp. 84-6 for details). This makes 4 sperm cells, or 1 ovum (the other 3 dying). Histology

Definition: A tissue is a group of cells that usually have a common embryonic origin, and function together to carry out specialized activities.

The structure and properties of a specific tissue are influenced by such things as the nature of the extracellular material that surrounds the tissue cells, and connections between the cells that compose the tissue.

Types of Tissue

Epithelial – covers body surface, lines hollow organs, body cavities and ducts; forms glands.
Connective – protects, supports and binds the body and organs; stores energy reserves as fat; provides immunity.
Muscle – responsible for movement and generation of force.
Bone – provides framework for body, supports, stores and produces materials and blood cells for the body.
Nervous – initiates and transmits action potentials that help coordinate body activities.

All tissues develop from 3 primary germ layers:
ectoderm
mesoderm
endoderm

Epithelial Tissue

Most epithelial tissues replace by mitosis → constant regeneration.
2 types:
covering and lining
glandular

Nomenclature:

Simple epithelium
Single layer of cells found in areas activities such as diffusion, osmosis, filtration, secretion and absorption occur.
Stratified epithelium
2 and layers – protect underlying tissues in area of high wear
Preodostratified epithelium
Looks like it, but it isn’t! Due to varying cell shapes and sizes.

Cell shapes

Squamous
Flat, attached like tiles. Thinness allows rapid movement of substances through them.
Cuboid
Cube / hexagon shaped. Important for secretion and some absorption.
Columnar
Tall and cylindrical – protect underlying tissues. Sometimes secrete and absorb.
Transitional
Can alter shape, often due to movement and stretching of bodily parts / organs e.g. the stomach or bladder.

Types of Epithelial Tissue

Name Description Location Function

Simple Squamous Epithelium

Single layer of flat cells Lines heart, lymph vessels, some serous membranes Filtration, Diffusion, Osmosis and some Secretion

Simple Cuboid Epithelium

Single layer of cubed cells Surface of ovary, kidney tubules, capsule of lens of eye Secretion and Absorption

Nonciliated simple columnar epithelium

1 Layer of rectangular cells, often containing goblet cells Lines GI tract from stomach to anus, ducts of glands and gallbladder Secretion and Absorption

Ciliated simple columnar epithelium

As above, but with cilia protruding into cavities Lines parts of upper resp. tract, Fallopian tubes, uterus, canal of spinal cord Moves fluids / particles along passageways

Stratified squamous epithelium

Several layers of cells – some cuboid or columnar cells in deep layers Skin layer; lining of mouth, oesophagus, vagina and tongue. Protection

Stratified cuboidal epithelium

2+ layers of cuboid cells Ducts of sweat glands, male urethra Protection
Stratified columnar epithelium Many polyhedral cell layers – columnar cells in superficial layer Lines part of urethra, excretory ducts of glands, anal mucous membrane Protection and Secretion

Transitional epithelium

Variable appearance – cuboid to squamous… Lines urinary bladder, ureters and urethra Permits distension

Pseudostratified columnar epithelium

All cells attached to membrane, but not all reach surface Upper resp. tract; epididymis; male urethra Secretion and movement of mucus

Glandular Epithelium

The function is to secrete substances into or onto the body surfaces / cavities.
May be one cell or a highly specialised group.

Exocrine Glands: exo – outside kine – to secrete
Flow onto free surfaces – skin (organs) duct surfaces. E.g. sweat glands /salivary glands
E.g. Mucus, sweat, ear wax, digestive enzymes.

Endocrine Glands: endo – within
Secrete information – extracellular fluid and into the bloodstream.
“Hormones” – regulate metabolic and physiological activities to maintain homeostasis. E.g. pituitary, thyroid and adrenal glands.

Connective tissue

Most abundant and widely distributed tissue in the body.
Binds, supports and strengthens, protects and isolates internal organs, compartmentalises structures – e.g. skeletal muscle.
Blood is a fluid connective tissue. Adipose (fat) tissue is a major site of stored energy reserves.

