HEALTH EDUCATION

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Title: HEALTH EDUCATION
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HEALTH
EDUCATION

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The Foundation for Research in Community Health

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3 & 4, Trimiti B Apts., 85, Anand Park, Aundh, Pune - 411007
Tel: (020) 25887020, Fax: (020) 25881308
Email: frchpune@giaspn01.vsnl.net.in

HEALTH EDUCATION
INDEX
i.

Respiratory Ailments

01 - 07

2.

The concepts of our people

08 - 11

3.

Ear and Throat Ailments

12 - 34

4.

Disorder of the Middle Ear

35 - 40

5.

Bronchitis (Acute, Chronic)

41 - 49

6.

Asthma

50 - 53

7.

Pneumonia

54 - 64

8.

Tuberculosis

65 - 72

9.

Diarrhoea and Dehydration

73 - 86

10. Types of Fever

87 - 106

11. Medicines

107 -

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Lession 1
Respiratory Ailments
Indications and Symptoms

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Aims
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On reading this lesson you will

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Be able to narrate the symptoms and indications related to the respiratory system.
• Acquire the skill of the method of observing signs and indications by asking questions

and examining patiems.
• Identify the respiratory illness.
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Knowledge
You will know about
• Pulse rate, Rate of breathing.

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Information about particular indications and signs of the respiratory system.

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Skill

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You will learn

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• To observe signs of respiratory distress.

• Diagnose the location of the problem from the sig
ns and indications related to the respiratory
system.

Perspective
You will understand

• How life-style affects the respiratory system

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2

Signs and Indications of Respiratory Ailments
a.

Phlegm

This is an indication found most of the time. It occurs during the diseases Pharyngitis,
Bronchitis, Tuberculosis and Pneumonia. The phlegm is not uniform. It is absent when there
is dry cough. The water-like variety flows through the nose while the thick variety is expelled
from the lungs.

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The white-watery phlegm is caused by viruses but the thick, greenish yellow-one is caused
by bacteria. TB or Pneumonia may include traces of red.

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According to place of origin
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2.

Thick phlegm from kings

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According to source,

1.
2.

White watery phlegm - virus
Thick greenish yellow phlegm - bacteria

3.

Traces of blood in phlegm - TB, cancer

Watery phlegm -from the nose
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b. Cough
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The nose, throat and vocal chords are the upper/outer parts of the respiratory system.
Tne trachea and its branches together with the lungs constitute the lower part of the respiratory

system.

Diseases of the upper/outer respiratory system

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Colds, pharyngitis, tonsillitis, disorders of adenoids and vocal cords, diphtheria are all

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respiratory disorders, of which diphteria is the most dangerous. Other ailments may get
v/ell soon.

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Cough accompanies both types of respiratory disorders except for those related to the

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nose. Most often the cough is dry and the sound is shallow. But cough originating in the

lungs is deep and the sputum progressively increases. Cough from the trachea sounds like
a flute.

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c. Pain

Cough may cause.
1. Pain while swallowing
2. Chest pain with fever

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pharyngitis, tonsillitis, laryngitis or diphtheria.

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pneumonia or TB (though heart ailments cause chest

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pain, they are not accompanied by fever)

3. Pain at the centre of the chest - bronchitis

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4. Pain in the chest and abdomen - If accompanied by cough, TB or pneumonia.

d. Fever

Infection of the respiratory system leads to fever. There is no fever when pollution is the
cause of respiratory disorders.
e. Increase in the rate of breathing

Faster breathing suggests a struggle for oxygen. This happens in case of TB, asthma,

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pneumonia and heart trouble.

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1.
2.

0 - 1 years

upto 40

1-4 years

upto 30

3.

5 and above

12-20

The normal rate of breathing provides sufficient quantities of oxygen. The rate of breathing

increases if there is 1. Obstruction of the air ways due to phlegm.
2. Chest pain which prevents the lungs from expanding completely.

f. Cynosis

The lips, nails etc turn blue when oxygen is insufficient, this condition is called cynosis.

g. Flared nostrils

Difficulty in breathing leads to this condition.
h. Weight loss

When the body fights against germs during fever, the body loses energy. Additionally

fever reduces appetite. Together these conditions cause weight loss. TB is an illness that
affects a patient over a period of time during which weight decreases.

i. Increase of pulse rate
The pulse rate increases due to fever, stress or disorders related to the lungs.

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j. Unequal expansion of chest

Normally left and right lungs expand equally during inhalation. However if one of them
gets affected by a disease like pneumonia or TB, it expands less.
k. Sounds heard when using a stethoscope
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When the air sacs are full of fluid, there is friction between fluid and air. This friction

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creates a sound like crumpling paper which can be heard through a stethoscope placed

over the patient’s chest.
If phlegm has accumulated in the air sacs,

sound as that of moving water is heard

during inhalation;
Wheezing
When there is difficulty in exhalation we can hear a sound like whistling e.g. - in case

of an asthma patient.

Barrel chest

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The shape of a patient
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’s chest may get deformed by illness. A drum
shape is caused ini emphysema creating difficulty during exhalation.

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Slow exhalation
A congested chest allows inhalation but obstructs exhalation.

Percussion Sound
Since air Ihas low density, thumping the chest creates a percussion sound.

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But when the
-- air sacs are congested, it creates a deep sound.

Drawing in of ribs

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This sign is useful in case of children

To elicit this sign, quieten the child and

remove the clothes covering the chest.

The ribs should expand during inhalation, but if the ribs get drawn
pneumonia.

inside, it suggests

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Exercises

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Complete the sentences

1. Diseases of the upper respiratory system are -

1.
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2.

3.

4.

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2. Diseases of the Lower respiratory system -

1-

2.

3.

4.

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3. A serious disease of the upper respiratory system is

4. Drawing in of ribs during inhalation indicates
5. Which 2 ailments are indicated by pain in the throat?

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6. How will you recognize that vocal cords are affected?

7. Which are the symptoms accompanying cough in tonsillitis

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8. Which 2 parts indicate cyanosis on observation?

1 2
9. Cough caused by pollution does not have

10. If only the right part of the chest expands properly it means that the left part is

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Exercises
Choose the correct alternative -

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1. The most common symptom of a respiratory illness is
1. Cough

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2. Fever

3. Headache

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4. Weight loss

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2. Phlegm caused by bacteria is
1. Greenish yellow

White

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2. Watery

4. All the above

3. The organs of the upper respiratory system are

1. Nose, throat, vocal cords
2. Nose, throat, trachea, vocal cords

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3.

Nose, throat, bronchus, lungs

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4.

Nose, vocal cords, lungs

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4. The organs of the lower respiratory system are

1. Nose, throat, vocal cord, lungs
2. Trachea, bronchus, bronchioles, lungs
3.

Throat, trachea, lungs

4.

Trachea, lungs, vocal cords

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5. Dry-cough is caused by infection of

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1. Upper area
2. Inner parts
3.

Trachea

4.

Lungs

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6. Pain in the middle of the chest, accompanied by cough and fever suggests -

1. Pneumonia,
2. Tonsillitis,

7.

3.

Bronchitis,

4.

Diphtheria

Which illness of the respiratory track

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is serious?

1. Diphtheria

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2. Tonsillitis

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3. Pharyngitis

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4. Adenitis

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Fill in the blanks

1. 16 to 20 times/min, 2. Ronchi,

1.

2.

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---------------------------- are heard in congested air sacs.
The breathing of an asthma patient sounds

3. The chest looks like a drum during
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3. Drawn in ribs, 4. emphysema, 5. whistle like

5.

- ------ -------------- ls an imPortant symptom of pneumonia among children
Normal breathing rate is

Match the suitable pairs

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1. Cynosis

2. Increase in breathing rate
3. Rales
4.

Pneumonia

5.

Cough due to pollution

6. Cough by infection

1. Shortage of O2 in the body

2. Blueness of Nails and lips
3. Increased rate of breathing
4. Friction of air with fluid

5. Presence of fever

6. Absence of fever

Answers
Complete the sentences

1. Cold, disorder of vocal cords, diphtheria, tonsillitis

2. TB, pneumonia, cancer, emphysema, bronchitis
3. Diphtheria
4. Pneumonia

5. Diphtheria, tonsillitis, pharyngitis, inflamed vocal cords
6. Cough will be accompanied by other symptoms like change

on pressing the neck/ throat.
7. Pain during swallowing, fever, redness of tonsils
8. Lips, nails
9. Fever
10. Infected

Correct Alternatives - 1-1, 2-1, 3-1, 4-2, 5-1. 6-3, 7-1
Blanks -

1-2, 2-5, 3-4, 4-3, 5-1

Pairs -

1-2, 2-1, 3-4, 4-3, 5-6, 6-5

in the voice, pain

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Lesson 2
Concepts of our people
Aim
On reading this lesson you will

• Understand peoples’ perceptions regarding respiratory diseases.

• Know which remedies are used for treating diseases of the respiratory system.
• Be able to classify peoples’ perceptions and remedies.
• Be able to inform people of which practices are right / wrong.

Knowledge
You will know about
• What people think about diseases related to the respiratory system

• Diseases having different names in the local language.

Skill
You will learn to

• Collect -information from the people.
• Connect the information with scientific knowledge.

Perspective
You will understand that

• People have their own concepts about illnesses.

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Community health- we realize the importance of knowing

eliefs and concepts of the people that we are working with. The people should not
be blamed for being ignorant. With a little understanding and correct information they soon

realize the advantage of using the information that we give.

There may be ™ch “ate m s°me ags-oM belief which we need to retain. Others need

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to be clarified and those with harmful results may be discarded.

Consider the following list of concept regarding the causes

which are true, which are false and which don’t matter :
1.

Cough is caused by change of weather.

2.

Cough and cold is caused by eating sour things.

3.

Respiratory diseases are herediatery.

4.

Respiratory diseases are caused by smoking.

5.

Respiratory diseases in infants

6.

Respiratory diseases are caused by infections.

of respiratory diseases. Discuss

are caused by faulty diet of the nursing mother,

Your responsibilities as a health worker
Collect information from the people you work with about their beliefs re

garding causes of respiratory diseases.

Clarify what is relevant.
Often their knowledge based on reason, eg. most people believe that change

m weather conditions causes cold. This is true as germs are more effective
in some seasons.
Some notions may be wrong. After gently correcting these wrong notions
people should be encouraged to take proper treatment for their symptoms.
Once they understand the real reason and the patient improves, people will
develop confidence in the health workers.

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Lesson 3
Diseases of the Nose and Throat
Cough and Cold

Aims
On reading this lesson you will understand

• Give the indications of coughs and colds.
• Describe the symptoms of coughs and colds.

• Treat coughs and colds.
• Observe the indications and symptoms to decide whether medical treatment is necessary.
• Explain how to prevent the disease.

Knowledge
You will know about

Skill
You will learn

• Home Remedies
• Identify serious indications to send the patient to a doctor.
Perspective
You will understand
• Medicines advertised for coughs and colds should be used after careful consideration.

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Coughs and Colds
Cough and cold is a commonly occurring illness. Children have to face it every two

months. This infection gets cured on its own. There is no remedy for virus. Only resistance

can cure viral infections. Thus no treatment is necessary for viral infection of the respiratory
tract.

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However, coughs and colds do cause suffering. A patient gets headaches, loses appetite

and feels, lethargic. 40% of the working people who take leave, do so due to cough and
cold. This affects our economy. Some remedy is needed to reduce the suffering. People
must know that

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1. Cough and colds last for a week with or without treatment.

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2. Antibiotics are no use.

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3. Advertisements for colds are useless. The syrups contain sugar and alcohol. The
linctus often contains codeine which leadens the mind. But our mental respiratory
control needs to remain active for our health, even if the cough keeps us awake.

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4. When the viral infection weakens the respiratory system, there may be a bacterial

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attack. If this affects the internal respiratory system, it can lead to serious diseases.

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Therefore its contains, should be diagnosed for treatment.
Serious indications

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Increased rate of breathing

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Sound inside the ribs

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Weezing

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Cough not cured by antibiotics

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Reddish phlegm

How you will be able to explain the cause

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Cough and cold is symptom resulting from the viral attack.
When some foreign body attacks the internal covering of the nose, the body secretes

a fluid to resist it. This medium helps to throw out the germs and the patient has a
running nose.
Three Causes of suffering form cold and cough
1. Allergy

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2. Pollution

3. Virus

Allergy
It may be caused by pollen, hair of animals etc. which cause sneezing and water flowing

from nose. In such cases

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Give a GPM tablet
Find out the cause of allergy and try to avoid it

Pollution

This leads to dry cough and running nose. Constant contact with pollutants weakens

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the respiratory system. Efforts should be made to reduce pollution.

Viral coughs and colds

A group of these minute germs is called the rhino virus.

Which people have coughs and colds often?

1. Age wise
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Children below 5

- 4 to 7 times a year

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Youth

- 2 or 3 times per year

• Above 55

- Quite often

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2. Nature of work

3.

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Women cooking on “Chulha”

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People working with cotton

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Potters

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Stone - workers

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Traffic Policeman

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4.

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People living in densely populated homes

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Homes without proper ventilation

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Homes in the vicinity of industry

Lack of proper diet

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The complaints of cough and cold persist when the diet lacks sufficient protein with

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vitamins A and C. Protein increases resistance while vitamins keep inner body living healthy
If you study the categories of people suffering from coughs and colds, you will find

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most of these belong to the poor classes, women cooking with smoke around, especially
in rural areas. Also children in developing countries have complete respiratory ailments which
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could prove fatal sometimes.

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Which factors cause higher frequency of coughs and cold

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More frequent during January, March and October
Cold weather

Reduction of humidity in the atmosphere and lowering of temperature of the body causes,

dryness. Lesser fluid reduces resistance to infections
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Physical Exercise

Over exertion can cause colds or coughs
Long-term infection

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Continuous infection by germs can cause tonsillitis or sinusitis

How does a cold spread?

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Sneezing and coughing throws out the virus from the body. This can infect other people
directly or through used handkerchiefs, hand-shake or kissing.

Complications resulting from coughs and colds

Bronchitis, tonsillitis or pneumonia and even diarrhoea can be caused due to persistent
coughs and colds.

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Treatment for coughs and colds

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Home-remedies continue to benefit us even today.

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1. Rest for about 3 days

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2. Warmth by covering with blankets or quills.

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3. Avoid smoking
4. Administer vitamin C through lemon ‘sharbat’.

