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DIAGNOSIS AND
TREATMENT IN
INTERNAL MEDICINE

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DIAGNOSIS AND
TREATMENT
IN INTERNAL
MEDICINE

Edited by
Patrick Davey
Consultant Cardiologist, Northampton General Hospital NHS Trust,
Northampton, UK

David Sprigings
Formerly Consultant Physician, Northampton General Hospital NHS Trust,
Northampton, UK

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1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2018
The moral rights of the authors‌have been asserted
First Edition published in 2018
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2018941300
ISBN 978–​0–​19–​956874–​1
Printed and bound in China by
C&C Offset Printing Co., Ltd.
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-​to-​date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-​pregnant
adult who is not breast-​feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.

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Preface

Diagnosis and Treatment in Internal Medicine came about through our experience on
the acute medical take. Here, sick patients present in large numbers with a vast range
of problems. What all patients need, as the bedrock of management, is a differential
diagnosis, and the central aim of our book is to help doctors formulate this. We asked
experts in their field to provide succinct and authoritative guidance across the breadth
of internal medicine. The assessment of symptoms or presenting problems is a major
element of the book, but there is also comprehensive coverage of disorders of the
body systems, including psychological aspects and palliative care. Chapters are struc-
tured so that key information can rapidly be found. Doctors need a broad perspective
on health and its promotion, and there are sections addressing nutrition, lifestyle, and
prevention of disease.
This book approaches medicine from the patient’s perspective, through the stories
that patients tell us about their illness, and provides the knowledge that turns these
narratives into diagnoses, treatment, health, and longevity. Throughout, our focus has
been on meeting the needs of doctors in the clinic, in the emergency department, or
on the ward.
Our eternal thanks go out to our contributors. Some 200 outstanding doctors have
produced admirably compact and lucid chapters. Throughout the lengthy gestation of
the book, we have been ably supported by the staff at Oxford University Press, who
have encouraged us and orchestrated the project. All praise should be directed to the
authors, and any mistakes are ours. Please do let us have your suggestions for improve-
ments (you can contact us at [email protected] and [email protected]).
Patrick Davey
David Sprigings

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Contents

Normal values xiii

Abbreviations xv
Contributors xxiii

PART 1 THE APPROACH TO THE PATIENT

1 Diagnostic reasoning 2 5 The psychological examination 18

2 Dealing with uncertainty 8 6 Confidentiality 22
3 Taking the history 12 7 Consent 24
4 The physical examination 15

PART 2 ASSESSMENT OF SYMPTOMS AND PRESENTING PROBLEMS

8 Palpitation 28 37 Anaemia 104

9 Acute chest pain 31 38 Bruising and bleeding 106
10 Chronic chest pain 37 39 Transient loss of consciousness 109
11 Hypotension 43 40 Coma 112
12 Acute breathlessness 47 41 Delirium (acute confusional state) 116
13 Chronic breathlessness 51 42 Seizures 120
14 Peripheral oedema 56 43 Difficulty speaking (including dysphasia and
15 Murmur 58 dysarthria) 123
16 Cough 61 44 Weakness 126
17 Wheeze 63 45 Tremor and other abnormal movements 131
18 Haemoptysis 65 46 Gait disorders 134
19 Pleural effusion 67 47 Sensory loss 137
20 Chylothorax 70 48 Headache 142
21 Difficulty swallowing 71 49 Loss of vision 146
22 Haematemesis 73 50 The red eye 150
23 Acute abdominal pain 75 51 Hearing loss 153
24 Chronic abdominal pain 78 52 Facial pain 155
25 Dyspepsia 81 53 Dizziness 157
26 Abdominal mass 83 54 Disorders of sleep 159
27 Constipation 85 55 Haematuria 161
28 Acute diarrhoea 87 56 Oliguria and anuria 163
29 Chronic diarrhoea 89 57 Polyuria 165
30 Rectal bleeding 91 58 Dysuria 167
31 Jaundice 93 59 Urinary incontinence 170
32 Ascites 95 60 Faecal incontinence 173
33 Chylous ascites 98 61 Vaginal discharge 175
34 Swelling in the neck 99 62 Joint pain 178
35 Splenomegaly and other disorders of the 63 Muscle pain 181
spleen 101 64 Low back pain 183
36 Lymphadenopathy 103 65 Painful leg 187

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 66 Leg ulcers 191 76 Fever 216
67 Limb ischaemia 193 77 Hyperthermia 218
68 Rashes 195 78 Hypothermia 221
69 Blistering rashes 197 79 Fatigue 224
70 Photosensitive rashes 200 80 Unintentional weight loss 226
71 Itching 203 81 Obesity: differential diagnosis 228
72 Lumps and bumps 205 82 Self-​harm 231
73 Falls 209 83 Alcohol intoxication 234
74 Immobility (‘Off legs’) 212 84 Intravenous drug use 239
75 Suspected anaphylaxis 214

PART 3 CARDIOVASCULAR DISORDERS

85 Normal function of the cardiovascular 105 Raynaud’s phenomenon 325

system 244 106 Heart muscle disease (cardiomyopathy) 327
86 Risk factors for cardiovascular disease 248 107 Tumours and the heart 332
87 Diagnosis and investigation in suspected heart 108 Cardiac infection 335
disease 252
109 Pericardial disease 340
88 Congenital heart disease in adults 263
110 Extrasystoles 342
89 Chronic stable angina 271
111 Sinus tachycardia 345
90 Acute coronary syndromes 275
112 Focal (ectopic) atrial tachycardia 348
91 Acute heart failure 280
113 Multifocal atrial tachycardia 351
Contents

92 Chronic heart failure 283

114 Atrioventricular nodal re-entrant
93 Aortic stenosis 287 tachycardia 354
94 Aortic regurgitation 290 115 Atrioventricular re-​entrant tachycardia 357
95 Mitral regurgitation 292 116 Atrial fibrillation 361
96 Miscellaneous valvar pathology: Mitral 117 Atrial flutter 366
stenosis, pulmonary stenosis, and tricuspid
regurgitation 295 118 Ventricular tachyarrhythmias: Ventricular
tachycardia and ventricular fibrillation 369
97 Percutaneous coronary intervention 299
119 Bradyarrhythmias 379
98 Heart surgery 302
120 Sudden cardiac death 384
99 Circulatory support therapy 306
121 Cardiac device therapy 395
100 Pulmonary hypertension 308
122 Drug-​induced cardiovascular disease 401
101 Venous thrombosis and pulmonary
embolism 312 123 Psychological management of coronary heart
disease 403
102 Aortic aneurysm 318
124 Treatment of terminal cardiovascular
103 Aortic dissection 320 disease 405
104 Peripheral arterial disease 322

PART 4 RESPIRATORY DISORDERS

125 Normal respiratory function 410 131 Pneumothorax 436

126 Diagnosis in suspected respiratory disease 412 132 Cystic fibrosis 439
127 Investigation in respiratory disease 415 133 Asthma 441
128 Upper respiratory tract infections, including 134 Chronic obstructive pulmonary disease 445
influenza 425 135 Respiratory failure 449
129 Pneumonia 427 136 Obstructive sleep apnoea 454
130 Tuberculosis 431 137 Bronchiectasis 456

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138 Sarcoidosis and other granulomatous lung 142 Occupational lung disease 472
disease 458 143 Pleural infection and malignancy 475
139 Interstitial lung disease 460 144 Drug-​induced lung disease 477
140 Pulmonary vasculitis 464 145 Psychology in respiratory disease, including
141 Lung cancer (including management of an dysfunctional breathing 480
isolated lung lesion) 467 146 Terminal care in respiratory illness 482

PART 5 INTENSIVE CARE MEDICINE

147 Critical illness 486 151 ICU treatment of acute kidney injury 496
148 Role of the intensive care unit 488 152 ICU treatment of sepsis and septic shock 498
149 ICU treatment of respiratory failure 490 153 Terminal care in the intensive care unit 501
150 ICU treatment of cardiovascular failure 493 154 Brain death 503

PART 6 DISORDERS OF THE KIDNEY AND URINARY TRACT, AND ELECTROLYTE

AND METABOLIC DISORDERS

155 Normal renal function 506 169 Inherited renal diseases 556
156 Diagnosis in suspected renal disease 509 170 The kidney in systemic disease 558
157 Investigation in renal disease 512 171 Renal vascular disease 561
158 Urinary tract infection 518 172 Management of terminal care in renal
159 Glomerulonephritis 521 disease 563
160 Interstitial renal disease 527 173 Disorders of plasma potassium 565

Contents
161 Nephrotic syndrome 529 174 Disorders of plasma sodium 568
162 Acute kidney injury 533 175 Disorders of plasma calcium 570
163 Chronic kidney disease 536 176 Disorders of plasma phosphate 573
164 Diabetic renal disease 540 177 Disorders of plasma magnesium 575
165 Urinary tract obstruction 543 178 Disorders of acid–​base balance 577
166 Renal calculi 546 179 Porphyria 580
167 Renal and bladder cancer 549 180 Aminoacidopathies, urea cycle disorders, and
organic acidurias 582
168 Renal replacement therapy 552
181 Amyloidosis 584

PART 7 DIABETES MELLITUS AND ENDOCRINE DISORDERS

182 Normal function of the endocrine system 588 188 Adrenal disease 612
183 Diagnosis and investigation in endocrine 189 Cushing syndrome 617
disorders 593 190 Short stature 619
184 Diabetes mellitus 596 191 Infertility 621
185 Hypoglycaemia 601 192 Pituitary disorders: Prolactinomas, acromegaly,
186 Thyroid disease 603 and pituitary apoplexy 625
187 Primary hyperparathyroidism 610

PART 8 GASTROINTESTINAL DISORDERS

193 Normal gastrointestinal function 632 195 Investigation in gastrointestinal disease 637
194 Diagnosis in suspected gastrointestinal 196 Immunology and genetics in gastrointestinal and
disease 635 hepatic medicine 641

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 197 Gastrointestinal infections 644 202 Malabsorption 660
198 Benign oesophageal disease 648 203 Inflammatory bowel disease 663
199 Peptic ulcer disease 651 204 Gastrointestinal tumours 667
200 Gall bladder disease 653 205 Functional gastrointestinal diseases 674
201 Pancreatic disease 656 206 Psychiatry in gastrointestinal medicine 676

PART 9 DISORDERS OF THE LIVER

207 Normal hepatic function 680 213 Autoimmune hepatitis 709

208 Investigation in liver disease 686 214 Genetic liver disease 713
209 Acute liver failure 690 215 Drug-​induced liver disease 718
210 Chronic liver failure 693 216 Miscellaneous liver diseases 721
211 Alcoholic liver disease 697 217 The liver in systemic disease 726
212 Viral hepatitis 700 218 Liver cancer 731

PART 10 NEUROLOGICAL DISORDERS

219 Normal neurological function 736 232 Motor neuron disease 794
220 Diagnosis in suspected neurological disease 739 233 Spinal cord disease 796
221 Investigation in neurological disease 742 234 Neuropathy 800
222 Demographics of neurological disease 752 235 Myopathy 804
Contents

223 Neurogenetic disease 755 236 Vasculitis in neurology 807

224 Neurocutaneous syndromes 760 237 Neurological tumours 812
225 Congenital neurological disorders 762 238 Non-​metastatic neurological manifestations of
226 Epilepsy 764 malignancy 815
227 Stroke 767 239 Neurosurgery 817
228 Dementia 777 240 Drug-​induced neurological disease 821
229 Neurological infection 781 241 Functional and dissociative disorders in
neurology 825
230 Disorders of movement 787
242 Palliative care in neurological disease 828
231 Multiple sclerosis 791

PART 11 DISORDERS OF THE SKIN

243 Normal skin function 832 254 Nail disorders 863

244 Approach to diagnosing skin disease 836 255 Mucosal disease 865
245 Investigation in skin disease 839 256 Genital disease 868
246 Skin infection and infestation 842 257 Polymorphic light eruption and actinic
247 Cutaneous vasculitis 845 prurigo 870
248 Acne 847 258 Disorders of pigmentation 872
249 Psoriasis 850 259 Skin cancer 874
250 Eczema 853 260 Skin markers of internal medicine 882
251 Urticaria 855 261 Drug-​induced skin disease 886
252 Bullous disorders 857 262 Psychocutaneous medicine 889
253 Hair disorders 860

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PART 12 DISORDERS OF THE MUSCULOSKELETAL SYSTEM

263 Normal function of the musculoskeletal 269 Systemic lupus erythematosus 918
system 892 270 Crystal arthropathy 921
264 Diagnosis in suspected rheumatological 271 Infection of joints and bones 925
disease 894
272 Vasculitis 927
265 Investigation in rheumatological disease 900
273 Osteomalacia 932
266 Osteoarthritis 906
274 Paget’s disease of bone 933
267 Rheumatoid arthritis 910
275 Osteoporosis and fragility fracture 935
268 Seronegative spondyloarthropathy 914
276 Genetic bone and joint disease 938

PART 13 HAEMATOLOGICAL DISORDERS

277 Normal blood function 944 285 Prothrombotic conditions 984

278 Diagnosis and investigation in haematology 951 286 Acute leukaemia 989
279 Deficiency anaemias 955 287 Chronic leukaemia 992
280 Haemolytic anaemia 958 288 Myelodysplasia 995
281 Normal platelet function 967 289 Lymphoma 996
282 Platelet disorders 970 290 Multiple myeloma and related conditions 999
283 Normal haemostatic function 975 291 Myeloproliferative disorders 1002
284 Bleeding disorders 979 292 Terminal care in haematological disease 1005