General Features

Three basic elements – cells, ground substance and fibres. The latter two form the tissues matrix. Hence, cells are usually kept apart from one another.
Not on surfaces (unlike epithelium), except joint surfaces.
Has a nerve supply, everywhere but in cartilage.
Highly vascular. Exceptions are cartilage which is avascular, and tendons which have reduced vascularisation.
Matrix is secreted by the cells contained therein, and might be fluid, semi fluid, gelatinous, fibrous, or calcified – exception is blood plasma.

Connective tissue functions

These bind structures together
Supports structures → rigidity
Protects – healing, immunity, padding etc.
Subdivides organs
Unites dissimilar tissues
Packing material
Energy store / mineral store
Restraining mechanisms
Deep fascia many aid movement of blood
Cell types (a selection)

-blast = immature cell. Means bud / sprout
-cyte = mature cell

Fibroblasts (fibres), chonrdoblasts (cartilage) and osteoblasts (bone) are capable of mitosis and secrete the matrix element of relevant tissues.
Chondrocytes and osteocytes are mostly involved in maintenance of the matrix.
Macrophages or histiocytes are immune cells, able to engulf bacteria and cellular waste by phagocytosis.
Plasma cells – develop from a certain white blood cell. They secrete antibodies → immune system. Especially found in GI tract and mammary glands (breasts).
Mast cells produce histamine, which dilates blood vessels → abundant alongside blood vessels.

Matrix

Gives specific property of each connective tissue.
Contains protein fibres embedded in ground substance.
Fibres include collagen, elastic fibres and reticular fibres.

Fibres types
The type and arrangements of fibres contributes to the properties the C.T. type. i.e. loose / dense; loose / random.

Collagen
There are over 12 types
It is flexible but with a high tensile strength
Constituent molecules = Tropocollagen. i.e. 3 coiled peptide chains
Produced by fibroblasts
Covalent cross-links between tropocollagen gives a high tensile strength.

Reticular
Much finer, but otherwise similar
Made from reticulin
From fibroblasts

Elastic
Made of elastin
It is very elastic – can stretch up to 1.5 times
From fibroblasts

Ground Substance
Composed of H2O and Proteoglycans. These are a combination of protein and glycosaminoglycan. The purpose of the latter is to trap things within the mix.
The purpose of a ground substance (GS) water content allows diffusion of gasses, ions and molecules.
Viscosity results in it being a mechanical barrier to bacteria.
Lubricates.

Connective Tissue Types

Loose connective tissue
a. Areolar connective tissue – fibres and cells as above, in semifluid ground substance
Found in skin, mucous membranes, blood vessels, nerves and around body organs.
b. Adipose connective tissue – specialised to store fats and oils
Found in skin, around heart and kidney, yellow bone marrow of long bones, around joints
Works to maintain temperature / homeostastic conditions and protection. Serves as an energy reserve..
c. Reticular connective tissue – found in liver, spleen, lymph nodes, red bone narrow
Forms framework (stroma) of organs.

Dense Connective Tissue
d. Regular and irregular

Cartilage
e. Hyaline – found in end of long bones, larynx, trachea, and bronchi.
Provides smooth surface for movement at joints, flexibility and support.
f. Fibrocartilage – found in pubic-symphysis, intervertebral discs and menisci of knee.
Provides support and fusion.
g. Elastic cartilage – in larynx, external ear and eustachian tubes.
Provides support and maintains shape of things.

Cartilage is capable of enduring more stress than most other connective tissues. It has a dense network of collagen fibres and elastic fibres, embedded in a rubbery ground substance.
Cartilage has no blood supply or nerves, except those in the very outside of any structure, within the peri-(outer)-chondrium.

Bone (Osseus) Tissue
Compact/Cortical or Spongy/Cancellous
Skeletal system has many functions.

Blood (Vascular tissue)
· Blood is a connective tissue with a liquid matrix called plasma.
· Plasma is mainly water, with a wide variety of dissolved substances e.g. nutrients, wastes, enzymes, hormones, etc – it is straw coloured.
· Also contains red and white blood cells.
Membranes

Epithelial layer and connective tissue layer = epithelial membrane.