5. Hot drinks like tea with ginger
6. Gargling with warm water and salt 3 to 4 times a day.
7. Inhalation of steam

8. Take paracetomol or kadha (‘brew’/home made) for fever.

9. Do not take antibiotic or suppressants

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Natural Remedy/Naturopathy
This follows a thought process that the disease itself is the remedy. According to this

eery, improper excretion causes cough and cold in order to get rid of unwanted material.
Treatment

In this theory, the body should rest not only without sot-re work but also give the digestive
system rest by fasting. In addition the patient should either use enema or drink soups to

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clean the mtestines. Cut 1/2 kg 'polak' (spinach) and tomatoes with 75 gms of turnips and

mgs ginger into small pieces. Boil in a litre of water in covered pan. Add salt lime-

iurce and jeera powder (cummin). Drink a cup every hour. Go for a brisk walk. Later keep

your feet, soaked in warm water. Provide this information. But the patient should follow natural

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remedies / naturopathy only if he/she has faith and a strong will.
Home Remedies

1.

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Boil 10 to 15 leaves of ‘tulsi’ (Basil) in a

cup of water with pepper till half remains.

Drink it 3 to 4 times a day.
2.

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Boil 5 leaves of tulsi and 2

pepper seeds, a bit of ginger, a couple of 4-inch pieces
of lemon grass in a cup of water, reducing to half. Drink it 3 times.

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or
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Drink lemon juice mixed with honey and warm water

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Remedies for children’s colds

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1.

Crush 3/4 tulsi leaves and give two drops of their juice to the children 3 times

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a day.

2.

Crush a spoonful of camphor in two spoonful of heated oil. Keep the mixture

m a bottle. Rub it on the nose and chest of the child to give relief.

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Ayurvedic Remedies

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Like naturopathy, Ayurvedic theory also believes that colds and coughs are caused by

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constipation.
Ayurveda is based on the principle of balance. The body consists of the 5 elements

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earth, wind, water, sky, and light. There are 3 'doshas, (faults) ‘pitta’, ‘kata’, ‘vaat’. If any

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of these are increased too much, we fall ill.
Improper digestion or excessive eating creates

a greater amount of .'xafa’ (phlegm)

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Ayurvedic Medicines
1. Piper Longum - Boil with milk and drink 3 times a day.
2. Control diet

3. Abstain from sleeping in the afternoon

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4. Avoid eating sour things

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Homeopathy

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This science believes that the very cause of the illness can help cure it. just as a thorn

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can remove a thorn. This theory recommends medicine according to the habits and nature
of individuals. The same medicine can cure different diseases. A particular remedy cannot
be recommended for an illness. That has to be decided after asking about some details

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regarding each patient.

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Given below is a list of some features of disorders with suggested medicines to be

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selected after interviewing the particular patient.
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Features of the diseases
Running nose, sneezing, red eyes,
watering eyes, discomfort, feeling
better in fresh air/open.

Allium Cepa 6C
1 pill for children
2 pills every 2 hrs. for adults till relief

2.

Greenish yellow-flow, more in the
morning, blocked nose, relief in the
open/fresh air

Pulsatilla b c

3.

Lung infection, pain, wet produc
live cough, fever, increased
pulse-rate

Ferrum phos 6C
1 pill for children
2 per 2 hrs for adults till reduction in indi
cation

4.

Weezing, mucous, noisy breath

5.

Sharp cutting pain, cough, sneezing

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Medicines

1.

Antimonuim Tart (as above)
Bryonica 6 C (Quantity as above)

Acupressure
This system believes that obstruction in any of the routes of the flow of energy in the
body causes disease.

People can try home-remedies and try any method of treatment in which they can participate
actively.

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Some techniques of overcoming colds
Low fever -

Home remedies
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Traditional methods

High fever -

Paracetemol

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Home remedies
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Traditional Treatment

If available, homeopathic or ayurvedic medicines can be given according to the
symptoms suggest practising Pranayam. (Breathing exercise).

Jal neti (for older people) -

Take some water mixed with a little salt in a dish. Draw
it in through one nostril and let it flow out through the other.
Insert a needle through each nostril and repeat.

(Do not use a needle for children)
Inhale steam through the mouth and exhale through the

nose. Mix some vicks or eucalyptus leaves in the water
when boiling. Continue for 5 minutes.
There are small air sacs above and below the eyes

which help us to speak. The germs infecting the nose
may attack them causing sinusitis.
Indications

1. When the patient bends down there is pain in the area of these air spaces.
2.

The patient gets a head-ache

3.

The nose gets blocked often.

4.

Sometimes there may be fever.

Signs

The patient experiences pain when these points are gently tapped.

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Sinusitis
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Aims
On reading this lesson you will understand

•

Describe its symptoms

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Name its indications

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Give treatment for it

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Know from signs and indications when to send the patient to the doctor

•

Explain the methods of prevention of sinusitis

Knowledge

You will know about
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The structure and function of the sinusitis

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The signs and indications of sinusitis

Skill
You will learn

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Perspective
You will understand
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Pay attention if the sinuses are infected repeatedly

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The disease of sinusitis
Treatment / Naturopathy
Natural

Remedy

As mentioned before, fasting, participation and will
power are important in this method. It is done as
follows -

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1. Enema once a day

2. Mud application on abdomen

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3. Diet control as given below-(abstain from salt)
Breakfast - one glass of Tender Coconut water

Noon
Supper

or snake gourd juice (Padwal)

- Raw vegetable salad or shredded fruit with coconut.

Boiled vegetables with a little rice or chapati

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Continue till reduction of headache, breathing and voice improvement

Home Remedies

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Application of ‘Dhaval’ (White) ‘Lep’ (Paste). --

Camphor - 10 gm Franken sense (BosveBa Gabra) 10 gm Grate them separately In water,

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ix em together with 30 ml ( 5 tea spoons of coconut oil). Beat it till the mixture becomes
very soft.

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Use this ointment over nose and temple for sinusitis. If inhaled with boiling water, it relieves

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blocked nose.

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Homeopathic Treatment (

Eupatonum 6 C - 1 pill for children and 2 for adults every 2 hours till the patient gets
relief.
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Allopathic treatment -

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1. Use heat treatment for pain

2. Use inhalation of steam.

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3. Take phenyephrine to relieve the blocked nose.

4. Use the antibiotic cotrimaxozole

Ayurvedic Treatment
Apply a paste of ‘moong’ skins with (black) pepper on head and cheeks.

You can use any of the above systems of treatment as desired by the patient. Sinusitis
is a repetitive illness. Note the period of treatment the gap between the repeated attacks
and the type of treatment. Use the method most suitable for the particular patient.

However, if the condition worsens, send to a specialist whenever -

1. Pain increases
2. The problem recurs every month

Acupressure

Acupressure

Home Remedy or
Yogasana
+
Ayurvedic Medicine

Home Remedy or
Yogasana
+
Homeopathic Medicine

Acupressure

Home Remedy or
Yogasana
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Allopathic Medicine

Your responsibility as a health worker is as follows
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Cough and Cold

•

Explain that cough and cold can get cured

by itself

Explain the importance of sinusitis

For Sinusitis
A patient suffering from sinusitis should be given information about the different

systems of treatment

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Pharyngitis

Aims
On reading this lesson you will understand

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Identify the signs of pharyngitis

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Give the indications of pharyngitis

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Give treatment for pharyngitis
Observe the indications and signs to explain when special attention is needed.

•

Explain how to prevent the disease.

Knowledge
You will know about
•

The reasons for irritation in the throat in pharyngitis.

•

The different systems of treatment available for pharyngitis

Skill
You will learn

•

Home Remedies for pharyngitis.

Perspective
You will understand
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Treatment for worms is essential since worms can also cause pharyngitis

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The disease Pharyngitis

Indications
Every person experience this disease

in his/her life. Following are its symptoms

1. Pain while swallowing
2.

Irritation/itching in throat

3. Dry cough
4.

Redness of throat can be seen from the inside

Reasons for Pharyngitis

1. Allergy
2. Virus
3. Worms in the stomach
1. Allergy

When people come in greater contact with particular items like pollen grains or dust
during certain reasons, they develop allergy.

Allopathic Treatment
CPM (Chloraphinarmine) pills,

Homeopathic Treatment
Allium Sepa 6 Q every two hours till conditions prevail.
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2. Virus

Cold and cough is often accompanied by Pharyngitis.

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Homeopathy - Bryonia 6 c every 2 hours

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Treatment

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1. Gargle using warm water with salt
2. Drink juice of tulsi leaves

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3. Drink milk heated with turmeric powder.
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3. Pharyngitis caused by worms

Worms are excreted with faces. If people defecate in the open, they stick to the
flies which carry them to open food. If this food is eaten or if hands are not washed carefully

after excretion, the worms from nails enter the mouth while eating. These worms reach the

intestines from where they enter the bloodstream. Then they reach the lungs, from where
they enter the food pipe through the respiratory tiacL On^e again they go to the intestines,
get excreted with the waste into the atmosphere.

> Contaminated food (containing eggs of worms)

Stomach
&
V

Small intestine
<

(

V

Blood

Lungs

Respiratory tract
i

v
Throat - where they cause irritation ]

v
Digestive tract

v
Excreted with faeces

i1

f

t
23
If a patient with dry cough continues, suffering even after taking CPM for 3 days, he should

be asked the following questions -

1. Have you observed worms in your stools?
2.

Do you experience itching at the anus?

If yes, deworming treatment is to be given
Allopathic
One Mebendezole tablet every morning and evening for 3 days.

Homeopathic

Seena 6 C for 3 days
Ayurvedic
Emelia Ribs powder (Latin name) Wavding’ (Marathi) mixed with jaggery for 15 days.

Home Remedies

Consume the milky juice of raw papaya- a few drops in the morning for 3 days.

The third night castor oil should be taken to purge the stomach (except for pregnant women).

2-5 years

- 2 drops

5-10 years - 10 drops
10-15 years - 15 drops

Above 15 - One spoonful

Home remedies should be followed immediately by allopathic treatment and then

Ayurvedic method for 3 weeks.
This procedure has been found useful through experience. It has not been proved

by any ‘pathy’ as such.
%

1

Your responsibility as a health worker is to
• Explain the causes of pharyngitis to people

• Point out the significance of gargling for pharyngitis
• If fever is accompanied by throat - ache and difficulty in swallowing consult a

f

doctor at once.

2±]

Tonsillitis and Adenitis

Aims
On reading this lesson you will understand

•

The symptoms

•

The indications
The treatment for Tonsillitis and Adenitis

pa,i“,o a dMor by

■

•

,he

Preventive Remedies.

Knowledge
You will know about
The structure and function of the tonsils and adenoids.
The harmful effect of infected tonsils on other organs.

Skill
You will learn
•

Observation of tonsils

•

Home remedies for tonsillitis

Perspective
You will understand
•

Immunisation is a social responsibility.

■ ^:„tT/;bdo:?oep:;da^

9lands In ,he respira^

of

25

The Conditions called Tonsillitis and Adenitis
Since both occur close to each other and are important in defending our body, they are

considered together for discussion of their disorders.

The tonsils are located in the throat while the adenoids occurs behind the nose.

Adenoids

3

Tonsils

Is

Their functions are :

1. Developing resistance
2. Produce white blood cells

3. Tonsils prevent infection and prevent serious illnesses like bronchitis and pneumonia
Infected tonsils lead to

• Production of toxic maternal which affect the kidneys or heart through blood.

J

• The pus produced can infect vocal cords, respiratory tract right upto the lungs

Susceptibility of Tonsillitis occurs among the following
4

• Greater frequency between the age 5 and 30 especially upto 12 years of age.
• During illness like typhoid
• People consuming polluted water

4

g

>

• People living in dense areas or studying in over crowed schools.

8

• During spring and dry summer.

4

• Among sinusitis patients

1

26

Symptoms
1. Pain while swallowing due to which children avoid food

or water. The pain may reach

the ears, which becomes sharper while swallowing
2. Fever from 102° F to 104°

3. Loss of appetite
4. Great thirst
5. Constipation

6. Bad breath

7. White coating on tongue

8. Pair in the throat.

Site of the pain

Indications
1. High fever
2. Increased pulse-rate

3. External examination - swelling of glands
4. Examination of throat - Tonsils become red with spots

Tonsils

Treatment

Rest

for 3 to 5 days

Diet

Liquids, warm and nutritive food, warm water mixed with a spoonful of lime juice and
a quarter teaspoon of honey to be drink slowly.

Gargling

With aspirin and warm water, twice a day for a week.

<

a

1

27

Fever and Pain

Give paracetemol till the patients feels better
1 yr.

75 mg - 4 times a day x 5 days

1-5 yrs.

125 mg - 4 times a day x 5 days

5-12 yrs.

250 mg 4 times a day x 5 days

12 yrs. and above -

500 mg 4 times a day x 5 days

Antibiotics

Cotrimaxazole for 5 days. In case of repeated attacks of tonsillitis, the patient must be
referred to the doctor.

Homeopathic Medicine

Pulsatila 6 C twice a day x 14 days.

Your responsibility as a health worker is as follows
•

Explain to people that the tonsils operation is advised only in case of monthly
attacks or if there is difficulty in speaking

•

The idea that a tonsils operation results in better height or health is totally wrong.

e

Help in ensuring immunization/vaccination of children

Explain the seriousness of disease.

•

Administer one dose of cotrimoxazole and arrange to meet a doctor after that

•

Ensure immunization of all the children of your region.

•

Inform the villagers about diseases.
Let them know which symptoms in their children should be reported to you for
consultation.

r
Money, means of transport and people’s health is needed in case of emergency.

So try to raise, a combined fund for the village. Try to train health workers in
case of additional help.

o

28
Exercises (Cough and Cold)
Correct Alternatives

1. What is cough and cold?
1. Disease
2. Indication
3. Illness

4. Symptoms
2. They infect us in case of cough and cold

1. Virus
2. Bacteria
3. Parasite

4. Allergy

3. An indication of a serious ailment of respiration is
1. Fever
2. Phlegm
3. Running Nose

4. Difficulty in breathing
4.

Reason for cough/cold according to Ayurveda

1. Constipation
2. Vomiting
3. Pitta (Acidity)

4. Kafa (Phlegm)
5.

Frequent coughs and colds occur among

1. Children and aged
2. Stone Workers
3. Under nourished

4. All the above

6.

