GENERALISED ANXIETY DISORDER (GAD)

This is a chronic (longer than 6 months) disorder characterized by excessive anxiety and worry about various life circumstances. Patients who have generalized anxiety disorder are pathologically anxious about everything. They are generally mistrustful of their own general level of competence and basic merit. They have a low threshold for anxiety and find it difficult to handle even the normal anxiety-provoking situations.

Epidemiology:
It is estimated that about 2 % of the general population suffer from generalized anxiety disorder. Onset is usually before age 20, the peak age group is 20-25 years. A history of childhood fears and social inhibition may be present. Women are more prone.

Aetiology and Psychopathology:
Though there may be genetic predisposition to develop this disorder, environmental factors are more important in the aetiology of GAD. Emotional conflicts in early childhood interfere with normal development of personality, especially when there is genetic predisposition. When this abnormal personality is confronted with the everyday stresses of life, the defense mechanisms which are used to anxiety normally become inadequate and fail.

Clinical features:
Patients with generalized anxiety disorder have persistent, excessive, and/or unrealistic worry associated with other signs and symptoms, which commonly include muscle tension, impaired concentration,autonomic arousal, feeling "on edge" or restless, and sleep disturbances. Patients with GAD readily admit to worrying excessively over minor matters with clinically significant distress or impairment in social, occupational or other areas of functioning.
The common symptoms are palpitation, trembling / shaking, excessive sweating, and dryness of mouth, breathlessness, chest pain, abdominal pain, headache, and heaviness of head, dizziness and unsteadiness, frequency of micturition, diarrhoea and disturbances of sleep.
Other general symptoms include hot flushes / cold chills; numbness or tingling sensations.
Common Signs are: Elevation of blood pressure, tachycardia, increased respiratory rate and sweating etc.
A person with GAD has tense, anxious, apprehensive appearance. Increased muscular tension is shown in his facial expression, and it produces tremors and aches in various parts of the body. He is irritable, forgetful, and complains of tiredness and lack of concentration. The person finds it difficult to control the worry.
Differential diagnosis:
Thyrotoxicosis has to be ruled out. Thyroid swelling, exophthalmia, and abnormal thyroid function tests suggest thyrotoxicosis. Cold and moist hands are common in GAD in contrast to warm and moist hands in thyrotoxicosis.

OBSESSIVE-COMPULSIVE DISORDER (OCD)

Obsessions are persistent, recurring ideas accompanied by a subjective feeling of compulsion which the patient tries to resist but cannot get rid of.

Compulsions are irresistible urges to carry out irrational activities.The patient knows about the irrationality of these obsessions and compulsions, but cannot prevent them. When he tries, the emotional tension mounts and he becomes miserable and exhausted.These obsessions and compulsions restrict the social activities and interpersonal relationships of the patient.

Epidemiology:
About 1 % of the patients attending a psychiatry clinic may have this disorder. The peak age of onset is around early adulthood, and both males and females are equally affected.

Aetiology and Psychopathology:
Though some genetic or constitutional factors may be involved in production of an obsessive type of personality, environmental factors are of primary importance in the causation of the symptoms. It often has a sudden onset (e.g. after stressful ‘loss’ event).
According to psychoanalysis school, patients with obsessive compulsive disorder have a disturbed development commonly around the anal phase of psychosexual development. Anxiety associated with sexuality is displaced to neutral ideas or acts.
Neuroimaging studies have demonstrated a decrease in caudate nucleus volume and abnormalities in frontal lobe white matter. The caudate nucleus seems particularly involved in the acquisition and maintenance of habit and skill learning.

Clinical Manifestations:
Patients with obsessive compulsive disorder usually have a particular type of personality which is characterized by ritualistic, rigid, perfectionist and meticulous tendencies. Patients often conceal their symptoms, usually because they are embarrassed by the content of their thoughts or the nature of their actions. Specific questions regarding recurrent thoughts and behaviors are to be asked, particularly if physical clues such as chafed and reddened hands or patchy hair loss (from repetitive hair pulling) are present. Tics are sometimes associated with OCD.
In all cases, obsessive-compulsive behaviors take up more than 1 hour per day & are undertaken to relieve the anxiety triggered by the core fear.

There are four major symptom patterns.
▪Most common one is an obsession of contamination followed by washing.
▪Second most common is obsession of doubt followed by a compulsion of checking.
▪Third form is one with merely intrusive obsessive thoughts without a compulsion. Such obsessions are usually repetitious thoughts of some sexual or aggressive act that is reprehensible to the patient.
▪Fourthly, there is obsessional slowness in which the obsession and compulsion seem to be united into slow carrying out of daily activities. Such patients can take hours in bathing, eating, shaving etc.

Most of the patients show features of depression because of the inconvenience and embarrassment caused by the symptoms. The patient realizes that the above symptoms are irrational, but cannot prevent them.

PHOBIC DISORDERS:

A phobia is a marked and persistent fear resulting in conscious avoidance of a specific feared object, activity or a situation. The patient avoids the phobic stimulus, and this avoidance usually impairs his occupational or social functioning. The affected individual is aware that the experienced fear is excessive and unreasonable to the given circumstances, but cannot help it.

Agoraphobia is the fear of public places; the patient tries his best to avoid such places or situations where escape may be difficult. The patient avoids crowds, public places, traveling away from home or alone. Agoraphobia is usually associated with panic disorder, but there exists a subgroup without panic disorder.

Social phobia is the specific fear of social or performance situations in which the individual is exposed to unfamiliar individuals or to possible examination and evaluation by others. This is different from agoraphobia where the patient is not bothered about the reaction of other people. Examples include having to converse at a party, use public restrooms, and meet strangers.

Simple phobias are specific phobias not covered by social phobia and agoraphobia. It is further sub-divided into five types: animals, aspects of natural environment, blood/ injection/ injury, situational and ‘other’. Common examples of simple phobia are fear of heights, fear of closed spaces (claustrophobia), fear of flying, fear of animals, fear of lightning and thunderstorm, fear of darkness, fear of blood, fear of crossing streets, etc.

Aetiology and Psychopathology:
Both genetic and environmental factors play a role in the aetiology.According to psychoanalysis school, phobias are the result of traumatic experiences in childhood such as separation anxiety (separation from mother) and unconscious conflict, which has been repressed and displaced into phobic symptoms. The unconscious anxiety is displaced to a neutral object or activity or situation.

Clinical Manifestations:
Onset is typically in childhood to early adulthood. The cardinal feature of phobic disorders is severe anxiety when the patient is exposed to specific object or situation or activity. Both mental and somatic symptoms of anxiety are present. To prevent the onset of anxiety, the patient avoids these objects or situations or activities. Most of the patients are able to live normal lives in spite of the phobic disorder because the phobic object or situation or activity is easily avoidable, but this avoidance usually impairs occupational or social functioning.
Panic attacks may be triggered by the phobic stimulus or may emerge spontaneously during the course of the illness. To get relief from anxiety, the patient may resort to abuse of alcohol or drugs. He may also develop features of depression.

Homoeopathy - A Medical Approach and Its History

Effective treatment of seborrheic dermatitis using a low dose, Oral homeopathic medication.

Effective treatment of seborrheic dermatitis using a low dose, Oral homeopathic medication consisting of Potassium bromide, Sodium bromide, Nickel sulfate, and Sodium chloride in a double-blind, placebo-controlled study

Author(s)
SMITH Steven A. ; BAKER Ardith E. ; WILLIAMS John H. ;
Abstract
BACKGROUND: Topical over-the-counter remedies exist to aid in the control of seborrheic dermatitis and chronic dandruff on a superficial level. Low-dose systemic oral nickel and bromide therapy has shown promise in providing improvement and eventual clearing of the disease.
OBJECTIVE: The purpose of this study was to further evaluate the effect of an orally administered low-dose, homeopathic mineral therapy (Potassium bromide 1X, Sodium bromide 2X, Nickel sulfate 3X, Sodium chloride 6X) on seborrheic dermatitis and chronic dandruff.
METHODS: Forty-one patients with seborrheic dermatitis and/or chronic dandruff were assigned to one of two treatment groups: Active (containing the medication) or placebo (vehicle). Study medication was administered in a placebo-controlled, randomly-selected, double-blind study for 10 weeks. At the end of 10 weeks all patients crossed over to the active medication, under a different label for an additional 10 weeks in an open study format.
RESULTS: Twenty-nine patients completed the 10-week blinded portion of the study. After 10 weeks of treatment, the disease state of the active patients improved significantly over that of the placebo patients (p<0.04). The placebo patients' condition before and after crossover to active treatment was also evaluated, showing significant improvement (p<0.01) 10 weeks after crossing over to active medication.
CONCLUSION: Oral therapy using a low-dose homeopathic preparation combining Potassium bromide 1X, Sodium bromide 2X, Nickel sulfate 3X, and Sodium chloride 6X, provides significant improvement in seborrheic dermatitis and dandruff after 10 weeks of dosing.
Journal Title
Alternative medicine review ISSN 1089-5159
Source
2002, vol. 7, no1, pp. 59-67 [9 page(s) (article)]
Language
Anglais
Publisher
Thorne Research, Dover, ID, ETATS-UNIS (1996) (Revue)
Location
INIST-CNRS, Cote INIST : 27046, 35400010037076.0040

Homeopathy Effective in Treating Neo-natal Pigs with Diarrhoea

A paper published on 15/1/10 in the peer-reviewed journal Homeopathy by Camerlink et al (2010) found that the homeopathic remedy Coli 30K was highly significantly (p< 0.0001) more effective than placebo in a placebo-controlled, observer blind RCT on the treatment of diarrhoea in neo-natal pigs.
52 sows of pigs form a commercial farm who were in their last month of gestation and had never been vaccinated against E.coli were randomly assigned to either a placebo group or treatment group. This included 300 pigs.

