WHERE THERE IS NO DOCTOR SOME VERY COMMON SICKNESSES

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Title
WHERE THERE IS NO DOCTOR SOME VERY COMMON SICKNESSES
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COMMUNITY HEALTH CEl L
47/1. (Pi<t Flwrj St. Marks Road,

D-71

Bangalore - 5S» 001.

CHAPTER

13

Some Very Common Sicknesses

This is a reprint from

WAcrc 'There Is No Doctor
(Indian adaptation)

published by the
Voluntary Health Association of India
C-14 Community Centre
Safdarjung Development Area
New Delhi 110016

181
CHAPTER

Some Very Common Sicknesses
DEHYDRATION
Most children who die from diarrhea die because they do not have enough water
left in their bodies. This lack of water is called dehydration.
Dehydration results when the body loses more liquid than it takes in. This can
happen with severe diarrhea, especially when there is vomiting as well. It can also
happen in very serious illness, when a person is too sick to take much food or
liquid.
People of any age can become dehydrated, but dehydration develops more
quickly and is most dangerous in small children.

A baby needs water to drink, especially in hot weather. Often a mother
does not give water to her baby till he is six months old. A baby cannot tell
his mother he is thirsty, but needs water several times a day. The mother
should take water from,a clean source and keep it in a covered pot If
possible, she should boil thewaterfor her baby. Especially when the baby
has diarrhoea or vomiting, he loses a lot of water from his body. He needs
extra water many times a day.

Any child with watery diarrhea is in danger of dehydration.

It is important that everyons-especially mothers—know the signs of
dehydration and how to prevent and treat it.

Signs of dehydration:
little or no urine; the urine is dark yellow
sudden weight loss---------dry mouth--------------------sunken, tearless eyes--------

sagging in of the 'soft spot'
in. infants----------------------

182

loss of elasticity or
stretchiness of the skin
Lift the skin between two fingers, like this. ...

If the skin fold does not fall
right back to normal, the child is
dehydrated.

v'ery severe dehydration may cause rapid, weak pulse (see Shock, p. 89) fast,
•ep breathing, fever, or fits (convulsions, p. 217)

Prevention and treatment of dehydration:

♦ A dehydrated person should drink large amounts of liquids: water, tea, soup.
etc. But do not wait for dehydration to begin.
♦ Dehydration can usually be prevented if a person with diarrhea, with or
without vomiting, is given plenty of liquids or Rehydration Drink from the very
first. This is especially important for small children with watery stools.
♦ Especially useful in the prevention and treatment of dehydration is the
following Rehydration Drink:

183

A mother can also make the Rehydration Drink like this:
She takes

and add it to 1 litre of boiled and cooled water.

Give the dehydrated person sips of this drink every 5 minutes, day and night,
until he begins to urinate normally. A large person needs 3 or more liters a day. A
small child needs at least 1 liter a day.
Keep giving Rehydration Drink often in small sips, even if the person is
vomiting. If the dehydrated person cannot drink enough to correct the dehydration
or if he vomits all he drinks, find a health worker who can give liquid through the
veins (intravenous solution).

Note: When possible, make Rehydration Drink using bee's honey or jaggery rather
than sugar. Honey consists partly of a simple sugar (glucose) that the body can use
more easily. Even better than honey is glucose powder. Making Rehydration
Drink with glucose or honey is especially important if the child is very
malnourished or has severe diarrhea. In some areas you can get small packages of a
Rehydration Mix containing glucose together with the right combination of
different salts (see p. 416)

DIARRHEA AND DYSENTERY
When a person has loose or watery stools, he has diarrhea. If mucus and blood
can be seen in the stools, he has dysentery.
Diarrhea can be mild or serious. It can be acute (sudden and severe) or chronic
(lasting many days).
Diarrhea is more common and more dangerous in young children, especially
those who are poorly nourished.

182

,'ery severe dehydration may cause rapid, weak pulse (see Shock, p. 89) fast,
ep breathing, fever, or fits (convulsions, p. 217)

Prevention and treatment of dehydration:
♦ A dehydrated person should drink large amounts of liquids: water, tea, soup,
etc. But do not wait for dehydration to begin.
♦ Dehydration can usually be prevented if a person with diarrhea, with or
without vomiting, is given plenty of liquids or Rehydration Drink from the very
first. This is especially important for small children with watery stools.

♦ Especially useful in the prevention and treatment of dehydration is the
following Rehydration Drink:
REHYDRATION DRINK—TO PREVENT AND TREAT DEHYDRATION

bicarbonate of

If you do not have
soda, use another %
teaspoon salt.

If available, add half a cup of orange juice or a little lemon juice to the Drink.

183

A mother can also make the Rehydration Drink like this:
She takes

and add it to 1 litre of boiled and cooled water.

Give the dehydrated person sips of this drink every 5 minutes, day and night,
until he begins to urinate normally. A large person needs 3 or more liters a day. A
small child needs at least 1 liter a day.
Keep giving Rehydration Drink often in small sips, even if the person is
vomiting. If the dehydrated person cannot drink enough to correct the dehydration
or if he vomits all he drinks, find a health worker who can give liquid through the
veins (intravenous solution)..
Note: When possible, make Rehydration Drink using bee's honey or jaggery rather
than sugar. Honey consists partly of a simple sugar (glucose) that the body can use
more easily. Even better than honey is glucose powder. Making Rehydration
Drink with glucose or honey is especially important if the child is very
malnourished or has severe diarrhea. In some areas you can get small packages of a
Rehydration Mix containing glucose together with the right combination of
different salts (see p. 416)

DIARRHEA AND DYSENTERY
When a person has loose or watery stools, he has diarrhea. If mucus and blood
can be seen in the stools, he has dysentery.

Diarrhea can be mild or serious. It can be acute (sudden and severe) or chronic
(lasting many days).

Diarrhea is more common and more dangerous in young children, especially
those who are poorly nourished.

184

This child is well nourished. He
is less likely to get diarrhea. If he
gets it he usually will get well
again quickly.

This child is poorly nourished.
He is more likely to get diarrhea
-and there is a much greater
chance he will die from it.

Diarrhea has many causes. Sometimes special treatment is needed. However,
most diarrhea can be treated successfully in the home, even if you are not sure of
the exact cause or causes.

THE MAIN CAUSES OF DIARRHEA:
poor nutrition (p.1 85 )
This weakens
the child and makes diarrhea from other
causes more frequent and worse.
virus infection or 'intestinal flu’ (diarrhea
usually mild)

an infection of the gut caused by bacteria
(p.1 55), amebas (p.1 97), or giardia (p.1 98)
worm infections (p.1 93 to1 97)
infections outside the gut (ear infections,
p. 355 tonsillitis,p. 356measles, p 358
urinary infections, p. 278)

malaria (falciparum type-in parts of
India, p. 1 89))
food poisoning (spoiled food, p.1 70)

inability to digest milk (mainly in severely
malnourished children and certain adults)

These children may need a special
enzyme tablet. Consult a health worker.
difficulty babies have digesting foods that
are new to them
allergies to certain foods (seafood, crayfish,
etc., p203); occasionally babies are allergic
to cow’s milk or other milk

side effects produced by certain medicines,
such as ampicillin or tetracycline
laxatives, purges, irritating or poisonous
plants, certain poisons
eating too much unripe fruit or heavy,
greasy foods

Preventing diarrhea:
Although diarrhea has many different causes, the most common are infection
and poor nutrition. With good hygiene and good food, most diarrhea could be
prevented. And if treated correctly, fewer children who get diarrhea would die.

185

Children who are poorly nourished get
diarrhea and die from it far more often
than those who are well nourished. Yet
diarrhea itself can be part of the cause of
malnutrition. And if malnutrition already
exists, diarrhea rapidly makes it worse.