Repeated cough/cold may cause

1. Bronchitis
2. Tonsillitis
3. Pneumonia

4. Diarrhoea

o

[291
7. Match the pairs

1. Allergy

*

*

2. Protein

1. Increasing Resistance
2. CPM pill

3. Vitamin

3. Natural remedy

4. Enema

4. Healthy internal lining s

5. Lemon juice

5. Cough, cold

6. Extracts of Tulsi leaves

6. Vitamin C

*
Fill in the blanks

%

(Allergy, Pollution, virus ) (Centre of Respiratory control) (Antibiotic) (Pulsatila) (4-7) (Protein,
vitamin C) (Virus) (On the disease/Person) (Resistance) (Natural)

1.

Cough/cold is caused by infection due to

2.

Children below 5 years of age may be attacked

times by germs affecting

respiration.

3.

1

medicines are not useful for cough/cold.

4.

Lack of

5.

Homeopathy treats

6.

The causes of cough/cold are

in the diet increases suffering due to cough/cold.

7.

not

is the reason behind cough/cold getting cured on its own.

(

8.

In homeopathy the medicine

is given in case of lung infection,

pain, productive cough and fever.
(

9.

In

remedy, medicine are not to be given for cough/cold.

10. Linctus Codein can harm the
c

Key
Correct Alternatives
(

1-2, 2-1, 3-4, 4-1, 5-4, 6Correct Pairs

I

(
(

1-2, 2-1, 3^4, 4-3, 6-7
Blanks

1-7, 2-5, 3-3, 4-6, 5-8, 6-1, 7-9, 8-4, 9-10, 10-2

(
(

30
Exercises - Sinusitis

Fill in the blanks
Participation of the patient, 14, Sinus, sinusitis, camphor ointment, Cotramexazole, swelling

and infection of sinus, pupetoruim, increased pain or repeated attack, tender coconut water,

snake-gourd
1. The air bags above the eyes and beneath the frame of the face are called

2. Sinusitis means
3. A person who gets headache, fever at times and increased pain on bending may have

4. According to Natural Remedies, sinusitis should be treated for

5. Drinking the juice of

days.

gives relief in sinusitis according to natural remedy.

6. Inhaling the vapour of
remedy.

is beneficial for sinusitis according to home

7. Allopathic treatment uses the medicine

8. The sinusitis patient should be sent to a doctor in case of

9.

in natural remedies/naturopathy is essential while treating sinusitis.

10. Homeopathy recommends

Key
Blanks

1-3, 2-7, 3-4, 4-2, 5-10, 6-5, 7-6, 8-9, 9-1, 10-8

for sinusitis

31
)

Pharyngitis

>

Fill in the blanks

Mebendezole, Fever and pain, swelling in the throat/infection, gargling with salt and water, (Allergy,
virus, worms), pharyngitis, bryonia, chlorophenaramine, (GPM)
1. A person with pain while swallowing, irritation in the throat, and dry cough is likely to
have
Pharyngitis means

2.

causes irritation in the throat.

3.
4.

is the allopathic medicine for pharyngitis caused by allergy.
Homeopathy recommends

5.

in case of pharyngitis caused by virus.

6. The home-remedy for pharyngitis is
7.

If pharyngitis is caused by worms, allopathy recommends

8. The patient should be sent to a doctor if pharyngitis is accompanied by

Key
Blanks
1-6, 2-3, 3-5, 4-8, 5-7, 6-4, 7-1,8-2

i'

I

132

Exercise (Tonsillitis and Adenitis) ?

n

J

[331

Lesson 4

Disorder of the Middle Ear

Aims
On reading this lesson you will understand

(

•

Give the symptoms of the middle ear ailments

•

Observe the indications of the middle ear ailments.

•

Give treatment for the middle ear ailments.

•

Note the symptoms and indications that require the attention of a doctor.

•

Explain prevention for it.

The ear has been divided into 3 parts according to its functions

(

(

Knowledge

(
(

You will know about
•

Structure and functioning of the ear

•

What care should be taken to prevent ear infection.

(

Skills
You will learn

•

The process of ear syringing (for cleaning)

Perspective
You will understand

n

•

Pain in the ear should not be neglected.

•

All the systems of our body are inter related.

[341

The Study of the Middle Ear Ailments

1. The Externa! Ear
It receives the sound from outside. There is a tympanic membrane at the end of the

tube of the ear. The sound from the external ear reaches the inner end through the tube.

Glands around the tube secrete a wax-like fluid sirumen which protect it.
Excess of this sirumen or dust trapped in it can block the tube, causing temporary deafness.
It may create pressure on the membrane causing pain in the ear.
2. The Middle Ear

A drum like tympanic membrane separating it from the external ear. Sound waves vibrate

it which in effect causes the 3 small bones of the ear- Malus, Inchus and Stepes to get
vibrated. The middle ear contains air entering it through the Eustachian tube from the upper

part of the throat. This is straight among children, causing infections from the throat or nose

to directly reach the ear. But it is bent among adults, preventing direct infection. The infection

of the Middle Ear can affect Mastoid, the bone behind it
3. The Internal Ear

The internal ear contains the centres of hearing and balance of the body. The vibration

of the bones of the middle ear creates waves in fluid contained in the semi-circular tubes.
They excite the nerves which carry the sound waves to the hearing cenfre of the brain.
How do cough and cold cause pain in the ear? There are 6 openings in the throat- 2 each
from the nose and the ears, one from the food pipe and one from the wind pipe.

The germs infecting the respiratory tract can pass these openings to reach the organs

of that passage. When they infect the ear, pain is caused. If they enter the digestive tract,
they cause motions.

Since all the systems are interconnected, the disease of one organ can obstruct the
working of another organ or its system. This must be kept in mind.

Symptoms of disorder in the middle car

1.

Pain in the ear
Since a baby cannot speak out, its hand may keep going to the' ear. When you pull

it slightly it will cry if there is pain. Thus you can realise that the c,/did is suffering from

n

r35~i
some problem of the ear.
2. Flow from the ear

Damage to the membrane of the ear causes liquid to flow-out.

Symptoms
These symptoms inside the ear can be observed only with special instruments and a
torch. Therefore you can find this out from a government hospital. Without this examination,

those details don’t mean much and are therefore not given here.

Treatment
Allopathic

1. Paracetemol for pain.
2. Cotrimaxazole for germs (antibiotic)
3. Application of ice to the external ear.

Ayurvedic
2 drops of Anu oil in the nose. Heat the ear with ‘Shahutat’ leaves soaked in milk.

Homeopathic
1. In case of a yellowish watery flow- Hepar Sulph be 3 times a day till reduction of
suffering.

2. Thick greenish flow - Pulsatilla 6 c - 3 to 4 times a day till better.
3. Thick white sticky flow - Kali Mur 3 or 4 times a day.
4. Pus with odour - Purogenniem 6 C - 3 to 4 times a day till better.

Long term ailment of the middle ear
If the flow continues for more than 2 weeks, antibiotics will have no effect. The ear should

be cleaned as follows -

- '■

1.

Take the 25 cm. tube and needle/syringe from your kit.

2.

Boil both the things (sterilize)

3.

Cool half a dish of boiled water

4.

Draw 0.5 ml in the syringe.

5. ’

Ask someone to hold the child’s head steady.

36

6.

Insert the tip of the syringe gently into the ear.

7. Join the tube to the syringe.
8. Press the syringe slightly to let water into it.
9. Draw out the water
10. Throw the dirty water away.
11. Take 5 ml water into the syringe and repeat the steps from 7 to 10 till you get
clean water from the ear.

12. Take some clean sheets of paper.

13. Roll a paper finely and insert one end into the ear.

14. Remove it after one minute and throw it away.
15. Roll the papers one by one, inserting them in the ear till the end comes out dry.
16. This procedure ensures drying of the ear.
17. The whole method has to repeated for many days.
If the complaint persists even after this, the patient should be sent to a doctor. He may

need surgery.

Prevention of Infection of the Ear

1.

Use of swab of cotton on a match-stick to clean the ear. Do not insert it to deep into

the ear. Gently remove the excess of sirumen in the ear.

2.

When a child has a cold, he should be taught to clean the nose by keeping one nostril
closed while exhaling fast from the other side. The mouth must be kept open during

this. (See MM-cold-Bleeding)
3.

Do not leave cotton etc, inside the ear. Explain to children that they should not put anything

into the ears.

4.

Do not allow children with infected ears to swim.

5.

Do not let a child drink milk when lying totally horizontal, because the milk may enter
the nose or Eustachian tube.

Treatment of Pain in the Ear

Give Aspirin to remove pain. Use germicide against infection, e.g. - ampicilin.

Try the following
1.

Mix vinegar with warm water. Put 3 to 4 drops of it in the ear (First add a spoon of

pre boiled and then cooled water with vinegar)

J

37
2.

Heat a little fresh coconut oil. When it cools a little, put a few drops it the ear 3 to

4 times a day.
3.

Clean the ear. Extract the juice of marigold leaves by crushing them. Put 2 drops to

stop pain in the ear.
4. To treat infection of the ear, put a few drops of fresh urine twice a day. If there is no
relief by the above means, consult a doctor.

*

I
A

38|
*

Exercises
Fill in the blanks

(Hepar Sulph) (Cotrimexazole) (Disorder of the middle ear) (Tympanic) Tympanic Membrane,

(Mallus, Inchus, Stepes), External Ear.
i

1. The

receives the sound.

2. The

occurs at the end of the external ear.

*

on the end of the tube.

3. Excess of dust in the ear brings
4. The middle ear contains the bones

5. There may be

in case of pain and flow from the ear.
for yellowish flow from ear.

6. Homeopathy recommends
7.

is administered for disorder of the middle ear.

Answers
Blanks

1-7, 2-5, 3-4, 4-6, 5-3, 6-1,7-2

i'

[~39

Lesson 5

Bronchitis (Acute)

Aims
On reading this lesson you will understand

•

Give the symptoms of acute bronchitis

•

Give the indications of acute bronchitis

•

Treat acute bronchitis

•

Know the symptoms and indications when the patient must see the doctor

Knowledge

You will know about
•

Causes of Acute Bronchitis

•

Different types of treatment for Acute Bronchitis

Skills
You will learn

•

Observation of breathing

•

Ayurvedic Treatment for acute bronchitis

Perspective

You will understand

•

■

?
€

If not treated, acute Bronchitis can be long term and serious

40

Acute Bronchitis
(A Respiratory Disorder that grows fast)
When the respiratory tract and the trachea are affected, excess of fluids are produced.
Usually this problem results from, viral infection.
Present complaint of patient will be as follows Excessive cough and phlegm.

Green and yellow phlegm, fever.
Light pain in the chest and stomach.

Physical Examination
1.

Stethoscopic Examination enables you to hear Ronchi.

2.

In case of great infection, weezing or whistle-like sound will also be heard.

Acute bronchitis gets cured in a week or two by itself. But often, there is a possibility

of other infections during an illness. So care needs to be taken to ensure that there is
no bacterial infection.
Care of the Patient

1. Rest- The energy should be used only to resist germs.
2.

Nutritive Diet- A diet rich in protein and vitamins should be provided-to increase the

resistance.

3.

Quantity of water- This should be increased to help dilution of phlegm so that it can

flow out .

4. Adulsa Syrup- This ‘kadha’ heals cough.
5.

The homeopathic medicine Aconite may be used.

6.

The patient must not smoke.

Treatment
If the patient is aged and has a history of lung ailments antibiotics, may be given. Smoking

is one of the main reasons for bronchitis which gets acute in crowds and icold seasons.

Early treatment and giving up of smoking cures the patient. But this doesn’t happen.
The cough is dry at first. Later it becomes productive and generates phlegm. The patient

repeatedly gets treated for cough. If this continues for a whole year, the patient develops
chronic bronchitis or long-term/disorder of the respiratory system.

Your responsibility as a health workers is this

• If a patient gets acute bronchitis repeatedly, he should be made to realise the need
t

to change his habits and stop smoking.

t

(

/

I

5

t
f

I

• Since this complaint may result from the smoke of the ‘chulha’, patients should be
advised to improve their roof and ‘chulha’ too.

42

Bronchitis (Chronic)
Aims
On reading this lesson you w;!! understand

•

The symptoms of chronic bronchitis

•

The indications of chronic bronchitis

•

Give the treatment for chronic bronchitis

Observe the symptoms and indications when the patient must be sent to a doctor.
•

Explain how to prevent it.

Knowledge

You will know about

•

The causes of chronic bronchitis

•

The bodily changes caused by it

Skills
You will learn
•

Observation of breathing

•

Ways of extracting the phlegm

Perspective
You will understand

•

Smoking is the main cause of chronic bronchitis

t

f

e
r

43

Chronic Bronchitis
(A long term disorder of the Respiratory System)
t

(

consider it a complaint when he describes other complaints If the t
h
P 'entdOeSnt
get damaged, the air-sacs get eniarged resutting in the disease oXZX^

(

<

Four stages of Chronic Respiratory Disorders

(

1st Stage - A lot of cough in the morning
2nd Stage - Climbing up liffing weight, extra walking leads to breathlessness and cough

along with ‘kafa’ .

3rd Stage - The patient cannot step out of the house,
the morning

complains of ’kafa’ and cough in

4th Stage- Experiences difficulty

stage send them to

even while talking you may treat patients upto the 2nd
the doctor if they are not the 3rd
_.J or 4th stage.

Current Complaints

1. A patient of chronic bronchitis has cough in the morning.

2.

He gets phlegm about a spoonful to a cupful

3. The phlegm is greenish yellow.
Critical observation

T

Cough and ‘kafa’ in the morning mainly signals that the patient has chronic bronchitis.

2'

Examination of the patient
1.

You

bear the weezing/whistle-like or bronchi sound through stethosoopic examination.

■

44
2. The chest resembles a drum.

3.

If the patient exhales slowly, it means he needs to use
out.

The natural effect of the illnessThe patient will get repeated attacks of coughs and cold, along with

pneumonia. All patients don’t get emphysema, but it proves fatal eventually
when the patient complains of breathlessness while resting, and the nails

or lips turn blue, you will know that the lung capacity has reduced.
Care of patients with chronic bronchitis

1. Giving up smoking by the patient is advised.
2. Antibiotics like cotrimaxazole are given.
3.

Fluid intake - Maximum consumption of liquid/water
helps to dilute the phlegm and bring it out.

4.

Prevent pollution inside the house.