Both groups would receive either the homeopathic remedy Coli 30k or placebo twice a week in their last four weeks pre-partum.

It was found that the treatment group had significantly less E.coli diarrhoea than the placebo group (P <0.0001). Furthermore in the homeopathic treatment group the diarrhoea was less severe, there was less transmission and duration appeared shorter.

Camerlink I, Ellinger L, Bakker EJ and Lantinga EA (2010) Homeopathy as replacement to antibiotics in the case of Escherichia Coli diarrhoea in neonatal pigs, Homeopathy, Vol.99 (57-62)

The Scientific Status of Homeopathy - Gudrun Bornhöft May 2009

Breastfeeding for more than six months leaves children less likely to suffer mental health problems later in life

Children who are breastfed for more than six months are less likely to have mental health problems in later life, according to new research.Experts believe that nutrients in mothers' milk, and the bonding process, may have a long-lasting effect on their babies' brain development.The finding, to be published in The Journal of Pediatrics, came after researchers analysed the medical records of more than 2,000 children in Western Australia.Professor Wendy Oddy, who led the study, said breastfeeding appeared to have 'significant benefits for the mental health of a child into adolescence'.She added: 'There has been much evidence about the benefits of early breastfeeding but the importance of this study is that it shows continued benefits from extended feeding.'Given the rising prevalence of mental health problems, interventions to assist mothers to breastfeed, and to breastfeed for longer, could be of long term benefit to the community.'As with any of these types of studies, it should be stressed that the findings do not mean that individual children that weren't breastfed will have mental health problems, it's about lowering the risk at a population level.Of the children studied just over half were breastfed for six months or longer, 38 per cent were breastfed for less than six month. The rest were not breastfed.They underwent mental health assessments when they were aged two, five, eight, ten and 14.For each additional month of breastfeeding, the behaviour score improved, the research by the Perth-based Telethon Institute for Child Health Research revealed. This remained valid even after other social and economic factors affecting parenting were taken into account.Dr Oddy added: 'There are a number of ways extended breastfeeding could assist child development. We know that breast milk is packed full of nutrients that help with the rapid brain development that occurs in the early years. It might also signal a strong mother-child attachment and these benefits may last.'UNICEF and the World Health Organization recommend infants should be exclusively breastfed for the first six months and 'that breastfeeding should continue to contribute an important part of a baby's diet through the second year of life and beyond'.
By DAILY MAIL REPORTER.
http://www.dailymail.co.uk/health/article-1244184/Breastfeeding-months-leaves-children-likely-suffer-mental-health-problems-later-life.html

John Martin Horninberger`s account 1836 - 1839

At Paris, my steps were first directed towards the domicile of the father of Homoeopathy, the celebrated Doctor Hahnemann. In Russia, I had been already told of the prodigious effects of his new healing system, and I earnestly desired to learn it at the source itself. The magnanimous old man and his lovely young wife received me in the most friendly manner, and I must not omit to mention, that the open and good-natured Homoeopathist made many interesting revelations to me respecting his new method of curing. It was particularly important to me that Hahnemann recommended to me his apothecary at Kothen, Doctor Lehman.


The voyage from London to Hamburg, which I performed in a steamer, lasted a day longer than ordinary, and was one of the most dreadful and annoying I have ever experienced. We were overtaken by a tempest, by which the vessel was tossed about in such a manner that all the passengers suffered from sea-sickness. If I say that our feelings were those of a person whose bowels are being cut through with sharp knives, the comparison would remain far behind the real fact. At Berlin, I met with an old friend, Doctor Ehrenberg, the naturalist, whom I accompanied many years ago to the ruins of Balbeck; he was in good health, and we conversed about that journey ; but Doctor Hemprich, his then travelling companion, had already left this world. According to Hahnemann's advice, I introduced myself, at Kothen, to Doctor Lehman, from whom I bought a considerable quantity of homceopathic medicines. From Kothen I went to Leipsic, Dresden and Toplitz, at which place was that celebrated congress of the Emperors of Austria and. Russia, the King of Prussia, and the most celebrated diplomatists, as also a great number of the elite of the nobility. It may easily be imagined, that on such an occasion there was no lack of festivals and amusements, in which I took some share, as I met with a very kind reception, owing, perhaps, to my oriental costume.

From Toplitz I returned to Kronstadt, my native country, in order to pass the carnival there among my relations. In the spring of the year 1836, I went to Vienna, on particular business, and I stayed there till the autumn. In the summer of the same year, the long-dreaded guest, Cholera, was raging in that capital. I myself felt the first symptoms of that dreadful and destroying epidemic. I had spasms and a diarrhea; I therefore lost no time in applying my remedies, taking, every half-hour, a homoeopathic dose of ipecacuanha. This remedy proved quite efficacious, and I was fortunate enough to be entirely recovered in the space of six hours.

As there are many substitutes ior ipecacuanha, I think it not superfluous to mention on this occasion, that it is only the genuine drug that can produce the desired effect ,that by which I was restored, was from Doctor Lehman.The good result which I experienced in myself and others, from adopting the homoeopathic system, induced me to extend the practice to a larger circle of patients. For that purpose I chose the capital of the Ottoman Empire, which I thought particularly suitable, as it was at no great distance from my native country, and because I was acquainted with the oriental languages, habits and manners. Besides that, my pecuniary circumstances were rather embarrassed, as the reader may be aware, owing to the losses I had sustained in different countries, particularly in Bokhara ( by the Armenians ) and in Russia (by my sable transactions). To carry out my plan, I petitioned for a passport to Constantinople, which I obtained without any difficulty.

I departed from Vienna, passed through Kronstadt and Bukarest for Gallaz, where I embarked, not as previously at Verna in an open vessel, but in a steamer bound to Constantinople. Contrary to my expectation, the Plague was raging there at that time, and the Europeans kept themselves shut up in their houses, far from any contact with the world. Under such circumstances, I had no alternative but to wait for another opportunity. To do this with more comfort, I hired a small house on the shores of the Bosphorus, in a village situated in the most pleasant part of that country, from which I enjoyed a beautiful prospect. On the very evening of my taking possession of the cottage, I was called to attend a Greek lady living in my neighborhood, who required my medical assistance. I was told that she had a fever. I found her in bed, complaining of being uneasy and costive, accompanied with a headache, so I ordered her an emollient clyster, which I myself was obliged to administer, as nobody could undertake to do it. But, to my alarm, I was informed on the following morning that she had died during the night of the plague, her husband having preceded her but a few days from the same complaint. The house of the deceased was immediately shut up. At that time the quarantine establishments at Constantinople were still in their original state of organisation, my small house therefore remained free, and luckily it was not infected with the plague. The circumstance of my not being myself affected by it — neither had I conveyed it to my household — induced me to believe that I had not any disposition to be attacked by that pestilential disease. I was also of opinion that the plague was not contagious. In order to have some experience in this matter, I tendered
my services at once to the plague-hospital at Pera, where the poor patients were left to their fate, as no medical assistance or any other aid was to be had without any authority or permission. I attended them at my own expense. I proceeded, to the satisfaction of all the attendants and patients, to treat the infected according to the homoeopathic principle, and my endeavours were mostly crowned with success. All this, effected by the most simple treatment, did not fail to procure me, in a very short time, a great reputation; so that, after the extinction of the plague,and the abolition of all quarantine, I was in great request among the most respectable private families. But, before I proceed to prove the efficacy of the minute doses of homoeopathic medicines, I must first speak of a special remedy, which proved very efficacious, employed as a prophylactic or curative; and, I dare to say, with respect to the plague, it might be considered as a specific.

During my stay at Constantinople I frequently had an opportunity of making the observation that many individuals, especially Armenians, wore a string, to which was attached a bean, called Strychnos Faba St. Ignatii, as a preventive against the plague. Having been informed that this bean was acknowledged to be an effective one, I administered it in minute doses, as a medicine, and that with the best success. The particulars will be mentioned in the course of this work.

Among the above-mentioned private houses in which they relied on my medical skill, was that of M. Shabert. The head of this respectable family had been formerly invested with the office of English interpreter.

It is the duty of a physician to have patience when he has occasion to attend old ladies; and thus I must crave the reader's indulgence while 1 relate what Mrs. Shabert communicated to me. She began thus:— " A young Greek stabbed my son with a stiletto ; and, at the moment when he was about to cry out for assistance, the Greek was so malicious as to thrust the weapon into his mouth and cut a blood-vessel, from which a violent bleeding ensued, and it could only be stopped by immediate surgical assistance. He was taken to the consulate, in front of which it happened, and where he was employed. By the application of red-hot iron, the blood was stanched but two or three days subsequently, the bleeding began afresh, and the patient felt exhausted; when the bleeding was renewed for the third time, he became much worse. On the ensuing night, he was restless, and in a state of great perturbation from his dreams. It appeared to him as if his adversary was running towards him, with the stiletto in his grasp. The attendant physicians, thinking this symptom to be the forerunner of another flow of blood, declared the patient's state to be very critical, being persuaded that, upon another bleeding, death was inevitable." In this awful position, the family proposed to the physicians to allow them a trial of homoeopathy. They readily consented, in the hope of meeting with a good opportunity of rendering homoeopathy ridiculous, and showing the public the inutility of that system. Mrs. Shabert having finished, her husband requested me to accompany him to the consulate, where his son was then lying, in order that I might cure him. I found the youth very much reduced, but tranquil in mind. His surgeon, a Frenchman, who was present, or rather was waiting for me, told me he had, by a repetition,stanched the blood with a red-hot iron and other styptics, but that another bleeding was to be feared as soon as the scab should come from the wound, and as the parents of the patient were anxious to try homoeopathy, he consented, and I administered, in his presence, three Lilliputian pills of Aranea diadema (Xooo ), and then took my leave. When I called on my patient in the morning, he told me that he had passed a quiet night, that his former physician had already been there, and on hearing that no bleeding had taken place, he had prescribed for him some pills; but he again and again repeated, that he felt no inclination to take them, as he preferred my medicine, which had proved so beneficial. Whilst I was preparing the medicament, the doctor, who was an Italian, came in, and was about to fasten a quarrel on me; but old M. Shabert took him by the arm and led him into another room, from which he disappeared, and I saw him no more. I repeated the medicine for eight days, at the end of which time he was completely recovered. I must observe here, that the Aranea diadema was prepared by Doctor Lehmann, at Kothen, whose medicines, as I have already mentioned, were recommended to me by Hahnemann.