Malnutrition causes diarrhea.
Diarrhea causes malnutrition.
This results in a vicious circle, in which
each makes the other worse. For this
reason, good nutrition is important in both
the prevention and treatment of diarrhea.

THE 'VICIOUS CIRCLE' OF
MALNUTRITION ANO DIARRHEA
TAKES MANY CHILDREN'S LIVES.

Prevent diarrhea by preventing malnutrition.
Prevent malnutrition by preventing diarrhea.

To learn about the kinds of foods that help the body resist or fight off
different illnesses, including diarrhea, read Chapter 11.
The prevention of diarrhea depends both on good nutrition and cleanliness.
Many suggestions for personal and public cleanliness are given in Chapter 12.
These include the use of latrines, the importance of clean water, and the protection
of foods from dirt and flies.

Here are some other important suggestions for preventing diarrhea in babies:

♦ Breast feed rather than bottle feed babies. Give only
breast milk for the first 2 months. Breast milk helps babies
resist the infections that cause diarrhea. If it is not possible
to breast feed a baby, feed him with a cup and spoon. Do
not use a baby bottle because it is harder to keep clean and
more likely to cause an infection.
♦ When you begin to give the baby new or solid foods,
start by giving him just a little, and mashing it well. He has
to learn how to digest new foods, and if he starts with too
much at one time, he may get diarrhea.
♦ Keep the baby clean-and in a clean place. Try to
keep him from putting dirty things in his.mouth.
♦ Do not give babies unnecessary medicines.

BREAST FEEDING HELPS
PREVENT DIARRHEA

186

Treatment of diarrhea:

For most cases of diarrhea no medicine is needed. If the diarrhea is severe, the
biggest danger is dehydration. If the diarrhea lasts a long time, the biggest danger
is malnutrition. So the most important part of treatment has to do with giving
enough liquids and good food. No matter what the cause of diarrhea, always take
care with the following:
1. PREVENT OR CONTROL DEHYDRATION. A person with watery diarrhea
must drink large amounts of liquids. If diarrhea is severe or there are signs of
dehydration, give him Rehydration Drink (pi 182). Even if he does not want to
drink, gently insist that he do so. Have him take several swallows every few
minutes.

2. MEET NUTRITIONAL NEEDS. A person with diarrhea needs food as soon
as he will eat. This is especially important in small children or persons who are
already poorly nourished.
♦ A baby with diarrhea should go on breast feeding.
♦ A small or underweight child, or anyone who is thin and weak, should get
plenty of body-building foods (proteins) and energy foods all the time he hag
diarrhea—and also when he gets well. If he stops eating because he is too sick
or is vomiting, he should eat again as soon as he can Although giving food
may cause more frequent stools at first, it can save his life.
♦ If a child who is underweight has diarrhea that lasts for many days or keeps
coming back, give him more food rich in protein. Often no other treatment
is needed
♦ When an older child or adult who is well nourished has a severe case of acute
diarrhea, he may recover more quickly on a liquid diet of teas, broths, or
Rehydration Drink. But if the diarrhea lasts more than 1 day, he should
begin taking food.
FOODS F-OR A PERSON WITH DIARRHEA

When the person is vomiting
or feels too sick to eat,
he should drink:

As soon as the person is able to eat, in addition to giving
the drinks listed at the left, he should eat a balanced
selection of the following foods or similar ones:

tea

energy foods
ripe or cooked bananas
rice
daliai (broken wheat) or other
well cooked grains
fresh maize (well cooked
and mashed)

body-building foods
dais and other pulses
beans’, lentils, or peas (well
cooked and mashed)
milk (sometimes this causes
problems, see the n
eggsZL)

potatoes
papaya

chicken (boiled or roasted)
meat, well cooked, without
fat or grease
fish (well cooked)

rice water

chicken, meat, egg, or bean
broth
sweetened drinks

REHYDRATION DRINK
Breast milk

DO NOT EAT OR DRINK

fatty or greasy foods
most raw fruits

highly seasoned food

alcoholic drinks
any kind of laxative or purge

187
Diarrhea and milk:

Breast milk is the best food for babies. Keep giving breast milk when the baby
has diarrhea. It does not cause diarrhea and will help the baby get better quickly.
Cow's milk, Buffalo's milk or Goat's milk can be good sources of protein for
children who have diarrhea. However, if the child is badly malnourished, he may
have trouble digesting the milk, and this may cause even more diarrhea. If this
happens, try giving less milk and mixing it with other foods. But remember: a
poorly nourished child with diarrhea must have enough protein, so if less milk is
given, well-cooked and mashed foods such as dais, beans, egg yolk, chicken.
meat or fish should be added. Beans are easier to digest if their skins have been
peeled,off and they are boiled and mashed.
As the child gets better, he will usually be able to drink more milk without
getting diarrhea.

Medicines for diarrhea:
For most cases of diarrhea no medicines are needed. But in certain cases, using
the right medicine can be important. However, many of the medicines
commonly used for diarrhea do little or no good. Some are actually harmful:

GENERALLY IT IS BETTER NOT TO USE THE FOLLOWING MEDICINES
IN THE TREATMENT OF DIARRHEA:

‘Anti-diarrhea* medicines with kaolin and pectin (such as Kaopectate, p.41 7)make
diarrhea thicker and less frequent, but they do not correct dehydration or control
infection. Some anti-diarrhea medicines, like diphenoxylate (Lomotil) may even make
infections last longer.
r
Fl

‘ANTI-DIARRHEA MEDICINES* ACT LIKE PLUGS. THEY KEEP IN

II

Y.//

THE INFECTED MATERIAL THAT NEEDS TO COME OUT.

y

‘Anti-diarrhea’ mixtures containing neomycin or streptomycin should not be used, as
these may irritate the gut and do more harm than good.

Antibiotics like ampicillin and tetracycline are useful in some cases of diarrhea. But
they themselves sometimes cause diarrhea, especially in small children. If, after taking
these antibiotics for more than 2 or 3 days, diarrhea gets worse rather than better, stop
taking them—the antibiotics may be the cause.

Do not give tetracyclin to a child below 8 years.
Chloramphenicol has certain dangers in its use (see p.401 land should never be used
for mild diarrhea or given to babies less than 1 month old.

Laxatives and purges should never be given to persons with diarrhea. They will make it
worse and increase the danger of dehydration.

For some effective home cures for mild diarrhoea. see Chapter 1

188

Special treatment in different cases of diarrhea:
While most cases of diarrhea can be treated by giving plenty of liquids and
nutritious food, sometimes special treatment is needed.

In considering treatment, keep in mind that some cases of diarrhea, especially
in small children, are caused by infections outside the gut. Always check for
infections of the ears, the throat, and the urinary system. If found, these
infections should be treated. Also look for signs of measles.
If the child has mild diarrhea together with signs of a cold, the diarrhea is
probably caused by a virus, or 'intestinal flu', and no special treatment is called
for. Give lots of liquids.

In certain difficult cases of diarrhoea, you may need an analysis of the stools or other
tests to know how to treat it correctly.
But usually you can learn enough by
asking specific questions, seeing the stools, and looking for certain signs. Here are
some guidelines for treatment according to signs.
1. Sudden, mild diarrhea. No fever. (Upset stomach? 'Intestinal flu'?)

♦ Drink lots of liquids. Usually no special treatment is needed.
Kaolin is useless in treating this as it does not attack the infection, nor treat
dehydration, (see P417).