5. Give medicines to dilate bronchi and dilution of
phlegm like Benadryl orAdulsa Syrup.
6. Give inhalation of steam
7. Make the patient lie down as shown in the figure to

remove the kafa’ from the body, patting
his back and chest.
Treatment

Home Remedies - 1. Make a Tails Patraadi Choorna’ for colds, cough, phlegm,, bronchitis
1. Talis

5 gm

2. Black pepper
3. Ginger
4. Piper longum

10 gm
20 gm
40 gm

5. Cinnmon
6. Cardomom
7. Sugar

40 gm
40 gm
320 gm

Grind them into a powder and keep in a closed container. Give the quantity according to

age-

(

(

Less than 1 year - 1 pinch with honey/mother’s milk 3 times a day

(

1-5 years - 1/4 spoon with pure ghee, 3 times a day

(
(

(

C
6

45

5 to 12 years - 1/2 spoon with honey, 3 times a day

Above 12 years - a spoon with honey, 3 times a day
(Without honey or sugar for diabetics )
This method may be used for long-term disorders,

Adulsa and ‘Kantakar’ Choorna

Take 25 leaves each Adulsa and ‘Kantakar’, dry item and powder them together.
Kafa - 1 spoon with honey, 3 times x 5 days
Asthma - 1 spoon with honey or hot water x 3 times throughout the season.

Cough - 1 spoon with honey x 3 times till better
TB- With allopathic medicines. 1 spoon with ghee x 3 times till better.
Bronchitis - 1 spoon with honey x 3 times till better
3. Moonga Choorna

For bronchitis take a 4 inch piece of ‘Moonga’ and grind it with a spoonful of jeera.

Mix the powder with a raw egg and a spoonful of ghee. It should be consumed everyday
till complaints persist.
•’js*-

Homeopathic Medicine

W'

v
■

Antimonuin Tart 6 c - 1 dose after every 3 hours till patient gets relief.

■

u

Your responsibility as a health worker is as follows
Explain the complications of chronic bronchitis

Ask patients to give up smoking.
J
(
■

r
» .

46

Exercises (Acute Bronchitis)

Fill in the blanks

Adulsa, (Disorder of the Respiratory Tract and Trachea), (Smoking, cold, crowd), Aconite, (Rich
in protein and vitamin), Virus
1. Bronchitis means
2-------------------- is the cause of acute bronchitis.
A diet---------------------------should be given during acute bronchitis.

4'--------------------------- syruP (kadha) is given during acute bronchitis.
5- ------------ is the homeopathic medicine.

6. Bronchitis may be aggravated by
Choose the correct Alternatives

1. A person with chest pain , fever, cough with greenish yellow phlegm has the disease
1. Bronchitis 2. Tonsillitis 3. Pharyngitis 4. Pneumonia
2. A bronchitis patient must be asked to drink more water because

1. A patient feels thirsty 2. Water brings relief 3. Water dilutes phlegm and brings it out 4
It stops phlegm

3. A bronchitis patient is advised to give up smoking because
1. It is a bad habit

2. It can cause long-term damage to the bronchi.
3. It causes cough

4. It creates phlegm.

4. What should be done to treat bronchitis?
1. Rest/Advice to give up smoking
2. Nutritive diet/increased water in take
3. Adulsa syrup.

4. All the above
5. If the patient is aged with history of lung disease he may be given this given 1. Ayurvedic 2. Anti viral 3. Antibiotic 4. Anti allergic

Answers

Blanks -1-2, 2-6, 3-5, 4-1,5-4, 6-3
Correct alternatives -1-1,2-3, 3-2, 4-4, 5-3.

i’

[771
Exercises (Chronic Bronchitis)

Fill in the blanks

(Morning), (lungs), (exhaling), (Long-term disorder or respiratory system) (drum), (cough)

1. A smoker who has repeated complaints of respiratory illness may have the disease
2. A patient of chronic bronchitis always complains of.
3. There is greater cough in the
in chronic bronchitis.

4. The chest becomes shaped like a
5. There is difficulty in

due to chronic bronchitis.

during chronic bronchitis.

6. Chronic bronchitis damage the.

Choose the correct alternatives

1. Emphysema causes enlargement of
1. Tonsils 2. Adenoids 3. Bronhus 4. Air-sacs
2. The main complaint in chronic bronchitis is

1. Flowing nose 2. Difficulty in swallowing 3. Cough and Phlegm in the morning
4. Ear-ache
3. In chronic bronchitis you should recommend

1. Giving up smoking 2. More water in take 3. Inhalation 4. All the above

4. A patient of chronic bronchitis should be sent to a doctor in case of the following
systems.

1. Pain while swallowing 2. Chest pain 3. Greater cough and phlegm in the
morning. 4. The patient has difficulty in stepping out/talking

hi

5. The reduced capacity of lungs is gauged from
1. Difficulty in breathing 2. Chest pain 3. Breathlessness/nails and lips turning blue
4. Pain while swallowing

Answers
-J

Blanks - 1-4, 2-6, 3-1,4-5, 5-3, 6-2,
Correct alternatives -1-4, 2-3, 3-4, 4-4, 5-3

48

Lesson 6

Asthma (Emphicema)
Aims
On reading this lesson you will understand

•

The signs of Emphicema/Asthma

•

The indications of Emphicema/Asthma

4

•

Treatment for Emphysema/Asthma

(

•

Know the signs and indications when to send the patient to the doctor.

•

Explain the methods of prevention.

Knowledge

You will know about

•

The causes of Asthma.

•

The actual signs and indications.

(
f

(

Skill

i

You will learn

(

•

Observation of breathing.

i

•

How to use the inhaler to reduce the suffering during Asthma.

I
(

Perspective
You will understand
•

<

(

Life style and allergy are responsible for Asthma.

(

(
(

(

(

(
(

c
(

%

[49]
%

The Illness of Asthma

%

One in every hundred people suffers from Asthma. The English word ‘Asthma’ has originated

%

from the original Greek word which means breathlessness/panting.

The respiratory tract of an asthma patient contracts/shrinks in size. Inhaling is smooth
but exhaling becomes difficult. There is friction between the air moving in and out. This

causes the whistle-like sound. The patient feels restless, whether sitting or lying down.
Asthma is mainly caused by allergy to particular things. Thus the patient suffers during those

♦

particular seasons.
Symptoms

1. Difficulty in breathing.
2.

Whistle like sound during breathing.

3. Cold, cough, phlegm, ‘kafa’.

9
0
3

Indication

Exhaling takes longer -slow

&

Treatment

©

3

a
B
8

1.

Use of salbutomol inhaler

2.

Use medicine prescribed by doctor for emergency

3.

In the absence of a prescription give the salbutol pills/tablets with you and send the

patient to

the doctor.

4. Give steam
5. Find out the cause of allergy of the patient.
a.

Pollen grains

b.

Hair of animals

c. Smell
d.

Working in the field

e.

Food habits

f.

Dust pollution

gh.

Flowers, particular grass of cats/dogs.
Odour of paint, flowers or incense
Use of pesticide or sprouting of millet consumption of grain, moong etc.

J-

Due to crackers.

i

i

I 50 |
Peter Hembraum was working with the tribals of Bihar. He used the following 'choorna'

(mixed powder) for asthma-

1. Tylophora asthmatica (Anantmool)
Ground leaves of Anantmoui - 1 „poonful with honey to be taken twice a day x 5 days
OR

2.

Grind 5 fresh leaves of 'Anantmool'-and take this paste with milk twice a day x 5 days
OR

3.

Half a spoon each of lime juice, 'paan' leaves, tulsl and honey together, 3 times a day

for 15 days.

For allergy due to dust
Mate .Kheer’ (porridge) on a full moon night and keep it. such that moonbeams tall
n ,1 the whole night. Add a spoonful of the bark of the 'Arjun' tree to it at dawn and have
the porridge before sunrise.

Chronic bronchitis or long-term respiratory ailments can result in complications like

mphysema . This is a Greek word which means 'excessive breathlessness'. The air sacs

ln^et'IT eXPand eXCeSSiVe'y' redUCing their elasticity- Though air enters the lungs, it is

difficult for it to go
” out.’ The oxygen and carbon dioxide cannot be exchanged oroperly, causing
suffering to the patient

I

1. Breathing problem
2. Pressure on the heart
3. Death
The patient with emphysema should be given an antibiotic dose, a medicine to dilate
expand the respiratory tract and sent to the doctor.

Home Remedy - To dilute the ‘phlegm’
1. V2 gm powder of “Yashtimadhu” with hot water, 3 times a day.
2.
Mixture9ofS|hoaritakl?M1/2 9m P°Wder With honey' 3 times a By
3. Mixture of 250 gm of black pepper (powdered) with 1 gm of jaggery -

twice a day

with milk.

Your responsibility as a health worker is as follows
Help the patient to understand his illness.

'

Help in changing the life style due to the illness
•

Discuss which medicine should
and keep

•

be taken in case of emergency with the doctor,

with the patient.

Help in identifying the allergy.

Encourage the patient to seek help of doctors or other treatment channels. Ayurvedic
methocis can give a lot of comfort.
■

- ------------------------ - ------------------- ---------- ----------- 1_____________________ I

<

51

Exercises
I

(Whistle-like), (breathlessness), (abstaining from allergy), (allergy of something), (friction

between incoming and outgoing air in the respiratory tract)

(

(

1. Asthma means

(

2. Asthma is caused by

(

3. The breathing sound is
(

4.

(

5.

in case of Asthma.

causes whistle-like sound of breathing.
is the main solution in treating Asthma.

(
(
i

Choose the correct alternative

1. Which of these contracts in case of an asthma patients.
1. Trachea 2. Tonsils 3. Respiratory tract 4. Lungs
2. Emphysema causes enlargement of

1. Air sacs 2. Trachea 3. Tonsils 4. Lungs

Answers
Blanks -1 -2, 2-4, 3-1,4-5, 5-3

Correct Alternatives -1-3, 2-1

TaA- Uo

09143

Lesson 7

Pneumonia
Aims
read'nS tllis

y°u will understand

The symptoms of Pneumonia

The indications of Pneumonia

•

Treatment of Pneumonia

“afc"S Whe" ,te —'

•’

see the doctor

Knowledge

You will know about

•

The causes °f Pneumonia

•

Symptoms and i. "
'cations of Pneumonia in small children
Treatment of Pneumonia

•

Skill
You will learn
Observation of rate of breathing
Send the patient to the doc,or in case

Of serious indications.
Perspective

You will understand

Serious consequences can be

prevented by treatment in the

)

primary stage.

53
The Disease Pneumonia

The UNICEF and WHO figures show that 28% deaths among children below 5 years

of age are caused by rapid infections of the respiratory tract in developing countries. These
children get infected by germs in their respiratory system about 4 to 7 times a year (Fiona

Plus, A Quarterly Bulletin on Primary Health Care and Community Health, Issue 31, December

1993.) They are victimised due to malnutrition, overcrowding, pollution and unhygienic conditions
of living.

The maximum fatality occurs among infants below 6 months.

The name Acute Respiratory Tract Infection suggests the sudden onset of the ailment.
The illnesses are classified according to the infected area of the respiratory tract. They

are broadly divided into diseases of the upper tract (like the nose , throat or vocal chords

which are not serious) like infection of the tonsils, cold, cough, swelling, pharyngitis which
are mild.
The second category is the serious and sometimes fatal diseases of the inner respiratory

system as in the trachea, bronchitis and finally air sacs, or lung tissues which are its parts.
The two main illness of this kind are Pneumonia and TB.

It is easy to differentiate between the infections of the two parts of the respiratory factors.
If cough and the phlegm are the deciding factors. If the upper tract is infected, the cough

is dry and the sound shallow. There is pain while swallowing. However, the inner system,

when infected, creates a flute-like sound which is deep. The cough is productive (gives
out phlegm or kafa ). The main diseases in this category are bronchitis, pneumonia and
TB.
Two months to 1 year (of age) - Indications

1. The baby cannot suck.
(

2. Attack of convulsion
3. The baby sleeps a lot and its difficult to awaken it.
(

(

4. The whistle-like sound is heard when the baby is fast asleep
5. Under nourished

Serious Illness - Treatment

v
(

1. Arrange to send to hospital immediately

<

2. Give the first dose of antibiotic

(

3. Give paracetamol in case of fever.

(

C
f

54
Serious Pneumonia- During breathing there is

I

1. Drawing in of ribs
2. Breathing rate is above 60 per minute

Treatment

1. Arrange to send to hospital immediately
2. Give the first dose of antibiotic
3. Give paracetamol in case of fever.

If it is not possible to send the baby to hospital, continue the dose of antibiotics and

observe the baby.
Follow -up
Whenever you visit the child,

you should observe -

1. Whether the condition of the child is worse (than/before)
2. Whether the ribs are drawn in while breathing.
3. Whether there are signs and indications of serious illness.
In case of any of the above symptoms, the baby should be

sent to the hospital immediately.

A) Pneumonia

1. If ribs are not drawn in while breathing.

2. If breathing becomes faster
2-12 months

above 50/minute

1-5 years

above 40 per minute

Treatment

Advise the mother to take the following care of the child-

1.

Give the dose of antibiotic properly

2.

Understand that paracetamol is used for fever.

3.

Decide whether you will visit the baby

or call the mother to get information about its

condition after 2 days.
i■

4.

Inform the mother which symptoms and indications

are serious enough to call you.
i
i

t

i
£

Fss]
B) In case of improvement of the child's condition, it means the treatment is correct.

ff

But if there is no improvement think of changing the antibiotic with another one like

r
r

amoxycilline. However if the condition becomes worse, the case is serious pneumonia
treat accordingly.

F

C

C) If there is only cough and cold (not pneumonia)

F

•

Chest is not drawn in while breathing.

•

The breathing rate remains unchanged/steady2-12 months - 50 per minute

1 to 5 years - 40/minute
*

•

in case of cough for more fthan 3‘ days,
'
send the patient to the hospital

•

Give paracetamol in case of fever.

•

Ask the mother to give. Adulsa syrup or
< any other ‘kadha’ for cough,

•

Explain that the child must get rest andi comfort.

Decide the place and timing of the next visit after
Feedback
The treatment

(

{

is correct if

•

The breathing rate is normal

•

The fever is less

•

The child has a normal intake of food and liquid

Treatment

of Paediatric Pneumonia

There are 5 main medicines used to treat children suffering from Pneumonia -

Cotrimaxazole, Ampicillin, Chloramphenycol, Benejork, Penicylin and Gentamycin. They are

all life-saving drugs but should be given in the right dosage keeping their side-effects in
(

mind. Health workers must know when and how to use them.