What did the surgeon do in the meanwhile? To show that the recovery of the young man was the effect of his treatment, he ordered a dog to be brought from the bazaar, and cut through its crural artery, and then applied his styptic ( creosote ) ; but seeing that the wound did not heal, he allowed the dog to escape, and a short time afterwards the animal was found dead in the street.

Another case occurred in the above-mentioned family, with a female, which may serve as an example how small homoeopathic doses not only produce effects, but sometimes cause great and beneficial excitement.

A sister of the young Shabert was troubled for many years with a megrim. This evil was accompanied with a nervous pain in the face, which made itself sensible at intervals of three or four days, in the early part of the day, like a disguised fever. In the moment of one of these paroxysms, I administered to her a dose of Pulsatilla; but afterwards she became so much worse, that her husband,Siguor Salzani, came to me at ten o'clock at night, in great alarm, to tell me that his wife had become almost mad, and that they had to use great efforts to prevent her from throwing herself out of the window. But this was her last paroxysm; at least she had no more during my stay at Constantinople. The dose of Pulsatilla which I administered to her, was one drop of the third dilution on a lump of sugar; the tincture I had brought with me from Vienna.

At that period, the prince Abdool Mesjeet (now Sultan)fell dangerously sick, and I was told that his royal father had dismissed all the physicians, English, French, Greek and Turk, on account of their unsuccessful treatment, and that my reputation and fortune would be established if I succeeded in curing him. I replied that my rule was — "Noli accedere, nisi vocatus," adding, that only on the request of the Sultan would I undertake to attend he royal prince; his majesty, however, was fortunate enough to find a physician who performed the cure in a few days. The Sultan ordered those doctors who had attended his son formerly, to make their appearance again in the seraglio, and presented him to them, asking whether they thought he was perfectly recovered. They expressed their astonishment at this unexpected and sudden recovery, and wished much to see that miraculous doctor, who had performed such a cure, in so short a time. The Sultan opened the door of a side room, out of which there issued an Armenian lady, in Turkish costume, whom he presented to them, smiling, as the miraculous doctor to whom his son owed his recovery, to the shame of the assembled doctors. To bestow on her greater honor, he ordered it to be publicly declared in all the Christian churches, that Mariam Khatoon ( Lady Mary ) had saved the life of the royal prince and was the only person who could cure the gelinjik, that being the Turkish term, derived from gelin, bride, and means the bride's disease. In Greek it is called nymphizze; it is a kind of cachexia, or hydrops alba. The royal Prince caught it in consequence of the measles, and they were in fear for his life, as his younger brother had died of the measles, having been improperly treated and bled during the disease.

As to the treatment which the Armenian lady employed, the following fact, which I insert, was generally rumored: — she placed the Prince in a heated oven (tandoor), which caused a profuse perspiration; after that, she fumigated him with the burning flesh of a weazel, also called nymphizze and his body was rubbed with oil. Besides this external treatment, she administered to him some medicines, of which the following three substances were the chief ingredients — ambergris, cochineal insects, and earth-worms. She ordered the Prince to observe a very strict regimen, not permitting him meat, or even broth, only light digestible fish (gelinjik balugi), because of its name being like that of the disease. This disease occurring frequently in the capital, and weasel flesh being a costly thing, the druggists there sell it dried. There are many Christian women, Greeks and Armenians, at Constantinople, practising the cure of that malady, the principal remedy for which, I am told, is Album Graecum (white dung of dogs). It is a question whether phosphate of lime might not take the place of that disgusting remedy, as it consists of nearly the same substances. That disease is said to occur in consequence of wrongly-treated acute eruptions, especially the measles, or in consequence of sudden fright or excessive fatigue: it gradually increases in virulence. It is to be recognised by a pulsation behind the ears and other parts; the pulse on the wrist is felt more up the arm than usual; the eyes and feet are swollen; the lips are pale; asthma is felt in walking, with weakness in the knees; finally, a slow consuming fever follows, which is succeeded by death.

I remained only two years at Constantinople, from the autumn of 1836 to that of 1838. During that time, my homoeopathic practice was extensive, as there were only myself and the private physician to the Russian ambassador who practised the new system; and it was so lucrative that I had no idea of leaving that place so soon, still less of returning to Lahore, until I learned from the Austrian internuncio, Baron Sturmer, who was in quarantine at Malta, and who had met with General Ventura, that the Maharajah had ordered the general to make inquiries for me in Europe, and to persuade me to go back to Lahore. Accordingly, the general invited me to accompany him thither, after the expiration of his leave of absence in the autumn. I yielded to this invitation, and went in company with the general from Alexandria to Bombay, whence he proceeded alone, with the utmost speed, to Lahore,as Runjeet Sing was dangerously ill, and as at that time the English were preparing to place the Shah Soojah on the throne of Cabul.

General Ventura was accompanied by a shawl merchant, named Monsieur Le Boeuf, and a captain of cavalry, M.Mouton, with his lady. These three persons the general requested me to accompany to Lahore, as they were unable to speak Hindostanee.

At Bombay we went on board a native vessel, and sailed to Gogo, and thence we continued our way, partly in carriages, partly on camels. Among our fellow travellers there were some native shawl merchants from Umritsir. We took the shortest road, through Palee, Ajmir, Hansi and Loodiana. We were hardly two days' journey from Gogo, when we were overtaken by two English captains, who had been ordered to examine our papers ; for they looked upon us as if we were Russian spies. At Palee the plague was raging, as it had then been for the last three years. Previous to our arrival there, we passed a very pleasant evening with the family of an English captain. On this occasion I made the acquaintance of an English physician, Dr. Keir, who informed me that the English physicians in India do not agree in their views respecting the plague at Palee: for some of them consider the disease to be a pestilential fever peculiar to India, while others declare it to be the same Plague that was so common in the East, and especially in Turkey and Egypt. He told me he would be very glad if I would write to him my opinion about it, should I on my journey observe the disease, as he considered it might be of great importance both to himself and to science, because I had had so much opportunity for studying the nature of the plague at Constantinople, adding that he intended to publish my report.

About noon we arrived at the infected Palee, where we ordered our tents to be pitched near to the large marsh, opposite to which the town lies. The first sight which presented itself to our eyes was the funeral trains of several of the inhabitants. After dinner, at two o'clock, I repaired to the governor, who was a Hindoo, and told him I was a traveller and a physician, and that I wished to see a few infected persons, and administer to them my medicines gratis, if he would kindly send some one to accompany me. He received me very affably, and yielded to my request. The man who accompanied me had not the trouble to escort me far, as in the very next house there were several patients, some of whom had only a short time to live. At these visits I neglected no circumspection and precaution. I never entered a house, but caused the patients to be brought before the door, where I examined them, writing down their names and their statements, and administering to them the remedies, and I departed without having touched any of them. The aspect of the town itself offered a sad spectacle: only now and then I met with a human being: the bazaars and shops were closed; they told me that the greater part of the inhabitants had either died, or left the town; and numbers of houses were quite deserted.The infected died in general on the third or fourth day; and scarcely one among twenty recovered. I saw carbuncles, buboes, bleeding at the nose — in one word all that I had seen in the hospital at Constantinople. I no longer, therefore, doubted that the disease was a most virulent Plague. It is true that it was not the plague of Turkey, Arabia or Egypt, but one peculiar to India; Palee being a province of that part of Asia. At four o'clock the same afternoon I returned to our tent, and retired to rest at the ordinary time, in the enjoyment of the best of health; and I should have slept longer than usual, if Madame Mouton had not come to awake me, and announce that the camels were ready for our departure. The moment I began to rise, I felt a pain in my groin; and a presentiment of having been infected with the plague, caused a rush of blood towards my heart, so that I had the feeling of one who had been stabbed with a dagger. The pain in the groin, the fever and my anxiety increased rapidly; and it was with difficulty that I moved a few steps, in order to examine the painful part, upon which I discovered some buboes, the size of peas. I felt a burning pain, so I placed myself in the kajaweh (basket) on my camel, and we departed. The station we had to reach was five miles distant; the reason why we made so short a journey was, that our only object was to quit the region of the plague, and even now I look upon it as fortunate that I was removed to a place where the healthy air probably aided the effect of the medicine which I had taken. As soon as we arrived at our station, I took some of the small pills of the above-mentioned Stryconos Faba St. Ignatii. Although Palee alone was infected by the plague, still the inhabitants of the village did not allow us to enter it; they, however, brought us all we were in want of, and took the money from our hands without any scruple. During my scientific excursion to Palee, my fellow-travellers had shot some ducks on the marshes, and these were prepared for our lunch. I was invited to partake of the repast, but did Dot feel any inclination to eat, as I was burning with fever, and my pain was almost insupportable; but not to cause suspicion, I took my place at the table, and the bits which I conveyed with one hand to my mouth, I transferred with the other to the napkin; this I performed with the skill of an adept. After dinner, I repeated the dose of the same medicine, laid down, and covered myself all over, and in a short time I began to perspire to such a degree, that my mattress was wetted through. In consequence of this perspiration, I got rid of the fever and anxiety, and entertained the hope of being restored to health, although the pains in the groin still continued. The swelling of the glands remained for three weeks, as I did not employ any local remedy. After my complete recovery; I wrote to the English physician (on whose account I had visited the infected town of Palee) the result of my experience, and read the letter to my companions, who manifested their astonishment, and blamed me for having exposed them to the infection of such a dangerous epidemic. My answer was, that I only did my duty as a physician, and that those who were not pleased with such proceedings ought not to travel in the society of a physician.