These include:
mucous membranes
serous membranes
cutaneous membranes (skin)
synovial membranes
Mucous Membranes

· These line body cavities that open to the exterior – digestive system, respiratory system, reproductive system and much of urinary system.
· Epithelial layer provides a barrier and secretes mucous and digestive enzymes.
· Function of mucous:
- prevents cavities drying out
- traps particles in respiratory passageways
- lubricates food in GI tract.
· The connective tissue layer binds the epithelium to underlying structures, and holds blood vessel in place. Enables diffusion of O2 and CO2 in correct directions.

Serous Membranes

· Line body cavities that do not open to the exterior, and line organs contained in such cavities
Always two layers:
Parietal (paries = wall)
Visceral (viscus = body)

Includes:
pleura – lungs
pericardium – heart
peritoneum – abdomen and pelvis
Secretes serous fluid to enable slip of layers.

Synovial membranes

· these line the carlines of freely movable joints.
· there is no epithelial surface.
· composed of areolar connective tissue, elastic fibers and fat.
· secrete synovial fluid → lubricates and nourishes cartilage.
· also found in cushioning fatty sacs (burasae) and tendon sheaths.
Body cavities

Cranial:
Brain
Cerebellum
Brain stern
Sensory organs
Arteries/Veins/Cranial nerves/Lymphatics

Thorax:
Oesophagus, Larynx, Bronchial Tree
Lungs
Heart
Diaphragm
Aorta, SVC, IVC

Abdomen – Digestive Viscera:
Stomach
Duodenum
Small Intestine
Large Intestine
Colon
Appendix
Liver / Gallbladder
Pancreas
Spleen
(Kidneys)

Pelvic:
Bladder
Sigmoid colon
Rectum
Ovaries
Uterus
Urethra
Uretas

Body Orientation Vocabulary

Superior  -  upper
Inferior  -  lower
Lateral  -  to side
Medial  -  in the centre
Proximal  -  close
Distal
Ipsilateral
Contralateral
Superficial
Deep
Internal
External
Parietal
Visceral
Cephalad
Caudal
Sagittal Plane
Coronal Plane
Transverse Plane

Bones

An animation on bone formation can be seen here.
Types of bone
a. Long – shaft + 2 extremities. E.g. femur, tibia
b. Short – e.g. carpals of wrist
c. Irregular – e.g. vertebrae
d. Flat – e.g. sternum, ribs, skull
e. Sesamoid – e.g. patella

Long Bone structure:

Diaphysis – this is the shaft of the long bone. It has a large open space inside, which contains yellow bone marrow.
2 x Epiphysis – these are the irregular ends of the long bones. They contain red bone marrow
Periosteum – this is the thin membranous layer that envelopes all bone. It is both highly vascular, and has a very good nerve supply. It serves as the attachment layer for muscle/tendon to fix to the bones.

Short bones contain red bone marrow.

Bone structure
Compact (corticol) bone – typically the “solid” outer layer of bone – composed of many “Haversian Systems” that enable a good blood supply throughout the bony structure
Cancellous (spongy) bone – contains a honeycomb framework of bony material called trabeculae. These serve as force distributors throughout the bone, enabling far greater forces to be applied to the skeleton without it breaking. It contains red bone marrow, which produces red and white blood cells.

Terminology:

-blast – gem / bud (osteoblasts from bone)
-clast – to break ( osteoclasts resorb bone – important for repair and maintenance)
-cyte – cell

Bone Functions
Provide framework for body
Provide attachments for muscles and tenders
Permit / control range of movement
Form boundaries, protecting organs
Red bone narrow – produces blood cells
Provide reservoir of minerals – (consider osteoporosis! and homeostasis)

Bone Fracture
Fractures are the same as breaks! They are classified in 3 ways:
- simple
- compound
- pathological

There are many types of fracture. The best way to see these is from X-rays – any good orthopaedic text can provide pictures. The following is a list of some of the major/common fracture types.