♦ If severe colic (painful cramps) is a problem, an antispasmodic like
belladonna may help. (For precautions and dosage, see p. 41 5)
2. Diarrhea with vomiting. (Many causes)
♦ If a person with diarrhea is also vomiting, the danger
of dehydration increases, especially in small children. It is
very important to give the Rehydration Drink (p. 1 82)
tea, fruit juice, or whatever liquids he will take. Give sips
every 5 to 10 minutes. If vomiting does not stop soon, you
can use medicines like promethazine (p. 419) or
phenobarbital (p.422).
♦ If you cannot control the vomiting or if the dehydration gets worse, seek
medical help fast.

3.
Diarrhea with mucus and blood. Often chronic. No fever. (Possibly amebic
dysentery. For more details, see page 197)
Use metronidazole (p407)Take the medicine according to the recommended
dose. If the diarrhoea continues after treatment for 4 days, seek medical advice
4.
Acute diarrhea with fever, with or without blood. (Bacterial dysentery?
Typhoid? Malaria?)

189

♦ If the person with diarrhea has a fever lasting more than 6 hours after
beginning treatment for dehydration, and seems very ill, give ampicillin if possible
(p. 399) If not, give tetracycline (p. 400)

♦ If the persons's condition is very poor or he is not improving with ampicillin
or tetracycline, seek medical help. If.there are signs of typhoid fever (see p.229),
give chloramphenicol (p. 401) in the recommended dose.

♦ In areas where the falciparum type of malaria is common, it is a good idea
that persons with diarrhea and fever also be treated with chloroquine (see p. 405),
especially if they have a large spleen.

5.
Yellow, bad-smelling diarrhea with bubbles or froth, without blood or mucus.
(Giardia? See p. 198)

♦ This may be caused by microscopic parasites called Giardia or perhaps by
malnutrition. In either case, plenty of liquid, nutritious food, and rest are often
the only treatment needed. Severe giardia infections can be treated with
metronidazole (p. 407) Mepacrine (Atabrine) is cheaper, but less effective.
6.

Chronic diarrhea (diarrhea that lasts a long time or keeps coming back).

♦ This is most commonly due to malnutrition, less commonly to a chronic
infection such as that caused by amebas. See that the child eats more nutritious
food, especially foods rich in proteins (p. 128) If the diarrhea still continues, seek
medical help.

7.

Diarrhea like rice water. (Cholera?)

♦ Rice water' stools are a sign of cholera (see p231 )ln countries where this
dangerous sign occurs, cholera often comes in epidemics (striking, many people at
once) and is usually worse in older children and adults. Cholera should be reported
to the authorities. Dehydration is extreme, especially if there is vomiting also. Treat
dehydration continuously and either give twice the usual dose of tetracyclin (p400)or
give the normal dose of chloramphenicol (p 401)Seek medical help.
Deaths in cholera are due to dehydration.

Care of Babies with Diarrhea
Diarrhea is especially dangerous in babies and small
children. Often no medicine is needed, but special
care must be taken because a baby can die very
quickly of dehydration.
♦ Continue breast feeding and also give sips of
Rehydration Drink.

GIVE HIM BREAST MILK

190

♦ If vomiting is a problem, give breast milk often,
but only a little at a time. Also give Rehydration
Drink in small sips every 5 to 10 minutes.

AND ALSO
REHYDRAT1ON DRINK

♦ If there is no breast milk, try giving frequent
small feedings of some other milk or milk substitute
(like milk made from soybeans) mixed to half normal
strength with boiled water. If milk seems to make the
diarrhea worse, give some other protein ( chicken,
lean meat, or skinned mashed beans, eggs,mixed with
honey, sugar, jaggery, or well-cooked rice or another
starchy food, and boiled water).
♦ If the child is younger than 1 month, try to find a health worker before
giving any medicine. If there is no health worker and the child is very sick, give
him an 'infant syrup' that contains ampicillin: (see p. 399) It is better not to
use other antibiotics.

When to Seek Medical Help in Cases of Diarrhea
Diarrhea and dysentery can be very dangerous—especially in small children.
In the following situations you should get medical help:

■ if diarrhea lasts more than 4 days and is not getting better—or more than 1
day in a small child with severe diarrhea
■ if the person is dehydrated and getting worse
■ if the child vomits everything he drinks, or drinks nothing

■ if the child begins to have fits, or if the feet and face swell
■ if the person was very sick, weak, or malnourished before the diarrhea began
(especially a little child or a very old person)
■ if there is much blood in the stools, this can be dangerous even if there is
little diarrhea (see gut obstruction, p. i07j

VOMITING
Many people, especially children, have an occasional 'stomach upset' with
vomiting. Often no cause can be found. There may be mild stomach or gut ache
or fever. This kind of simple vomiting usually is not serious and clears up by itself.

191

THE CARE QE A PERSON WITH ACUTE DIARRHEA

DIARRHEA

192

Vomiting is one of the signs of many different
problems, some minor and some quite serious, so it is
important to examine the person carefully. Vomiting
often comes from a problem in the stomach or guts,
such as: an infection (see diarrhea, p. 183), poisoning
from spoiled food (p.170 ), or 'acute abdomen' (for
example, appendicitis or something blocking the gut,
p.107). Also, almost any sickness with high fever or
severe pain may cause vomiting, especially malaria
(p. 227),hepatitis (p.209), tonsillitis (p. 356) earache
(p. 355). meningitis (p.226), urinary infection (p. 278),
gallbladder pain (p. 375) or migraine headache (p. 199)

Danger signs with vomiting—seek medical help quickly!
• dehydration that increases and that you cannot control, (p. 181)
• severe vomiting that lasts more than 24 hours
• violent vomiting, especially if vomit is dark green, brown, or smells like feces
(signs of obstruction, p. 107)
• constant pain in the gut, especially if the person cannot defecate (shit) or if
you cannot hear gurgles when you put your ear to the belly (see acute
abdomen: obstruction, appendicitis, p. 107)
• vomiting of blood (ulcer, p. 149; cirrhosis, p. 374)

To help control simple vomiting:
♦ Eat nothing while vomiting is severe.
♦ Sip some tea with sugar but without any milk. Adding ginger or
lime juice may also help.
♦ Sip a cola drink or ginger ale. Some herbal teas, like camomile, may
also help.
♦ For dehydration give small frequent sips of cola, tea, or
Rehydration Drink (p. 182).
♦ If vomiting does not stop soon, use a vomit-control medicine like
promethazine (p.419), diphenhydramine (p. 419) or phenobarbital
(p. 422).

Most of these come in pills, syrups, injections, and suppositories (soft pills you
push up the anus). Tablets or syrup can also be put up the anus. Grind up the
tablet in a little water. Put it in with an enema set or syringe without a needle.
When taken by mouth, the medicine should be swallowed with very little
water and nothing else should be swallowed for 5 minutes. Never give more than
the recommended dose. Do not give a second dose until dehydration has been
corrected and the person has begun to urinate. If severe vomiting and diarrhea
make medication by mouth or anus impossible, give an injection of 1 of these
vomit-control medicines. Promethazine may work best. Take care not to give too
much.

193

WORMS AND OTHER INTESTINAL PARASITES
There are many types of worms and other tiny animals (parasites) that live in
people's intestines and cause diseases. Those which are larger are sometimes seen

The only worms commonly seen in the stools are roundworms, threadworms,
and tapeworms. Hookworms and whipworms may be present in the gut in large
numbers without ever being seen in the stools.

Note: The most popular 'worm medicines' contain piperazine. These work only
for roundworms and threadworms. Other worms must be treated with other
medicines.

Roundworm (Ascaris):
20 to 30 cm. long. Color: pink or white.

1

How they are spread:

Feces-to-mouth. Through lack of cleanliness, the roundworm eggs pass from
one person's stools to another person's mouth.
Effect on health:

Once the eggs are swallowed, young worms hatch and enter the bloodstream;
this may cause general itching. The young worms then travel to the lungs,
sometimes causing a dry cough or, at worst, pneumonia with coughing of blood.
The young worms are coughed up, swallowed, and reach the intestines, where
they grow to full size.