I cannot tell how it was that 1 caught the plague, in spite of all my precautions, unless it was that when I was entering the town, there was a violent wind blowing, whirling the pestiferous dust up into the air and this might have communicated the virus to my body externally, and even internally — externally, by absorption through the lachrymal glands of the eyes, the pituitous membrane of the nostrils, and the cavity of the ear; internally, by the respiration of the lungs. The infection was not produced by immediate contact; had that been the cause, I should certainly not have escaped it at Constantinople if the predisposition to it lies in every one. At this time I must have had a predisposition for the contagion, for some days before I had felt an itching in the body, and a kind of plethora, owing to the irregular manner of living which is consequent on the inconveniences and difficulties of long journeys. It is certain that the plague does not require a long time to develop itself, as it made its appearance a few hours after my visiting the patients. In some cases an interval of two or three days may occur before the symptoms are visible. The malaria of Palee, I believe, is generated by the exhalation of the immense marsh, whither thousands of birds and reptiles resort, and which serves at the same time as a depository for all the substances ejected from the town. The government could easily prevent the obnoxious influence of this marsh, by converting it into fertile ground.

Arrived at Lahore, I found my former patron, the Maharajah, Runjeet Sing, seated on a chair, with swollen feet, and making himself understood by gestures and signs with his hands ; his organs of speech being paralysed to such a degree, that he was not able to utter a single articulate sound, and other means of imparting his thoughts were not in his possession, as he never had learned to write.

From time to time I had occasion to relate many of the cures effected by the new method of homoeopathy, by the aid of which I had cured myself in Vienna of the cholera and lately in Hindoostan of the plague. Although they did not doubt the truth of my assertions, it was not without difficulty that they could prevail on themselves to trust me with the treatment of the maharajah, because the favourable season — it being spring — allowed the native physicians to rely on other trials which they had to make :meanwhile I succeeded in some homoeopathic cures quite to my satisfaction. But the greatest sensation produced, was by a cure which I undertook at the request of the minister, Raja Dhyan Sing. He committed to my medical care a native of Cashmere, Aboo Ibrahim, commander of his jesails (camel-artillery), in whose head, ten years previously, a bullet had been lodged at an affair with the Affghans, and which no native surgeon had been able to extract, and in consequence he was paralysed on one side. I trepanned him, and extracted the bullet which was stuck beneath the skull, and pressed the brain, without, however, affecting that organ. My patient having been a drunkard, and roubled with indigestion in consequence of his weakened stomach, I administered to him some physic,to accelerate his recovery; and I succeeded in restoring him to perfect health, in the short space of two months. When relieved from his hemiplegy, I presented him to the minister, and he introduced him to the Maharaja.

Meanwhile, the excessive heat had come on. At this time the fakeer Azeez-oo-Deen came unexpectedly and called on me, as the native physicians were unable to improve the health of the maharajah. This man, who had formerly been physician in ordinary to the king, told me that the maharajah had never taken any remedy prescribed by a European physician, and that he used to give all the remedies which had been ordered him by the English doctors, Murray,Steel, and Macgregor, to his servants, to try the effect on them ; but that he was now resolved to take my medicines, which I was to prepare in his presence. This I promised to do. It was then mid-day, the time when the durbar (assembly) leaves the palace, so,accompanied by the fakeer, I presented myself to the king. I found with him only the minister, Dhyan Sing. I had brought with me the tinctura Dulcamara, and three empty corked little phials. First of all, I asked for a gudwai (water-carrier), and ordered him to bring the spirit that the maharajah was in the habit of drinking; this had been distilled, in my presence, from Cabul grapes,and it was rectified, because Runjeet Sing preferred strong spirits. I put the three empty phials into the hands of the gudwai, and ordered them to be rinsed with the same spirit, and afterwards each of them to be half filled with spirit, about one drachm in each phial. When this was done, I put just one drop of the essence of Dulcamara (woody-nightshade) into one of those phials which the water-carrier held in his hand, and I ordered him to cork it and shake it. Then I desired the fakeer to mark it number "one," and I put a drop out of it into the second phial, causing it to be corked and shaken like the first and marked number "two". In the same manner, the third dilution was made, and number
“three" was marked on it. From this last, I ordered one single drop to be
let fall on a lump of sugar, which, at my request, the maharajah put into his mouth, where it was retained until dissolved. I ordered the same dose to be administered to the patient every morning and evening. During the preparation of the medicine, some persons who were standing by could not forbear smiling; and the fakeer himself was of opinion that such a minute dose could not be hurtful, should it even be supposed to be poison. But what was the result? On the first day there was no sensible amelioration in the health of the maharajah; On the second day he felt somewhat better; and on the third he was in such a merry humor that, at five o'clock in the afternoon, he ordered the minister, Dhyan Sing, to put a pair of gold bracelets on my arms, valued at five hundred rupees, in his own presence and in that of the durbar; this present was accompanied with two Cashmere shawls of the same value, and, whilst I sat on the floor, the minister laid them upon my shoulders, the maharajah telling me that my physic had produced in him the best effect. It was, of course, quite natural that this event should fill my heart with joy, as it inspired mc with the hope that the king would soon recover, and thus lay the first stone of my reputation and future fortune. This scene took place in the royal garden, Shahbelore, two miles from the city, where I had resided for three days. On the fourth day, early in the morning, the minister allowed me to visit my patients in the city; but while there, I heard that several mounted messengers had been despatched from Shahbelore to request me to return to that place. I galloped back; and on the road I overtook some hakims (Mohamedan physicians) and astrologers, travelling the same way, on elephants, on horseback, or carried in palanquins, from which I presumed that the maharajah had met with some accident, which made me very anxious. Arrived at Shahbelore, I was told that the maharajah had an attack of fever. On examining him, however, I could not find the least symptom of fever, it being in fact only excitement. The gudwai, who was in charge of the medicine, was of opinion that the fever proceeded from too great a dose, which the maharajah had asked for on the previous evening, namely, two drops at once; but I thought that could not be the cause of the alteration, one drop more or less not being able to produce such an effect. The physicians of the city were invited to a consultation. That was all they desired; for they had been touched to the quick on hearing that the maharajah was recovering, and that he had made me presents of gold and robes of honour. They would have preferred seeing the king die, rather than acknowledge me, an European, as his saviour. That was the reason why all my endeavours and all my demonstrations turned out fruitless. The prudent minister was of opinion, that it did not lie in his power to decide; the fakeer, Azeez-oo-Deen, exercising such magic influence on the maharajah, that only by addressing myself to him could I obtain any decision according to my desires. I reminded the fakeer of his own words, that such minute doses could not be hurtful, even if it should be poison. Besides, I observed, that it was not every fever, especially when appearing in so mild a form that could be of bad consequence, as nature sometimes cures diseases by reaction in the frame; and that, under such circumstances, it was advisable to lay aside all medicine, and await the result. But he objected to that, saying that the maharajah was too feeble to endure such a fever. '' But," continued he, "let us hear what opinion the other physicians have." All my arguments availed nothing. The consultation, at which the fakeer presided, was composed of a dozen hakims from Peshawur and Lahore, Hindoo physicians, astrologers, &c., each of whom imagined that he possessed the deepest knowledge of medical art. Most of them carried large books, to cover their want of real learning. In fine, they agreed unanimously to administer to the patient a majoon (electuary), of which jowahirad ( precious stones ) constituted the principal ingredient. The fakeer himself prepared and administered it to the patient; but in less than a fortnight the maharajah gave up his temporal life. He died at the fortress in my presence, upon which the minister ordered the gates to be shut; but I readily obtained his permission to absent myself. The fakeer, who exercised great influence in the household of the royal court, and who had begun his career at Lahore as a barber, with a few boxes of ointment, did not live long after his patron, Runjeet Sing. Azeez-oo-Deen — of Arabian origin, and descended from the Ansari Arabs of the desert — was the oracle of Runjeet Sing. He, the prime-minister Dhyan Sing, and Dewan-Deena-Nauth, minister of finance, constituted the triad of which the privy-council of the king was composed. The latter has been recently promoted to the rank of rajah by the English.

DSM IV Criteria for Post-Traumatic Stress Disorder

A. The person has been exposed to a traumatic event in which both of the following were present:
1. The person experienced, witnessed or was confronted with an event that involved actual or threatened death or serious injury, or a threat to the physical integrity of others.
2. The person's response involved intense fear, helplessness or horror. Note: In children, this may be expressed instead by disorganized or agitated behavior.
B. The traumatic event is persistently re-experienced in one (or more) of the following ways:
1. Recurrent and intrusive distressing recollections of the event, including images, thoughts or perceptions. Note: In young children, repetitive play may occur in which themes or aspects of the trauma are expressed.
2.Recurrent distressing dreams of the event. Note: In children, there may be frightening dreams without recognizable content.
3. Acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations and dissociative flashback episodes, including those that occur on awakening or when intoxicated). Note: In young children, trauma-specific reenactment may occur.
4. Intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
5. Physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.
C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by three (or more) of the following:
1. Efforts to avoid thoughts, feelings or conversations associated with the trauma
2. Efforts to avoid activities, places or people that arouse recollections of the trauma
3. Inability to recall an important aspect of the trauma
4. Markedly diminished interest or participation in significant activities
5. Feeling of detachment or estrangement from others
6. Restricted range of affect (e.g., does not expect to have a career, marriage, children or a normal life span)
D. Persistent symptoms of increased arousal (not present before the trauma) as indicated by two (or more) of the following:
1. Difficulty falling or staying asleep
2. Irritability or outbursts of anger
3. Difficulty concentrating
4. Hyper vigilance
5. Exaggerated startle response
E. Duration of the disturbance (symptoms in Criteria B, C and D) is more than 1 month.
F. The disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning.
Specify if:
Acute: if the duration of the symptoms is less than 3 months.
Chronic: if the duration of symptoms is 3 months or more.
With Delayed Onset: if the onset of symptoms is at least 6 months after the stressor.