Contents
PART 14 DISORDERS OF THE IMMUNE SYSTEM

293 Functions of the immune system 1008 298 Combined T-​and B-​cell
294 Clinical features and diagnosis of immunological immunodeficiencies 1028
disease 1013 299 Complement deficiencies 1031
295 Neutrophil abnormalities 1017 300 Hypersensitivity diseases 1034
296 Human immunodeficiency virus infection 1020 301 Immunological support 1038
297 Antibody deficiencies 1025 302 Immunosuppressive therapy and therapeutic
monoclonal antibodies 1040

PART 15 INFECTIOUS DISEASES

303 Defences against infection 1044 312 Spirochaetal infection (non-syphilis) 1079
304 Nature and demographics: Epidemiology of 313 Syphilis 1082
infective organisms 1048 314 Rickettsial infection 1084
305 Diagnosis in suspected infective disease: 315 Fungal infection 1086
The history and examination 1051
316 Protozoal infection: Gut organisms 1091
306 Investigation in infection 1058
317 Protozoal infection: Malaria 1094
307 Treatment of infection 1061
318 Worm infection (including hydatid
308 Viral infection 1064 disease) 1098
309 Sepsis 1068 319 Prion disease 1101
310 Bacterial infection 1071 320 Sexually transmitted disease
311 Mycobacterial infection other than (gonorrhoea) 1103
tuberculosis 1075

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 PART 16 CANCERS

321 Cancers related to infection 1106 326 Prostate cancer 1118

322 Principles of oncogenesis 1109 327 Breast cancer 1122
323 Presentations in suspected cancer 1111 328 Ovarian and testicular cancer 1126
324 Diagnosis and staging of cancer 1113 329 Symptom control in cancer 1128
325 Treatment of cancer 1115 330 Dying from cancer 1131

PART 17 DIETARY, LIFESTYLE, AND ENVIRONMENTAL FACTORS

AFFECTING HEALTH

331 Normal nutritional function 1134 337 Physical activity and its role in disease
332 Starvation and malnutrition 1136 prevention 1155
333 Vitamin deficiencies 1139 338 Smoking 1158
334 Nutritional support in the critically ill 1144 339 Alcohol 1160
335 Poor diets 1147 340 Environmental radiation 1164
336 Obesity: epidemiology, prevention and 341 Air pollution 1166
management 1150 342 Non-​prescription drugs 1168

PART 18 PREVENTION OF DISEASE

343 Prevention of cardiovascular disease 1172 347 Prevention of neurological disease 1183
Contents

344 Prevention of respiratory disease 1176 348 Prevention of cerebrovascular disease 1187
345 Prevention of kidney disease 1179 349 Prevention of infection 1189
346 Prevention of gastrointestinal disease 1181 350 Prevention of cancer 1192

PART 19 SCREENING FOR DISEASE

351 Screening for cardiovascular disease 1196 354 Screening for gastrointestinal disease 1206
352 Screening for respiratory disease 1202 355 Screening for neurological disease 1209
353 Screening for kidney disease 1205 356 Screening for cancer 1211

Index 1215

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Normal values

Common haematology values

Haemoglobin men: 130–​180 g/​l
women: 115–​160 g/​l
Mean cell volume, MCV 76–​96 fl
Platelets 150–​400 × 109/​l
White cells (total) 4–​11 × 109/​l
• neutrophils 40%–​75%
• lymphocytes 20%–​45%
• eosinophils 1%–​6%
Blood gases
pH 7.35–​7.45
PaO2 >10.6 kPa (75–​100 mm Hg)
PaCO2 4.7–​6 kPa (35–​45 mm Hg)
Base excess ±2 mmol/​l
U&ES (urea and electrolytes)
Sodium 135–​145 mmol/​l
Potassium 3.5–​5 mmol/​l
Creatinine 70–​120 μmol/​l
Urea 2.5–​6.7 mmol/​l
eGFR >90
LFTs (liver function tests)
Bilirubin 3–​17 μmol/​l
Alanine aminotransferase, ALT 5–​35 IU/​l
Aspartate transaminase, AST 5–​35 IU/​l
Alkaline phosphatase, ALP 30–​150 IU/​l (non-​pregnant adults)
Albumin 35–​50 g/​l
Protein (total) 60–​80 g/​l
Cardiac enzymes
Troponin T <0.1 μg/​l
Creatine kinase 25–​195 IU/​l
Lactate dehydrogenase, LDH 70–​250 IU/​l
Lipids and other biochemical values
Cholesterol <5 mmol/​l desired
Triglycerides 0.5–​1.9 mmol/​l
Amylase 0–​180 Somogyi U/​dl
C-​reactive protein, CRP <10 mg/​l
Calcium (total) 2.12–​2.65 mmol/​l
Glucose, fasting 3.5–​5.5 mmol/​l
Prostate-​specific antigen, PSA 0–​4 ng/​ml
T4 (total thyroxine) 70–​140 mmol/​l
Thyroid-​stimulating hormone, TSH 0.5–​5.7 mU/​l
Abbreviations: eGFR, estimated glomerular filtration rate; PaCO2, partial pressure of carbon dioxide in arterial blood; PaO2, partial pressure of oxygen in arterial blood.
Reproduced from M Longmore and IB Wilkinson et al., Oxford Handbook of Clinical Medicine, Ninth Edition, 2014, with permission from Oxford University Press

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Abbreviations

γGT gamma-​glutamyl transferase ALL acute lymphocytic leukaemia

5-​ASA 5-​aminosalicylic acid ALP alkaline phosphatase
6MP 6-​mercaptopurine ALS amyotrophic lateral sclerosis
AA AA protein-​related renal amyloidosis ALT alanine aminotransferase
AAA abdominal aortic aneurysm AMA anti-​mitochondrial antibody
AAFB acid-​and alcohol-​fast bacteria AMD age-​related macular degeneration
AASV antineutrophil cytoplasmic antibody-​associated AMI acute myocardial infarction
systemic vasculitis AML acute myeloid leukaemia
Ab antibody AMP adenosine monophosphate
ABC Airway, Breathing, and Circulation ANA antinuclear antibody
ABCDE Airway, Breathing, Circulation, Disability, and ANC absolute neutrophil count
Exposure ANCA antineutrophil cytoplasmic antibody
ABG arterial blood gas ANS alcohol nurse specialist
ABP arterial blood pressure anti-​dsDNA anti-​double-​stranded DNA antibody
ABPA allergic bronchopulmonary aspergillosis anti-​HBc antibody to the hepatitis B core antigen
ABPI ankle–​brachial pressure index anti-​HBe antibody to the hepatitis B e antigen
ABPM ambulatory blood-​pressure monitoring anti-​HBs antibody to the hepatitis B surface antigen
AC air conduction anti-​LKM anti-​liver kidney microsomal type 1 antibody
ACD anaemia of chronic disorders anti-​LPA anti-​liver–​pancreas antigen antibody
ACE angiotensin-​converting enzyme anti-​SLA anti-​soluble liver antigen antibody
ACE-​I angiotensin-​converting-​enzyme inhibitor anti-​SMA smooth muscle antibody
ACPA anti-​citrullinated protein/​peptide antibody anti-​TNF anti-​tumour necrosis factor
ACR albumin–​creatinine ratio ANZDATA Australia and New Zealand Dialysis and Transplant
ACS acute coronary syndrome Registry
ACT activated clotting time APACHE Acute Physiology and Chronic Health Evaluation
ACTH adrenocorticotropic hormone APC activated protein C
AD autosomal dominant APKD adult polycystic kidney disease
ADA adenosine deaminase APS antiphospholipid syndrome
ADC apparent diffusion coefficient APTT activated partial thromboplastin time
ADH antidiuretic hormone APTTr activated partial thromboplastin time ratio
ADP adenosine diphosphate AR autosomal recessive
ADT androgen deprivation therapy ARB angiotensin II receptor blocker
AEIPF acute exacerbation of idiopathic pulmonary fibrosis ARDS acute respiratory distress syndrome
AF atrial fibrillation ARF acute renal failure
AFB acid-​fast bacilli ARPKD autosomal recessive polycystic kidney disease
AH atrium–​His ARR aldosterone:renin activity ratio
AHF acute heart failure ARSAC Administration of Radioactive Substances Advisory
AHI apnoea hypopnoea index Committee
AI adrenal insufficiency ART antiretroviral therapy
AIDS acquired immune deficiency syndrome ARVC arrhythmogenic right ventricular cardiomyopathy
AIH autoimmune hepatitis ARVC/​D arrhythmogenic right ventricular cardiomyopathy/​
AIN anal intra-​epithelial neoplasia dysplasia
AION anterior ischaemic optic neuropathy AS ankylosing spondylitis
AIP autoimmune pancreatitis ASAS Assessment of SpondyloArthritis International
AIVR accelerated idioventricular rhythm Society
AJCC American Joint Committee on Cancer ASD atrial septal defect
AKI acute kidney injury AST aspartate aminotransferase
AL amyloid light chain AT antithrombin
ALA amoebic liver abscess ATG antithymocyte globulin
ALD alcoholic liver disease ATL adult T-​cell leukaemia
ALERT Acute Life-​threatening Events Recognition and ATN acute tubulointerstitial nephritis
Treatment ATP adenosine triphosphate
ALF acute liver failure AUDIT Alcohol Use Disorders Identification Test

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 AV atrioventricular CCF congestive cardiac failure
aVF augmented voltage unipolar left foot lead CCP cyclic citrullinated peptide
AVIR accelerated idioventricular rhythm CCS Canadian Cardiovascular Society
aVL augmented voltage unipolar left arm lead CD Crohn’s disease
AVN atrioventricular node CDC Centers for Disease Control
AVNRT atrioventricular nodal re-​entrant tachycardia CDI cranial diabetes insipidus
AVP arginine vasopressin CF counting fingers
AVPU Alert, Voice, Pain, or Unresponsive CGD chronic granulomatous disease
AVRT atrioventricular re-​entrant tachycardia CHD coronary heart disease
AVSD atrioventricular septal defect CHF congestive heart failure
AZA azathioprine CI confidence interval
BAE bronchial artery angiography and embolization CIDP chronic inflammatory demyelinating
BAL bronchoalveolar lavage polyradiculoneuropathy
BC bone conduction CIPO chronic idiopathic pseudo-​obstruction
BCC basal cell carcinoma CIS carcinoma in situ
BCLC Barcelona Clinic Liver Cancer CJD Creutzfeldt–​Jakob disease
BCNIE blood culture-​negative infective endocarditis CK creatine kinase
BCP basic calcium phosphates CKD chronic kidney disease
BCR B-​cell receptor CLL chronic lymphoid leukaemia
BCT broad-​complex tachycardia CMAP compound muscle action potential
BD brain death CMC carpometacarpal
BDD body dysmorphic disorder CML chronic myeloid leukaemia
BI bacterial index CMRI cardiac magnetic resonance imaging
BIMA bilateral internal mammary artery CMT Charcot–​Marie–​Tooth disease
BIPAP bi-​level positive airway pressure CMV cytomegalovirus
BIPSS bilateral inferior petrosal sinus sampling CNS central nervous system
BMD bone mineral density COCP combined oral contraceptive pill
Abbreviations

BMI body mass index COP cryptogenic organizing pneumonia

BMRC British Medical Research Council COPD chronic obstructive pulmonary disease
BMT bone marrow transplantation CPAP continuous positive airways pressure
BNP brain natriuretic peptide CPB cardiopulmonary bypass
BO Barrett’s oesophagus CPEX cardiopulmonary exercise testing
BP blood pressure CPP combined physical and psychological programme
BPH benign prostatic hypertrophy CPPD calcium pyrophosphate dihydrate deposition
bpm beats per minute CrAG cryptococcal antigen
BPPV benign paroxysmal positional vertigo CRAO central retinal artery occlusion
BRAO branch retinal artery occlusion CRF clinical risk factor for parental hip fracture
BRF bone risk factor CRH corticotrophin-​releasing hormone
BrS Brugada syndrome CRP C-​reactive protein
BRVO branch retinal vein occlusion CRT cardiac resynchronization therapy
BSA body surface area CRVO central retinal vein occlusion
BSD brainstem death CS corticosteroid
BSE bovine spongiform encephalopathy CSF cerebrospinal fluid
BSG British Society of Gastroenterology CSH carotid sinus hypersensitivity
BTS British Thoracic Society CSM carotid sinus massage
CABG coronary artery bypass graft surgery CT computed tomography
CAD coronary artery disease CTA computed tomography angiography
CADASIL cerebral autosomal dominant arteriopathy with CTD connective tissues disease
subcortical infarcts and leucoencephalopathy CTEPH chronic thromboembolic pulmonary hypertension
CAH congenital adrenal hyperplasia CTPA computed tomography pulmonary angiography
CAM Confusion Assessment Method CVA cerebral vascular accident
cANCA cytoplasmic antineutrophil cytoplasmic antibody CVD cardiovascular disease
CAP community-​acquired pneumonia CVID common variable immunodeficiency
CaSR calcium-​sensing receptor CVP central venous pressure
CBCD chronic bullous disease of childhood CVPT catecholaminergic polymorphic ventricular
CBD common bile duct tachycardia
CBG cortisol-​binding globulin CWS cotton-​wool spot
CBT cognitive behavioural therapy CXR chest X-​ray
CBZ carbimazole CYC cyclophosphamide
CCB calcium-​channel blocker DA dermatitis artefacta