Many roundworms in the intestines may cause discomfort, indigestion, and
weakness. Children with many roundworms often have very large, swollen bellies.
Rarely, roundworms may cause asthma, fits, or a dangerous obstruction or
blockage in the gut (see p. 107) When the child has a fever, the worms sometimes
come out in the stools or crawl out through the mouth or nose. Occasionally they
crawl into the airway and cause gagging.

194

Prevention:
Use latrines, wash hands before eating or handling food, protect food from flies,
and follow the guidelines of cleanliness described in the first part of this chapter.
Treatment:

One dose of piperazine will usually get rid of roundworms. For dosage, see page
411. Some home remedies work fairly well. For a home remedy see chapter 1

Threadworm (Pinworm, Enterobius):
1 cm. long. Color: white. Very thin and threadlike.
How they are transmitted:

These worms lay thousands of eggs just outside the anus (ass
hole). This causes itching, especially at night. When a child
scratches, the eggs stick under his nails, and are carried to food
and other objects. In this way they reach his own mouth or the
mouths of others, causing new infections of threadworms.

/*^\
( \
//
a/pz
Zrj

A

Effect on health:
These worms are not dangerous. Itching may disturb the child's
sleep.

JPj,

Treatment and Prevention:

♦ A child who has pinworms should wear tight diapers or pants while sleeping
to keep him from scratching his anus.
♦ Wash the child's hands and buttocks (anal area) when he wakes up and after
he has a bowel movemerit. Always wash his hands before he eats.

♦ Cut his fingernails very short.
♦ Change his clothes and bathe him often—wash the buttocks and nails
especially well.
* Put Vaseline, or some mustard oil in and around his anus at bedtime to help
stop itching.

♦ Give him a worm medicine that contains piperazine. For dosage, see page
411. When one child is treated for these worms, it is wise to treat the whole
family at the'same time. For home remedies, see Chapter 1
♦ Cleanliness is the best prevention for threadworms. Even if medicine gets rid
of the worms, they will be picked up again if care is not taken with personal
hygiene. Pinworms only live for about 6 weeks. By carefully following the
guidelines of cleanliness, most of the worms will be gone within a few weeks,
even without medicine.

195

Whipworm (Trichuris, Trichocephalus):
3 to 5 cm. long. Color: pink or gray.

This worm, like the roundworm, is passed from the feces of one person to the
mouth of another person. Usually this worm does little harm, but it may cause
diarrhea. In children it occasionally causes part of the intestines to come out of
the anus (prolapse of the rectum).
Prevention: The same as for roundworm.
Treatment: If the worms cause a problem, give thiabendazole or mebendazole. For
dosage, see pages411 and 41 2. For prolapse of the rectum, make the child sit in a
tuo of warm water. This should make the intestine pull back in. If this does not work.
seek medical heip.

Hookworm:

1 crp. long. Color: red.

Hookworms cannot usually be seenxin the feces. A stool analysis is needed to
prove that they are there.

How hookworms are spread:
3. The person coughs up the
young worms and swallows
them.

2. In a few days they reach
the lungs through the blood­
stream. They may cause a dry
cough (rarely with blood).

1. The baby hookworms
enter a person’s bare feet.
This can cause itching.

4. A few days later the person
may have diarrhea or a
stomach-ache.

5. The hookworms attach
themselves to the walls of the
worms can cause
and severe anemia.

hookworm eggs leave
dy in the person’s
The eggs hatch on
moist soil.

Hookworm infection can be one of the most damaging diseases of childhood.
Any child who is anemic, very pale, or eats dirt, may have hookworms. If possible,
his stools should be analyzed.
Treatment: Use thiabendazole, mebendazole, tetrachloroethylene (T.C.E.), or
bephenium. For’dosage and precautions, see pages 411 and 41 2. Treat anemia by
eating foods rich in iron and if necessary by taking iron pills (p. 147).

Prevent hookworm: Build and use latrines.
Do not let children go barefoot.

196

Tapeworm:
In the intestines tapeworms grow several meters long.
But the small, flat, white pieces (segments) found in the
feces are usually about 1 cm. long.
Occasionally a segment
may crawl out by itself
and be found in the
underclothing.
adult
tapeworm

People get tapeworms from
eating pork (pig meat), beef
(cow meat) or other meat that
is not well cooked.

segments

Prevention: Be careful that all meat is well cooked, especially pork. Make sure no
parts in the center of roasted meat are still raw.

When a person eats poorly

Effect on health: Tapeworms in the intestines sometimes cause mild stomach­
aches, but few other problems.

The greatest danger exists when the cysts (small sacs containing baby worms)
get into a person's brain. This happens when the eggs pass from his stools to his
mouth. For this reason, anyone with tapeworms must follow the guidelines of
cleanliness carefully—and get treatment as soon as possible.

Treatment: Take niclosamide ( see p.412)', dichlorophen(p. 413) or quinacrine
(mepacrine, Atabrine, p. 407). Follow instructions carefully. For home
remedies, see Chapter 1 page 19

197

144

Trichinosis’
These worms are never seen in the stools. They burrow through the person's
intestines and get into his muscles. People get these worms, like tapeworms, from
eating infected pork or other meat that is not well cooked.
Effect on health: Depending on the amount of infected meat eaten, the person
may feel no effects, or he may become very sick or die. From a few hours to 5
days after eating the infected pork, the person may develop diarrhea and feel sick
to his stomach.

In serious cases the person may have:
• fever with chills
• muscle pain
• swelling around the eyes and
sometimes swelling of the feet

• small bruises (black or blue spots)
on the skin
• bleeding in the whites of the eyes

Severe cases may last 3 or 4 weeks.

Treatment: Seek medical help at once. Thiabendazole may help a little. For
dosage, see p. 41 1. (Cortico-steroids may also help, but should be given by a health
worker or doctor.)

Important: If several people who ate meat from the same pig gel sick afterward,
suspect trichinosis. This can be dangerous; seek medical attention.
Prevention of trichinosis:
♦ Eat pork and other meat only if it is well-cooked.
♦ Do not feed scraps of meat or leftovers from butchering to pigs.
Ameba as seen

Amebas:

under microscope

These are not worms, but tiny animals—or parasites—that
can be seen only with a microscope (an instrument that
makes things look much bigger).

Microscope

How they are transmitted:
The stools of infected people have millions of these tiny
parasites. Because of poor sanitation, they get into the source
of drinking water or into food, and other people become
infected.

Signs of infection with amebas:
Many healthy people have amebas without becoming sick. However, amebas are
a common cause of severe diarrhea or dysentery (diarrhea with blood)—especially
in persons already weakened by other sickness or poor nutrition. Less commonly,
amebas cause painful, dangerous abscesses in the liver.

198

Typical amebic dysentery consists of:
• diarrhea that comes and goes—sometimes alternating with constipation
• cramps in the belly and a need to have frequent bowel movements, even
when little or nothing—or just mucus—comes out
• many loose (but usually not watery) stools with lots of mucus, sometimes
stained with blood
o in severe cases, much blood; the person may be very weak and ill
» usually there is no fever

Diarrhea with blood may be caused by either amebas or bacteria. However,
bacterial dysentery (Shigella) begins more suddenly, the stools are more watery,
and there is almost always fever (p.189). As a general rule:
Diarrhea + blood + fever = bacterial infection (Shigella)
Diarrhea + blood + no fever = amebas

Occasionally bloody diarrhea has other causes. To be sure of the cause, a stool
analysis may be necessary.
Sometimes amebas get into the liver and form an abscess or pocket Of pus. This
causes tenderness or pain in the right upper belly. Pain may extend into the right
chest and is worse when the person walks. (Compare this with gallbladder pain,
p.375) hepatitis, p.209) and cirrhosis, p. 374) If the person with these signs
begins to cough up a brown liquid, an amebic abscess is draining into his lung.
Treatment:
♦ If possible get medical help and a stool analysis.