Dr Triller`s Rules of Health. This reputable author flourished towards the close of the 17th century, and published a highly esteemed series of Epic poems, entitled, The Abduction of a Saxon Prince.

RULES OF HEALTH.

I.

There is a charm in health and length of days,
Which all men covet, and which most might gain;
And I shall now attempt, in humble lays,
To tell how I my aged-life did gain.
However man the debt of nature pays.
He may,at least,longevity obtain;
Learn how I lived, and note what I advise,
As proper means to win so rich and rare a prize.

II.

Tis to divine beneficence we owe
Not only life, but that great blessing—health;
Yet,man must ever carefully bestow
Attention on himself, to aid the wealth
Which nature has bestowed, as though.
Without our will, she would do good by stealth;
Nor should we treat her rudely,lest we feel
That nerves and muscles are not made of stone nor steeL


III.

This lesson have I learned in nature's school —
To act as she dictates, A calm, contented mind
I sought;took food and exercise by rule;
And hence, was able year to year to bind.
Our delicate construction, man's misrule
Too oft destroys body,and,with it,mind.
It was not by the aid of drug,nor herb,nor charm,
I reached old-age, and kept life free from harm.

IV.

The curing virtues which in med'cines dwell,
Should in disease alone be in request;
If you resort to them when you are well,
You may expect them to disturb your rest.
Besides,you rob them of their power disease to quell,
If in your service they are idly pressed;
They who would not medicaments forestall,
Should take in health no medicines at all.

V.

By tinctures,powders,mixtures,draughts, and pills,
A hale man always undermines his strength;
Lays the foundation for a host of ills,
Which take away from life degrees of length:
Medicine not needed, many a person kills,
Which, kept till wanted, might give health and strength;
He who a sink-hole of his body makes,
Decided steps for its destruction takes,

VI.

Those are mistaken who in every Spring
And Autumn fancy that they physic need;
Nature relieves herself:both man and thing
Are subject to her laws; to purge and bleed
For custom's sake, what is it but to fling
Health, strength, and life away? Blockhead indeed
Is he,who swallows med'cines he does not require ;
Long ere his time, shall such a dunce expire.

VII.

He who would spend an aged life in ease,
Must, in his habits, keep within due measure;
In labor,food,and sleep,the medium seize,
in wine and women take not too much pleasure.
Such was the counsel of Hippocrates,
Who thought good health was an important treasure:
And,at the age of six score years, expired,
Loved, honored, reverenced, and much admired.

VIII.

Night into day let no man think of turning,
Nor sleep by day to wake up when tis night;
A brain confused, or with strong potions burning,
Cannot conceive of men or things aright:
Let me remark,such feasting folks concerning,
They are not wise; but act as if in spite
Of sense and reason;for,surely,every one
Requires some rest after hard labor done.

IX.

Why should we,glutton like,our bodies feed
As if we wished grim Death to cast his dart?
Why should we hasten to the grave with speed,
As if from all our friends we longed to part?
Of temperance every man on earth has need.
To save him from affliction's direful smart;
Then why use food as if it held the germs
Which make ourselves rich nourishment for worms?

X.

Suppose that we should wish our lamp to burn,
We trim it,nicely, with sufficient oil;
But,if we overcharge the feeding urn,
Of course,the brilliancy of light we spoil,
Or,put it wholly out:hence, we may learn,
Without much labor or fatiguing toil.
If man his " feeding urn " ( his body ) surfen,
The darkness of the grave must prove the forfeit.

XI.

A little generous wine makes glad the heart;
Unbends the mind o'er which dull sorrow reigns:
Lightens sad melancholy of its smart,
And makes infirmity forget its pains;
Invigorates the blood; performs its part
In quickening circulation through the veins;
It prompts digestion, and the stomach braces,
Languor dispels, depression, too, displaces.

XII.

If you a recipe for Death require —
Drink, when o'ertieated, ice-cold water;
The effect of which, when freely you perspire.
Is,to produce of health a complete slaughter:
Should this not fully act to your desire,
It will to comfort leave but little quarter;
And a consuming, slow, yet sure decay,
Will take, midst sufferings, life, at length, away.


XIII.

But above all things, let us never fail
To seek the freshest and the purest air;
The richest blessing in the world's vast pale,
Either for peasants, courtiers, or the fair;
Without it, all creation would grow stale,
And Death usurp dominion everywhere;
All animated nature through its aid
Is vivified, and from destruction stayed:


XIV.

Tis the balsamic stay of human life,
Increasing strength, and general health bestowing;
All those who slight it, set themselves at strife
With the Creator's aim, with good o'erflowing:
Enjoy the bracing air when Spring is rife
With balmy odors gentle zephyr's blowing;
They are rich stores of nature's vital wealth,
Producing length of days and perfect health.


XV.

Therefore I say to those who age admire,
In the free air gaily yourselves disport;
And of its virtues full supply acquire,
By vigorous exercise and merry sport;
So may each one most healthfully respire,
And strengthen every outwork of life's fort;
By air and exercise the body thrives,
And men of sense thus lengthen out their lives.


XVI.

But, while I thus commend the bracing air,
I must enjoin, in terms not less emphatic,
That you avoid all drafts; for they prepare
The way, and bring on pains rheumatic,
Which to remove may baffle all your care,
And leave, for years, those twinges so erratic:
Air is of use, but drafts are dangerous things
And spare not peasants, merchants, bankers, kings,


XVII.

Also avoid, as you would shun the pest,
Air that is foul, no matter how created;
In crowded rooms be not a frequent guest,
Nor sit for hoars with wine or grog elated;
Foul-air and drinking will disturb your rest.
And bring on pains not easily abated ;
And should you feel such fumes affect your brain,
Rush to fresh-air to make you well again.


XVIII,

Cleanliness is next to Godliness, says Paul;
And common-sense corroborates his saying;
Some wash but seldom, others not all —
Yet, washing is as needful, oft, as praying:
If once you into filthy habits fall,
You are from prudence and religion straying;
Keep pure your body by such free ablutions
As may preserve you from unclean pollutions.


XIX.

"Neglect not bathing, as too many do,
For, thereby, you may ward off many an ill;
Sometimes a warm-bath may your strength renew;
But, of the cold, be sure to take your fill.
The Easterns, old and young, this course pursue,
Nor shun the water though it should be chill ;
"Hence, such diseases as fell gout and stone,
To Indians and to Persians are scarce known.


XX.

Clean linen as a comfort we esteem,
And frequent changes of our underdress ;
These as essential to our health, I deem,
And therefore urge them on you with some stress-
'Tis of importance, trifling though it seem.
What I would now upon your minds impress —
Forget not that whene'er you are attiring.
Not to put on cold garments, while perspiring.


XXI.

Do not neglect the sea, nor flowing river.
But, in due season, go to beach or brink;
Yet, do not stand undressed, to shake and shiver,
Nor from the healthy plunge affrighted shrink;
Lave well your limbs, e'en though muscles quiver.
And learn to swim, nor be afraid to sink;
Swimming invigorates all the limbs and breast.
Makes the day cheerful, and at night brings rest.


XXII.

But, above all, let Diet have your care,
For, therein healthy action most depends
Of after-efforts you may well despair
For past imprudences to make amends:
To this point, therefore, I again repair,
As frequent repetition sometimes tends
To impress a truth more strongly on the mind,
And its observance to our practice bind.


XXIII

A few words more, and then, I shall have done —
Let man consider well our nature's laws;
In every mortal underneath the sun,
Effects are consequent upon some cause;
Body and mind united are in one,
And each affects the other; therefore, pause
Before intemperance blasts the body's healty
And robs the mind of intellectual wealth.


XXIV.

All who these Rules will wisely lay to heart,
May hope to reach a venerable age,
Nor wish to stay, nor fear hence to depart;
For what is Death hut freedom to the sage?
Death has no terrors that can make them start;
And when they quit, at length, this mortal stage,
Pleased with the life of prudence that is past,
In hope they quietly shall breathe their last !

Homoeopathy cure for soldiers affected with frost bite.