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DADS distal acquired demyelinating symmetrical ET essential tremor
DAH diffuse alveolar haemorrhage EUA examination under anaesthesia
DAS Disease Activity Score EUS endoscopic ultrasound
DAT drug action team FAP familial amyloid polyneuropathy
DBS deep brain stimulation FAST Face Arm Speech Test
DCM dilated cardiomyopathy FBC full blood count
DEXA dual-​energy X-​ray absorptiometry FDA Food and Drug Administration
DF Maddrey discriminant function FDG fluorodeoxyglucose
DHEA dehydroepiandrosterone FDP fibrinogen degradation products
DHEAS dehydroepiandrosterone sulphate FEV1 forced expiratory volume in 1 second
DI diabetes incipidus FFA free fatty acid
DIC disseminated intravascular coagulopathy FFR fractional flow reserve
DILD drug-​induced lung disease FFS five-​factor score
DILS diffuse infiltrative lymphocytosis syndrome FHH familial hypocalciuric hypercalcaemia
DIP distal interphalangeal FI faecal incontinence
DIS dissemination in space FiO2 inspired fraction of oxygen
DIT dissemination in time; FISH fluorescent in situ hybridization
DLCO diffusing capacity of the lung for carbon monoxide FLAIR fluid attenuated inversion recovery
DLE discoid lupus erythematosus FLI fatty liver index
DM diabetes mellitus FNAC fine-​needle aspiration cytology
DMARD disease-​modifying anti-​rheumatic drug FOB faecal occult blood
DOT directly observed therapy FSGS focal segmental glomerulosclerosis
DPP-​4 dipeptidyl peptidase-​4 FSH follicle-​stimulating hormone
DRE digital rectal examination FTD frontotemporal dementia
dsDNA double-​stranded DNA FUO fever of unknown origin
DSE dobutamine stress echocardiography FVC forced vital capacity
DST dexamethasone suppression test FVL factor V Leiden

Abbreviations
DU duodenal ulcer FXTAS fragile X-​associated tremor/​ataxia syndrome
DVLA Driver and Vehicle Licensing Agency G1 Genotype 1
DVP diastolic blood pressure G2 Genotype 2
DVT deep-​vein thrombosis G3 Genotype 3
DWI diffusion-​weighted imaging G6PD glucose-​6-​phosphate dehydrogenase
EBUS-​TBNA endobronchial ultrasound-​guided transbronchial GA general anaesthesia
needle aspiration GABA gamma-​aminobutyric acid
EBV Epstein–​Barr virus GAD glutamic acid decarboxylase
ECG electrocardiogram GAD65 glutamic acid decarboxylase autoantibody
Echo echocardiography GALT gut-​associated lymphoid tissue
ECOG Eastern Cooperative Oncology Group GAS Group A streptococcus
EDTA ethylenediamine tetra-​acetic acid GBM glomerular basement membrane
EEG electroencephalogram GBS Guillain–​Barré syndrome
EGDT early goal-​directed therapy GCA giant cell arteritis
eGFR estimated glomerular function rate GCS Glasgow Coma Scale
EHEC enterohaemorrhagic Escherichia coli GFR glomerular filtration rate
EIA enzyme immunoassay GGO ground-​glass opacity
ELISA enzyme-​linked immunosorbent assay GH growth hormone
EMG electromyography GI gastrointestinal
ENA extractable nuclear antigen antibody GIST gastrointestinal stromal tumour
ENT ear, nose, and throat GMC General Medical Council
EOTR end-​of-​treatment response GN glomerulonephritis
EPAP expiratory positive airway pressure GnRH gonadotropin-​releasing hormone
EPO erythropoietin GOLD Global Initiative for Chronic Obstructive Lung
EPP erythropoietic protoporphyria Disease
ePPi extracellular pyrophosphate GORD gastro-​oesophageal reflux disease
EPR electronic patient record GOS Glasgow Outcome Score
EPS electrophysiological study GP general practitioner
ERCP endoscopic retrograde cholangiopancreatography GPA granulomatosis with polyangiitis
EROA effective regurgitant orifice area GPI glycosyl-​phosphatidylinositol
ESC European Society of Cardiology GRA glucocorticoid-​responsive aldosteronism
ESR erythrocyte sedimentation rate GU gastric ulcer
ESRD end-​stage renal disease GUM genito-​urinary medicine

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 GvHD graft-​vs-​host disease IBD inflammatory bowel disease
HAART highly active antiretroviral therapy IBS irritable bowel syndrome
HAP hospital-​acquired pneumonia IC intermittent claudication
HAS human albumin solution ICA islet cell autoantibody
HAV hepatitis A virus ICa,L L-​type calcium current
Hb A adult haemoglobin ICD implantable cardioverter defibrillator
Hb A1c haemoglobin A1c (glycosylated haemoglobin) ICH intracranial haemorrhage
Hb F fetal haemoglobin ICP intracranial pressure
Hb haemoglobin ICU intensive care unit
HBc hepatitis B core protein ID infectious disease
HBeAg hepatitis B e antigen IDL intermediate-​density lipoprotein
HBPM home blood-​pressure monitoring IDU intravenous drug users
HBsAg hepatitis B surface antigen IE infective endocarditis
HBV hepatitis B virus IFD invasive fungal disease
HCC hepatocellular carcinoma IFN interferon
HCM hypertrophic cardiomyopathy IFN-​alpha interferon alpha
HCV hepatitis C virus IgA immunoglobulin A
HD Huntington’s disease IgE immunoglobulin E
HDL high-​density lipoprotein IgG immunoglobulin G
HDU high-​dependency units IgM immunoglobulin M
HDV hepatitis D virus IGRA interferon gamma release assays
HER2 human epidermal growth factor receptor 2 IHD ischaemic heart disease
HEV hepatitis E virus IK1 inward rectifier potassium current
HF heart failure IKr rapidly activating component of the delayed rectifier
HFmrEF heart failure with mid-​range ejection fraction potassium current
HFpEF heart failure with preserved ejection fraction IKs slowly activating component of the delayed rectifier
HFrEF heart failure with reduced ejection fraction potassium channel
Abbreviations

HHT hereditary haemorrhagic telangiectasia IL interleukin

HHV6 human herpes virus 6 IL-​6 interleukin 6
HHV7 human herpes virus 7 ILD interstitial lung disease
HHV8 human herpes virus 8 IM intramuscular
HIFU high-​intensity focused ultrasound IMD inherited metabolic disease
HIGM hyperimmunoglobulin M IMIg intramuscular immunoglobulin
HIT heparin-​induced thrombocytopenia IMPACT Ill Medical Patients’ Acute Care and Treatment
HIV human immunodeficiency virus INa sodium current
HLA human leukocyte antigen INa,K sodium–​potassium pump current
HM hand movements INCX sodium-​calcium exchanger current
HMW high molecular weight INR international normalized ratio
HNPCC hereditary non-​polyposis colorectal cancer IPAP inspiratory positive airway pressure
HNPP hereditary neuropathy with liability to pressure palsies IPD idiopathic Parkinson’s disease
HPA hypothalamic–​pituitary–​adrenal IPF idiopathic pulmonary fibrosis
HPIV human parainfluenza virus IPG implantable pulse generator
HPV human papilloma virus IPI International Prognostic Index
HRA Human Rights Act 1998 IPJ interphalangeal joint
HRCT high-​resolution computed tomography IRIS immune reconstitution inflammatory syndrome
HRS hepatorenal syndrome IRRT intermittent renal replacement therapy
HS hereditary spherocytosis IRT immunoreactive trypsinogen
HSCT haemopoietic stem cell transplantation ISS International Staging System
HSP Henoch–​Schönlein purpura IST inappropriate sinus tachycardia
HSV herpes simplex virus ITP immune thrombocytopenia
HTLV1 human T-​lymphotrophic virus 1 ITT insulin tolerance test
HUS haemolytic–​uraemic syndrome ITU intensive therapy unit
HUV hypocomplementaemic urticarial vasculitis IUD intrauterine device
HV His–​ventricle IV intravenous
IA2 islet antigen 2 autoantibody IVC inferior vena cava
IAA insulin autoantibody IVDU intravenous drug use
IABP intra-​aortic balloon pump IVF in vitro fertilization
IAH intra-​abdominal hypertension IVIg intravenous immunoglobulin
IAP intra-​abdominal pressure IVUS intravascular ultrasound
IBA identification and brief advice JVP jugular venous pulse

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KCO carbon monoxide transfer coefficient MDS myelodysplasia
KDIGO Kidney Disease: Improving Global Outcomes MDT multidisciplinary team
KEEP Kidney Early Evaluation Program MELAS mitochondrial encephalomyopathy with lactic
KS Kaposi’s sarcoma acidosis and stroke-​like episodes
KSHV Kaposi’s sarcoma-​associated herpesvirus MELD Model for End-​Stage Liver Disease
LACS lacunar stroke MEN multiple endocrine neoplasia
LAD left anterior descending MERRF myoclonic epilepsy with ragged red fibres
LAE left atrial enlargement MG myasthenia gravis
LAVAT local anaesthetic video-​assisted thoracoscopy MGUS monoclonal gammopathy of unknown significance
LBBB left bundle branch block MHC major histocompatibility complex
LBC liquid-​based cytology MHRA Medicines and Healthcare Products
LBD Lewy body dementia Regulatory Agency
LBP low back pain MI myocardial infarction
LCIS lobular carcinoma in situ MIC minimum inhibitory concentration
LCSD left cervicothoracic sympathetic denervation MM malignant melanoma
LCX left circumflex artery MMA methylmalonic acidaemia
LDCT low-​dose computed tomography MMR measles, mumps, rubella
LDH lactate dehydrogenase MMSE Mini-​Mental State Examination
LDL low-​density lipoprotein MND motor neuron disease
LEMS Lambert–​Eaton myasthenia syndrome MOAI monoamine oxidase inhibitor
LET linear-​energy transfer MODY maturity-​onset diabetes of the young
LFT liver function test MOF multi-​organ failure
LH luteinizing hormone MPO myeloperoxidase
LIMA left internal mammary artery MPS myocardial perfusion scan
LMN lower motor neuron MR mitral regurgitation
LMWH low-​molecular-​weight heparin MRA magnetic resonance angiography
LN lymph node MRA magnetic resonance angiography

Abbreviations
LOS lower oesophageal sphincter MRC Medical Research Council
LP lumbar puncture MRCP magnetic resonance cholangiopancreatography
LPA Lasting Power of Attorney MRI magnetic resonance imaging
LPP lichen planopilaris MRSA meticillin-​resistant Staphylococcus aureus
LQTS long-​QT syndrome MRV magnetic resonance venography
LR likelihood ratio MS multiple sclerosis
LSMDT local skin cancer multidisciplinary team MSE mental state examination
LT leukotriene MSF Mediterranean spotted fever
LTBI latent infection with Mycobacterium tuberculosis MSM men who have sex with men
LTNP long-​term non-​progressor MSU monosodium urate
LV left ventricular MSUD maple syrup urine disease
LVAD left ventricular assist device MTP metatarsophalangeal
LVEF left ventricular ejection fraction MTX methotrexate
LVESD left ventricular end-​systolic diameter MUP minimum unit price
LVH left ventricular hypertrophy MuSK muscle-​specific kinase
LVNC left ventricular non-​compaction MUST Malnutrition Universal Screening Tool
LVOT left ventricular outflow tract NAAT nucleic acid amplification test
LVRS lung volume reduction surgery NAC N-​acetylcysteine
MAC Mycobacterium avium complex NAD nicotinamide adenine dinucleotide
MALT mucosa-​associated lymphoid tissue NADPH nicotinamide adenine dinucleotide phosphate
MAP mean arterial pressure NAFLD non-​alcoholic fatty liver disease
MAT multifocal atrial tachycardia NAPQI N-​acetyl-​p-​benzoquinone imine
MBL mannan-​binding-​lectin NASH non-​alcoholic steatohepatitis
MCA middle cerebral artery NCRN National Cancer Research Network
MCandS microscopy, culture, and sensitivities NCS nerve conduction study
MCBT mindfulness-​based cognitive therapy NEWS National Early Warning Score
MCH mean cell haemoglobin NFD nephrogenic fibrosing dermopathy
MCHC mean cell haemoglobin concentration NGT nasogastric tube
MCI mild cognitive impairment NHL non-​Hodgkin’s lymphoma
MCP metacarpophalangeal NICE National Institute for Health and Care Excellence
MCV mean corpuscular volume NIHL noise-​induced hearing loss
MDM multidisciplinary meeting NIHSS National Institutes of Health Stroke Scale
MDR multidrug-​resistant NIPPV nasal intermittent positive pressure ventilation