♦ Mild gut infection with amebas can be treated with metronidazole (for dosage.
length of treatment, and precautions, see p 407)
♦ For severe dysentry or amebic abscess, take metronidazole (for dosage see p 407)
If metronidazole is not available, use chloroquine (P 405) . Seek medical help.
Prevention: Make and use latrines, protect the source of drinking water, and
follow the guidelines of cleanliness. Eating well and avoiding fatigue and
drunkenness are also important in preventing amebic dysentery.

Giardia:
The giardia, like^he ameba, is a microscopic parasite that lives
in the gut and is a cbmmon cause of diarrhea, especially in
children. The diarrhea may be chronic or intermittent (may come
and go).
A person who has yellow, bad-smelling diarrhea that is frothy
(full of bubbles) but without blood or mucus, probably has giardia.
Giardia as
The belly is swollen with gas and uncomfortable, there are mild
seen under
intestinal cramps, and the person farts a lot. There is usually no
a microscope
fever.
Giardia infections often clear up by themselves. Good nutrition helps. Severe
cases are best treated with metronidazole (for dosage, see p.407) ■ Quinacrine
( p. 407) is cheaper but does not work as well.

199

HEADACHES AND MIGRAINES
SIMPLE HEADACHE can be
helped by rest and aspirin. It often
helps to put a cloth soaked in hot
water on the back of the neck and
to massage (rub) the neck and
shoulders gently. Some other home
remedies also seem to help.

For simple or nervous headache,
folk cures sometimes work as
well as modern medicine.

Headache is common with any
sickness that causes fever. If head­
ache is severe, check for signs
of meningitis (p. 225;

Headaches that keep coming
back may be a sign of a chronic
illness or poor nutrition. It is
important to eat well and get
enough sleep. If the headaches do
not go away, seek medical help.
A MIGRAINE is a severe throbbing headache often on one side of the head
only. Migraine attacks may come often, or months or years apart.

A typical migraine begins with blurring of vision, seeing strange spots of light,
or numbness of one hand or foot. This is followed by severe headache, which may
last hours or days. Often there is vomiting. Migraines are very painful, but not
dangerous.
TO STOP A MIGRAINE, DO THE FOLLOWING AT THE FIRST SIGN:
♦ Take 2 aspirins with a cup of strong
coffee or strong black tea.
♦ Lie down in a dark, quiet place. Do
your best to relax. Try not to think
about your problems.

♦ For especially bad migraine headaches,
obtain pills of ergotamine with
caffeine {Cafergot, p. 41 5). Take 2
pills at first and 1 pill every 30
minutes until the pain goes away. Do
not take more than 6 pills in 1 day.

200

COLDS AND THE FLU
Colds and the flu are common virus infections that may
cause runny nose, cough, sore throat, and sometimes fever
or pain in the joints. There may be mild diarrhea,
especially in young children.
Colds and the flu almost always go away without
medicine. Do not use penicillin, tetracycline, or other
antibiotics, as they will not help at all and may cause harm.
♦ Drink plenty of water and get enough rest.
♦ Aspirin (p. 414) or acetaminophen (p.414) helps lower fever and relieve
body aches and headaches. More expensive 'cold tablets' are no better than
aspirin. So why waste your money?
♦ Inhale steam; this helps to clear a stuffy nose.

♦ No special diet is needed. However, fruit juices, especially orange juice or
lemonade, are helpful.
For treating coughs and stuffy noses that come with colds, see the next pages.
If a cold or the flu lasts more than a week, or if the person has fever, coughs up
a lot of phlegm (mucus with pus), has shallow fast breathing or chest pain, he
'uld be developing bronchitis or pneumonia (see p. 207 and 208) An antibiotic
.,ay be called for. The danger of a cold turning into pneumonia is greater in old
people small children and those who have lung oroblems like chronic bronchitis.

Sore throat is often part of a cold. No special medicine is needed, but it may
help to gargle with warm water. However, if the sore throat begins suddenly, with
high fever, it could be a strep throat. Special treatment is needed (see p. 356)

Prevention of colds:
♦ Getting enough sleep and eating well helps prevent colds. Eating oranges,
tomatoes, and other fruit containing vitamin C may also help.
♦ Contrary to popular belief, colds do not come from getting cold or wet but
can be made worse by getting wet. A bold is 'cauaht' from others who have
the infection and sneeze the virus into >he air.
♦ To keep from giving his cold to others, the sick person should eat and sleep
separately—and take special care to keep far away from small babies. He should
cover his nose and mouth when he coughs or sneezes.

♦ To prevent a cold from leading to earache (p. 355). do not blow your nosejust wipe it. Teach children to do the same.

201

STUFFY AND RUNNY NOSES
A stuffy or runny nose can result from a cold or allergy (see next page). A lot
of mucus in the nose may cause ear infections in children or sinus problems in
adults.

To help dear a stuffy nose, do the following:
1. In little children, carefully suck the
mucus out of the nose with a suction
bulb or syringe without a needle, like this:

2. Older children and adults can put a little salt
water into their hand and sniff it into the nose.
This helps to loosen the mucus.

3.

Breathing hot water vapor as described on page205. helps clear a stuffy nose.

4.
Wipe a runny or stuffy nose, but do not blow it. Blowing the nose may lead
to earache and sinus infections.
5.
Persons who often get earaches or sinus trouble after a cold can help prevent
these problems by using decongestant nose drops like phenylephrine (p. 418)
After sniffing a little salt water, put the drops in the nose like this:

With the head sideways, put 2 or 3 drops
in the lower nostril. Wait a couple of
minutes and then do the other side.
CAUTION: Use decongestant drops no
more than 3 times a day, for no more
than 3 days.

A decongestant syrup (with phenylephrine or something similar) may also help.

Prevent ear and sinus infections—wipe but do not blow your nose. |

3—

W wo
COMMUNITY HEALTH CELL
(FirsrEinm) Sv.toatkg Read;

Bancialore -

OOH.

202

SINUS TROUBLE (SINUSITIS)
Sinusitis is an acute or chronic (long-term) inflammation of the sinuses or
hollows in the bone that open into the nose.

Signs:

• Pain in the face above and below the eyes, here
(It hurts more when you tap lightly just over the
bones, or when the person bends over.)
• Thick mucus or pus in the nose, perhaps
with a bad smell. The nose is often stuffy.

• Fever (sometimes).
Treatment:

• Sniff a little salt water into the nose (see p. 201)
♦ Put hot compresses on the face.

♦

Inhaling steam helps relieve congestion

♦ Use decongestant nose drops such as phenylephrine (Neo-synephrine, p. 418)

♦ Use an antibiotic such as tetracycline (p. 400), ampicillin (p. 399), or
penicillin (p.397).
♦ If the person does not get better, seek medical help.

Prevention:
When.you get a cold and a stuffy nose, try to keep your nose clear. Follow the
instructions on page 201

HAY FEVER (ALLERGIC RHINITIS)
Runny nose and itchy eyes can be caused by an
allergic reaction to something in the air that a person
has breathed in (see the next page). It is often worse
at certain times of year.

Treatment:

Use an antihistamine such as chlorpheniramine
(p.420). Dimenhydrinate (Dramamine, p.420),
Usually sold for motion sickness, also works.
Prevention:

Find out What things cause this reaction (for
example: dust, chicken feathers, pollen, mold) and
try to avoid them.

203

ALLERGIC REACTIONS
An allergy is a disturbance or reaction that affects only certain persons when
things they are sensitive or allergic to are . . .