Chennai.
Scientists have reported homoeopathic remedy to treat frost bite that affects soldiers stationed in high altitude areas such as Siachen.
Studies undertaken at the Command hospital in Chandigarh six months ago on 80 soldiers with frost bite showed that homoeopathic treatment based on an extract of an herb Aloe vera was effective, Dr William Selvamurthy, Director of New Delhi based Defense Institute of Physiology and Allied Sciences (DIPAS), told the 86th Indian Science Congress here.
The alcoholic extract of aloe vera, given orally along with two complementary sulphur and phosphorus based compounds, improved the condition of all soldiers affected by frost bite, Selvamurthy told delegates at the environmental physiology section at the congress this morning.
The studies were prompted by encouraging findings in rats in which frost bite symptoms were experimentally induced and which benefitted from the homoeopathic remedy.
The animal studies have shown that the aloe vera extract, when given immediately after exposure to extreme cold, penetrates the cold injured tissues and makes them warm. There are no signs of cold shock, the blood vessels dilated and circulated was re-established.
Even when given six days after an attack of frost bite, there was complete restoration of health.
Victims of frost bite develop irregular circulation of blood, blueness in tissues, numbness and swollen veins.
Other symptoms include lowered vitality, stinging and burning pain and icy coldness of limbs.
Another major finding by DIPAS is that inhalation of nitric oxide gas can treat serious breathing disorders that develop in soldiers and mountaineers in high altitudes.
The condition is known as High Altitude Pulmonary Edema (HAPE), is characterized by high blood pressure and decreased oxygen supply.
Rapid ascent to high altitudes, vigorous physical exertion and history of previous attacks of HAPE increase the risk for developing this disorder.
Studies on 14 patients at High Altitude Medical Research Centre at Leh showed the inhalation of pure chemically synthesized nitric oxide oxygen relieves HAPE symptoms, Selvamurthy reported.
A mixture of 50% nitric oxide and 50% oxygen had a better effect, the DIPAS team found. The two gases probably act on separate but complementary mechanisms to restore blood pressure.
Selvamurthy said his team was first to use inhaled nitric oxide in patients with severe HAPE symptoms.
Times of India; January 05, 1999.

Dr. John Martin Honingberger`s first visit to Lahore 1829-1833

On my arrival at Lahore, I found that the king, Runjeet Sing, with his army and the four French officers, was absent, having gone to-wards Peshawur ; but at the commencement of the rainy season, in the middle of June, they had all returned to Lahore, and I was well received. The first patient I had to attend, after my arrival at Lahore, and before I got public employment, was Achilles, an adopted son of General Allard. This boy was afflicted with a fistula on the spine,of long duration, and which had been several times superficially healed by the native surgeons. He was so reduced, that one could truly say, he was but skin and bone :•' Ossa atque pellis totus est," which of course rendered the case most difficult. I was convinced that my medical reputation depended upon this case. General Allard told me that the boy would die, if not attended to, that he could no longer bear to see him in that pitiful state, and urgently solicited my aid. He did not at that time imagine that his darling Achilles would outlive him; but the destiny of man lies hidden. Allard died at Peshawur, and was buried at Lahore; and Achilles returned from France to Lahore, where he also died, and was buried in the cemetery, near to General Allard's own tomb, which was in his adjacent garden.

I ventured to perform an operation, and that by force, for the boy made an obstinate resistance, when I placed him on a sofa. General Allard holding his arms and General Ventura his feet, while I made a cut along the fistulous sore, which caused him to be senseless for the following thirty- six hours, and to suffer with severe fever. My assiduous attendance accelerated the radical cure of the fistula, his strength visibly increased, and after a few months he regained his original plumpness, and, six years afterwards, when General Allard and his family arrived at Bordeaux,
where I then was, I was astonished at Achilles' healthy appearance. On his returning to Lahore a few years afterwards, in company with Benjamin Allard, who went to take possession of the estates of his deceased brother, and to whom he officiated as interpreter in the Indian language, he fell sick, and died under the treatment of the native physicians. I was much grieved at the unexpected intelligence of his death, and paid him the last honours, by attending his remains to the grave. To encourage the suppuration of the opened fistula, I employed a mild stimulating remedy, namely, cantharides infused in honey, on fist, twice a day, applied to the wound, by which it was soon cured. At the recommendation of General Allard, shortly afterwards, Rajah Suchet Sing, the younger brother of the minister, requested me to accompany him into the
mountains, to attend him there professionally, to which I readily agreed, as, in consequence of my recent illness, I was very weak, and the summer heat of Lahore was intolerable. Besides that, my friends, the generals, advised me to accept the offer on account of the great influence the
young Rajah Saheb possessed as one of the first personages at the court, and as by curing him I should establish my reputation.

Although my post was at that time not fixed, and consequently I did not depend on, nor was I subject to any one I nevertheless imagined that my departure for the mountains had met with the consent of Runjeet Sing. But it was not so. The young Rajah, who had a secret disease, had induced me privately to accompany him, whilst Runjeet Sing, in my four months' absence, inquired after me several times of General Avitabile, who had first introduced me to him. It was, probably, for that reason that he detained me for nine months without giving me my dismissal, or appointing me to any office. General Allard said to me one day, jesting, “It is very difficult to get an appointment here, but still more so to get one's dismissal, when once in office.'' He himself,
feeling an excessive longing to revisit his dear native land', after an absence of so many years, petitioned for a short leave of absence, which the sly Runjeet Sing repeatedly promised, but a long time elapsed before he obtained it.

On the third day after our starting for the mountains, we arrived at Suchetghur, at the foot of the hills, not far from Samba. We made our journey partly on horses, and partly on elephants. At that place, the rajah had his stables and cannon-foundry, and several new-cast cannons and mortars
were tried in his presence. One of the former burst, and a gulendas (Indian artilleryman) was stunned. The rajah requested me to examine the man, who complained of a violent pain on his right side, accompanied by severe shivering ; but, to the great astonishment of all the spectators, there was not the least trace of any external violence, whereupon the rajah himself, considering the case insignificant, opposed my wish to bleed him, and sent him some of his own mumiai. But at ten o'clock at night, about five hours after the accident had taken place, a messenger was
sent by the rajah requesting me to attend the man, and bleed him. I instantly complied, and found that he had been, according to the custom of the Hindoos, taken out of his charpai ( bed ) and laid on the floor where he expired in agony before I could give him any assistance. I do not know whether his liver was injured or not, a post-mortem examination not being allowed to be made; but it certainly was an extraordinary case, such as has never occurred during my medical practice of thirty years. His death must have been owing to a shock from the piece of hot metal, which,
in passing near him, had injured some important organ necessary to the support of life, as fright alone could not have caused such violent pains and so sudden a death,

From Suchetghur, we were conveyed in palanquins in two days, in the mountains, to Ramnuggur, where the rajah had, besides his castle, a fortress, in which his treasures were
concealed. We passed the rainy season on the hills; and in the autumn we descended, in order to witness the Duseire-feast at Umritsir. Thence, we went, with Runjeet Sing to Nadoun, on the Beas river, where the Maharajah married the two daughters of the famous Rajah Sansar Chund,
both orphans, and brought them to Lahore. We passed Jowalla-Meki, a sacred place in the eyes of the Hindoos, where there is a volcano. From thence, I travelled, with Rajah Suchet Sing, along the hills to Besouli, Jesrota, and Nurpore, where he was appointed receiver general of the revenues.

On my return to Lahore, I was informed, by General Allard, that a number of his dragoons had been bitten by a mad jackal in the night, while they were endeavouring to kill it. Several of the soldiers, who were seized with hydrophobia, had died, some of them in the barracks, and others on their way home. The general made me the offer of experimenting on some of the bitten soldiers, who had already applied for leave of absence, that they might die near their families. I consented to it, and eighteen men were placed under my care. I was happy to find, in consequence of my treatment, that not one of them was attacked by hydrophobia. Thereupon, General Allard recommended my mode of treating this malady to Dr. A. Murray, who was on a visit to Lahore with the political agent of Loodiana, Colonel Sir C. M. Wade. They both requested me to publish it for the benefit of suffering humanity, to which I agreed without any reserve; and it was read in a public assembly at Calcutta, July 2nd, 183 1, and published. I take
the liberty to introduce an extract : —

" Dr. Honigberger's object, in the treatment of hydrophobia, is to keep up a copious suppuration from the part bitten by the rabid animal, which he accomplishes, at first, by applying the actual cautery, and afterwards by using stimulants to the wound. He also administers a compound of mercury and extract of tobacco, in pills, until they produce a flow of urine ; and at the same time he recommends tincture of cantharides in an emulsion of bitter-almond to be repeatedly given, until a slight degree of dysuria is excited. Various other remedies and local applications are also
spoken of as useful in hydrophobia. It does not appear that any other person has yet made trial of some of the remedies proposed by Dr. Honigberger,"

This was my treatment twenty years ago, when I practised Alloeopathy ; but, since that period, I have made many interesting trials and experiments.

A short time after the publication of the above-mentioned method, I had a case where I tried, as a preventive, the endermic application, i. e,, I applied on the somewhat enlarged bitten part some extract of nux vomica, upon which the patient passed an unquiet night, dreaming of dogs
running after him. I thought it a bad omen, and regarded it as a symptom of the approach of hydrophobia ; and I did not rely on the local application only, but gave him also, internally, a pill of the same remedy ( extractum nuc. vomic. ) one grain, mixed with three grains of carbonate of
soda ; to which he considered he owed his recovery, as it caused an evacuation.

I introduced to our distinguished guests. Col. Wade and Dr. Murray, an Akalee or Nahung, whose nose, ears and hands had been cut off by order of Runjeet Sing (he had even deserved the gallows ), and whose nose had been so well restored in the mountains that we were all surprised,
and confessed it could not have been better done in Europe. As we know, from history, this operation was even in the remotest antiquity, practised by the Hindoos ; and they formed the nose out of the cuticle of the forehead, which proceeding is now, and always will be the same. In Europe, where cutting off of noses is only in use, in exceptional cases — as when ulceration or other circumstances make it requisite — this operation is usually performed with the cuticle of the arm, and judiciously too, as, according to our custom, the head mostly is uncovered, and a scar on one's forehead, with a new nose on the face, makes rather an ugly appearance ; whilst, in the East, the scar remains hidden beneath the turban.