Usually, pneumonia among children is caused by infection of bacteria like streptococcus

Pneumonia and Haemophilus Influenza. Cotrimaxazole is an effective and affordable medicine
with minimum side-effects.

(

Infants of less than 2 months are not
t ' much benefited by Cotra, so they should be given
ampicyllin. They should be sent to the doctor
------------ ■ as soon as possible (using ‘cotra’ only as
a stop-gap arrangement for the time-being).

Cotrimaxazole (Adults) Cotrimaxazole (Children) Ampicillin children who cannot swallow
the pills should be administered its powder with honey and water or milk. If there is improvement

after 48 hours, give the complete dose for 5 days.

56
If there is no improvement, keep giving

contrimaxazole for 2 days.

c p

----------------- -^7777^-^7^Nfd^om 2 months to 5 years

Age/Weight

Children’s Tablet
(Sulphamethoxazoij

Tryomethoprim 20

Children’s Syrup
Cu'mhamethoxazol)
Tryomethoprim zuu

mg (1 spoon/5 ml)

mg (1 tablet)

Less than 2
months/upto

Adult tablet only if
children’s tablet

unavailable
Sulphamethoxazol
400 mg
Tryomethoprim 80 mg

1/2 spoon
2.5 ml twice a day

1 tablet twice a day

1/4tablettwiceaday

3.5 kg

2-12 months
!3.5to10kg
1-5 years
10-19 kg

2 tablets twice a day

1 spoon
5 ml twice a day

3 tablets twice a day

1 1/2 spoon
7.5 ml twice a day

1/2 tablet twice a day

1 tablet twice a day

■
t in, the child sleeps too much, turns blue,
If condition worsens i.e. chest/ribs get drawn
to send it to a hospital at once
gets a convulsion, arrange t_ ---

Directions for the mother

The child must be taken to a

f€ II
C f
f I
e a
t I
€ f

r ■
I

e
e
€
€

C.

c
f

c

f
(

hospital in case of

<
(

.

Difficulty in breathing

•

Drawing in of chest

.

Inability to drink anything

I
(
i

The child being difficult to wake up

The a„«os sho- be «en

a< .east 5 days. 3 days a«er Unp— in cend«on.

FsTI

r
Pneumonia

1.

Breathing rate 2m - 12 months more 60/minute

2.

1 year - 5 years - breathing more than 50 per minute.

▼

Cotra

After 2 days (48 hours later)

Deterioration

No Change

Improvement

Serious Pneumonia

Reduced breathing rate
J

▼
Easier breathing

Give Cotra

1. Drawing in of ribs

Call after 2 days

2. Difficulty in breathing
3. Unable to suck
4. Dull

Y
Child able to drink milk

Improvement

.?

Deterioration
•V

T
Give cotra for 3 days

Send to doctor

U

The main aim of the health worker is to recognize when the illness is serious and send
the patient immediately to a doctor so that he gets treated with the proper technique. This
can cure dangerous diseases and save lives of patients preventing the consequences of

I.

serious illnesses is as important explaining the need to use the medicines prescribed by

the doctor. Otherwise the most skilled of doctors and the best of hospitals cannot save

a patient if medicines are not taken as advised.

i

PsF]
Following is the method to question a parent who complains of respiratory problems

of his child, to find out the seriousness of the problem, whether -

1.

The child is consuming any diet

2.

The baby can suck its mothers nuik.

3.

Has an convulsion

4. Sleeps too much and is difficult to awaken

5.

Strider - loud sound while breathing

6.

Weezing sound when child is quiet

7.

High or low temperature (not normal)

8. Very undernourished
If serious, the child must be sent to a hospital.

Acute Pneumonia

Less than 2 months
1. Breathing rate above 60/min

2. Drawing in of ribs.
2 months - 5 years

1. Breathing rate above 50/min

2. Drawing in of ribs
Treatment

1. Prescribe cotra according to age

2. Keep the child warm (wrapped up)
3. Let the child continue with/mother's milk.

4. If unable to arrange for a vehicle to carry the child to the hospital, take care of the
child till then.

If pneumonia is absent, reduced conditions
1. Low rate of breathing.

2. No drawing in of chest.

i'

*r

59|
Advise the mother to take the following care
:■

Q

a

•

Keep the child warm

•

Continue breast feeding the child

•

Keep the child’s nose clean.

•

Explain that she should call you in the following cases -

1. Increase of illness.
2. Difficulty in breathing
3. The child doesn’t drink milk.

0

The child can thus be saved from rapidly increasing
Respiratory Tract Infections

Weight at birth should be raised
Babies born underweight suffer seriously when infected. Carrying pregnant women

should be encouraged to eat well, exert less and have a regular check-up
Breast feeding is best for children and should be encouraged upto 6 months. From

6 months onwards it should be accompanied by top feeding

a
&

a

a
a

Suitable Diet

Sudden respiratory infections can lead to pneumonia in <
case of underdeveloped children.
Mother’s should be explained what the children's diet should be
------ They must understand that
children must be fed every 3 to 4 hours.
Vaccination
espiratory diseases like measles, chicken pox, TB, diphtheria etc., often lead to

8>
■

pneumoma. 25% infant mortality in developing countries is caused by pneumonia Therefore
mothers should be encouraged to get their children immunized against these diseases
Vaccines for all of them are available

j

Vitamin A

s
al

ava^hf|'C,enCy
the auanfifH

V.ltam'n A 'nCreases the risk of respiratory diseases. This is sufficiently
r m"k'

°f brSaSt feeding'tOp feedin9 should supplement

CKashiDhalh°rh HVI 30110 thr°U9h carrots' mangoes, milk, leaves of ’moonga', white gourds
-

i ren should be given 2 lakh units of vitamin A at intervals of 6 months.

I
i
i

[60]
Pollution within the house

Homes are polluted by smoke. People should be encouraged to use smokeless chulha’s
for cooking or to arrange a chimney for the smoke to go out.
Family planning should be advocated to avoid over-crowding. Also the importance of

cross-ventilation should be explained and followed.
Adult Pneumonia
Signs and Indications

A patient suffering from Pneumonia complains of high fever, cough, phlegm, faster breathing
and chest-pain.

When you make enquiries you will discover that the patient had suffered from a cold

or flu just before this condition or even from

1. Measles

2. Chicken pox

3. Diphtheria

Pneumonia starts with high fever and shivering. The patient gets phlegm of yellowish

colour, sometimes with blood. There is pain in the chest with faster breath(ng.
Symptoms

1. Dilated nostrils

2. High fever
3. Faster breathing
4. Unequal expansion of chest
5.

Tapping of chest leads to no depth of sound

6. Sound of Rails on stethoscopic examination
7. Nails or lips turn blue in case of insufficient oxygen.
If treated, the patient shows improvement within 24 to 48 hours.
Children may even vomit. So they must be given sufficient water. Otherwise dehydration
can lead to death.
If a pneumonia patient doesn’t respond to treatment , he may have TB. So he should

be sent to a doctor.

i

»*

FsiH
Care of a Pneumonia Patient
•

Observe the patient regularly and send to a doctor in case of no improvement after
24 hours.

•

Give cotrimaxazole or amoxcilli as antibiotics.

•

Keep giving water to drink.

•

Give paracetamol for fever and Ayurvedic Kadha or Adulsa Syrup for cough. Juice of

Adulsa leaves may be given, one spoon at a time.
•

Ensure a healthy diet/breast feeding for infants

•

Send the patient to a doctor in the following cases 1. The baby stops crying
2. Faster rate of breathing
3. Cough persists after treatment

Your responsibility as a health worker is as follows

•

Explain the symptoms of pneumonia to parents and guardians of young children.

•

Explain the ways of reducing the risk of pneumonia

62
Exercises
Choose the correct alternatives

1. ------------------------ - percent of crJd mortality below 5 years of age in caused by Acute
Respiratory Tract Infection in developing countries.

1. 40

2. 28

3. 30 4. 20

2. How many times are children below 5 years infected by germs in the respiratory

tract?
1. 1-2

2. 4-7

3. 5-6 4. 7-8

3. The cause of Respiratory Tract Infections among children of developing countries is
1. Over crowding 2. Under nourishment 3. Unclean Surroundings 4. Born under

weight
4. Send a child below 1 year to a doctor in case

1. The child cries excessively 2. Faster breathing

3. Drawing in of ribs

4. 2 and 3 above

5. If the child has pneumonia its mother should relate the indications
1. Difficulty in breathing 2. Drawing in of ribs

3. Lack of appetite

4. Difficulty in awakening the child 5. All the above.
6. In case of fever/cough/faster breathing/chest pain, the disease indicated is -

1. Pneumonia

2. Bronchitis

3. TB

4. Pharyngitis

Fill in the blanks
(Vaccination), (Streptococcus Haemophaius Pneumonia), (Five), (Yellow), (Age)
1. The colour or ‘kafa’ during pneumonia is

2. Small children can be prevented from getting pneumonia by

3. Cotramexazole should be taken for

4. Cotramexazole should be given according to
5. ------------- -— ar)d

cause pneumonia.

Answers
Alternatives - 1-2, 2-2, 3-4, 4-3, 5-5, 6-1

Blanks - 1-4, 2-1, 3-3, 4-5, 5-2

days.

res]

Lesson 8

Tuberculosis
st.
•ft

s.

Aims
On reading this lesson you will understand

• What tuberculosis actually is

• How the phlegm ‘kafa’ of the TB patient is to be collected.
• Causes of TB

• How the phlegm is to be destroyed
• Prevention of TB
Knowledge

You will know about
• The reasons for getting the TB disease

• The reasons for other examinations related to TB

Skill
You will learn
• Diagnosis of TB from its symptoms and indications
• Know from the symptoms and indications when to send the patient to the doctor.

Perspective
You will understand
• TB can be cured with proper treatment for the complete care.

• The treatment for TB requires the cooperation of the family and society

t

a

rsi]
The djsease of TB has been afflicting human beings since prehistoric times. Even the

Vedas refer to it. It is

great problem today also. Almost 4 lakh people succumb to this
disease annually in our country and the mortality rate for TB is the highest.

What is TB?

to th h'S t
3 baCt6ria Ca"ed M,crobacte^s Tubercle which is similar
he bacteria causmg Leprosy. If an infected TB patient is not being treated, his cough
eezes can throw out the bacteria which attacks the bodies of other people which it
I It? I O .

The entry of the bacteria in the body is not the same as getting the disease.
Every person has the resistance to germs. The body fights bacteria and destroys it,

n ro mg its numbers. If any bacteria remain, they keep multiplying. Then the body has
th

r 9reater

ac ena

°f them' 'f thS PerS°n 9GtS SOme Other il,ness- or 18 malnourished,

ecome, active and the body may become a victim of TB

Children are given TB vaccination to prevent them from developing the disease The
vaccne contains weak bacteria which cannot produce the disease but create resistance
in

e o y. If, m future, the microbacteruim tubercle enters such a body, the body can resist

However, if a vaccinated child is undernourished or lives/works in overcrowded areas

e bacteria may not be overpowered continuously by the body, thus developing the disease

However, the condition will be milder due to immunization.
In miliary TB the bacteria are found in blood, thus affecting all the organs e g even

the covering of the bram can get affected. This kind of TB can be fatal and usually doesn’t

occur among vaccinated children. Although we have not been able to eradicate TB com
pletely, we have been able to control this dangerous condition to a great extent.
Most often, TB infects the lungs, causing pulmonary TB. When a patient oets this disease

he infects the people around him. If the microbacterium tubercule attacks the lymphatic glands’
bones, covering of the brain, eyes, intestines or kidneys, the disease is called extra pulmonary TB.

Symptoms

1. Excessive Cough
3. Phlegm

5. Weight loss

2. Light Fever

4. Phlegm with traces of blood

6. Pain in the chest
7; Persistence of symptoms in spite of treatment.

z

*

[65|
*n case this continues beyond

a week, the patient must be sent to a government hospital

to test the possibility of TB.

Check up
The easiest, quickest and cheapest test for TB the sputum test. The health worker can
learn the procedure of this test as follows -

The patient should be asked to
1. Rinse the mouth to remove food particular
2. Cup the hands over the mouth.
3. Take a deep breath

4. Cough out a sufficient quantity of phlegm for testing
5. Spit it into the sputum cup for the test.

The method of testing sputum
1. Spread some sputum on a glass slide and dry it on the flame of a spirit lamp.
2. Drop a little Carbol Fuschin on it and dry it again over the flame. Keep it aside

for about 5 minutes to cool.

3. Add some drops of alcohol and keep for 30 seconds. Wash the slide with water.
4. Put a few drops of blue Methyl. After 30 seconds, wash it again with water.

5. Dry the slide in the sun to get it ready for examination. If it displays reddish rodshaped tubercule bacilli, the slide shows infection

When the sputum test is. positive, the patient should be sent immediately for treatment

m the primary health centre. The greater the no. of bacteria seen, the stronger the infection
will be.
The national TB control programme was evaluated in 1992. The problems given earlier
were discussed during this. The WHO finalised a new programme to control TB. According

to the new method of treatment DOTS, (directly observed treatment for a short period ),
the medicine has to be taken in the presence of the health worker.

DOTS is conducted at 2 levels. At the intensive level, the patient has to take the 9
medicines thrice a week for 2 to 3 months infront of the health worker.

The second one is the regular level of 4 to 5 months when the patient takes the medicine

every week. The sputum test is conducted from time to time during the treatment as follows:

1.

Before the first level of treatment (3 samples)

2.

Just between the two levels of treatment (3

samples)
•4

n

66
3. At the end of the treatment

If the sputum test reveals bacteria again, the patient is treated by consulting the doctor.
After the programme was started, the Social Health Centre tried to find out the difficulties

in this method of treatment.

Main difficulties

1. Visiting the primary health centre frequently is costly and tiring. It disrupts employment.

If relatives need to accompany the patient, the frequent visits become even more expensive.
Dots is still conducted in certain districts of the country. Only time will tell how useful

it is.
There have been good results from many areas. The medicines recommended at the
start are continued in DOTS. Only its duration and combination varies. You can get details

from doctors at the primary health centre.

Since TB is a contagions disease, all Indians are threatened by it till it is totally eradicated.
Collective Participation to prevent TB
Information about the disease must be spread in order to control it. Only when all the

members of the public will contribute, the disease be brought under control.