Please note that this table is not exhaustive…

Fracture Type Description
Partial The break across the bone is incomplete
Greenstick Partial fracture – one side of bone breaks, and the other side bends. Common in children
Closed (simple) Bone does not come through skin
Open (compound) Broken ends/end protrudes through skin
Comminuted Bone splinters at site of impact, and smaller fragments lie between break ends
Stress Microscopic fractures due to inability to withstand multiple repeated stressful impact
Spiral Bone is twisted apart
Impacted One fragment driven into the other
Colles’ Fracture of distal end of radius, with distal end displaced posteriorly
Pott’s Fracture of distal end of fibula, with serious injury to tibial articulation at ankle

Fracture Healing
Example of a simple break:
Once fractured, blood supply is impaired / broken
ß
Blood pours into the fracture cavity
ß
Blood clots around the site of the fracture
- a fracture haematoma
ß
Swelling, inflammation and start of healing

Fibroblasts arrive on site and capillaries form to provide blood supply
ß
Collagen fibres connect the break ends
ß
A fibrous Callus is formed

Osteoblasts now form and secrete bone, and previous cartilage becomes ossified (turned to bone)
ß
New Trabeculae are formed
ß
Bony callus is formed

Remodelling: dead elements are removed by osteoclasts
ß
Compact bone is formed and medullary canal is reopened.

Muscles

3 kinds of muscles tissue:
Skeletal
Cardiac
Smooth

1. Skeletal muscles tissue:

So named because it is attached primarily to bones, and moves the skeleton.
It is a voluntary muscle tissue, because it can be made to contract and relax by conscious control

2. Cardiac muscles tissue

Forms most of the heart
Involuntary – controlled by automatic effects of nerves and hormones

3. Smooth muscles tissue

In the walls of hollow internal structures e.g. blood vessels, stomach, intestines
Usually involuntary

Function of Muscles
1. Motion – gross and fine
2. Movement of substances within the body
3. Stabilising body positions and regulating organ volume
4. Thermogenesis – by-product of muscle contraction is heat (85% of all body heat) and shivering.
The Neuromuscular Junction

For excitable cells to communicate, specialised regions called synapses exist.

The Sliding Filament Theory.

Muscle Metabolism

ATP – Adenosine Triphosphate
ADP – Adenosine Diphosphate

Initially, creatine photosphate and ATP present in a muscle tissue can supply enough energy to contract maximally for 15 seconds.
After that time, glucose must be catabolised to generate ATP.
The process of catabolism produces a net gain of ATP (after using some in the actual process of creation!).
This process is called Glycolysis , and does not require O2 to occur. Hence, it is an anaerobic reaction.
As well as ATP, pyruvic acid is produced, which, when absorbed by mitochondria and in the presence of O2, produces large amounts of ATP and lactic acid.
¯O2, ­ lactic acid.

As lactic acid builds in the muscles, it prevents maintenance of homeostatic conditions, and muscles begin to fatigue. It takes far longer for this acid to be dispersed than it does to create it.

Point of note – alcohol slows down the rate at which lactic acid is resorbed by the body.

Skeletal Muscles

The following list contains the most commonly mentioned muscles. It is by no means exhaustive. In any health/medical profession, the better your anatomy is, the more you can understand and rationalise things. Hence, it is strongly advised that you try to look at as many as possible, using whatever texts most appeal to your style of learning.

The Neck

Sternocleidomastoid Mastoid process of skull to clavicle and sternum Elevates thorax in deep breathing; flexes head; side-bends and rotates head
Scalene (Ant, Med, Post) Lateral aspects of cervical vertebrae, to ribs 1 and 2 Elevate ribs 1 and 2; flexes spine; side-bends neck, with minor rotation
Trapezius Base of skull, and all cervical and thoracic vertebrae, to scapula and clavicle Elevation and rotation of scapulae; side-bending of neck; retraction of scapulae; neck extension