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 NIV non-​invasive ventilation PET positron emission tomography
NK natural killer PEX plasma exchange
NMO neuromyelitis optica PFT pulmonary function testing
NMS neuroleptic malignant syndrome PG prostaglandin
NP nosocomial pneumonia PH pulmonary hypertension
NPL no perception of light PHT pressure half-​time
NRH nodular regenerative hyperplasia PI pancreatic insufficiency
NRT nicotine replacement therapy PIP proximal interphalangeal
NS nephrotic syndrome PISA proximal isovelocity surface area
NSAID non-​steroidal anti-​inflammatory drug PJP Pneumocystis jiroveci pneumonia
NSCLC non-​small cell lung carcinoma PJRT persistent junctional reciprocating tachycardia
NSLBP non-​specific low back pain PK pyruvate kinase
NSTEMI non-​ST-​elevation myocardial infarction PKU phenylketonuria
NSVT non-​sustained ventricular tachycardia PL perception of light
NTA National Treatment Authority PLAX parasternal long-​axis view
NTG glyceryl trinitrate (nitroglycerin) PLE polymorphic light eruption
NTM non-​tuberculous mycobacteria PLMS periodic leg movements during sleep
NT-​pro-​BNP N-​terminal brain natriuretic peptide PLS primary lateral sclerosis
NYHA New York Heart Association PML progressive multifocal leucoencephalopathy
OA osteoarthritis PML progressive multifocal leukoencephalopathy
OAC oral anticoagulation PMN polymorphonuclear
OCP oral contraceptive pill PMT pacemaker-​mediated tachycardia
OCSP Oxfordshire Community Stroke Project PNH paroxysmal nocturnal haemoglobinuria
ODI oxygen desaturation index PNS peripheral nervous system
OGD oesophagogastroduodenoscopy POF premature ovarian failure
OHS obesity hypoventilation syndrome POI premature ovarian insufficiency
OLM ocular larva migrans POTS postural tachycardia syndrome
Abbreviations

ONJ osteonecrosis of the jaw PPH primary pulmonary hypertension

OPSI overwhelming post-​splenectomy infection PPI proton-​pump inhibitor
OSA obstructive sleep apnoea PPM permanent pacemaker
PABA para-​aminobenzoic acid PPMS primary progressive multiple sclerosis
PACNS primary angiitis of the central nervous system PPV polysaccharide pneumococcal vaccine
PaCO2 partial pressure of carbon dioxide in arterial blood pred. predicted
PAH pulmonary arterial hypertension PRES posterior reversible encephalopathy syndrome
PAI primary adrenal insufficiency PRR pattern recognition receptors
PAMP pathogen-​associated molecular patterns PS performance status
pANCA perinuclear antineutrophil cytoplasmic antibody PSA prostate-​specific antigen
PAO2 partial pressure of alveolar oxygen PsA psoriatic arthritis
PaO2 partial pressure of oxygen in arterial blood PSAX parasternal short-​axis view
PAT Paddington Alcohol Test PSC primary sclerosing cholangitis
PBC primary biliary cholangitis PSP primary spontaneous pneumothorax
PC20 the provocative concentration required to cause a PT prothrombin time
20% fall in the forced expiratory volume in 1 second PTA pure tone audiogram
PCI percutaneous coronary intervention PTCA percutaneous transluminal coronary angioplasty
PCO2 partial pressure of carbon dioxide PTH parathyroid hormone
PCOS polycystic ovary syndrome PTU propylthiouracil
PCP pneumocystis pneumonia PUD peptic ulcer disease
PCR polymerase chain reaction PUJ pelvic–​ureteric junction
PCT porphyria cutanea tarda PUO pyrexia of unknown origin
PCV pneumococcal conjugate vaccine PUVA psoralen plus ultraviolet light A
PD Parkinson’s disease PVC premature ventricular complex
PDA patent ductus arteriosus PVE prosthetic valve endocarditis
PE pulmonary embolus PVL Panton–​Valentine leukocidin
PEA pulseless electrical activity PVT portal vein thrombosis
PEEP positive end-​expiratory pressure RA rheumatoid arthritis
PEFR peak expiratory flow rate RAPD relative afferent pupillary defect
PEG percutaneous endoscopic gastrostomy RAS reticular activating system
PEG-​IFNα pegylated interferon alpha RAST radioallergosorbent testing
PEI percutaneous ethanol injection RBBB right bundle branch block
PEM protein-​energy malnutrition RBC red blood cell

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RBV ribavirin SPECT single-​photon emission computed tomography
RCC red-​cell count SQTS short-​QT syndrome
RCM restrictive cardiomyopathy SRH stigmata of recent haemorrhage
RCT randomized control trial SSP secondary spontaneous pneumothorax
RDT rapid diagnostic test SSRI selective serotonin reuptake inhibitor
REM rapid-​eye-​movement ssRNA single-​stranded RNA
RF rheumatoid factor SSSS staphylococcal scalded skin syndrome
RFA radiofrequency ablation STD sexually transmitted disease
RIP Riyadh Intensive Care Programme STEMI ST-​elevation myocardial infarction
RIPA ristocetin-​induced platelet aggregation STI sexually transmitted infection
RNP ribonucleoprotein STIR short T1 inversion recovery
RNS repetitive nerve stimulation SUA serum uric acid
ROSIER Recognition of Stroke In the Emergency Room SUDEP sudden unexpected death in epilepsy
RPGN rapidly progressive glomerulonephritis SUNCT short-​lasting neuralgiform headache with
RR relative risk conjunctival injection and tearing
RRT renal replacement therapy SV40 simian virus 40
RS reactive site SVC superior vena cava
RSV respiratory syncytial virus SVR sustained virologic response
RTA road traffic accident SVT supraventricular tachycardia
RUQ right upper quadrant SWEDD subjects without evidence of dopaminergic deficits
RV right ventricular T3 triiodothyronine
RVAD right ventricular assist device T4 thyroxine
RVOT right ventricular outflow tract TAA thoracic aortic aneurysm
RVOTO right ventricular outflow tract obstruction TACE trans-​arterial chemo-​embolization
SAA serum amyloid A protein TB tuberculosis
SAAG serum–​ascites albumin gradient TBG thyroxine-​binding globulin
SAB Staphylococcus aureus bacteraemia TBNA transbronchial needle aspiration

Abbreviations
SAECG signal-​averaged electrocardiogram TCA tricyclic antidepressant
SAH subarachnoid haemorrhage TCR T-​cell receptor
SAI secondary adrenal insufficiency TdP torsades de pointes
SALT speech and language therapists TE thromboembolism
SaO2 arterial oxygen saturation TFPI tissue factor pathway inhibitor
SAPS Simplified Acute Physiology Score TFT thyroid function test
SARS severe acute respiratory syndrome TGA transposition of the great arteries
SBP systolic blood pressure Th T helper
SCA sudden cardiac arrest Th2 T-​helper type 2
SCC squamous cell carcinoma TIA transient ischaemic attack
SCD sudden cardiac death TIN tubulointerstitial nephritis
SCID severe combined immune deficiency TINU tubulointerstitial disease with uveitis
SCLC small cell lung carcinoma TIPS transjugular intra-​hepatic portosystemic shunt
SCLE subacute cutaneous lupus erythematosus TK tyrosine kinase
ScvO2 central venous oxygen saturation TKI tyrosine kinase inhibitor
SD standard deviation TLC total lung capacity
SF synovial fluid TLCO transfer factor for carbon monoxide
SHBG sex hormone-​binding globulin TLoC transient loss of consciousness
SIADH syndrome of inappropriate antidiuretic hormone TLR Toll-​like receptor
excretion TLS tumour lysis syndrome
SIRS systemic inflammatory response syndrome TM tympanic membrane
SIV simian immunodeficiency virus TNFα tumour necrosis factor alpha
SLE systemic lupus erythematosus TNM tumour, node, and metastases
SLNB sentinel lymph node biopsy TOE transoesophageal echocardiography
SMA smooth muscle antibody TPMT thiopurine methyltransferase
SMART Specific, Measurable, Achievable, Realistic, TPO thyroid peroxidase
and Timed TPR total peripheral resistance
SMR standard mortality ratio TRH thyrotropin-​releasing hormone
SNHL sensorineural hearing loss TRUS trans-​rectal ultrasound
SNRT sinus node re-​entrant tachycardia TSE transmissible spongiform encephalopathy
SOD sphincter of Oddi dysfunction TSH thyroid-​stimulating hormone
SOFA Sequential Organ Failure Assessment TT thrombin time
SOV single-​organ vasculitis TTE transthoracic echocardiography

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 TTP thrombotic thrombocytopenic purpura VC vital capacity
TURBT trans-​urethral resection of bladder tumour VCD vocal cord dysfunction
TURP trans-​urethral resection of the prostate VCLAD very long-​chain acyl-​coenzyme A dehydrogenase
TWI T-​wave inversion deficiency
UA undifferentiated arthritis VDRL Venereal Disease Research Laboratory
U&E urea and electrolytes VEGF vascular endothelial growth factor
UC ulcerative colitis VF ventricular fibrillation
UCD urea cycle disorder VGCC voltage-​gated calcium channel
UDCA ursodeoxycholic acid VGKC voltage-​gated potassium channel complex
UGIH upper gastrointestinal haemorrhage VKA vitamin K antagonist
UKPDS UK Prospective Diabetes Study VLDL very-​low-​density lipoprotein
UKRR UK Research Reserve VLM visceral larva migrans
ULN upper limit of normal VOC volatile organic compound
ULT urate-​lowering therapy VPC premature ventricular complex
UMN upper motor neuron VQ ventilation–​perfusion
UNSCEAR United Nations Scientific Committee on the Effects VSD ventricular septal defect
of Atomic Radiation VT ventricular tachycardia
URTI upper respiratory tract infection VTE venous thromboembolism
USRDS United States Renal Data System VUJ vesicoureteric junction
USS ultrasound scan VZV varicella zoster virus
UTI urinary tract infection WBC white blood cell
UUN urinary urea nitrogen WCC white-​cell count
UV ultraviolet WG Wegener’s granulomatosis (granulomatosis with
UVA ultraviolet light A polyangiitis)
UVB ultraviolet light B WG–​MPA Wegener’s granulomatosis–​microscopic polyangiitis
VA effective alveolar volume WHO World Health Organization
VaD vascular dementia WPW Wolff–​Parkinson–​White syndrome
Abbreviations

VAD ventricular assist devices XO xanthine oxidase

VAP ventilator-​associated pneumonia XP xeroderma pigmentosum
VATS video-​assisted thoracoscopic surgery

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Contributors

Richard Abbott Peter G. Bain

Consultant Neurologist, Leicester Royal Infirmary, Leicester, UK Reader and Honorary Consultant in Clinical Neurology, Charing
Cross Hospital, London, UK
Yasir Abu-​Omar
Consultant Cardiothoracic and Transplant Surgeon, Papworth Amitava Banerjee
Hospital, Papworth Everard, UK Senior Clinical Lecturer in Clinical Data Science and Honorary
Consultant Cardiologist, University College London, London, UK
Bhavyang Acharya
Consultant in Palliative Medicine, Cynthia Spencer Phil Barber
Hospice, Northamptonshire Healthcare NHS Foundation Consultant Respiratory Physician, University Hospital of South
Trust, Northampton, UK Manchester, Manchester, UK

David Adlam Simon Barry

Senior Lecturer in Acute and Interventional Cardiology and Consultant in Respiratory Medicine, University Hospital Llandough,
Honorary Consultant Cardiologist, University of Leicester, Penarth, UK
Leicester, UK
Dirk Bäumer
Joshua Agbetile Consultant Neurologist, Peterborough and Stamford Hospitals NHS
Consultant Respiratory Physician, Homerton University Hospital, Foundation Trust, Peterborough, UK
London, UK
Mike Beadsworth
Daniel Ajzensztejn Consultant in Infectious Diseases and General Medicine,
Consultant Clinical Oncologist, Oxford University Hospitals NHS Royal Liverpool University Hospital, Liverpool, UK
Foundation Trust, Oxford, UK
Nick Beeching
Raza Alikhan Senior Lecturer and Honorary Consultant in Infectious Diseases,
Consultant Haematologist, University Hospital of Wales, Liverpool School of Tropical Medicine and Royal Liverpool
Cardiff, UK University Hospital, Liverpool, UK

Rob Andrews Tony Bentley

Associate Professor of Diabetes University of Exeter, Exeter, UK Consultant Microbiologist, Northampton General Hospital NHS
Trust, Northampton, UK
Tim Anstiss
Member, British Psychological Society, and Fellow, Royal Society Anthony Bewley
of Arts Consultant Dermatologist, Barts Health NHS Trust, London, UK,
and Honorary Senior Lecturer, University of London, London, UK
Charles M. G. Archer
Specialist Registrar in Dermatology, Churchill Hospital Oxford, UK Kailash P. Bhatia
Professor of Clinical Neurology, University College London,
Clive B. Archer London, UK, and Honorary Consultant Neurologist, National
Consultant Dermatologist, Guy’s and St Thomas’ NHS Foundation Hospital for Neurology and Neurosurgery, London, UK
Trust, London, UK
Malini Bhole
Richard Armstrong Consultant Immunologist, The Dudley Group NHS Foundation
Consultant Neurologist, Royal Berkshire NHS Foundation Trust, Trust, Dudley, UK
Reading, UK, and Oxford University Hospitals NHS Foundation
Trust, Oxford, UK Benjamin Bloch
Consultant Orthopaedic Surgeon, Nottingham University Hospitals
Kaleab Asrress NHS Trust, Nottingham, UK
St Thomas’ Hospital, London, King’s College London; Royal North
Shore Hospital, University of Sydney, Australia James Bonnington
Consultant Intensivist, Nottingham University Hospital NHS Trust,
Stephen Aston Nottingham, UK
National Institute for Health Research Academic Clinical Lecturer
in Infectious Diseases, University of Liverpool, Liverpool, UK Ian Bowler
Consultant and Deputy Clinical Lead in Microbiology, John Radcliffe
Mona Bafadhel Hospital, Oxford, UK
Consultant Respiratory Physician, Oxford University Hospitals NHS
Foundation Trust, and Senior Clinical Researcher, University of Marilyn Bradley
Oxford, Oxford, UK Consultant Physician in Genitourinary Medicine, Royal Liverpool and
Broadgreen University Hospitals NHS Trust, Liverpool, UK
Fahd Baig
Clinical Research Fellow, University of Oxford, Oxford, UK Rowland J. Bright-​Thomas
Consultant Respiratory Physician, University Hospital of South
Manchester, Manchester, UK