Spread of TB
TB is not hereditary. It spreads from one person to another. A patient suffering from

it gives out numerous bacteria through his coughing, which enter the bodies of the sur
rounding people through breathing.

How can we prevent the spread of TB?

1. To avoid the spreading of TB. the patient must begin treatment immediately. The treat
ment must be continued as long as recommended by the doctor. The patient must be
given medicines for a minimum of 6 months to 1 year. Within days of treatment the

coughing and spit will be reduced, so will the no. of bacteria in the sputum.

2.

The phlegm spit out while coughing should be kept in a container with Lysol. It should
either be burnt or poured out into the lavatory and the tin buried.

3.

The 1 B patient must have a well-ventilated room. Fresh air will reduce the no. of germs
in the room.

68

6. Write sequentially how you collected the phlegm of a TB patient.

Treatment

Treatment Regimen is the plan by a which a TB patient is treated with more than 2 medicines
m combination for a long time. This strengthens the fight against the microbes successfully.
The dosage and proportion is as follows Medicine

Strength

Dosage

Side-effects

Streptomycin (s)

1 gm vial
intramuscular injection

0.75 mg deep
vomiting

Giddiness, headache,

INH (H)

100/300 mg tablets

300 mg-single dose

Spinal cord problems
(Given B 6)

Rifampicin

150 gm vial
450 mg capsule

450 mg on empty
stomach (morning)

Vomiting, rash on skin

Pyrazinamide

500 gm tablets

1500 mg single dose

Pain

Ethambutol

100, 200 mg
400, 800 mg tablets

800 mg single dose

Eye problems

Thiacetazene

50 mg, 150 mg

single dose of tablets

Vomiting, rash on skin

___________________

Your responsibility as a health worker in as follows

The patient must be made to understand the need to take the medicines regularly
and on time.
• Explain to the family how necessary it is to take medicines continuously.
Encourage the patient to take his prescribed dose.

• Ensure that medicines are regularly available at the primary health centres
!

•

Make the family members understand the greater need for the patient to have
protein.

TB can be cured and prevented. Yet it is one of the fatal diseases afflicting. India

specially among the poor and undernourished.

67

Prevention through BCG
BCG is s cheaper, safe and

more effective means of controlling TB than its treatment,
Since infection can
i occur at a young age, infants should be given BCG at the earliest,
Although, there are <different opinions about. Continuing BCG, at present it is given because
it also helps to control leprosy.

Vaccination of BCG
It IS given through injection. After about 8 weeks

, a little swelling appears at the point,
The area of vaccination on the body should neither be
covered nor be exposed to direct
sunlight.

The Cycle of TB

People who

00^177^7^ 'h "'“e

Children r

TB PafenlS f°r ,On9 Can 9et the disease-

00 n° eVe op any symPtoms in the primary stages of TB. They may
then go into) the next stage which may be dangerous and even fatal. If treated on tome,
children can remain healthy and grow normally.

weak'le to ^7 T fOU"d a"’0"9 aCk"IS P":"CU'arly amOng ,hose wl’“
tnfect (he people atopnd. They can be cred by treatment but die if left-untreated.
Control of IB- 3 types of care

1.
2.

3.

All the children must be given BCG to prevent infection.
TB patients must be identified for tn
eatment. A person with cough for more than 15 days
must get a sputum test done.

i

of g

Spread awareness about the disease and

I
I

Self-study

i

1

Zccauls TBb 3 PatiCTt iS fa'°llral’le 10 a,'acks by tbe "“rabaclerulm tubercule

2.

How many TB pabents are there In yur „liagt,o

3.

e °enryda„afmOn,h'y

I
I

'b' am°l',“

How will you find our
TB

i

paired

everyday from your primary health centre.

4.
5.

Present a skit to give people information about IB

i

ll’e TB Pa"e"te °'V°“r V'"a9e ca" be «""d<aged to lake their medicines

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69
r

Exercises

F

F<H the blanks
kin r'Ch ^ie^Follution free air), Bacteria, (Poverty/Mal-nutrition), (Myco bacteria tubercule),
TB (due to the phlegm from
i cough or sneezes of TB patients,), BCG
to

1. TB is caused by
________
2. -------------------------is the bacteria which causes TB.
3. TB spreads due to
4.

is the vaccination to control TB.
5. If antibiotics cannot cure cough after 15 days, the patient is likely to suffer from

6-

lead to TB.

7. Along with medicine, a TB patient needs

and

Match the correct pairs

1. The microbes of TB

1. Prevents TB

2. BCG

2. Rod-shaped

3. Rifampicin

3. Problem of spinal cord

4. INH
5. TB

4. Medicine taken on an empty stomach
.

5. No. of microbes

6. Sputum Test

6. Infectious disease

Choose the correct alternatives

1. The National TB Control Programmer
was reviewed in the year
1- 1991 2. 1992
2. Dots stands for

3. 1987

4. 1986

1. Taking medicine preventing TB
2. Completing the dose preventing TB
3. Testing for TB

4. Taking the medicine in front of the health worker
3. What kind of a disease is TB?

1. Hereditary
2. Non-infectious

3. Contagions
4. All above

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70
4. Which is tested for TB?

' 1. Blood

2. Sputum 3. Urine 4. Skin

5. A TB patient must complete the recommended dose till the end so that

1. The disease is cured

i
<

2. Medicines fight against bacteria
3. Discontinuing medicine mid way reactivates microbes

i

4. All the above factors
(

6. The sputum of a TB patient must be destroyed in order to

1. Reduce unhygienic conditions
2. Prevent infection through bacteria
3. Repeated cough and phlegm

4. All the above

i

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Keys

(
<

Blanks - 1-2, 2-4, 3-6, 4-7, 5-5, 6-3,7-1.
Pairs - 1-2, 2-1, 3-4, 4-3, 5-6, 6-5

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Alternatives - 1-2, 2-4, 3-3, 4-2, 5-3, 6-2
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71

Lesson 9
Diarrhoea and Dehydration

Aims
On reading this lesson you will understand

•

What is diarhoea?

•

What are the causes and types of diarhoea?

•

The symptoms of dehydration

•

The treatment for diarhoea.

Knowledge
You will know about
•

How serious diarhoea is, specially for children.

•

Which symptoms of dehydration can be seen.

•

How can diarhoea be controlled by nutritive diet.

Skill
You will learn

•

How can diarhoea be classified?

•

How do the symptoms of diarhoea indicate its seriousness.

•

Which treatment can be given for diarhoea.

•

How is ora! rehydration and ORS conducted.

Perspective
You will understand
•

The information that diarhoea can prove dangerous for children necessitates imme

diate treatment with care.

fe
72

Introduction
Diarhoea means having loose or watery motions. They are often frequent and are seen
as some disorder related to the stomach and intestines. Diarhoea is an important public
health problem among children in developing countries. Every year 50 lakh children die due

e

to diarhoea (below 5 years). In other words it is fatal for 4,000 children everyday. Malnutrition
aggravates these figures, just as it leads to other illnesses too.
‘Gastro Enteritis’ is the term used when diarhoea and vomiting are the symptoms. It

may be accompanied by fever when excreta contains blood or mucous, the illness is diagnosed
Dysentery. It is more common among children below 2 years of age. Fever is found with

€
C

c

it. Diarhoea is risky among infants. Every year, about 20 lakh children succumb to it in
the world.

10% of child mortality is caused by diseases involving loose motions. It must be noted
that this rate is less among those less than 6 months because these infants are breast

fed, thus protected from diarrhoea. However children above 6 months, being top-fed, they

i

are prove to the infections of their surroundings. This is the age when they can put anything

into their mouths. Other reasons include allergy to particular food, emotional outburst or
weakness, excessive intake of raw fruit etc. The virus like E coli, salmonella and stephylococus

I
(

are responsible for the infections.
Classification of diarhoea - into 2 groups

1. Acute diarrhoea upto 14 days.

2. Long-term diarrhoea - longer than 2 weeks.
Acute diarhoea

This occurs suddenly but for about a week. The frequency of motions increases from
4 to 5 times a day till upto 30 or even 40 times in 24 hours. Rarely a patient may get

upto 100 motions! These may be light fever. Older children get diarrhoea due to different
kinds of infections. Broadly, 50% of diarhoea cases are caused by virus, mainly the Rota

Virus. The remaining half have other reasons.
1. Toxins (food poisoning)
2. Attack on internal tissues

Toxins
These are released by bacteria which reduce water and electrolytes from the lining of
the intestines.

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73
Internal attack - Microbes attack internal tissues which are then given out through motions.

Long - term diarrhoea

1. This shows a hereditary disorder that requires enzymes for digestion. This does not
cause dehydration.
2. Amoeba can also cause long-term diarhoea.

Dehydration
If new-born babies suffer from motions and vomiting, there is a shortage of water content
in the body. This condition is called dehydration.

The following symptoms are observed in this-

Either no urine or very little is passed, that too, deep yellow
There is sudden weight-loss

The mouth becomes dry

Eyes are dry
The fontanelle gets a depression.

i

74
Symptoms of dehydration
Mild
Irritable child

Medium

Very disturbed

Critical
Lies very dull

NormaTpulse-

Weak pulse

Pulse -weak, limbs cold

NormafurinlF

Less urine

Urine greatly reduced

Fontanelle depressed

Top of head greatly depressed

Shrunken eyes

Eyes very greatly shrunk

Drawn, dry face

Face very dry and drawn

Lining of mouth-dry

Lining of mouth very dry

Flaky lips

Lips greatly flaked

Skin less soft

Hardening of skin

Thirsty

Feeling very thirsty
Child may get comatose

100% weight loss.
5% weight less

5-10% reduction in weight

100% weight loss

If the skin doesn't return to its
normal shape on letting go, there
is dehydration.

Hold the skin between 2 fingers
to test its flexibility, and pinch, pull
it slightly.

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75

Diarhoea among new-born infants

A normal new-born baby has a greenish motion the first day (meconium). This continues

for 3 more days. On the 4th or 5th day, the motion turns slightly yellowish. From the 6th
day it passes yellow motions. Upto one mouth, it is normal for babies to pass semi-liquid

motions while drinking milk.

Causes for loose motions among infants

1. Misconception- Passing motions upto 5 or 6 times a day is normal in the first 4 days
It is not an illness.

2.

Infection- Those who look after the babies may pass on their own respiratory or internal
infections to them. More often improper sterilization of bottles in case of top-fed babies

causes loose motions.
3.

Medicine induced - If the nursing mother is taking ampicilin, the baby may get loose

motions.

Symptomatic of disease
The incubation period is 1 to 3 days. The child drinks less milk and becomes irritable.
The temperature may become 100° F. When diarhoea, begins, the motions are watery, yellow
and acidic (causing inflammation at the rectum). They are frequent.

Signs of risk among infants
•

Lack of appetite

•

Eyes drawn in

•

Skin turns dusky

•

Depression of top of head( Depressed Fontanelle)

•

Dullness in the infant

Treatment of Diarhoea
1. Fluids

Mild and medium dehydration can be successfully treated by giving liquids through the
mouth. The mother should be advised to give liquids available at home in a quantity such

that the infant doesn t vomit, e.g. -tender coconut, butter-milk, salted rice soup, sherbet, mild
tea. In case of great vomiting, give- 2 to 3 spoonfuls at intervals of 5 minutes. If a ver/

large quantity of liquid goes into the stomach at one go, it increases the activity in the

76
stomach too much, causing vomiting or motion. In case the infant is breast-fed, that should

be continued.
Oral Rehydration Treatment
A mixture can be prepared for this at home. 8 flat spoons of sugar, one flat spoon

of salt mixed with a , i re of water, should be used with some lime juice if available.
Alternatively mix 3 pinches of salt with a handful of sugar in
1/2 litre of water which

is pre boiled then cooled.
ORS
In case of continued diarhoea, use

rehydration of children.

the following formula recommended by WHO for

Glucose 20 gm
Nad 3.5 gm

NaHCO4 2.5 gm

Tri Sodium Citrate 2.1 gm

in 1 litre water

Kcl 1.5 gm

m 24 hours
SP°On' A 1 Year °ld Child should get 1000 ml
loose motion P
°
CaUSSd by constant motions has to be compensated after every
loose motion. Prepare ORS sufficient for 6 to 12 hours at a time, so that it doesnj get

Emergency Treatment
Acute dehydration can lead lo death if not controlled. It reduces

n sue

conditions, intravenous fluids need to be given (IV fluids)

urine and circulation.

(

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77]
Home-Made Saline

f

£
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f

(
f
(

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In the absence of the doctors (unavailability) this can be used. It is a life saving saline

taken orally. Readymade packets are available in the market. But these should be mixed
with a litre of boiled water after cooling it. However, the solution can also be prepared at

home with the material in the following proportion- 1 litre water, 20 gm of glucose (or 40

gm i.e., 8 spoons of sugar), 3 to 5 gms of salt (3/4 spoon or a pinch), 2.5 gms of cooking

soda (1/2 spoon or 2 pinches) and 1.5 gm of KCI if available. It should not taste saltier
than tears, lime-juice may be added for taste.

This life-saving solution is a boon for rehydration of the body. Since salt and water cannot
be absorbed by themselves, it is necessary to add some sugar. Thus the fluid balance

of the body can be maintained.

Important tips while giving life-saving solution/mixture

• Give Redydration in spite of vomiting.
•

Rehydration has some use to contain vomiting.

The water used must be clean and pure. Since sugar can cause fermentation,

a limited quantity should be made at a time.
•

r

1 litre solution is sufficient for a 2 years old child for 24 hours. 100 ml

more should

be given after every motion continuously.

78
• Children less than 1 year old should be given double the quantity of water

since the salt is too much for it.
• Even if ready-made packets are available in the market, the solution can
be made at home immediately with the onset of motions.
• Dehydration makes a child irritable and other symptoms are also visible.

Keep giving saline solution till the dry skin and eyes, depression of head
and drying up of tongue and mouth continues.

• If the child drying up of tongue and mouth continues needs IV fluid admin
istration. At times it is difficult to locate the veins of a child. Also, saline

has to be given very slowly through the needle-30 ml in 1 hour. Excess

of it may cause infection leading to death.

Thus it !s important to remember then home-made/ oral solution is safer, quicker

and more effective.

k
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Diet

(

Breast-feeding should be continued during diarrhoea or vomiting. Breast-milk has a certain
amount of resistance to these disorders, saves the child from malnutrition and also controls
the damage to the digestive system faster Dehydration is also controlled to some extent.