The Back

Erector Spinae Connects the vertebrae, the skull and the sacrum, in many combinations Spinal extension, side-bending and rotation
Quadratus Lumborum 12th rib to top of pelvis, posteriorly, and vertebrae T12 to L4 Thoracic and lumbar extension; lumbar side-bending; helps breathing
Rhomboid Major T2-T5 to medial border of scapula Retraction and elevation of scapula
Rhomboid Minor C7-T1 to medial border of scapula Retraction and elevation of scapula
Latissimus Dorsi Iliac crest, T7-S5 and lower 4 ribs, to bottom of scapula and internal surface of humerus Extension, medial rotation and adduction of shoulder. Helps breathing

The Abdomen

Rectus Abdominus Pubic area of pelvis to ribs 5-7
External Oblique Ribs 5-12 to anterior pelvic crest and linea alba
Internal Oblique Inguinal ligament and iliac crest to ribs 7-12
Transverse Abdominus Thoracolumbar fascia, ribs 7-12 and anterior pelvic crest to Linea alba
Diaphragm Sternum, lower 6 ribs and cartilage, L1-3 to central tendon in apex of muscular dome Main muscle of breathing; aids in blood flow/pumping

The Pelvis

Coccygeus Ischium of pelvis to sacrum and coccyx Flexion of coccyx; supports pelvic viscera
Levator Ani Inner surface of pelvis to coccyx and fibrous raphe in centre of pelvic bowl Sphincter actions; supports pelvic organs; maintains intra-abdominal pressures

The Shoulder

Coracobrachialis Scapula to medial mid-shaft of humerus Flexion of shoulder; adduction of abducted shoulder
Biceps brachii 2 points on the scapula to proximal end of radius Flex shoulder; flex elbow; supinates forearm and hand
Deltoid Lateral clavicle and scapula to lateral mid humerus Abducts, flexes of extends arm, depending on fibres used
Triceps Attaches to scapula, twice to the humerus, and down to the ulna Extension of Elbow; extension of shoulder
The Rotator Cuff Muscles
Teres Major Lower lateral border of scapula to medial upper humerus Extension and medial rotation of shoulder
Teres Minor Lateral border of scapula to medial upper humerus Lateral rotation of shoulder; part of rotator cuff
Supraspinatus Upper scapula to top of humerus Abduction of arm; part of rotator cuff
Infraspinatus Lower scapula to top of humerus Lateral rotation of arm; part of rotator cuff
Subscapularis Anterior surface of scapula to anterior upper humerus Medial rotation of arm; part of rotator cuff

The Elbow

Brachialis Distal anterior humerus to proximal ulnar Flexion of elbow
Supinator Lateral epicondyle of humerus to tip of ulnar and lateral radius Supinates forearm
Pronator Teres Medial epicondyle of humerus to ulnar and lateral radius Pronates forearm; assists elbow flexion

The Hip

Gluteus (Max, Med, Min) Posterior pelvis, pelvic ligaments and sacrum to proximal femur and ITT Extension of hip; abduction of hip; lateral rotation of hip
Rectus Femoris Anterior aspect of pelvis to patella tendon Flexion of hip; extension of knee
Vastus Lateralis Anterolateral aspect of femur to patella tendon
Vastus Medialis Medial posterior line of femur to patella tendon
Vastus Intermedius Lateral posterior line of femur to patella tendon
Biceps Femoris Base of posterior pelvis and mid femur to head of fibula Hip extension; knee flexion; lat. knee rotation
Sartorius Anterior aspect of pelvis to medial upper tibia Flexion of hip; flexion of knee; lat. hip rotation; medial knee rotation
Psoas major L1-5 and discs L1-5, to internal proximal femur Flexion of hip; flexion of spine; side-bending spine
Adductors Medial lower pelvis (various points) to medial femur Adduction of hip; some of these help with flexion of hip

The Knee

Gastrocnemius Lateral and medial femoral condyles to Achilles tendon Plantar flexion of ankle; Knee flexion

The Ankle

Soleus Superior posterior fibula and across tibia, to Achilles tendon Plantar flexion of ankle;
Tibialis Anterior Superior lateral tibia and interosseous membrane to medial cuneiform and base of 1st metatarsal Dorsiflexion of ankle; inversion of foot
Biomechanics of movement

3 structural classifications of joints:

Ø Fibrous – e.g between the bones of the skull
Ø Cartilaginous – e.g the anterior rib joints
Ø Synovial

Here we focus on the synovial joints.
These are typically also diarthroses. That means they are “freely movable joints”
The distinguishing feature of these is the “Synovial Joint Cavity”. Also the presence of articular cartilage.