■ breathed in
■ eaten
■ injected
■ or touch the skin
Allergic reactions, which can be mild or very serious, include:

• itching rashes, lumpy patches or hives (p. 244)
o runny nose and itching or burning eyes (hay fever, p. 202)

• irritation in the throat, difficulty breathing, or asthma (see next page)

• allergic shock (p.-83)
• diarrhea (in children allergic to milk—a rare cause of diarrhea, p. 184)
An allergy is not an infection and cannot be passed from one person to another.
However, children of allergic parents also tend to have allergies.
Often allergic persons suffer more in certain seasons—or whenever they come
in touch with the substances that bother them. Common causes of allergic
reactions are:

204

ASTHMA
A person with asthma has fits or attacks of difficult
breathing. Listen for a hissing or wheezing sound,
especially when breathing out. When he breathes in,
the skin behind his collar bones and between his
ribs may suck in as he tries to get air. If the person
cannot get enough air, his nails and lips may turn
4
blue, and his neck veins may swell. Usually there is
no fever. There may be cough with a little white phlegm.

sitting
up to
breathe

Asthma often begins in childhood and may be a problem for life. It is not
contagious, but is more common in children with relatives who have asthma. It
is generally worse during certain months of the year or at night. Persons who have
had asthma for years may develop emphysema (see p. 207).
An asthma attack may be caused by eating or breathing things to which the
person is allergic (see p.203). In children asthma often starts with a common cold
In some persons nervousness or worry also plays a part in bringing on an asthma
attack.

Treatment:

* If asthma gets worse inside the house, the person should go outside to a
place where the air is cleanest. Remain calm and be gentle with the person.
Reassure him.
♦ Give a lot of liquids. This loosens mucus and makes breathing easier.
Breathing water vapor may also help (see p. 205).
♦ For mild attacks give ephedrine or theophylline (see p. 419)
♦ If the asthma attack is especially bad, inject Adrenalin. Adults: 14 ampule;
children % ampule. You can
repeat the dose every half
hour, as needed up to 3
Inject
times For precautions, see
Adrenalin

* If the person has a
.
just under
fever, or if the attack lasts
' 1
the skinmore than 3 days, or if the phelgm becomes thick and yellowish, give
tetracycline capsules (p.400) or erythromycin (p.400).
♦ In rare cases, roundworms cause asthma. Try giving piperazine (p.411) to
asthmatic children if you think they have roundworms.
♦ If the person does not get better, seek medical help.
♦ Do not give any drugs that sedate the patient
Prevention:
A person with asthma should avoid eating or breathing things that bring on
attacks. The house or work place should be kept clean. Do not let chickens or
other animals inside. Put bedding out to air in the sunshine. Sometimes it helps to
sleep outside in the open air. Persons with asthma may improve when they move
to a different area where the air is cleaner.
If you have asthma do not smoke—smoking damages your lungs even more.

205

COUGH
Coughing is not a sickness in itself, but is a sign of many different sicknesses
that affect the throat, lungs, or bronchi (the network of air tubes going into the
lungs). Below are some of the problems that cause different kinds of coughs:

DRY COUGH WITH

COUGH WITH MUCH

LITTLE OR NO PHLEGM:

OR LITTLE PHLEGM:

COUGH WITH
A WHEEZE OR WHOOP

AND TROUBLE BREATHING:

cold or flu (p.2OO)
worms—when passing through
the lungs (p. 1 93)
measles (p. 358)
smoker's cough
(smoking, p.1 78)

bronchitis (p. 207)
bronchiectasis (p.'2 0 8)
abscess of the lung
(p-208)

asthma (p.204)
whooping cough (p.360)
diphtheria (p.361)
■heart trouble (p.37 1)

pneumonia (p.208'
asthma (p.204)

CHRONIC OR PERSISTENT COUGH:

COUGHING UP BLOOD:

tuberculosis (p.21 9)
smoker’s or miner’s cough (p.1 78)
asthma (repeated attacks, p.204)
chronic bronchitis (p.207)
emphysema (p.207)

tuberculosis (p.21 9)
pneumonia (yellow, green, or
blood-streaked phlegm, p. 208)
severe worm infection (p. 1 93)
cancer of the lung (p.178)

Coughing is the body's way of cleaning the breathing system and getting rid
of phlegm (mucus with pus) and germs in the throat or lungs. So when a cough
produces phlegm, do not take medicine to stop the cough, but rather do some­
thing to help loosen and bring up the phlegm.

Treatment for cough:
1. To loosen mucus and ease any kind of cough,
drink lots of water. This works better than any
medicine. (However, potassium iodide may help. See
page 418)

Also breathe hot water vapors. Sit on a chair with
a bucket of very hot water at your feet. Place a sheet
over your head and cover the bucket to catch the
vapors as they rise. Breathe the vapors deeply for 15
minutes. Repeat several times a day. Some people like
to add mint or eucalyptus leaves or Vaporub.or tincture
benzoine but hot water works iust as well alone.

206

2. For all kinds of cough, especially a dry cough, the following cough syrup
can be given:
/SSi

For home remedies see p 13.
Take a teaspoonfui every 2 or 3 hours. For little children and people who have
difficulty in breathing, leave out the alcohol.

3. For a severe dry cough that does not let you sleep, you can take a syrup
with codeine (p. 418), Tablets of aspirin with codeine {or even aspirin alone)
also help. If there is a lot of phlegm or wheezing, do not use codeine.
4 For a cough with wheezing (difficult, noisy breathing), see Asthma (p. 204).
Chronic Bronchitis (p.207), and Heart Trouble (p. 371).

5. Try to find out what sickness is causing the cough and treat that. If the
cough lasts a long time, if there is blood, pus, or smelly phlegm in it, or if the
person is losing weight or has continual difficulty breathing, see a health worker.

6. If you have any kind of a cough, do not smoke. Smoking damages the lungs.
To prevent a cough, do not smoke.
To cure a cough, treat the illness that causes it—and do not smoke.
To calm a cough, and loosen phlegm, drink lots of water—and do not smoke.

HOWTO DRAIN MUCUS FROM THE LUNGS (POSTURAL DRAINAGE):
When a person who has a bad cough
is very old or weak and cannot get rid
of the sticky mucus or phlegm in his
chest, it will help if he drinks a lot of
water. Also do the following:

♦ First, have him breathe hot water
vapors to loosen the mucus.
♦ Then have him lie partly on the
bed, with his head and chest hanging
over the edge. Pound him lightly on
the back. This will help to bring out
the mucus.

207

BRONCHITIS
Bronchitis is an infection of the bronchi or tubes that carry air to the lungs. It
causes a noisy cough, often with mucus or phlegm. Bronchitis is usually caused by
a virus, so antibiotics do not generally help. Use antibiotics only if the bronchitis
lasts more than a week and is not getting better, if the person shows signs of
pneumonia (see the following page), or if he already has a chronic lung problem.
CHRONIC BRONCHITIS

Signs:
• A cough, with mucus that lasts for months or years. Some­
times the cough gets worse, and there may be fever. A person *t,arre|
who has this kind of cough, but does not have another longchest’
term illness such as tuberculosis or asthma, probably has
i
chronic bronchitis.
• 11 occurs most frequently in older persons who have been
heavy smokers.
• 11 can lead to emphysema, a very serious and
incurable condition of the lungs. A person with emphysema
has a hard time breathing, especially with exercise, and his
chest becomes big 'like a barrel'.

Treatment:

Emphysema can result
from chronic asthma
or chronic bronchitis.

♦ Stop smoking.
♦ Take an anti-asthma medicine with ephedrine or theophylline (p. 418 -419)

♦ Persons with chronic bronchitis should use ampicillin or tetracycline every
time they have a cold or 'flu' with a fever.
♦ If the person has’trouble coughing up sticky phlegm, have him breathe hot
water vapors (p. 205) and then help him with postural drainage (see p 206 ).