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 Elaine Buchanan Lucy Cottle
Consultant Physiotherapist, Oxford University Hospitals NHS Consultant Physician in Infectious Diseases, Leeds Teaching
Foundation Trust, Oxford, UK Hospitals NHS Trust, Leeds, UK

Chris Bunch Anthony Cox

Consultant Physician and Clinical Haematologist, John Radcliffe Senior Lecturer in Clinical Pharmacy and Drug Safety, University of
Hospital, Oxford, UK Birmingham, Birmingham, UK

Sarah Cader Sonya Craig

Consultant Neurologist, Basingstoke and North Hampshire Consultant Respiratory and Sleep Physician, Aintree University
Hospital, Basingstoke, UK Hospital, Liverpool, UK

Caroline Cardy Anjali Crawshaw

Consultant Rheumatologist, Worcestershire Royal Hospital, Consultant Respiratory Physician, Queen Elizabeth Hospital,
Worcester, UK University Hospitals Birmingham NHS Foundation Trust,
Birmingham, UK
Alan Carson
Consultant Neuropsychiatrist, NHS Lothian, Edinburgh, UK, and Paul Cullinan
Reader, University of Edinburgh, Edinburgh, UK Professor of Occupational and Environmental Respiratory Disease,
National Heart and Lung Institute, Imperial College, London, UK
Matteo Cella
Lecturer in Clinical Psychology, King’s College London, Nicola Curry
London, UK Consultant Haematologist, Churchill Hospital, Oxford, UK

Aron Chakera David Cutter

Consultant Nephrologist, Sir Charles Gairdner Hospital, Perth, Consultant Clinical Oncologist, Oxford University Hospitals NHS
Australia Foundation Trust, Oxford, UK

Trudie Chalder Adam Darowski

Professor of Cognitive Behavioural Psychotherapy, King’s College Consultant Physician, John Radcliffe Hospital, Oxford, UK, and
London, London, UK Honorary Senior Lecturer, Oxford University, Oxford, UK

John Chambers Parthajit Das

Contributors

Professor of Clinical Cardiology and Consultant Cardiologist, Guy’s Consultant Rheumatologist, Kettering General Hospital NHS
and St Thomas’ NHS Foundation Trust, London UK Foundation Trust, Kettering, UK

Hannah Chapman Patrick Davey

Specialist Registrar in Clinical Oncology, Mount Vernon Cancer Consultant Cardiologist, Northampton General Hospital NHS
Centre, Northwood, UK Trust, Northampton, UK

Mas Chaponda Emily Davies

Consultant in Infectious Diseases and General Medicine, Royal Consultant Dermatologist, Gloucestershire Royal Hospital,
Liverpool University Hospital, Liverpool, UK Gloucester, UK

Mimi Chen Geraint Davies

Consultant Endocrinologist, St.George’s University Hospitals Reader in Infection Pharmacology and Consultant in Infectious
Foundation NHS Trust, London, UK Diseases, University of Liverpool, Liverpool, UK

Nigel Clayton Paul Davies

Senior Chief Clinical Physiologist, Wythenshawe Hospital, Consultant Neurologist, Northampton General Hospital NHS Trust,
Manchester, UK Northampton, UK

Sian Coggle Sam Dawkins

Consultant in Infectious Diseases and Acute Internal Medicine, Specialist Registrar in Cardiology, John Radcliffe Hospital, Oxford, UK
Cambridge University Hospitals NHS Foundation Trust,
David de Berker
Cambridge, UK
Consultant Dermatologist and Honorary Senior Lecturer, University
Graham Collins Hospitals Bristol NHS Foundation Trust, Bristol, UK
Clinician Scientist, Imperial College, London, UK
Aminda De Silva
Cris S. Constantinescu Consultant Gastroenterologist, Royal Berkshire NHS Foundation
Professor of Neurology and Consultant Neurologist, Nottingham Trust, Reading UK
University Hospital NHS Trust, Nottingham, UK
Sarah Deacon
Graham Cooke Consultant Respiratory Physician, Worcestershire Royal Hospital,
Reader Infectious Diseases, Imperial College, London, UK Worcester, UK

Susan Cooper Miguel Debono

Consultant Dermatologist and Honorary Senior Clinical Lecturer, Consultant Endocrinologist and Honorary Senior Lecturer, Royal
Oxford University Hospitals NHS Foundation Trust, Oxford, UK Hallamshire Hospital, Sheffield, UK

Patrick Deegan
Metabolic Physician, Addenbrooke’s Hospital, Cambridge, UK

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Alastair Denniston Sherif Gonem
Consultant Ophthalmologist, University Hospitals Birmingham National Institute for Health Research Clinical Lecturer in
NHSFT & Hon Professor, University of Birmingham, Respiratory Medicine, University of Leicester, Leicester, UK
Birmingham, UK
Lynsey Goodwin
Dhananjay Desai Specialist Trainee in Infectious Diseases and General Medicine,
Consultant Respiratory Physician, University Hospital Coventry, Royal Liverpool University Hospital, Liverpool and North
Coventry, UK Manchester General Hospital, Manchester, UK

Michael Doherty Warren Grant

Professor of Rheumatology and Head of Division of Academic Consultant Clinical Oncologist, Cheltenham General Hospital,
Rheumatology, School of Medicine, University of Nottingham, Cheltenham, UK
Nottingham, UK
Tracey Graves
Moutaz El-​Kadri Consultant Neurologist, Addenbrooke’s Hospital, Cambridge, UK,
Consultant Cardiologist and Electrophysiologist, Sheikh Khalifa and Hinchingbrooke Hospital, Huntingdon, UK
Medical City, Abu Dhabi, UAE
Alexander L. Green
Michelle Ellinson Spalding Associate Professor and Consultant Neurosurgeon, John
Freelance Dietitian, London, UK Radcliffe Hospital, Oxford, UK

Christine Elwell Seamus Grundy

Consultant Oncologist, Northampton General Hospital NHS Trust, Consultant Respiratory Physician, Aintree University Hospital,
Northampton, UK Liverpool, UK

Clare England Pranabashis Haldar

Senior Research Associate, University of Bristol, Bristol, UK Senior Clinical Lecturer in Respiratory Medicine, University of
Leicester, Leicester, UK
Ben Esdaile
Consultant Dermatologist, Whittington Hospital, London, UK George Hart
Honorary Research Professor, University of Manchester,
Robin Ferner Manchester, UK
Honorary Professor of Clinical Pharmacology, University of

Contributors
Birmingham, Birmingham, UK Yvonne Hart
Consultant Neurologist, Newcastle Upon Tyne NHS Foundation
Tom Fletcher Trust, Newcastle, UK
Wellcome Trust/​Ministry of Defence Research Training
Fellow and Speciality Registrar in Infectious Diseases, Liverpool Catherine Harwood
School of Tropical Medicine, and Royal Liverpool University Professor in Dermatology and Honorary Consultant Dermatologist,
Hospital, Liverpool, UK Queen Mary University of London, London, UK

Colin Forfar Victoria Haunton

Consultant Cardiologist, Oxford University Hospitals NHS Consultant and Honorary Senior Lecturer in Geriatric Medicine,
Foundation Trust, Oxford, UK University Hospitals of Leicester NHS Trust, Leicester, UK

Martin Fotherby Neil Herring

Consultant Stroke Physician, Leicester Royal Infirmary Leicester, UK Associate Professor of Cardiovascular Physiology, University
of Oxford, Oxford, UK, and Consultant Cardiologist, Oxford
Anthony Frew University Hospitals NHS Trust, Oxford, UK
Professor of Allergy and Respiratory Medicine, Royal Sussex County
Hospital, Brighton, UK William G. Herrington
Honorary Consultant Nephrologist, Churchill Hospital,
Paul Frost Oxford, UK
Consultant in Intensive Care Medicine, University Hospital of
Wales, Cardiff, UK Melvyn Hillsdon
Associate Professor of Exercise and Health Behaviour, University of
Hill Gaston Exeter, Exeter, UK
Emeritus Professor of Rheumatology, University of Cambridge,
Cambridge, UK Stephan Hinze
Consultant Neurologist, Great Western Hospital, Swindon, UK
David J. Gawkrodger
Professor Emeritus in Dermatology, University of Sheffield, Sandeep Hothi
Sheffield, UK Bye Fellow, University of Cambridge, Cambridge, UK, and Specialist
Registrar in Cardiology and General Internal Medicine, Glenfield
Sir Ian Gilmore Hospital, Leicester, UK
Honorary Consultant, Royal Liverpool University Hospital, and
Honorary Professor, University of Liverpool, Liverpool, UK Jonathan A. Hyam
Consultant Brain and Comprehensive Spinal Neurosurgeon,
William Gilmore National Hospital for Neurology and Neurosurgery, London, UK,
Research Fellow, National Drug Research Institute, Curtin and Honorary Senior Lecturer in Neurosurgery, University College
University, Perth, Australia London, London, UK

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 Sarosh Irani Chris Lavy
Honorary Consultant Neurologist and Senior Clinical Fellow, John Professor of Orthopaedic and Tropical Surgery, and Consultant
Radcliffe Hospital, Oxford, UK Orthopaedic and Spine Surgeon, University of Oxford, Oxford, UK

Simon Jackson Richard Lessells

Consultant Urogynaecologist, Oxford University Hospitals NHS Senior Infectious Diseases Specialist, University of KwaZulu-Natal,
Foundation Trust, Oxford, UK Durban, South Africa

Kassim Javaid Andrew Lever

Honorary Consultant Rheumatologist, University of Oxford, Professor of Infectious Diseases, University of Cambridge,
Oxford, UK Cambridge, UK, and Honorary Consultant Physician,
Addenbrooke’s Hospital, Cambridge, UK
Rachel Jeffery
Consultant Rheumatologist, Northampton General Hospital NHS Keir Lewis
Trust, Northampton, UK Professor of Respiratory Medicine, University of Swansea,
Swansea, UK
Andrew A. Jeffrey
Consultant Respiratory Physician and Director of Medical Su-​Yin Lim
Education, Northampton General Hospital NHS Trust, Specialist Registrar in Neurology, Leicester General Hospital,
Northampton, UK, and Honorary Senior Lecturer, University of Leicester, UK
Oxford, Oxford, UK
Mark P. Little
Liberty Jenkins Senior Investigator, National Cancer Institute, Bethesda, MD, USA
Fellow in Neuromuscular Medicine, Stanford University Hospital,
Yoon Loke
Palo Alto, CA, USA
Professor of Medicine and Pharmacology, University of East Anglia,
Andrew M. Jones Norwich, UK
Consultant Respiratory Physician, University Hospital of South
Melanie Lord
Manchester, Manchester, UK
Speech and Language Therapist, Fen House, Ely, UK
Michael Jones
Raashid Luqmani
Clinical Fellow in Cardiology, Oxford University Hospitals NHS
Professor of Rheumatology, University of Oxford, Oxford, UK
Contributors

Foundation Trust, Oxford, UK

Linda Luxon
Nerissa Jordan
Professor Emeritus of Audiovestibular Medicine and Honorary
Consultant Neurologist, Fiona Stanley Hospital, Perth, Australia
Consultant Physician in Neuro-otology, University College London
Elizabeth Justice and University College Hospitals NHS Trust, London, UK
Consultant Rheumatologist, Queen Elizabeth Hospital Birmingham,
Graz Luzzi
Birmingham, UK
Consultant in Genitourinary Medicine, Wycombe General Hospital,
Manish Kalla High Wycombe, UK, and Honorary Senior Clinical Lecturer,
Lecturer in Medicine and Clinical Research Fellow, University of University of Oxford, Oxford, UK
Oxford, Oxford, UK
Robert MacKenzie-​Ross
Alexandra Kent Respiratory Consultant, Royal United Hospital, Bath, UK
Research Fellow, John Radcliffe Hospital, Oxford, UK
Rubeta Matin
Satish Keshav Consultant Dermatologist, Churchill Hospital, Oxford, UK
Gastroenterologist and Honorary Senior Lecturer, John Radcliffe
Jane McGregor
Hospital, Oxford, UK
Consultant Dermatologist, Barts Health NHS Trust, London, UK
Saifudin Khalid
Tess McPherson
Consultant Respiratory Physician, Royal Blackburn Hospital,
Consultant Dermatologist, Churchill Hospital, Oxford, UK
Blackburn, UK
Benedict Michael
Richard Knight
National Institute for Health Research Senior Clinician Scientist
Professor of Clinical Neurology, National CJD Research And
Fellow University of Liverpool, Liverpool, UK, and Post-​Doctoral
Surveillance Unit, Edinburgh, UK
Researcher/​Lecturer, Massachusetts General Hospital/Harvard
Robin Lachmann Medical School Boston, MA, USA
Consultant in Metabolic Medicine, National Hospital for Neurology
Siraj Misbah
and Neurosurgery, London, UK
Consultant Clinical Immunologist, John Radcliffe Hospital, Oxford, UK,
Ajit Lalvani and Honorary Senior Clinical Lecturer, Oxford University, Oxford, UK
Chair of Infectious Diseases, Director of the National Institute of
Amit Mistri
Health Research Health Protection Research Unit, Director of the
Consultant in Stroke Medicine, Leicester Royal Infirmary,
Tuberculosis Research Centre, and Head of Respiratory Infections,
Leicester, UK
National Heart and Lung Institute, Imperial College London,
London, UK Sajjan Mittal
Consultant Haematologist, Northampton General Hospital NHS
Trust, Northampton, UK