Types of Synovial Diarthrosis Joints

Type Description Examples
Gliding Articulating surfaces usually flat Intercarpal/tarsal joints
Hinge Convex into concave surfaces Elbow; ankle; Knee
Pivot Rounded or pointed element fits into ring of bone and cartilage Atlas on Axis; proximal radioulnar joint
Condyloid Oval-shaped condyle fits into elliptical cavity Joint between radius and carpals
Saddle Think of a rider in a saddle. Can tilt forward/back, and side to side Joint between trapezium and metacarpal of thumb
Ball-and-socket Ball fits into cuplike depression Hip; shoulder

Skeletal muscles produce movements by exerting forces on tendons, which in turn pull on bones or other structures, such as skin.

We describe the various motions very specifically, so that communication is facilitated between professionals. The following list is the descriptors for the various bodily motions and positions.

Flexion

Extension

Abduction

Adduction

Circumduction

Inversion/Supination

Eversion/Pronation

Dorsiflexion Plantar flexion

Elevation Depression

Retraction Protraction

The body is very well protected.  Only when defenses are weakened can harmful bacteria gain a foothold.  The factors that bring about reduced vitality are found in the basic causes of disease.  When one or more of the causative factors predisposing to disease are present, the body is forced to act vigorously to reestablish proper equilibrium.  The result is acute disease. The body is equipped with various avenues of action to free itself of these burdens.

Fever increases the body’s metabolic rate and circulation of the blood and lymph, thereby speeding the removal of toxins from the body, and nutrition to diseased areas.  The increased circulation also acts as a carrier for the body’s more complicated defences such as white blood cells and antibodies.  Fever also creates a less favourable environment for both bacteria and viruses, which generally have a very narrow temperature range for optimal growth.  As fever increases, these organisms begin to die faster than they can reproduce, Hippocrates stated, “Give me fever and I will cure any disease.”

Sweating carries toxins out of the system through the skin.  It helps keep the rising temperature within a range that will not endanger the long-term health of the body.  

Mucous secretions also remove toxic material from the body.  Cells of some mucous membranes protect against invasion by the action of the tiny cilia that move particles of foriegn matter and debris toward the nearest outlet.  These cilia are stimulated by external irritants, bacteria, viruses or internal toxins.

Inflammation, swelling and edema are actions by the body to localise a problem.  Inflammation indicates a local increase in metabolic activitie with increased blood and lymph supply, and an increased capillary supply to aid in transport of blood-borne defenses.  Edema, or fluid accumulation, aids in diluting an undesirable, toxic or irritating substance.  

Local infection results from breakdown of vital tissues into waste matter, which then provides a suitable environment for bacterial spread until the body’s forces can remove the waste material.  The reduced vitality occurs first, the infection is secondary.  Boils, acne, and other local infections may also be the result of an inner cleansing process.  

Diarrhea and vomiting are obvious attempts by the body to rid itself of toxic substances.  Local irritants may initiate this action as will systemic toxins.

Pain is a natural mechanism by which the body draws attention to a problem area.  Pain indicates that the malfunction can no longer be tolerated or compensated for, and that further derangement may become injurious.

Sneezing and coughing are vigorous attempts by the body to rid the respiratory system of irritants and toxins.  The coughing up of mucus can reduce the spread of infection by preventing morbid material from stagnating, and also can help prevent blockage of smaller respiratory passages of particles and irritants.

All these acute symptoms of “disease” are in fact the result of an intelligent action by the body to reestablish equilibrium and positive health.  As such they are corrective and eliminative and should not be suppressed.  What is commonly called acute disease is really the result of nature’s efforts to eliminate waste matter or poisons from the body and to repair injured tissues.  If this acute condition is not allowed to run its natural course, or is treated with suppressive methods and therefore not allowed to fulfill its intended function of elimination, then eventually chronic disease will result.