In time of peace, the Nahungs gave a great deal of trouble to Runjeet Sing. On one occasion, he was even forced to place two pieces of cannon outside the Delhi Gate of Lahore, in the vicinity of Seidgenj, where the robbers congregate, because this band dared to intercept the communication of that city. They shut themselves up in Meea-Meer, five miles distant from Lahore, thence they made their appearance as rebels, but they were defeated, and forced to depart, and from the town also, to Umritsir. The individual just alluded to as deserving the gallows, had cut off the arm of a sentinel, for having prevented him from entering the tent of the king by a private entrance. The Nahung had a servant with him, who underwent no punishment, because he did not behave in an aggressive manner ; but the offender, by the order of Runjeet Singh, lost his ears, nose, and hands, by the same sabre with which he had so skilfully cut off the arm of the soldier on royal duty. After the sad execution, he ran to drown himself in a well, but was prevented by the people who were accidentally present. When the king was informed of the fact, the culprit was sent to me, and put under my care and medical attendance, with strict orders to watch him, to prevent his committing suicide, and to present him, when cured, to the king. According to his own statement, he was drunk with bhang ( hemp ) when he committed the
crime, and his only intention for intruding on the king had been to ask a gapa ( gift ). These robbers do not like to enter military service; they prefer begging, and living by pillage.

Rajah Heera Sing, son to the minister Dhyan Sing, who was a favourite of Runjeet Sing, was afflicted with diabetes, and we ( I and the five native physicians ) were consulted, at the palace garden of Hazooree Bagh, in the presence of Runjeet Sing, and on that occasion 1 made
mention of milk-sugar. As neither the Maharajah nor his physicians had ever heard of any sugar prepared from the milk of cows, they were curious to see a specimen of it, and I was ordered to prepare some in the gulab-haneh ( rose-watar house ), in the presence of the fakir, Noor-oo-Deen ; but they had scarcely patience to wait for its preparation, I produced some white and fine crystallized milk-sugar, which I presented in a box to Runjeet Sing, of which he gave a few pieces to a boy to taste, but he did not find it so sweet as cane-sugar, so no one spoke any more about it, and the milk scene was thus at its end. The gulab-haneh, where the rose-waters and the bedemusk ( aqua flor. salicis Babylon ), which they use as cooling beverages in the hot season,
were distilled, was the very place where I at first practised, and it was there I gave lessons in pharmacy and chemistry to the fakirs Aziz-oo-Deen and Noor-oo-Deen. The spirit produced from Cabul grapes, for the use of Runjeet Sing, was distilled in that place in my presence, by his own people, because every thing eatable or drinkable, destined for the Sikhs and Hindoos, must be prepared with their own hands, no Christian or Musselmaan being permitted to touch it, lest they should pollute it. There were also the royal magazines, under the care of Noor-oo-Deen, where I prepared different opiates, and many amusing metallic oxydes ( kooshtegee ), to please the fakir and Runjeet Sing, for which they held me in high estimation. Among others, I prepared some morphine, with a large dose of which the Maharaja would surely have killed a famous opium-eater, if I had not been consulted in time, and administered to him some antidotes. I thought it strange that no one at Lahore was aware of the existence of coffee, and its usefulness. Even the learned fakirs, Aziz-oo-Deen and Noor-oo-Deen ( brothers ), who were of Arab descent, knew coffee only from their books, under the denomination of bun, and the sample which I showed them in 1832, in the Durbar, was the first they had ever seen ; but when the
English arrived it became generally known. Neither had they any notion of our cantharides ; for which they substitute meloe telini, a fly of greater efficacy, containing more cantharidine than cantharides. They are seldom employed by the native physicians for blistering, although they know the utility of them in cases of hydrophobia.

Besides what had been mentioned on the effects of blistering in the description of my own disease, the following may likewise serve as a proof how beneficial that process is when properly employed, and it may, in some cases, even save a patient's life.

General C-- , had brought on a disease, by an external misapplication of mercury, while he was with the court at Umritsir. It was in the warm season, and on the fourth day after the application, he became so indisposed that my services were called into requisition. The native physicians
had previously administered different remedies, but without success. On examination, I found that the stomach and intestines were affected, which disturbed the functions of digestion, and caused a violent purging, with a burning of the anus; I commenced by bleeding him, and applying leeches; after which, the diarrhoea having been suppressed, an intermittent fever, exhibiting itself at various periods, of from three to seven days, was the consequence. Observing no improvement in the health of my patient, I conceived that the heat of the climate exercised an injurious influence over him, and that no hopes of his recovery could be entertained unless he were removed. I therefore solicited permission for him to remove to a cooler locality upon which we were sent to Deenanuggur, in the proximity of the mountains, to which place the Maharajah intended to retire with the court.

The disease having lasted three months, and the patient becoming weaker, he began to complain of a burning at the region of the heart; 1 tried to apply some leeches but I was obliged to cease, owing to his falling into a swoon. He daily grew worse and worse; and shortly after became
delirious, with his eyes open, and his feet cold. The officers of his brigade, who were accidentally present, shed tears for their general, whom they expected to lose. I freely confess, that I had no hope of his recovery, seeing that his strength was daily declining. In this desperate
state I applied three blisters, one on the nape of the neck, and the other two on the calves of his legs ; at the same time I gave him ray favorite opiate ( opium, camphor, ipecacuanha and tartar emetic ) : and he thus was saved. In the same night an eruption appeared, consisting of many thousand pustules, principally on the neck, shoulders, and groins. From that moment the disease visibly diminished ; his convalescence took a rapid course, and after a few weeks he was entirely recovered.

During the time of my patient's convalescence, Rajah Suchet Sing came down from the hills to Deenanuggur, as was supposed, to meet the court. One day, the kind Rajah Saheb invited me to accompany him in a boat, on a duck shooting excursion, on an extensive lake. As the rajah had
not his own parasol with him, I gave him mine out of politeness ; for as I was shooting, I did not want it. It was extremely hot, and I had nothing on me but a thin shirt, not even a waistcoat or jacket, so I was exposed to the burning rays of the sun for some hours, and the consequence was a severe coup-de-soleil. My friend C , on witnessing my state, despaired of my life, his " Tissot "
stating that a coup-de-soleil was extremely dangerous. But how great was his surprise, when he saw me recovering on the third day! Happily, the attack did not affect my head, but only one of my shoulders, and by applying leeches and poultices I recovered.

The king of England had at this time sent five immense horses as a present to Runjeet Sing. Alex. Burnes had brought them up the Indus, and they were much admired for their size and uncommon height. One of them was lost on the way, and another became the famous riding-horse of the Maharajah, who, being of a very low stature; appeared, when on the back of the animal, like an ape on an elephant. This horse fell sick, and although I had him immediately under my care, and spared no trouble, he became, like other dead animals, food for the dogs, carrion birds, and Pariahs, the lowest caste in India, who eat any animal, whatever may have been the cause of its death.

The horse had several ulcers on his legs, which having been healed by internal and external remedies, caused convulsions, and in that state he perished. I afterwards had other opportunities of curing similar ulcers with a simple remedy, according to ray medium system, namely, by la-
manaria saccharina ( probably because it contains iodine ), such ulcers being a kind of scrofula. This disease occurs very often in the Punjab, and the natives call it Zeherbadi (venomous swellings), as it ulcerates, and secretes a serous and corroding matter. By adhering to the same system,I also cured horses affected with glanders. Arsenic and dulcamara alternately administered, in small doses, in the morning and evening, proved very effective. The French
veterinary surgeons administer for this disease hydrochloric acid, which, diluted with water, they pour into the mouth of the horse, or use it as a local embrocation : this I learnt from the celebrated naturalist, Victor Jacquemont, on his visiting Lahore, en route to Cashmere, &c., and he declared glanders to be incurable. At Vienna, as in England, I believe, they kill at once horses affected with that disease.

During the congress of Rupore, on the frontier of India, I attended, at Wuzeerabad, the governor of that province, General Avitabile, who, having sprained his ankle, had called in the native surgeons, barbers and bunglers, and they had so assiduously applied irritating poultices and embrocations, that the leg became inflamed, and was approaching to mortification. Under my treatment, the patient recovered, and the leg was restored to its former functions. Subsequently, he was afflicted with a contraction of the muscles of the face, which, on account of his long, crooked nose, appeared the more striking; this disease ascribed to his immoderate- indulgence in champagne, which affected his brain. Although I cured him at that time, two years ago he died suddenly of apoplexy, from continuing the same excess, in his own country. Having acquired
immense riches, he returned to Europe, to enjoy in his native land ( Naples ) the fruits of his exertions, and there he died in the autumn of his life. Peace to his ashes! although many an unfortunate man was hung by his orders, at Wuzeerabad as well as at Peshawur, where he exercised his sway in a most arbitrary manner. The pleasure which he took in seeing people hung by dozens must be attributed to the affection of his brain. General Allard told me that the Maharajah once reprimanded him for having executed some musselmaans ; whom General
Avitabile had ordered to be hung because they were of opinion, that, under the- protection of a European governor they might be at liberty to eat beef! The opinion of Runjeet Sing was, that he ought to have imprisoned the criminals, and then allowed them to escape. It is well known, however, that General Avitabile was an active man; that he introduced many useful reforms
into the country, and was of good service to the English army on their march to Cabul. Living in his house for three years, I had an opportunity of knowing him well; I therefore, conclude with the proverb, "De mortuis nil nisi bonura ; " particularly so because I am indebted to him for the following important discovery :• — During the time I was performing the before-mentioned cures at Wuzeerabad, I lost, on a hunting excursion, a hare in the copses, which we thought to find in a burrow. Wishing to get the hare, I sent to a village for some bels (pokers), in order to enlarge the hole. We succeeded in doing so; but great was our astonishment when, instead of the hare, we caught a musk-deer, which diffused so strong an odour, that I was seized with a
headache, which lasted for three days. The man who dragged him out, was so frightened at finding an 'animal previously unknown to him, that he instantly threw it down, and our hounds bit it so violently that it was nearly killed. Having taken it home, I was advised by General Avitabile to cut off the musk-bag, which I did, and keep to this day ; it being considered that un-
less that operation is performed previously to the death of the animal, the useful substance of the musk-deer will entirely disappear ; the rest of the animal was regarded as useless, which I now regret, believing that it was the most valuable specimen I ever met with, as I have never heard of such animals being found in the plains of India. Those to whom I showed the musk-bag in
Europe, suggested that the animal had found his way there from the Himalaya, and it might have been so ; but the odour and appearance of the musk of Cashmere and Thibet is quite different. The exterior of the bag of this animal resembles that of the musk of China, it has smooth, soft, and short hair ; but the interior is a yellowish brown mass, as hard as bees-wax, whereas, the Chinese musk is of a reddish-brown colour, and in grains of a friable nature. Without having prepared the bag, I put It into an iron box, and found that in the rainy season the insects had destroyed the external hair, without having touched the internal parts. The musk has, like that of
China, a strong, agreeable scent.