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Susan Mollan Joanna Pepke-​Zaba
Consultant Ophthalmologist, University Hospitals Birmingham Consultant Respiratory Physician, Papworth Hospital, Papworth
NHSFT & Clinical Fellow, University of Birmingham, Everard, UK
Birmingham, UK
Erlick A. C. Pereira
Rhiain Morris Senior Lecturer in Neurosurgery, St George’s, University of London,
Clinical Psychologist, Oxfordshire Counselling and Psychology London, UK, and Consultant Neurosurgeon, St George’s Hospital,
Practice, Oxford, UK London, UK

Karen Morrison Jeremy Perkins

Associate Dean for Education and Student Experience, Director Consultant Vascular Surgeon, John Radcliffe Hospital, Oxford, UK
of Medical Education, and Professor of Neurology, University
Joanna Peters
of Southampton, Southampton, UK, and Honorary Consultant
Locum Consultant in Infectious Diseases and Medical Microbiology,
Neurologist, University Hospital Southampton, Southampton, UK
Royal Sussex County Hospital, Brighton, Sussex, UK
Alia Munir
Katrina Pollock
Consultant Endocrinologist, Royal Hallamshire Hospital, Sheffield, UK
National Institute for Health Research Clinical Lecturer in
Louisa Murdin Genitourinary Medicine, Imperial College London, London, UK
Consultant Audiovestibular Physician, Guy’s and St Thomas’ NHS
Jenny Powell
Foundation Trust, London, UK
Consultant Dermatologist, Basingstoke and North Hampshire
Elaine Murphy Hospital, Basingstoke, UK
Consultant in Inherited Metabolic Disease, National Hospital for
Jonathan Price
Neurology and Neurosurgery, London, UK
Clinical Tutor in Psychiatry, University of Oxford, Oxford, UK
Chandramouli Nagarajan
Natalia Price
Consultant Haematologist and Adj. Assistant Professor, DUKE-NUS
Consultant Urogynaecologist, John Radcliffe Hospital, Oxford, UK
Medical School, Singapore General Hospital, Singapore
Susan Price
Pradip Nandi
Consultant in Clinical Genetics, Oxford Regional Genetics Service,
Consultant Rheumatologist, Northampton General Hospital NHS
Oxford, UK

Contributors
Trust, Northampton, UK
Norman Qureshi
Abdul Nasimudeen
Consultant Cardiologist and Electrophysiologist, Imperial College
Consultant Chest Physician, Northampton General Hospital NHS
Healthcare NHS Trust, London, UK
Trust, Northampton, UK
Kazem Rahimi
Pavithra Natarajan
Professor of Medicine, University of Oxford, Oxford, UK
Consultant in Infectious Diseases, North Manchester General
Hospital, Manchester, UK Kim Rajappan
Consultant Cardiologist, John Radcliffe Hospital, Oxford, UK
John Newell-​Price
Professor of Endocrinology and Consultant Endocrinologist, Tommy Rampling
University of Sheffield, Sheffield, UK Academic Clinical Fellow, University College London, London, UK
Jim Newton James Ramsden
Consultant Cardiologist, Oxford University Hospitals NHS Consultant ENT Surgeon, John Radcliffe Hospital, Oxford, UK
Foundation Trust, Oxford, UK
Anna Rathmell
Pippa Newton Medical Manager, Takeda UK Ltd, Wooburn Green, UK, and Lay
Consultant in Infectious Diseases, Manchester University NHS Member, South Central–​Oxford C Research Ethics Committee,
Foundation Trust, Manchester, UK Bristol, UK
Kannan Nithi David Ratliff
Consultant Neurologist and Neurophysiologist, Northampton Consultant Vascular Surgeon, Northampton General Hospital NHS
General Hospital NHS Trust, Northampton, UK Trust, Northampton, UK
Christopher A. O’Callaghan Karim Raza
Professor of Medicine and Honorary Consultant Physician and Professor of Clinical Rheumatology, University of Birmingham,
Nephrologist, University of Oxford, Oxford, UK Birmingham, UK
Liz Orchard Dave Riley
Consultant Cardiologist, John Radcliffe Hospital, Oxford, UK Palliative Medicine Consultant and Clinical Director,
Northamptonshire Healthcare NHS Foundation Trust,
Rakesh Panchal
Northampton, UK
Consultant Respiratory Physician, Glenfield Hospital, Leicester, UK
Simon Rinaldi
Manish Pareek
MRC Clinician Scientist and Honorary Consultant Neurologist,
Senior Clinical Lecturer in Infectious Diseases, University of
University of Oxford, Oxford, UK
Leicester, Leicester, UK, and Honorary Consultant in Infectious
Diseases, Leicester Royal Infirmary, Leicester, UK

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 Joanna Robson Christine Soon
Consultant Senior Lecturer in Rheumatology, University of Consultant Dermatologist, Northampton General Hospital NHS
the West of England, Bristol, UK Trust, Northampton, UK

Kufre Sampson David Sprigings

Consultant Clinical Oncologist, Leicester Royal Infirmary, Formerly Consultant Physician, Northampton General Hospital
Leicester, UK NHS Trust, Northampton, UK

John Saunders Robert Stevens

Consultant Gastroenterologist, Royal United Hospital, Bath, UK Consultant Rheumatologist, Doncaster Royal Infirmary,
Doncaster, UK
Alys Scadding
Consultant in Respiratory Medicine, Glenfield Hospital, Jon Stone
Leicester, UK Consultant Neurologist and Honorary Reader in Neurology,
University of Edinburgh, Edinburgh, UK
Matthew Scarborough
Consultant in Clinical Infection, John Radcliffe Hospital, Oxford, UK Sarah Stoneley
Consultant Geriatrician, Leicester Royal Infirmary, Leicester, UK
Alexander Schmidt
Director, Professor of Musicians’ Medicine, and Consultant Michael Stroud
Neurologist, Kurt Singer Institute for Music Physiology and Consultant Gastroenterologist and Professor of Clinical Nutrition,
Musicians’ Health, Berlin, Germany Southampton University Hospital, Southampton, UK

Susanne Schneider Kenny Sunmboye

Consultant Neurologist, Ludwig-​Maximilians-​Universität München, Consultant Rheumatologist and UKNIHR CRN East Midlands
München, Germany Musculoskeletal Disorders Specialty Lead, University Hospitals of
Leicester, Leicester, UK
Martin Scott-​Brown
Consultant Oncologist, University Hospital Coventry, Coventry, UK Ravi Suppiah,
Consultant Rheumatologist, Auckland District Health Board,
Aung Sett Auckland, New Zealand
Consultant Stroke Physician, Fairfield General Hospital, Bury, UK
Joanna Szram
Contributors

Shireen Shaffu Consultant Respiratory Physician, Royal Brompton and Harefield

Consultant Rheumatologist, Leicester Royal Infirmary, Leicester, UK NHS Foundation Trust, London, UK
Karen K. K. Sheares David Taggart
Respiratory Consultant, Papworth Hospital, Papworth Everard, Professor of Cardiovascular Surgery, John Radcliffe Hospital,
Cambridge Oxford, UK
Jackie Sherrard Kathy Taghipour
Consultant Physician, Department of Sexual Health, Churchill Consultant Dermatologist, Whittington Health NHS Trust, London, UK
Hospital, Oxford, UK
James Taylor
Cheerag Shirodaria Consultant Rheumatologist, Northampton General Hospital NHS
Honorary Consultant Cardiologist, John Radcliffe Hospital, Oxford, UK Trust, Northampton, UK
Ehoud Shmueli Sherine Thomas
Consultant Gastroenterologist, Northampton General Hospital, Consultant in Infectious Diseases and General Medicine, Barts
NHS Trust, Northampton, UK Health NHS Trust, London, UK
Kevin Shotliff Bryan Timmins
Consultant Diabetologist, Chelsea and Westminster Hospital, Consultant Neuropsychiatrist, Northamptonshire Healthcare NHS
London, UK Trust, Northampton, UK
Salman Siddiqui Jonathan Timperley
Clinical Senior Lecturer , Glenfield Hospital, Leicester, UK Consultant Cardiologist, Northampton General Hospital NHS
Muthu Sivaramakrishnan Trust, Northampton, UK
Consultant Dermatologist, Ninewells Hospital and Medical School, Stacy Todd
Dundee, UK Consultant in Infectious Diseases and General Medicine, Royal
Jacky Smith Liverpool University Hospital, Liverpool, UK
Professor of Respiratory Medicine, University of Manchester, Palak Trivedi
Manchester, UK, and Honorary Consultant, University Hospital of Academic Clinical Lecturer and Specialist Registrar in Hepatology
South Manchester, Manchester, UK and Gastroenterology, University of Birmingham, Birmingham, UK
Roger Smyth Martin R. Turner
Consultant Psychiatrist, Royal Infirmary of Edinburgh, Edinburgh, UK Professor of Clinical Neurology and Neuroscience, John Radcliffe
Tom Solomon Hospital, Oxford, UK
Professor of Neurology, University of Liverpool, Liverpool, UK

xxviii
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Another random document with
no related content on Scribd:
fruits are small and the tree-characters are not such that the variety
can compete with the standard Reine Claude plums. Esperen was
produced from seed in 1830 by Major Esperen of Malines, Belgium;
it was first fruited in 1844, and was introduced in 1847 by Louis Van
Houtte of Ghent, Belgium. It obtained the designation Drap d’Or from
its close resemblance to that variety.

Tree large, vigorous, upright-spreading, productive; trunk stocky, rough;

branches rough, with numerous, large, raised lenticels; branchlets brash;
leaves flattened, two and one-half inches wide, five inches long, obovate
or oval; margin serrate; petiole thick, tinged red, pubescent, with from two
to five large, globose glands.
Fruit mid-season; about one and one-half inches in diameter, roundish-
oval; cavity shallow, narrow, often lipped; color yellow streaked and
mottled with green, overspread with thin bloom; skin thin, tender, rather
sour; flesh yellow, tender, sweet, aromatic; of good quality; stone free, one
inch by five-eighths inch in size, oval, with pitted surfaces; ventral suture
blunt; dorsal suture wide, deep.

EXCELSIOR
Prunus triflora × Prunus munsoniana

1. Glen St. Mary Cat. 1891-2. 2. Am. Pom. Soc. Cat. 26. 1897. 3. Vt.
Sta. Bul. 67:11. 1898. 4. Ga. Sta. Bul. 68:9, 36. 1905.

Excelsior has not fruited on the Station grounds and is placed in

the list of leading varieties because of the prominence given it in the
above references. The variety was originated by G. L. Tabor, Glen
Saint Mary, Florida, in 1887, from seed of Kelsey supposed to have
been pollinated by Wild Goose, although some authorities believe
De Caradeuc to have been the male parent. It seems to be a
promising variety and was mentioned in the last three catalogs of the
American Pomological Society.
Tree vigorous, vasiform; branches slender; leaves of medium size,
narrow; margin finely crenulate, glandular; petiole short, with from
one to three small glands; flowers small, scattered; fruit early; of
medium size, roundish, dark red with heavy bloom; skin tough; flesh
firm, yellowish with red tinge towards the center; quality good; stone
of medium size, compressed, clinging.

FIELD
 FIELD

Prunus domestica

1. Mich. Hort. Soc. Rpt. 288. 1889. 2. Am. Gard. 14:50, 395. 1893. 3.
Rural N. Y. 55:622. 1896. 4. Cornell Sta. Bul. 131:184. 1897. 5. Mich. Sta.
Bul. 169:244. 1899. 9. Ibid. 187:77, 78. 1901. 7. Waugh Plum Cult. 101,
104 fig. 1901. 8. Ohio Sta. Bul. 162:239, 240 fig., 254, 255. 1905.
Early Bradshaw 2.