Top-fed children should be given milk diluted with an equal quantity of water. Avoid top

milk during vomiting but give it after vomiting stops. Older children should be given liquids
like gruel or soup rather than solid food like rice, dal, chapatti. Diet must be continued

to prevent undernourishment.
|(

(

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79

Guiding Principles of Treatment
Oagnose th8 disease
A
—e to tneXT give

(
(

P nsate for dehydration.

(

be shown

a
mUSt
10 a specialist if it doesn’t ok
'Movement. Sometimes it ■
SntSh°W

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(

1° administer Intra yP
necessary
child.
"0US sa,ine to the

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t

/ ’

Whenever there

/
/

are complaints like
bleeding,
pain, badodourorfew
accompanying microbe

deluded diarrhoea,
some antibiotics and
be started. (Cotri or oral rehydration must
AmPi, antibiotic and
rnetronidazole are

/
/

’
!

/

*

(

.

aotiamoeba/ geardia)
Do not give injections.
They are to be used
on'y in case Of excessj,
Ve bleeding or fever
in specia' diseases.

& h

Indigestion causes
responsible for it are re
enable to eat till d'
mmed- Children are
B„ ,
ldWS,'W«»^SPerSist

reasMM*£l should „ever be
d'“”""UME»splinoase
Of indigestion
shSdren mus|

<‘el. L®hl 'POP and mm

receive nutritive

continued

ensures this is

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80

Preventive Measures

1.

2.

Encourage continuing breast-feeding for as

long as possible.

bowls ZdhXtXXfreehy9,en'C’ ln 0386 °f t0P'feeding' ensure that

spoons and

3.

Malnourished children easily get diarrhoe.
a .Avoid giving open or fly-interested food.
4. Avoid giving
open or fly-infested food.

and otheHnT

e"'''™8'''is ',er>' Important The most effect™

dtamhTe h

'S 10 Pr°"de Mfe d™ki"S

dtarrhoea by ensuring safe drinking „ater t0 our p30p|e

■e way to control diarrhoea
fulfil our aim of preventing

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81
Introduction

Everyone experiences loose motions during childhood. Motions may be very watery as
in diarrhoea, or just slightly looser than normal. They may be caused due to improper digestion

because of acidity. Bacteria or amoeba are the main reasons. Motions may contain just
mucous, but otherwise they may include blood and mucous.

A normal healthy person usually passes one motion a day, which is fairly well-formed
(thick). But during some diseases, not only are the stools "not well-formed’ but also repeated
(

many times a day. At times, blood or a sticky mucous is also excreted with it.

<

If the disorder is in the small intestine, the food and water remains undigested and
unabsorbed, thus causing watery motions. Even when there is no food in the stomach, the
<

intestinal contents cause motions which are usually whitish during diarrhoea. When motions
are very watery, usually there is no bleeding.
The cause of diarrhoea has to be identified to decide the treatment. Particular medicines

%

are used again amoeba and bacteria. But if the cause is viral infection, antibiotics don't
help.

Whatever the cause of diarrhoea, dehydration has to be supplemented by rehydration
How is this disease caused? Reasons

Microbes cause diarrhoea. They spread through the excreta of the patient (by contact
with hands, food, water or flies). The contaminated water is mainly responsible for this.

Diarrhoea among those above 5 years of age is usually caused by amoebic and bacterial

infections caused by unhygienic food/water, lack of personal cleanliness. Usually the bacterial
infections spread in the beginning of the rainy season, like outbreaks of cholera. There

is great pain when caused by bacteria. Bleeding starts after 2 or 3 motions and fever may
also afflict the patient. But in amoebic dysentery motions are dilute and often contain blood

and/or mucous. Other symptoms are gases, a sense of incomplete motion and even froth.
Giardia is another microbe that causes frothy motions, which are accompanied by a peculiar
sound which cannot be controlled.

People can be made aware of information about indigestion, diagnosis of loose motions
etc.

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82
Treatment
Since loose motions are of different types, it is necessary to find the cause. Viral motions
have no particular medicine in modern science. Metronidazole should be given for amoebiasis
or Giardiasis. Worms may cause motions (but not suddenly in adults) for which Mebendazole
is given.
Always use salt water and sugar solution to compensate for dehydration caused by loose
motions.

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Exercises
Fill in the blanks (Environmental Cleanliness) (long term) (Ampicilin) (ORS) Breastfeeding

nium

, intravenous, Meco-

•------------------ diarrhoea doesn’t cause dehydration.

r

2. The greenish motion passed by new-born on the first day is called

3- Use of--------------------- by a nursing mother may cause diarrhoea in the baby.
4. The WHO has formed an
formu|a to treat dehydration caused by

diarrhoea among children.

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5. One has to resort to---------- ---------------- while treating acute dehydration.
6. It IS cheaper and easier to give
to save a new born infant from diarrhoea.
7. --------------------- is an important measure to prevent the spread of diarrhoea.

Choose the correct alternatives -

days.

1. Acute diarrhoea lasts for

1. 0-14 2. 0 to 8 3. 0 to 15 4. upto 10 days
2. Long term diarrhoea continues for

days

1.15 2. 14 3. more than 15 4. 20 days

3. The symptoms of dehydration are
1. Drying of mouth / skin
2. Less or no urine
3. Depression of top of head

4. Weight loss
5. All the above

Match the correct pairs -

1. Rota Virus

1. E-coli

2. Medium Dehydration

2. IntraVenous

3. Dehydration

3. Very irritable child

4. Acute dehydration

4. Viral motions

5. Infections Diarrhoea

5. Life Saving Solution

Answers

Blanks - 1-2, 2-7, 3-3. 4-4, 5-6, 6-5, 7-1

Correct Alternatives - 1-1, 2-3, 3-5

Correct pairs - 1-4. 2-3, 3-5, 4-2, 5-1

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84

Part 2
Fill in the blanks

(B~in9) (Metronfcoie) (Mebe^oie) (Dyse„t^ (Loose motions and Vomit,ng)

1. Having watery motions i:
--- is called
2. When loose motions

are accompanied by mucous, bleeding stomach-ache, it is called

3. The patient gets

anH
------- ------- ai i(j_______ ________cholera
4. The medicine recommended for Amoet^sl^iZrdiasis is
-------------- must be given to children having diarrhoea
6' ------- ----------- 'S recommended when motions are caused by worms.
Answers

Blanks - 1-6, 2-4, 3-5, 4-2, 5-1, 6-3

85

Lesson 10

Types of Fever

Aims
On reading this lesson you will understand

•

The different types of fever.

•

Classify the types of fever according to symptoms and indications, as well as methods

of treatment.
Knowledge

You will know about

•

Symptoms and indications related to types of fever

•

The causes of fever

•

The serious signs of fever

•

1 reatment according to types of fever

Skill
You will learn
•

What are the home remedies for fever?

•

Give medicines according to their proportions.

•

What care needs to be taken alongside medicines.

Perspective
You will understand

•

n

Fever is not a disease,

but a symptom of illness.

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*

186]
Introduction
Fever is only a symptom of illness and not a disease by itself. The body resists germs,

resulting in fever. If it rises too much, it can cause serious damage like bursting of blood
vessels of the brain. That is why efforts must be made to reduce the fever. It is measured

by a thermometer in Celsius or Fahrenheit.
Fever
Low

Medium

High

99 to 101° F
101 to 103° F
Above 103 F

38° C to 41° C
41° C to 43° C
Above 43° C

Means of Reducing Fever
1. Wipe the body with cold water

2. Rest
3. Paracetamol (according to age)
Serious Signs of Fever

1. Fever for longer than 15 days
2. Getting fits

3. Stiff neck
4. Fever within 42 days of abortion or miscarriage /delivery

87

Lesson 11
Types of Fever
Malaria

Introduction
the dT namefflOriginateS fr°m the ltalian word ^ich mearl polluted air. Malaria is one of

develoom
9
k6'"95
development of the country.

11 °bStrUCtS the eC0n0mic and industrial

History
It has been one of the Chief health problems si.
. since ancient times. Hippo crates has
described in before 5 BC. This disease has
also been referred to in the Atharva Veda
of India.
Geographical Expanse
The malarial parasite is found in all countries from 40°
areas are like a heaven for it.

sound to 60° North. The tropical

What is malaria?

aim "XeXZ Z temPera,Ure' '

Sh'Verin9 ,0"°Wed

How is it caused

It is caused by a microbe called Plasmodium. They

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are of 3 types in India.

1. Plasmodium Vivax
2. Plasmodium falciparum
3. Plasmodium Malaria©

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the pafe^te'Z

i 'S thS CaUSS °f thS maximUm spread of malada in about 70% of

affects 25 to 30°/'

T ban9er°US than that caused by Plasmodium Falciparum which

,
° people- The Istter creates mjany problems and could be fatal. The third
variety affects only 1% while
,
.
...j a fourth type ‘plasmodium ovale' is not found in India.

[88]
How does Malaria spread?
The mosquito called Anopheles of the female gender spreads the disease. When it bites

a patient, it sucks the parasite with the blood. It grows inside the mosquito upto 14 days.
Whenever it bites another person, the parasite enters the body of the new victim. After an
incubation period of 14 days, it causes fever in the person.

Different types of parasites take different periods to destroy the red blood cells from
the time they enter the blood.

Symptoms and Signs oflne disease
The patient feels restless after the malarial parasite enters the body. He also develops

headache muscular pain, vomiting and stomach-ache. These symptoms are similar to those
of flu. After 14 days the symptoms peculiar to malaria is seen i.e. shivering and fever. It
starts in the afternoon as has 3 stages.
Cold stage

The patient feels very cold, wraps his blankets, his teeth chatter and this continues for

15 minutes to 1 hour.
The Stage of Fever
The patient feels very hot, uncovers himself and has a headache. The fever can rise

upto 106° F. This condition lasts from 2 to 6 hours.
Sweating Stage
Great sweating is followed by reduction in fever. This is typical of malaria.
Diagnosis of Malaria

When the history of the patient reveals high fever after cold and shivering followed by
sweating and reduction of fever, the blood-test is conducted. The pathological laboratory
can decide the type of the malarial parasite.
Treatment

There are 2 objectives in this

1.

Reducing fever and other kinds of suffering

2.

Destruction of male and female parasites in the blood.

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—1„ tahiets. One dose is suttX:

r ,ever-

Prescribed Dosage, of Chloroquin

S. No.

Age

Weight of
Medicine

No. of
tablets

Less than 1 year

75 mg

"1/2

1 to 4 years

150 mg

1

4 to 8 years

300 mg

2

8 to 14 years

450 mg

3

600 mg

4

600 mg

4

f

1
2

3

4
5

Above 14

6
_____

Pregnam/Voman

Treatment for total eradication

of Flaciparum Malaria

For Adults
1st Day - 600 mg chloroquin at once. 2 tat)|ets of 150

mg after 6 hours.
Second day - 150 mg chloroquin x twice

Third day - 150

mg chloroquin x twice

Chloroquin is not to be taken
Pregnant women

on an empty stomach, It may be taken with milk.

may be given chloroquin with no

danger of harm to the foetus.

Side Effects of Chloroquin
Normally digestible.
Sometimes causes giddiness, vomiting, restlessness or rash on the skin.

1

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Harm caused by Malaria

1.

Cerebral Malaria

2.

Secondary Anaemia

3.

Mild Jaundice

4.

Renal Failure

c

Critical Condition Needing Expert Help
1.

Growing restlessness, unrelated movement.

2.

Delirious talk and distraught behaviour.

Anopheles Mosquito

J

The female of the species survives on human blood while the male lives on plants. The
female Anopheles requires protein obtained from human blood for which its mouth is adapted

r

to suck blood below the human skin.
The life cycle of a mosquito has 4 stages of which the first 3 - egg, lava and pupa

are completed in water. The eggs are also laid in water and hatch within 3 days. The larva
feeds in water. After 10 days it is transformed into a pupa which comes to the top of the
water regularly for breathing. After about 4 days, the mosquito emerges from it. An adult
mosquito can fly upto 1 to 2 km. It may live from a few hours to some months.

i
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Control of Malaria

Measures need to be taken at individual as we!-, as social levels to control Malaria,
Personal safety and prevention of spreading is basic to unified efforts.
Measures

1.

Doors and windows be covered with nets in areas with a lot of mosquitoes.

2. Apply repellents to open parts of the body e.g. citronella oil, eucalyptus, odomos cream

3

4.

5.

etc.
Use mosquito nets while sleeping.
Prevent growth of mosquito larva by using ‘Gambuzia’ fish in ponds etc. where mosquito

breed.
are emptied
Observe one dry day per week when all utensils used for storing water

and dried in the sun.
6. Use soak pits to get rid of waste/sewage water.
Use kerosene (rock-oil) in stagnant water to prevent growth of mosquitoes
7.
Spray DDT powder solutions using 100-200 mg/per sq. ft. of wall or oor.

8.

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Exercises

Fill in the blanks
(Plasmodium Vivax/Falciparum/Malariae), (Malaria), (Bite of female Anopheles) (Chloroquin)

(Blood) (Unrelated Movements/Delirious condition) (14)
1. Malaria is caused by.
2. Fever after cold/shivering, sweating followed by lowering of temperature are symptoms

of.

3. Malaria is treated with the medicine
4. In case of

and

as symptoms, at once the patient

of Malaria must be sent to the doctor.

5. These are the types of Malarial parasites

6. The incubation period in malaria is

days.

is tested for Malaria
Choose the correct alternatives

1. This is a harmful effect of malarial infection.

1. Cerebral malaria
2. Anaemia
3. Mild Jaundice

(

• 4. Less urine

5. All the above
(

2. How should malaria be treated?

1. With medicine
2. Use mosquito nets around the bed
I

3. Fever/other suffering to be reduced, destroy mosquitoes

(

4. All the above
Answers
Blanks - 1-3, 2-2, 3-4, 4-6, 5-1, 6-7, 7-5

i

Correct alternatives - 1-5, 2-4

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92

Influenza

zr z*on hry ,o

ShiVOr'n9- meet her hard-working

a 'kadda- ot gt„3er and ,U MeX^he"

eVeiyday’ She continued to get drenched in the rain. She developed

a couqh On^d

retuned to find herSb^in^s^!^'^^Sel, " ’ bla^ke,

mo7Te *"*to ,he

laV dOW"' Her mo,her

~

a -—-

Questions
What kind of fever do you think Ganga had?
What will you ask the patient's relatives about?
How will you check the patient? What will you

examine?