I thought that where one animal was found, more of the same race ought to exist, but I could not purchase any of a similar description. I now regret not having examined the hole where the precious animal was caught, as its companion might have been there, neither did I preserve the skin. Still I hope that the publication of this incident will induce English sportsmen in India to try to obtain the prize which escaped me, although the animal must be very rare, as neither the native physicians nor the druggists possess any knowledge of it. When in search of them, it ought to be considered that these interesting creatures are shy, prefer solitude, and live in copses, where their holes are made deep in the ground, beneath bushes, and thus they are saved from total extermination. Many naturalists are of opinion that the subject in question might perhaps have been another kind of animal, which possessed the same odour, just as different plants emit a similar scent. The exultation I felt on having found a real musk-deer, caused me to neglect
making a proper examination of its characteristic marks, its prominent tusks — being satisfied with the scent. To the best of my recollection, the size was that of a hare, and it was of a slender cylindric frame.

Whilst I was residing at Wuzeerabad, a young Hindoo lady ( katretee ) came to call on General Avitabile with presents, as a token of her gratitude for his having preserved her from the fate of a Suttee, i. e., being burnt alive with the body of her deceased husband ; which proves that many
of these victims of Brahminism feel en aversion to that horrid ceremony. The woman confessed, that on the day of the burning of her husband, and in her extreme grief, she was ready to sacrifice her life, hoping to enter paradise with her partner, but that now she felt more happy at
having been preserved.

Runjeet Sing related to me that Dr. Allen (an American, and governor of Goojerat ) used secretly to employ his time in his fortress in the practice of alchymy. I could not forbear laughing at the idea of his expecting to convert common metals into gold, as the conversion of quicksilver
into silver was found to be quite impossible. Subsequently, my assertion was verified by the discovery he made, that the doctor's alchymy consisted in manufacturing false coin. Runjeet Sing reposed much confidence in me, and insisted on my accepting the command of an artillery department, or the office of governor of a province, like the Generals Ventura, Avitabile, and Dr. Allen ; this, however, I refused, deeming that I had not sufficient abilities to execute such
an office properly ; but upon his giving me the choice, I accepted the management of a gunpowder manufactory and also a gun-stock establishment. Notwithstanding my numerous occupations, which were very lucrative, I was affected with nostalgy, i. e., I felt an irresistible longing to visit my native country, which I had not seen for many years, to such a degree, that my sole thoughts and endeavors were how to secure my return home. I was so occupied
with this idea, that if they had offered me the Koh-i-noor ( which is valued at half-a-million ) to remain there for the remainder of my life, I should have refused it. General Allard's words ; “ It is difficult to get an appointment here, but, when obtained, it is still more difficult to quit it," were continually in my thoughts, and it cost me much trouble to obtain my dismissal, or rather my liberty.

PANIC DISORDER:
‘Panic’ derives its meaning from the Greek god ‘Pan’ who was in the habit of frightening humans and animals ‘out of the blue’.

Panic attack: It is a period of intense fear characterized by a group of symptoms (given below) that develop rapidly, reach a peak intensity in about 10 minutes, and generally do not last longer than 20-30 min (rarely over 1 hr). Attacks may be either spontaneous (‘out of blue’) or situational (usually where attacks have occurred previously). Sometimes attacks may occur during sleep (nocturnal panic attacks), and rarely, physiological symptoms of anxiety may occur without psychological component (non-fearful panic attacks).

Panic disorder: The recurrent panic attacks, which are not secondary to substance misuse, medical conditions, or another psychiatric condition. There are distinct episodes of intense fear and discomfort associated with a variety of physical symptoms. The frequency of occurrence may vary from many attacks a day, to only a few attacks a year. There is usually the persistent worry of having another attack or the consequences of attack (which may lead to phobic avoidance of places or situations) and significant behavioural changes related to attack.

Epidemiology: In India the prevalence rate of panic disorder in psychiatry clinics is around 3 %. Panic disorder without agoraphobia is more or less equal among males and females, but panic disorder with agoraphobia is more among females. It develops in early adulthood, the mean age of onset being around 25 years.

Aetiology and Psychopathology:
The exact etiology of panic disorder is unknown but appears to involve a genetic predisposition, altered autonomic responsivity, and social learning. Panic disorder has a moderate heritability of around 30 – 40 %. Most studies suggest that vulnerability is genetically determined, but critical stressors are required to develop clinical symptoms.
Intravenous infusion of sodium lactate can evoke an attack in about two-thirds of the panic disorder patients, as do yohimbine and carbon dioxide inhalation.
Neuroanatomical model of aetiology suggests that panic attacks are mediated by ‘fear network’ in brain that involves the amygdale, the hypothalamus and the brain stem centres.
Psychoanalytic model suggests that panic attacks are the consequences of parental deprivation in early childhood.

Clinical features:
The diagnosis of panic disorder is based on the following criteria:-
A separate period of intense fear or discomfort in which four (or more) of the following symptoms are developed abruptly and reach the peak within 10 minutes (in order of frequency of occurrence):
1. Palpitations, pounding heart, or accelerated heart rate.
2. Sweating. 3. Trembling or shaking.
4. Sense of shortness of breath or smothering.
5. Feeling of choking. 6. Chest pain or discomfort
.7. Nausea or abdominal discomfort.
8. Feeling dizzy, unsteady, light-headed, or faint.
9. Derealisation (feelings of unreality) or depersonalization (being
detached from oneself).
10. Fear of losing control or going crazy. 11. Fear of dying.
12. Paresthesia (numbness or tingling sensations).
13. Chills or hot flushes.
In some individuals, anticipatory anxiety develops over time and results in a generalized fear and a progressive avoidance of places or situations in which a panic attack might recur.
Researches suggest that individuals with panic disorder had a significantly higher rate of supporting gastrointestinal symptoms, including those typically associated with irritable bowel syndrome, than those with other or no psychiatric diagnosis.
Differential Diagnosis:
A wide variety of conditions can present as panic disorder.
a. Substance or alcohol misuse / withdrawal.
b. Mood disorders/other psychiatric disorders secondary to medical
conditions.
C.Medical conditions presenting with similar conditions e.g. hyperthyroidism, hypoglycaemia, anaemia, mitral valve prolapse, atrial tachycardia, coronary heart disease, epilepsy, asthma etc.

BEHAVIOURAL AND COGNITIVE THEORIES OF ANXIETY

BEHAVIOURAL AND COGNITIVE THEORIES OF ANXIETY
Behavioural theory

John Watson, the father of behaviourism, proposed that neuroses arouse out of traumatic learning situations and then persist to influence behaviour throughout life.
‘Stimulus – response’ concept of anxiety, which emerged from this, posits that certain stimuli when associated with fear could show up an anxiety response. For e.g. if a dog bites a child, the child will respond with anxiety the next time he sees a dog. This response will occur even if the dog does not actually bite him again. Thus anxiety has a protective function here. This anxiety could become a reaction to a danger signal that was recognised to forebode a harmful situation.
So, anxiety is viewed as an unconditioned inherent response of the organism to painful or dangerous stimuli. In anxiety and phobias, this becomes attached to relatively neutral stimuli by conditioning.
Systematic desensitization: The principle of reciprocal inhibition (i.e. anxiety and relaxation cannot coexist) is the core of this.
Systematic graded exposure to the source of anxiety is coupled with the use of relaxation techniques (the ‘desensitisation’ component).
Flooding/implosive therapy: The high levels of anxiety cannot be maintained for long periods, and a process of ‘exhaustion’ occurs. By exposing the patient to the phobic object and preventing the usual escape or avoidance, there is extinction of the usual anxiety response.

Anxiety and Cognitive performance
The cognitive model of anxiety postulates that anxious individuals invariably exaggerate the level of threat in a given situation. So, there is evidence of selective information processing (with more attention paid to threat related information), negative automatic thoughts and perception of decreased control over internal and external stimuli.

Cognitive behavioural modification or CBM developed from this approach helps in treatment of anxiety resulting from inadequate coping skills. It aims to ‘change the way you feel, by changing the way you think’.

Anxiety and rational thinking
Albert Ellis developed a treatment technique based on rational thinking in 1955. Several research studies have confirmed the relationship between anxiety and negative / irrational thinking.
The RET (Rational emotive therapy) belief holds that individual’s own thoughts and beliefs about difficulties create negative emotions as anxiety. The individual’s reaction towards a situation is based on his set of beliefs and attitudes. So, the patients are taught to identify, challenge, and change their irrational beliefs which maintain and justify their anxiety. After all, anxiety, by definition is not attributable to sources of real danger and is as such irrational.