This offspring of Bradshaw resembles its parent in tree, and in

size, color and shape of fruit, though not so closely as to be readily
mistaken for the older variety. Differences which distinguish the fruits
of the two are: The Field is a trifle smaller, the fruit is more nearly
round, lacking the prolonged neck of Bradshaw and is more plump at
the base, the parent plum being markedly obovate; Field is earlier
than Bradshaw, the latter difference accounting for the synonym,
“Early Bradshaw.” The quality is not such as to commend either of
these plums, but of the two Field is slightly the better. In tree-
characters, Bradshaw excels in having a larger tree and in being
more productive. The foliage of Field is very good, it ripens its wood
well and begins to bear while young, but it is inclined to a biennial
bearing habit which makes the average in quantity of fruit a little too
low for a market plum which Field is, if worth planting at all. A good
quality of this variety is that it withstands the brown-rot very well. It is
doubtful if Field is worthy of a place in the fruit-growing regions of
New York, unless, perhaps, where a plum of the Bradshaw type, but
a little earlier, is wanted. Like Bradshaw, Field is comparatively little
attacked by San José scale.
Field is a seedling of Bradshaw grown in Schoharie County, New
York. It was first noted by S. D. Willard of Geneva, New York, in
1889, as “a variety worthy of cultivation.”

Tree of medium size and vigor, upright-spreading, dense-topped, hardy,

productive; branches ash-gray, smooth except for the numerous, small,
raised lenticels; branchlets slender, short, with internodes of medium
length, greenish-red changing to brownish-drab, with a trace of red, dull,
pubescent becoming slightly less so at maturity, with numerous,
inconspicuous, small lenticels; leaf-buds below medium in size, short,
obtuse, appressed.
Leaves folded backward, obovate, two and one-sixteenth inches wide,
four and three-eighths inches long; upper surface dark green, nearly
glabrous, with shallowly grooved midrib; lower surface sparingly
pubescent; apex abruptly pointed, base acute, margin serrate, with a few,
smallish, black glands; petiole seven-eighths inch long, thick, tinged with
red, sparingly pubescent.
Season of bloom intermediate, short; flowers appearing after the leaves,
one inch across, white, with a yellowish tinge at the apex of the petals;
scattered on lateral buds and spurs, singly or in pairs; pedicels five-
eighths inch long, thick, with few, short, scattering hairs, greenish; calyx-
tube green, campanulate, glabrous; calyx-lobes above medium in width,
obtuse, slightly pubescent on both surfaces, glandular-serrate, somewhat
reflexed; petals broadly oval, entire, tapering below to short, broad claws;
anthers yellowish; filaments three-eighths inch long; pistil glabrous, shorter
than the stamens.
Fruit mid-season, period of ripening short; one and seven-eighths
inches by one and five-eighths inches in size, oblong-oval, compressed,
halves equal; cavity shallow, narrow, abrupt; suture shallow, broad; apex
roundish; color dark purplish-red, overspread with very thick bloom; dots
numerous, small, russet, clustered about the apex; stem three-quarters
inch long, sparingly pubescent, adhering well to the fruit; skin thin, slightly
sour, separating readily; flesh greenish-yellow, medium juicy, sweetish,
mild; of fair quality; stone clinging, one inch by five-eighths inch in size,
ovate with roughened and deeply pitted surfaces, blunt at the apex and
base; ventral suture broad, distinctly furrowed; dorsal suture acute.

FOREST GARDEN
 FOREST GARDEN

Prunus hortulana mineri

1. Minn. Hort. Soc. Rpt. 81. 1882. 2. Am. Pom. Soc. Cat. 42. 1883. 3.
Minn. Hort. Soc. Rpt. 412. 1889. 4. Ia. Hort. Soc. Rpt. 55. 1890. 5. Cornell
Sta. Bul. 38:37, 86. 1892. 6. Mich. Sta. Bul. 118:53. 1895. 7. Wis. Sta. Bul.
 63:24, 37. 1897. 8. Wis. Hort. Soc. Rpt. 136. 1899. 9. Waugh Plum Cult.
148. 1901. 10. Can. Exp. Farm Bul. 43:30. 1903. 11. Ohio Sta. Bul.
162:254, 255. 1905. 12. S. Dak. Sta. Bul. 93:17, 49 & 54 Pl. 1905.

Forest Garden is placed by most horticulturists in Prunus

americana, but the trees growing on the Geneva Station grounds
belong to the Miner group of Prunus hortulana and the herbarium
specimens of foliage and flowers sent from other stations make it
probable if not certain that the trees here are true to name. This
variety is little grown in the East, but it is widely distributed in the
central West where both in tree and fruit-characters it seems
adapted to the needs of the climate and soil. It is one of the latest of
its group, maturing at a good time for shipping, for which it is further
adapted by its tough skin and firm flesh. While Forest Garden is not
preeminently a dessert plum, it has a spicy flavor that makes it
pleasant eating and it is admirably adapted for culinary purposes,
especially for preserving.
This variety is from a wild plum found in the woods bordering on
the Cedar River, near Cedar Rapids, Iowa, by Thomas Hare, and
introduced by H. C. Raymond, of the Forest Garden Nurseries,
Council Bluffs, Iowa, about 1862. The American Pomological Society
placed the variety on its fruit catalog list in 1883, dropped it in 1891,
and replaced it in 1897.

Tree medium to large, often very vigorous, spreading, with sprawling

habit, inclined to be flat-topped, perfectly hardy, variable in
productiveness, bearing young, somewhat susceptible to shot-hole
fungus; trunk small in proportion to the size of the tree, shaggy; branches
rather rough, zigzag and inclined to split, thorny, dark ash-brown, with
numerous, small lenticels; branchlets thick, long, willowy, with short
internodes, greenish changing to dark chestnut-red, glossy, with thin
pubescence when young, which disappears in autumn, with conspicuous,
numerous raised lenticels; leaf-buds small, short, obtuse, plump,
appressed.
Leaves falling early, folded upward, elongated-oval, or obovate, peach-
like, one and three-quarters inches wide, four and one-quarter inches
long, thin and leathery; upper surface smooth, with a shallow, grooved
midrib; lower surface silvery-green, pubescent; apex taper-pointed, base
somewhat abrupt, margin doubly crenate, glandular; petiole three-quarters
inch long, sparingly pubescent, faintly tinged with red, usually with two
conspicuous, globose, brownish glands below the base of the leaf.
Blooming season late and long; flowers appearing with the leaves;
seven-eighths inch across, white, with a strong, disagreeable odor; borne
in dense but scattering clusters on lateral buds and spurs, in threes or in
fours; pedicels nine-sixteenths inch in length, slender, glabrous, greenish;
calyx-tube green, narrowly campanulate or obconic, glabrous; calyx-lobes
narrow, obtuse, slightly pubescent, margined with few hairs and with dark-
colored glands, slightly reflexed; petals oval, erose, tapering to long claws
of medium width; anthers yellowish; filaments seven-sixteenths inch in
length; pistil glabrous, shorter than the stamens.
Fruit variable in season which is usually late and short; about one and
one-eighth inches in diameter, rather large, roundish-ovate or nearly oval,
slightly compressed, halves equal; cavity shallow, wide, flaring; suture a
line; apex roundish or somewhat pointed; color light or dark red, with thin
bloom; dots numerous, russet, conspicuous; stem slender, five-eighths
inch long, glabrous, detaching from the fruit at maturity; skin thick, tough,
slightly astringent, adhering; flesh dark golden-yellow, juicy, coarse,
fibrous, melting, sweetish next the skin but rather sour toward the center,
with a strong and peculiar flavor, aromatic; fair to good; stone clinging,
three-quarters inch by five-eighths inch in size, oval, turgid, blunt and
slightly flattened at the base, ending in an abrupt but sharp point at the
apex, nearly smooth; ventral suture narrow, faintly ridged; dorsal suture
acute.

FOREST ROSE
 FOREST ROSE

Prunus hortulana mineri

1. Mich. Pom. Soc. Rpt. 290. 1889. 2. Ia. Hort. Soc. Rpt. 55. 1890. 3.
Cornell Sta. Bul. 38:55, 86. 1892. 4. Mich. Sta. Bul. 123:19. 1895. 5. Ia.
Sta. Bul. 31:346. 1895. 6. Colo. Sta. Bul. 50:36. 1898. 7. Ohio Sta. Bul.
 113:154. 1899. 8. Waugh Plum Cult. 173. 1901. 9. Budd-Hansen Am.
Hort. Man. 296. 1903.

Forest Rose, like Forest Garden, belongs to Prunus hortulana

mineri, the two being similar in many respects. Forest Rose,
however, is not as attractive in color as the other variety, the
difference not being well brought out in the color-plates, is smaller
and does not keep nor ship quite as well. The variety under
discussion is better in quality than Forest Garden and better adapted
than the last named variety for the home orchard at least. While
somewhat variable in productiveness, in most localities it bears
annually and abundantly. The trees are rather more thorny than most
of its species.
This variety is said by H. A. Terry of Crescent, Iowa, to be a
seedling of Miner, grown by Scott & Company, a Missouri nursery
firm, and introduced by William Stark, Louisiana, Missouri, in 1878.
Terry offers no evidence to show that this plum is a seedling of Miner
and there is a question as to whether more is really known of its
parentage other than that it came from Missouri.

Tree medium to large, intermediate in vigor, upright-spreading, open-

topped, hardy, variable in productiveness somewhat susceptible to attacks
of shot-hole fungus; trunk very rough and shaggy; branches rough, thorny,
dark ash-gray, with numerous lenticels; branchlets numerous, slender,
variable in length, with internodes of medium length, green changing to
dull reddish-brown, glossy, glabrous, with numerous, small, raised
lenticels; leaf-buds small, short, obtuse, appressed.
Leaves falling early, folded upward, elongated-oval or obovate, one and
one-half inches wide, four inches long, thin; upper surface dull red in the
fall, rugose, glabrous, with the midrib and larger veins deeply grooved;
lower surface light green, somewhat pubescent along the midrib; apex
acuminate, base acute, margin crenate or serrate, with small, dark glands;
petiole slender, five-eighths inch in length, sparsely pubescent along one
side, tinged with red, glandless or with from one to three small, globose or
oval, greenish-brown glands on the stalk.
Flowers seven-eighths inch across, white, with a disagreeable odor;
borne in dense clusters on lateral buds and spurs, in pairs or in threes;
pedicels five-eighths inch long, below medium in thickness, glabrous,
 greenish: calyx-tube green, narrowly campanulate, glabrous; calyx-lobes
short and narrow, acute, serrate, somewhat reflexed, glabrous on the
outer surface, but more or less pubescent on the inner surface and along
the margin, which is strewn with red glands; petals oval, dentate, tapering
below into narrow, lightly pubescent claws of medium length; anthers light
yellow; filaments one-half inch in length; pistil glabrous, shorter than the
stamens.
Fruit late, season short; one and one-eighth inches by one inch in size,
roundish-oval; cavity shallow, narrow, flaring; suture a line; apex roundish;
color dull crimson overspread with thin bloom; dots very numerous, small,
gray, conspicuous; stem slender, three-quarters inch long, smooth, not
adhering to the fruit; skin thick, tough, astringent, inclined to crack under
unfavorable conditions, adhering; flesh dull apricot-yellow, juicy, fibrous,
tender and melting, sweet next to the skin but tart toward the center,
aromatic; fair to good; stone clinging, five-eighths inch by one-half inch in
size, oval, acute at the apex, with pitted surfaces; ventral suture somewhat
blunt.

FOTHERINGHAM
Prunus domestica
1. Rea Flora 208. 1676. 2. Langley Pomona 91. 1729. 3. Miller
Gard. Dict. 3:1754. 4. Forsyth Treat. Fr. Trees 19. 1803. 5. Downing
Fr. Trees Am. 299. 1845. Floy-Lindley Guide Orch. Gard. 286, 383.
1846. 7. Thompson Gard. Ass’t 517. 1859. 8. Hogg Fruit Man. 701.
1884. 9. Waugh Plum Cult. 102. 1901.
Foderingham 1. Fotheringay 8. Foderingham Plum 2. Grove
House Purple 5, 7, 8. Red Fotheringham 8. Sheen 2, 5, 6, 7, 8.
Fotheringham is probably one of the oldest varieties of plums now
cultivated. Although but little if at all grown in this country, it has
maintained its place among standard English varieties for at least
two and a half centuries. The exact time of its origin is not certain,
but it was undoubtedly during the first half of the Seventeenth
Century as Hogg records a reference made to it by Rea in 1665. It
was first grown extensively at Sheen, in Surrey, England, about 1700
by Sir William Temple, who gave it the name Sheen. The variety is
described as follows:
 Tree hardy, vigorous, productive. Fruit matures just before Reine
Claude; of medium size, obovate; suture distinct; stem one inch long; color
reddish-purple with thin bloom; flesh greenish-yellow, sweet, sprightly;
good; freestone.

FREEMAN
Prunus domestica
As this variety grows in the Station orchard it is a remarkably fine
plum. The fruits are attractive, of high quality and the tree-characters
are for most part very good. It is certainly a desirable plum for any
home plantation, and if it proves as productive elsewhere as about
Geneva, it may well be worth growing in commercial orchards.
Freeman is a chance seedling found in the yard of a Mr. Freeman
of Cortland, New York, about 1890 and shortly afterwards introduced
by E. Smith & Sons of Geneva, New York, but is as yet hardly known
by plum-growers.