If you have a chronic cough
(or want to prevent one),

do not smoke!

203

BRONCHIECTASIS
When the elastic tissue of the lung is damaged either by infection, by too much
smoking, or by inhaling too much smoke and dust, the person gets bronchiectasis

Signs:
Cough with a lot of white phlegm, especially in the morning.
To test for bronchiectasis, ask the person to spit the
phlegm into a glass. Let it stand. After sometime the
phlegm will separate into 3 layers as shown.
\ gpj-

*

*

Occurs in heavy smokers and also in people who
live in overcrowded places, near factories, etc

tSt'./

■ Usually no fever
• Can lead to emphysema
Treatment:
’ Stop smoking
* Postural drainage (p. 206). Especially in the morning.
* Steam inhalation
• Diet rich in protein (p 128-129) helps to make new tissues.
* If possible, try to change your place of living.

HIM
'HICK
DICKER

ABSCESS OF THE LUNG
This is caused by an obstruction of the bronchiole* (thin branches of the bronchi
inside the lungs, see illustration onp209)The bronchiole gets infected and forms an
abscess The pus drains into the lungs and is coughed out as phlegm. This is a
dangerous condition as the infection can spread to the entire lung.
Signs:
• Cough with thick, yellow and foul - smelling phlegm
• high fever which decreases once a day with sweating
• rapid pulse
■ patient very ill.

Treatment:
' Postural drainage (see p. 206)
• penicillin injection (p. 398) if penicillin is not available, use ampicillin or
tetracycline (p. 399 and 4'00)
’ aspirin or acetominophen for fever.
• steam inhalation
• seek medical help

PNEUMONIA
Pneumonia is an acute infection of the lungs. It often occurs after other
respiratory illnesses such as measles, whooping cough, flu, bronchitis asthma—or
any very serious illness.and .s especially dangerous m children.

209

Signs:

» Rapid, shallow breathing, sometimes with
wheezing. The nostrils may spread with each breath.
• Cough (often with yellow, greenish, or slights
bloody mucus).
• Chest pam increases with coughing or on taking
deep breaths, improves by lying down on affected
side.
• High fever.
The person looks very ill.

• A very sick child who takes
more than 50 shallow breaths a
minute probably has pneumonia.

• trachea

bronchi-.
(air tubes)-

lungs

(If breathing is rapid and deep.
check for dehydration, p. 181)

Treatment:

♦ For pneumonia, treatment with antibiotics can make the difference between
life and death. Give penicillin (p. 397) or sulfonamide tablets (p.4 02). In serious
cases, inject procaine penicillin (p. 399). or ampicillin (p. 399), Give small
children % to Vs the adult dose.
♦ Give aspirin or acetaminophen (p.414) to lower the temperature and lessen
the pain.

♦ Give plenty of liquids. If the person will not eat, give him liquid foods or
Rehydration Drink (see p. 182).
♦ Ease the cough and loosen the mucus by giving the person plenty of water
and having him breathe hot water vapors (see p. 205) Postural drainage may also help
(see p. 206)

♦ If the person is wheezing, an anti-asthma medicine with theophylline or
ephedrine may help.

HEPATITIS
Hepatitis is a virus infection that harms the liver. Hepatitis often causes little
or no rise in temperature. The disease is usually mild in small children and
more serious in older persons. It often comes as an epidemic

210

May have a fever.

After a few days, the eyes
turn yellow.
Sight or smell of food may
cause vomiting.

The urine turns dark yellow
or brown , and the stools
become whitish.

in general, the person is very sick- for 2 weeks and remains very weak for 1 to
3 months after.
Treatment:
• Antibiotics do not work against hepatitis In fact some medicines will cause
added damage to the sick liver. Do not use medicines.
♦ The sick person should rest and drink lots of liquids. If he refuses most food,
give him orange juice, papaya, and other fruit, sugarcane juice mashed
beans, dal. vegetables.chicken or other proteins (p. 1 28). It may help to take
vitamins:
♦ To control vomiting, see p. 192.
♦ When the sick person can eat, give a balance of energy foods and protein.
Beans, meat, chicken, and boiled eggs are good. Avoid lard and fatty foods. Do
not drink any alcohol for a long time afterward.

Prevention:

♦ The hepatitis virus passes from the stool of one person to the mouth of another by
way of contaminated water or food (see p. 1 60). To prevent others from getting sick.
it is very important to bury or burn the sick person's stools and to keep him very
clean. The person providing care should wash his hands well after each time he goes
near the sick person.
♦ Small.children often have hepatitis without any signs of sickness, but they
can spread the disease to others. It is very important that everyone in the house
follow all the guidelines of cleanliness with great care (see pages 167to 171').
WARNING: Hepatitis can also be transmitted by giving injections with needles
that are not sterile (not well boiled). Always boil needles and syringes before each
use.

ARTHRITIS (PAINFUL, INFLAMED JOINTS)
Most chronic joint pain, or arthritis, in older people cannot be cured
completely. However, the following offer some relief:

211

♦ Rest. If possible, avoid hard work and'heavy exercise that bother the painful
joints. If the arthritis causes some fever, it helps to take naps during the day.
♦ Place hot compresses (cloths soaked in hot water) on the painful joints (see
p. 23bto p. 236)
♦ Aspirin helps relieve pain; the dose for arthritis is higher than that for calming
other pain. Take 3 tablets, 4 to 6 times a day. If your ears begin to ring, take less.
To avoid stomach problems caused by aspirin, take it with food, milk,
bicarbonate of soda, or plenty of water.

♦ It is important to do simple exercises to help maintain or increase the range
of motion in the painful joints.
If only one joint is swollen and feels hot, it probably is infected—
—especially if there is fever. Use an antibiotic such as penicillin
•, V
(see p 397) and if possible see a health worker.
I
Painful joints in young people and children may be a sign of
other serious illness, such as rheumatic fever (p. 356) or
tuberculosis (p. 219)

\

\ ,/
} «

BACK PAIN
Back pain has many causes. Here are some:
Chronic upper back pain with cough
and weight loss may be TB of the
lungs (p. 219)

Mid back pain in a child
may be TB of the spine
especially if the backbone
has a hump or lump.

Standing or sitting wrong,
with the shoulders
drooped, is a common
cause of backache.

In older people, chronic back pain is
often arthritis.

Pain in the upper right back may be
from a gallbladder problem (p. 37 5)

Low back pain that is worse the day
after heavy lifting or straining may
be a sprain.

Acute (or chronic) pain here may be
a urinary problem (p. 2 78)

Severe low back pain that first comes
suddenly when lifting or twisting
may be a slipped disc,

Low backache is normal for some
women during menstrual periods or
pregnancy (p 294)

especially if one leg or foot becomes
painful or numb and weak. This can
result from a pinched nerve.

Very low back pain sometimes comes
from problems in the uterus, ovaries,
or rectum.

Treatment and prevention of back pain:
♦ If back pain has a cause like TB, a urinary infection, or gallbladder disease,
treat the cause. Seek medical help if you suspect a serious disease.

212

♦ Simple backache, including that of pregnancy, can often be prevented or
made better by:
always standing straight

sleeping on a firm flat surface
like this or on the floor

back-bending
exercises

♦ Aspirin and hot soaks (p.235) help calm most kinds of back pain.

♦ For low back pain that comes from lifting or straining, quick relief can
sometimes be brought like this:

Have the person lie
with one foot
tucked under his
knee.

Then, holding this shoulder
down,
forcefully push this knee
over so as to twist the back.
Do this first on one side and
then the other.

CAUTION: Do not try this if the back pain is from a fall or injury.