What will you diagnose after observation?

Which medicines will you
What advice will

recommend?

you give the family members of the patient? Give reasons.

.

I.

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93

Rheumatic Fever
6 years old Pradeep went to a distant village to

attend school. It was winter. One day his throat was

hoarse. He couldn’t Swallow his food. His mother gave
him a soft diet. She made him gargle with warm salted
water. Within 2 days he recovered and attended school.
In December

they had guests He ate poorees

and meat with
them-Soon he got

fever. The next day

he had a swelling on his left knee. It spread to his feet,
turning red. After some days he became well again.

Soon he started falling ill repeatedly. He had chest
pain. His mother took him to the doctor. The doctor said
that Pradeep had got rheumatic fever. It can damage
the heart. So he had to give him a penicillin injection.

Questions
1. Which financial category of society gets this disease?
2. Which age is prone to get this disease?
3. What are the damages caused by this disease?

94

Exercises

- Rheumatic Fever

The Story of Pradeep

Fill in the blanks

1. In the beginning Pradeep had difficulty in

(Swallowing)

2. After some days, fever was accompanied by the symptoms

(Swelling of

left leg, pain & redness)
3.

The above symptoms disappeared by themselves because they were caused by
(Virus)

4.

Repeated pain, swelling, fever suggests infection by

5. Symptoms of

(Bacteria).

are pain, swelling and redness of joints ( rheumatic fever)

6.

Penicillin injection is an

7.

Repeated infections of respiratory system can cause

medicine (anti bacterial)

(Rheumatic fever).

n

....

95

Heat Stroke

A middle-aged man was out in the sun with a young boy. They drank some water
and continued walking in the hot sun. The man felt uncomfortable and vomited. He got fever.

The boy thought he had acidity and would soon get well. He took him home. His wife gave

t

him some jaggery to eat before drinking cold water. But he felt giddy and swooned.
Questions

How will you treat a man in the above condition?

What will you advise to control such fever?
What problems can acidity lead to?

Which home-remedies are possible for such problems?

Self Study

Fill in the blanks

1. The man faced this problem due to

(travelling in great heat}

'i

96

Urinary Tract Infection
Urinary Infection is caused by microbes. Its symptoms are - getting fever after great
shivering repeated sensation of urine, I
burning sensation while passing it, smoke-coloured
urine and pain in the lower abdomen.
1. Use of catheter

2. During pregnancy there is pressure on the tip of the urinary bladder, causing some
urine to remain. This period is prone to infection by germs

3. Drinking less water.

4. Lack of personal cleanliness.
The above factors may cause urinary infection. Following are the home remedies for it-

1. Drinking more water.

2. Drinking sandalwood ‘sherbet’ (cold drink)
3. Drinking water of soaked cummin and corriander seeds i '
'
whenever shivering is accompanied by fever, lower backache and bleeding with urine, the doctor must be
consulted so that the infection doesn’t reach the kidney.

Questions
>

Which types of fever cause shivering? What is the characteristic feature of this

symptom of shivering during fever?
>

Which other conditions cause this kind of fever?
What do you recommend to those

>

who suffer these complaints repeatedly?

Explain which other serious diseases are

caused by these complaints, their symptoms and when the patient should be sent to the doctor.

Choose correct alternatives
A

;
~---------------- - has the symptoms of fever after shivering, suffering during passing
urine and lower backache. Infection of the
1. Respiratory Tract 2. Urinaiy Tract 3. Digestive system 4. Reproductive Systems

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»

97

Jaundice (Hepatitis)
Sakharam Patil was the village chief. He was healthy
and had worked hard doing physical exercises. He often

t

travelled to the District Office for administrative work.
People looked after his food and drink whenever he went

t

there. He felt he was unaffected by outside food or water

unlike women who fell ill with change of food. However,

(

once he lost his appetite.

(

He started getting light fever and was reluctant to

walk. His wife felt he was ill and wanted him to see a
doctor. But he inter
(

preted this as some black magic and tried some rituals

to set his health right.

Soon he started getting stomach ache. His stools
became whitish and urine looked smoky. Some villagers
advised him to sacrifice an animal which he did with

all rituals. However his wife consulted a doctor. Sakharam
refused to meet him because he thought jaundice could

be cured by a wise villager Maske Baba. The villager
asked him to drink the juice of ‘Eranda’ (Castor) 3 times.
He also made him wear a garland of some herbs.

Sakharam also did some things at home which his wife
suggested. Within 2 months he got well again, but continued feeling weak.

Questions
1. Are man healthier than women? Why? What advise might the

doctor have given to

Sakharam’s wife?

2.

What are the harmful effects caused by jaundice? Describe

Choose the correct alternative

1. What was Sakharam Patil’s first complaint?

n

1. Lack of Appetite

3. Mild Fever

2. Restlessness

4. Fatigue

its critical symptoms.

98

2. What kind of disease is Jaundice?

3.

1. Non-infectious

2. Hereditary

3. Infectious

4. Allergy

What is the cause of Jaundice?

1. Virus

2. Bacteria

3. Divine Curse

4. Parasite

Fill in the blanks

(Smoky/Whitish), (Change in food/water/surroundings)
1.

In Jaundice, the colour of urine is

2.

Jaundice is caused by

and faces is

Answers
Alternatives - 1-1, 2-3, 3-1

Blanks - 1-2, 2-1

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1

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K

[~99|

Tuberculosis
Mangala lived in a village called Hirapur. She had
cough. She also started getting fever every evening. She
climbing heights made her breathless. She lost her
appetite. After 8 to 10 days, she couldn’t bear the suffering.
She tried taking ‘Adulsa’ for her cough, in vain. So she
went to a private doctor who gave her medicine for 3
days and an injection. However, she continued to have
fever every evening with constant coughing. Her weight
reduced by 5 kg.

Then she consulted another doctor. He asked her to
get an X-ray of her chest. She waited for a few days.
When she began getting kafa’
(phlegm) with cough. She got
an X-ray done. When the doctor
saw it, he told her she would
need medicines for 7 or 8 months since her chest was congested.
Mangala started feeling better after 15 days. Since she had stopped
buying further medicines. She started getting fever regularly again,
with cough and phlegm. So she went to the primary health centre
and brought medicine for 3 days.
Not finding any change in her illness she consulted a ‘Bhagat’
(witch-doctor) who said she would improve in 2 days if she sacrificed
a hen. Mangala revisited the private doctor with her X-ray. He saw
it and insisted that she needed to continue medicines for several
months. When she mentioned that she couldn’t afford the cost,
the doctor advised her to visit the Government hospital.
(
(

In the Government Hospital, Mangala was given medicines for a month. After taking
those, she felt better and once again discontinued her treatment. Within a few days, she
started getting ‘phlegm’ with cough. The neighbours began whispering that she had TB
but Mangala had never been told so by any doctor.
When Mangala’s husband got her check-up done in the government hospital - blood,
urine, phlegm and X-ray - all were tested to conclude that she had TB.

A programme called DOTS had recently been launched in the Government Hospital.
Under this, all likely TB patients were being observed, because they often avoided taking
medicines, thus deteriorating in health. The patients were made to realise the importance
of taking the medicines punctually and regularly for a long period.

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o

The doctor advised the couple to visit the hospital on fixed days to take the medicines.
He also cleared their misconceptions about TB. Then they stopped worrying and were
determined to follow the doctors instructions about continuing the treatment.

-

Foo]
Choose the correct alternatives

►

1. What complaint did Mangala have at first?

1. Loss of Appetite
2. Breathlessness while climbing
3. Fever rising every evening

(■

4. Weight loss
5. All the above

h

2. What causes TB? -1. Virus

h
k
h
h
h

2. Bacteria

3. How should TB be treated?

1. By going to a witch doctor
2. Visiting a private hospital
3. Discontinuing medicine on improvement

4. Completing the dosage as advised by the doctor

J
Fill in the blanks

J

(Blood and Urine/ Phlegm/X-ray) (DOTS programme)

1. The

is available for treatment of TB in a government hospital

2. TB was diagnosed on the basis of Mangala’s test of- and report or

Answers
Correct Alternatives - 1-5, 2-2, 3-4

B

Blanks - 1-2, 2-1

i

H

101

Post-Pregnancy Fever
This is the story of the wife of Lord Chhatrapati Shivaji namely Saibai. She gage birth
to two children, Sakhu and Sambhaji. After her second delivery. She became seriously ill.

She had suffered a lot during labour and started getting fever everyday.

Though Lord Shivaji tried to get the best treatment for her, the royal Vaidya couldn’t
cure her. Special prayers and rituals were also conducted, but in vain. She had excessive

white discharge, which proved fatal for her.
Following are the symptoms and indications of fever within 10 days of delivery/miscarriageshivenng followed by fever, fatigue, pain in private parts and lower abdomen, redness of
face due to high temperature, deep red vaginal flow with blood clots and odours, as well

as faster pulse.
/

In case of insufficient cleanliness at the time of delivery, remains of placenta or membrane

in the uterus can cause fever.

A patient being treated for such fever needs complete rest. The pulse, fever and breathing
should be checked and the patient sent to the doctor, without medical treatment it may
prove fatal.
i

Questions

1. What caused Saibai’s death according to you?
2. What are the other symptoms of this illness?
3. What questions will you ask such a patient?

4. How will you check the patient?
5. What are the reasons for this type of fever?
Fill in the blanks

(Infection during delivery) (The place and time of delivery) (When did the fever start) (Excessive

white discharge with odours) (Constant fever after delivery)

1. Saibai
'
lost her life because of
2. This disease may be caused by
3. This disease may lead to
Such a patient should be asked about
Answers Blanks
1-4, 2-3, 3-1, 4-3

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102

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Wound
Rupali was descending the hill after collecting
flowers and leaves for her herbarium with her friends.

Suddenly she stumbled over a stone and fell down. The
stone injured her foot and it started swelling
A woman over there

crushed some leaves
and applied them to her

wound. When Rupali
returned home, her foot

was paining a lot. Her
mother applied turmeric to it. The wound had become red
and hot. After 3 days she got fever and a swelling in her

groin. Feeling worried

her mother took her to the

primary health centre.
There the doctor cleaned

her wound with iodine, dressed it and gave her medicine
for 3 days. He explained that she had got fever because

of the wound.

Questions

1. What questions will you ask the patient /his or her relatives?
2. Give reasons for means/ways of checking the patient.
3. How will you diagnose the problem? Give reasons.
4. What will you ask the patient (and his relatives) to do? Explain why?

5. Are there any home-remedies for this kind of fever in your village

Choose the best alternatives

1. Why does a fever caused by a wounded foot cause a swelling in the groin?
1. Infection 2. Swelling 3. Increasing pain 4. All above.

Correct Alternatives

1-1

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103

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grandmother and aunt were looking after him. He became
irritable and turned red as bis fever rose. They decided

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L
o ake him to the doctor if he didn't feel better next
day. However, he couldn't steep. He passed a veg, watery - A*

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motion and cried loudly which sounded like his stomach

Since Neil's mother worked in a near-by village his I-------- i

f
4:

t-'

feverX'st d'd mUCh- They 9aVe him Para“'a™1

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---------- - —-----------------

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up for the loss of water.

(
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' syrup
was given to stop vomiting.

(

Finally Neil slept for a while, drank coffee

(

and slept again. But he was awoken by another

t

loose motion. He was too weak to even raise
his head. He was constantly given medicines,

nee soup and a mixture of salt, soda with sugar.
Jtion would be thrown up immediately,
was hardly passing any urine. But the rice

took him to theuT
doctor.
lost 1 kg after thethey
last'Lrek'?check
The Wh
^hd

W3S Wei9'’ed'

f°Und he h2d

water which had le he
a eK s cbeck-l'P Tiste had been a loss of
so that “ es „
™lUPk Th;
deCided ,0 9i- -

infections He Zn en
-ty to ofakei™

Sh°U'd n0' be
other
“,he ,amay said they—

drink sufficient
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WaS"1 Sleepv'

They forced
he began infproyin
I" the morning tears couid «„

loose motion, he drank
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' W,,e" he crfed

"T6- Though he passed a

a couple of loose motions he
Wafer Thou9h he 90t
aching The next Hat h
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36 006 He lndicated fhat his legs were
y. e passed urine normally, had normal temperature L

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and even revealed a new tooth on the third day. He didn’t get any other infection.

Neil must have got infection because

1. Cold and cough
2.

Eating anything during teething

3.

Possibly swallowing bath water

Questions

(

I

J

What signs or symptoms are seen if a patient gets infection?

(

t
What are the symptoms of dehydration?

4

e
4
Fever is present in case of both, kinds of diarrhoea - viral as well as bacterial. How will
you different ate between them?

I
The story of Neil (Fever due to diarrhoea)

Choose the correct alternatives
1. The symptoms of dehydration are

1. Weight loss 2. Absence of urine

(

3. Laziness in the child

4. All above

c

Fill in the blanks - (OR8, Dehydration)

is the sign (symptom of infection in a patient).

1.
2.

Dehydration is treated by.

Answers

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I

Correct Alternatives 1-4

Blanks 1-2, 2-1

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Medicines
Name

Description

Indications

Donts

Side -Effects

1. Amoxycillin

Anti-fever

Pneumonia Sinusitis

2. B-Complex

Vitamin B rash

Dry mouth rash

3. Benzyl benzoate

Itching Antibiotic Itching Anti biotic

New born infant skin Inflammation
with scar
Membranes

of eyes,

4. Chloroquine

Anti malaria

Malaria

Weak-liver

headache

5. Chlorophenyr-amine

Anti -allergic

Rhinitis, all types of rash New-born

6. Codeine

Cures dry cough Dry cough

7. Cotramoxazole

Anti bacterial

Nursing
mother Diarrhoea Rash
/liver
infection.
Single nuclei WBC

No side effect

Vomiting,
giddiness

change
Fatigue,
in
appetite,
reduced
eyesight, dry mouth

Past
asthma, Constipation vomiting
pregnancy
faster heart beat
operation,
large
intestine problems
Infections of Ear, nose, Pregnant or Nursing Vomiting,
diarrhoea,
throat, urinary tract, mother
rash, restlessness
pneumonia

(

8. Ferrous Sulphate

Pregnant
Mother

(

9. Folic Acid

Pregnancy,
Nursing,
mother, inflamed mouth

Nursing

Stomach-ache
constipation
or
diarrhoea, black stools

No side effect

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