Tree intermediate in size and vigor, upright-spreading, productive;

branchlets slender, pubescent; leaves oval, one and one-half inches wide,
two and three-quarters inches long; margin serrate or almost crenate,
eglandular or with small dark glands; petiole reddish, glandless or with
from one to four globose glands; blooming season intermediate, short;
flowers appearing after the leaves, creamy-white, usually in scattering
clusters at the ends of lateral spurs; borne singly or in twos.
Fruit mid-season, ripening period short; about one and one-half inches
in diameter, roundish or roundish-oval; cavity very shallow, small, often
lipped; color golden-yellow, blushed and mottled with red on the exposed
cheek, covered with thin bloom; flesh light golden-yellow, firm but tender,
sweet, pleasant flavor; very good to best; stone dark colored, free, seven-
eighths inch by five-eighths inch in size, irregular-oval, somewhat
flattened, abruptly contracted at the base, with surfaces roughened;
ventral suture prominent.

FREESTONE
 FREESTONE

Prunus insititia
1. Am. Gard. 14:148. 1893. 2. Waugh Plum Cult. 129. 1901.
Freestone Damson 2.
 Freestone is a Damson separated from other Damsons chiefly in
being sweeter and more free of stone. It is so inferior to varieties of
its species in several particulars as to have little value for
commercial planting. The fruits are smaller and the pits larger in
proportion to the amount of flesh than with several better known
Damsons and the trees do not bear as large crops as plums of this
species should; these faults of fruit and tree condemn the plum. To
offset the defects in the tree, freedom from black-knot and immunity
to leaf-blight may be mentioned as compensating somewhat. Still
Freestone is hardly to be mentioned as worth planting in either home
or commercial orchard. The origin of this Damson is unknown. Stark
Brothers, Louisiana, Missouri, who introduced the variety about
1889, describe it as “a selected sort which is very hardy, free from
insects, and productive.”

Tree of medium size and vigor, upright-spreading, vasiform, hardy, not

always productive; branches dark ash-gray, thorny; leaves folded upward,
oval, one and one-quarter inches wide, two and one-quarter inches long;
upper surface dark green, rugose; lower surface silvery-green, pubescent;
margin finely serrate, eglandular or with small, brownish glands; petiole
five-eighths inch long, glandless or with one or two small glands; blooming
season late and of medium length; flowers appearing after the leaves,
seven-eighths inch across, the buds creamy, changing to white when
expanded; borne in clusters on lateral buds and spurs, usually in pairs;
anthers reddish; filaments five-sixteenths inch long; pistil shorter than the
stamens.
Fruit late, season long; seven-eighths inch in diameter, roundish-oval;
cavity very shallow and narrow; flesh yellowish-green, juicy, tender, sweet,
mild; fair in quality; stone free, tinged red, five-eighths inch by one-half
inch in size, oval, turgid, with roughened surfaces, acute at the base, blunt
at the apex; ventral suture broad, blunt; dorsal suture with a broad,
shallow groove.

FRENCH
 FRENCH

Prunus insititia

1. Mich. Hort. Soc. Rpt. 289. 1889. 2. Ibid. 64. 1891. 3. Cornell Sta. Bul.
131:184 fig. 40 I. 1897. 4. Mich. Sta. Bul. 169:245. 1899. 5. Waugh Plum
Cult. 129. 1901.
 French Damson 4. French Damson 1, 2, 3.

Far better than the Freestone just discussed is the French

Damson, which in some respects surpasses all other plums in its
group. Thus it is the largest of the Damsons, so large, indeed, as to
lead many to believe that it may be a hybrid with some Domestica
plum, the size of the trees, blossoms and foliage also leading to such
a supposition. This excellent Damson is largely grown for the market
in western New York, good quality as well as size and appearance
aiding in selling the product. The fruits have but one defect, the pit is
large for the amount of flesh. Curiously enough in some seasons the
stone clings and in others is perfectly free. It is in tree-characters that
the French plum best shows its superiority over other Damsons. The
trees are large, the largest of the Damsons in New York, hardy, bear
abundantly and annually and carry their foliage so well that fruit and
wood usually ripen perfectly even when the trees are not sprayed.
The season is a little after that of the more commonly grown
Shropshire, which in most years is an advantage. French, while
becoming popular, is still too little known in New York, where its
behavior warrants quite general planting.
S. D. Willard, a nurseryman of Geneva, New York, probably
introduced French in this country; at least it was brought to notice
mainly through his recommendation. The origin is unknown, but it is
probably an introduction from France and may be an old variety
renamed. The figure of Prune Petit Damas Violet given by Poiteau is
so very similar as to suggest that French may be identical with that
sort.

Tree large, vigorous, spreading, dense-topped, hardy, productive;

branches numerous, ash-gray, roughish, thorny, with lenticels variable in
size; branchlets inclined to develop spurs at the base, rather slender,
short, with short internodes, greenish-red changing to dark brownish-drab,
dull, somewhat zigzag, thickly pubescent, with inconspicuous, small
lenticels; leaf-buds intermediate in size and length, pointed, free.
Leaves folded upward, long-oval, one and one-quarter inches wide,
three inches long; upper surface dark green, covered with fine hairs, with
a grooved midrib; lower surface pubescent; apex abruptly pointed, base
abrupt, margin serrate or nearly crenate, with a few, small, dark glands;
 petiole eleven-sixteenths inch long, rather slender, pubescent, faintly
tinged with red, usually having two very small, globose, greenish-brown
glands on the stalk or base of the leaf.
Blooming season intermediate in time and length; flowers appearing
after the leaves, one and five-sixteenths inches across, white; borne on
lateral spurs, usually in pairs; pedicels five-eighths inch long, slender,
covered with short pubescence, greenish; calyx-tube green, campanulate,
glabrous; calyx-lobes narrow, obtuse, glabrous on the outer surface, thinly
pubescent along the margin and at the base of the inner surface,
glandular-serrate, reflexed; petals oval, dentate or fringed, tapering below
to short, broad claws; anthers distinctly reddish; filaments seven-
sixteenths inch in length; pistil glabrous, equal to the stamens in length.
Fruit late; one and one-half inches by one and one-eighth inches in
diameter, ovate, halves equal; cavity very shallow, narrow, flaring; suture a
line; apex roundish; color dull black, overspread with thick bloom; dots
numerous, small, brownish, inconspicuous; stem slender, three-quarters
inch long, sparingly pubescent, adhering well to the fruit; skin thin, tough,
separating readily; flesh greenish, juicy, fibrous, tender, sweet, pleasant
and sprightly; good; stone variable in adhesion, seven-eighths inch by
one-half inch in size, oval, roughened, acute at the base, blunt at the
apex; ventral suture rather narrow, heavily furrowed and somewhat
winged; dorsal suture with a shallow groove of medium width.

FROGMORE
Prunus insititia

1. Flor. & Pom. 265, Pl. 1876. 2. Mich. Hort. Soc. Rpt. 289. 1889. 3.
Can. Exp. Farm Bul. 2nd Ser. 3:51. 1900. 4. Waugh Plum Cult. 130. 1901.
Frogmore Damson 1, 2. Frogmore Prolific Damson 3.

Frogmore may be considered among the best of the Damsons in

quality for the culinary purposes to which this fruit is commonly put.
The flesh is tender, sweet and good, but adheres rather too tightly to
the stone. The tree of Frogmore is all that could be desired in
productiveness and quite equals most other Damsons in general and
probably surpasses them all, at least on the grounds at this Station,
in length of time that the fruit hangs on the tree. The habit of growth
of this variety varies from that of Prunus insititia as commonly found,
the leaves being larger, the tops more spreading and the branches
less thorny. The variety has hardly been tried enough in New York to
warrant either recommending or condemning it. According to the
Florist and Pomologist, published in 1876, this variety originated a
few years previous to the date of publication in the Royal Gardens at
Frogmore, England.

Tree inferior in size and vigor, round-topped, open, hardy, very

productive; branches thorny, the bark on the older branches splitting
transversely to the direction of growth, making grooves or rings about
three inches apart and two inches or more in length; branchlets slender,
almost glabrous throughout the season, covered with light bloom; leaves
bright red on first opening, somewhat folded backward, obovate, one and
three-eighths inches wide, three and one-half inches long; upper surface
dark green, rugose; lower surface silvery-green, pubescent, margin
eglandular; petiole five-eighths inch long, slender, greenish, glandless or
with one or two small, globose, yellowish-green glands usually at the base
of the leaf; blooming season intermediate in time and length; flowers
appearing after the leaves, one inch across, white, in scattered clusters on
lateral spurs; borne singly or in pairs; anthers yellow with tinge of red;
filaments five-sixteenths inch long; pistil glabrous, equal to the stamens in
length.
Fruit late, season of medium length; one and one-eighth inches by one
inch in size, roundish-oval, compressed, purplish-black, overspread with
thick bloom; flesh golden-yellow, juicy, tender, sweet; good; stone clinging,
three-quarters inch by one-half inch in size, oval, smooth, somewhat acute
at the base and apex; ventral suture blunt or with a short, narrow wing;
dorsal suture with a narrow, shallow groove.

FROST GAGE
Prunus domestica

1. Prince Pom. Man. 2:52. 1832. 2. Mag. Hort. 4:45. 1838. 3. Hoffy
Orch. Comp. 2:1842, 4. Downing Fr. Trees Am. 300. 1845. 5. Horticulturist
3:446. 1848. 6. Cole Am. Fr. Book 219. 1849. 7. Am. Pom. Soc. Rpt. 54.
1852. 8. Hogg Fruit Mun. 362. 1866.
American Damson 8. Frost Plum 4, 6, 8. October Gage 3.
 Frost Gage is too small for market purposes and moreover the fruit
withers rather quickly after picking; the quality is above the average.
The plum is not a Gage, only green fruits being entitled to this name.
At one time this was one of the most popular commercial varieties in
the Hudson Valley, but because of its susceptibility to black-knot it
has lost favor with growers. Downing in 1838 traced the history of
this variety to a tree standing on the farm of a Mr. Duboise, Dutchess
County, New York, Mr. Duboise stating that the original had been
planted by his father. It is doubtful if this is the first tree, however, for
in 1849 Charles Hamilton of Canterbury, Orange County, reported
trees of Frost Gage thirty to forty years old on his place.

Tree of medium size, upright, very productive; branchlets thick; leaves

flattened, oval or obovate, one and one-half inches wide, two and three-
quarters inches long; margin crenate or serrate, with few, small, black
glands; petiole short, usually with one or two glands; blooming season
intermediate, short; flowers appearing after the leaves, white, with a little
yellowish tinge; borne on lateral buds and spurs, singly or in twos.
Fruit late; about one and one-eighth inches in diameter, roundish, dark
purplish-black, covered with thick bloom; stem slender, persistent; skin
tough, sour; flesh greenish-yellow, juicy, firm, sweet, mild; fair to good;
stone clinging, small, irregular-ovate, somewhat oblique.

FURST
Prunus domestica

1. Mas Le Verger 6:45. 1873. 2. Lange Allgem. Garten. 2:421. 1879. 3.

Oberdieck Deut. Obst. Sort. 413. 1881. 4. Lauche Deut. Pom. 8, Pl. 1882.
5. Guide Prat. 159, 363. 1895.
Eugen Fürsts Frühzwetsche 4, 5. Fürst’s Frühzwetsche 2, 3, 4. Fürst’s
Frühzwetsche 1, 4, 5. Quetsche Précoce de Fürst 1, 5.

Furst would undoubtedly be well worthy of very general cultivation

in plum orchards were it not for the fact that it is very similar to the
Italian Prune. The two fruits differ only in season, the Furst being a
few days earlier, and in the tendency of the variety under discussion
to shrivel about the neck. It may be that Furst will succeed in some
localities where the Italian Prune is not a success.
Furst was propagated by the Baron of Trauttenberg, Prague,
Bohemia, who had received it from Professor Pater Hackl,
Leitmeritz, Bohemia, under the name Furst, given in honor of
Eugene Furst, son of the founder of the School of Horticulture of
Frauendorf, Bavaria. Furst Damson has been confused with this
variety, but it is a different plum. Its fruits are distinctly necked and
much inferior in quality, and its shoots are glabrous, while in this
variety they are not. The United States Department of Agriculture
introduced Furst in 1901 and through them this Station received
cions for testing.

Tree of medium size, round-topped, productive; branchlets thick,

marked with slight scarf-skin; leaf-scars very prominent; leaves folded
upward, obovate, two and one-half inches wide, four and one-half inches
long; margin doubly serrate or almost crenate, eglandular or with small
dark glands; petiole thick, pubescent, glandless or with from one to three
globose glands usually on the stalk; blooming season late; flowers one
and one-eighth inches across, white, the opening buds tipped with yellow;
borne on lateral buds and spurs, singly or in twos.
Fruit late; one and seven-eighths inches by one and one-half inches in
size, oval, slightly necked, purplish-black, covered with thick bloom; dots
numerous, reddish, conspicuous; stem thick; flesh greenish-yellow, juicy,
very fibrous, firm, sweet, mild, with pleasant aroma; good to very good;
stone one and one-eighths inches by five-eighths inch in size, free,
irregular-oval, with rather long, tapering, oblique apex, the surfaces
heavily pitted; ventral suture prominent, often winged; dorsal suture wide.

GEORGESON
 GEORGESON

Prunus triflora

1. Ga. Hort. Soc. Rpt. 52, 99. 1889. 2. Am. Gard. 12:308, 501, 574.
1891. 3. Ibid. 13:700. 1892. 4. Cornell Sta. Bul. 62:23, 27. 1894. 5. Tex.
Sta. Bul. 32:488, 489. 1894. 6. Ga. Hart. Soc. Rpt. 94. 1895. 7. Cornell