♦ If back pain from lifing or twisting is sudden and severe with knife-like pain
when you bend over, if the pain goes into the leg(s), or if a foot becomes numb
or weak, this is serious. A nerve coming
from the back may be 'pinched' by a
slipped disc (pad between the bones of the
back). It is best to rest flat on your back
for a few days. It may help to put some­
thing firm under the kneesand mid back.

♦ Take aspirin and use hot soaks. If pain does not begin to get better in a few
days, seek medical advice.

VARICOSE VEINS
Varicose veins are veins that are swollen,
twisted, and often painful. They are often

213

seen on the legs of older people and of
women who are pregnant or who have had
many children.

Treatment:
There is no medicine for varicose veins. But
the following will help:
• Do not spend much time standing or
sitting with your feet down. If you have no
choice but to sit or stand for long periods, try
to lie down with your feet -up for a few
moments every half hour. Also, sleep with
your feet up (on pillows).

Use elastic stockings (support hose) or elastic bandages to help hold in the
veins. Be sure to take them off at night.
♦ Taking care of your veins in this way will help prevent chronic sores or
varicose ulcers on the ankles (p.254).

PILES (HEMORRHOIDS)
Piles or hemorrhoids are varicose veins of
the anus or rectum, which feel like little
lumps or balls. They may be painful, but
are not dangerous. They frequently appear
during pregnancy and may go away
afterwards.

If a hemorrhoid begins to bleed, the
person will have signs of anemia (see p. 146)

Treatment:
Sitz bath.To get relief from pain, heat a tub full of water. Add a pinch of
potassium permanganate. Soak your buttocks in this hot water for half an hour. Do
*

214

• Certain bitter plant juices (witch hazel, cactus, etc.) dabbed on the hemorrhoids
help shrink them. So do hemorrhoid suppositories, (see p.424)
• Apply ’Preparation H’ in and around the anus. This is freely available in
pharmacies.
• Piles may be caused in part due to constipation. It helps to. eat plenty of fruit or
food with a lot of fibre, like tapioca or green plantains
When to seek medical help:

*
•
•

very large hemorrhoids
severe pain
non-stop bleeding of hemorrhoids.

ANAL FISSURE
sometimes when a person passes hard stools he may tear the anal opening This
produces terrible pam with a burning feeling and lasts for 2 to 3 hoursiafter a bowel
movement. The anus produces a watery discharge at the site of the tear and this
causes itching. The tear can also get infected.
Treatment:
• Avoid getting constipated. Eat a lot of fibre foods like vegetaoles and fruits.
• Make a sitz bath (see piles) and sit in it
* After passing stools, take a little lignocaine jelly (see green pagesjon your finger
and apply it in and around the anus Wash hands well.before applying.
• If the condition does not improve, a small operation will help cure it.

SWELLING OF THE FEET
AND OTHER PARTS OF THE BODY
Swelling of the feet may be caused by a number of different problems, some
minor and others serious. But if the face or other parts of the body are also
swollen, this is usually a sign of serious illness.

Women's feet sometimes swell during the last three months of pregnancy.
This is usually not serious. It is caused by the weight of the child that presses on
the veins coming from the legs in a way that limits the flow of blood. However, if
the woman's hands and face also swell, she feels dizzy, has a headache, has
problems seeing, or does not pass much urine, she may be suffering from poisoning
or toxemia of pregnancy (see p. 295). Seek medical help fast.
Old people who spend a lot of time sitting or standing in one place often get
swollen feet because of poor circulation. However, swollen feet in older persons
may also be due to heart trouble (p. 371) or. less commonlv. kidney disease
(p. 278) and urinary tract infection following strep throat (p.357)
Swelling of the feet in small children may result from anemia (p. 147) or
malnutrition (p. 125). In severe cases the face and hands may also become swollen
(see Kwashiorkor, p.133)-.
If there is any small infected cut or wound on the foot, the foot may swell due to
cellulitis. There is fever and pain

215

Treatment:

To reduce swelling, treat the sickness that causes it. Use little or no salt in food.
Herbal teas that make people urinate a lot usually help (see home remedies.
chapter 1) Also do the following:

In case of cellulitis. Penicillin injections are necesarry. for dosage, see p. 398.

HERNIA (RUPTURE)
A hernia is an opening or tear in the muscles covering the belly. This permits
a loop of gut to push through and form a lump under the skin. Hernias usually
come from lifting something heavy, or straining (as during childbirth). Some
babies are born with a hernia (see p.364). In men, hernias are common in the
groin. Swollen lymph nodes (p.101)may also cause lumps in the groin. However
A hernia is

and you can feel it with a

Lymph nodes are
t usually here//

It gets bigger when
you cough (or lift).

and do not get bigger
when you cough.

216

How to
prevent a hernia:
Lift heavy
things like this

not
like this.

How to live with a hernia:
♦ Avoid lifting heavy objects.

CAUTION: If a hernia suddenly becomes large or painful, try to make it go back
in by lying with the feet higher than the head and pressing gently on the bulge. If
it will not go back, seek medical help.
If the hernia becomes very painful and causes vomiting, and the person cannot
have a bowel movement, this can be very dangerous. Surgery may be necessary.
Seek medical help fast. In the meantime, treat as for Appendicitis (p. 107).

FITS (CONVULSIONS)
We say a person has a fit when he suddenly loses consciousness and makes
strange, jerking movements (convulsions). Fits come from a problem in the brain.
In small children common causes of fits are high fever and severe dehydration. In
very ill persons, the cause may be meningitis, cerebral malaria, or poisoning. A
person who often has fits may have epilepsy.

♦ Try to figure out the cause of a fit and treat it, if possible.
♦ If the child has a high fever, lower it at once with cool water (see p. 88)
♦ If the child is dehydrated, give an enema of Rehydration Drink slowly. Send
for medical help. Give nothing by mouth during a fit. or it he is unconscious.
♦ If there are signs of meningitis (p. 225), begin treatment at once and seek
medical help.
♦ If you suspect cerebral malaria (p.227), inject chloroquine (p. 406).
EPILEPSY

Epilepsy causes fits in people who otherwise seem fairly healthy. Fits may
come hours, days, weeks, or months apart. In some persons they cause loss of

217

consciousness and violent movements. The eyes often roll back. In mild types of
epilepsy the person may suddenly 'blank out' a moment, make strange
movements, or behave oddly. Epilepsy is more common in some families
(inherited). Or it may come from brain damage at birth, high fever in infancy, or
tapeworm cysts in the brain (p. 196).
Epilepsy is not an infection and cannot be 'caught'. It is often a life-long
problem. However, infants sometimes get over it.

Medicines to prevent epileptic fits:

Note: These do not 'cure' epilepsy; they help prevent fits. Often the medicine
must be taken for life.
♦ Phenobarbital often controls epilepsy. It costs little (see p. 422).
♦ Diphenylhydantoin may work when phenobarbital does not. Sometimes
both medicines are needed together. Use the lowest possible dose that
prevents fits (see p. 422).
When a person is having a fit:
" place a bit of wood, a key. or a similar object
covered with a clean cloth between
his teeth, so that he does not bite his tongue:
' do not try to restrain him during a fit.
* protect him from any dunger. like fire, sharp
stones, etc., to prevent him from harming himself. (F

clear the people around him so that he gets enough fresh air to breathe;
if he vomits or spits, turn his head to one side so that he does not choke;
if needed.clear his mouth of the vomit;
after he recovers from the fit. give him hot tea with plenty of sugar in it
After the fit he may be dull and sleepy ; let him sleep or rest before he starts his
normal work;
if fits last a long time, inject diazepam (Valium) or phenobarbital or paraldehyde
(for dosage see p 423) If the fit still does not stop after 1 5 minutes, give a second
dose.

The book \^/hcrc There Is No Doctor is available
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