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The Theories and Techniques of Aro-healing as an Alternative Therapy




, , , Can cancer be inherited? Cancer isn't passed on in the same way as, say, blue eyes or blonde hair. (One such cancer is a rare eye cancer called retinoblastoma.) However, certain cancers, such as breast, bowel and ovarian cancers, do cluster in some families, and may be caused by a single gene. Others may have inherited pre-cancerous conditions, such as polyposis coli - small growths on the large bowel which can turn into bowel cancer. My husband smokes. Does this mean I have a higher risk of lung cancer? Unfortunately, yes. Passive smokers stand a 10 to 30 per cent higher risk of contracting lung cancer - a good reason to encourage your husband to give up cigarettes.                           Is there a link between stress and cancer? There's no hard evidence that stress boosts the risk of cancer, though it can affect the immune system. Trials are now being done to see if relaxation can improve the body's defences against cancer. Of all the medical conditions, cancer is probably the most dreaded and feared. But early diagnosis and ever-improving modern treatments can often lead to a complete cure. One in three of us in the UK will suffer from cancer at some time in our life, and one in five of us will die from it. The most common cancers are lung, breast, bowel, ovary, kidney and melanoma - the most dangerous form of skin cancer. The good news is that almost a third of the people who develop cancer will be cured. And many more will live for several years with the disease, without any problems directly linked to it. HOW CANCER DEVELOPS Our bodies are made up of a variety of different tissues. Each is made up of millions of cells, all arranged in an orderly manner. The appearance and shape of cells from different organs and tissues vary. For example, liver cells are completely different to skin cells. Throughout our lives, cells are constantly lost and replaced by a process of division. Normally this process is under strict control, so that exactly the right number are produced to replace those that are lost. If an injury occurs, the rate of cell production speeds up until it has healed, then slows down again. OUT OF CONTROL Malignant cancer cells divide and grow uncontrollably and will continue to do so indefinitely unless some form of treatment is given. Eventually, they become so numerous that they are visible as a tumour or growth. Cancer cells develop from the body's own normal cells in a series of stages that takes place over many years. The first step is a damaged gene in an individual cell. The faulty gene may be inherited or it may be triggered by factors such as smoking, over-exposure to the sun, or certain types of bacterial or viral infection. But, once it has developed, it switches off another gene which tells the cell when to stop dividing. Abnormal cells are produced all the time, but are destroyed by the body's defence system. When cancer occurs, for some unknown reason, the system breaks down and an abnormal cell survives. LACK OF RESPONSE The cell becomes progressively more abnormal and responds less and less to the body's normal control mechanisms. Eventually, there are enough cancerous cells to form a tumour. Cells from the edge of the tumour then invade and damage the surrounding tissues. Though cancer usually develops unseen, the cells can often be recognized before they become cancerous. For example, a cervical smear test is designed to pick up abnormal cells in the cervix at a pre-cancerous stage when they can be easily treated. BENIGN TUMOURS To most of us, the word 'tumour' automatically signifies cancer. But, in fact, most tumours are found to be benign, or harmless. Unlike malignant tumour cells, benign tumours go on dividing, and may even push aside normal tissue, but they do not invade it. They are also unlikely to spread. It's the ability of cancer cells to spread, or metastasize, that makes the disease so serious. Cancers which metastasize early on are called aggressive tumours, while others don't start to spread until a later stage. Tumours are often graded depending on how aggressive they are. The cells spread via the blood and the lymph - fluid produced by the lymphatic system, which is part of the immune system At first, they pass into blood vessels in the primary, or original, tumour. They may also pass into the lymphatic system of surrounding tissues, from where they drain back into the bloodstream. As the blood travels round the body, some of the cells become stuck at the end of fine blood vessels called capillaries in various organs elsewhere. In a second stage of metastatis, the cancer cells pass through the walls of the blood capillaries and enter a nearby organ, such as the lungs, liver, bone or brain. This organ is often far away from the original tumour. Most of these cells die but some may survive to form secondary tumours, which may also begin to metastasize. Symptoms A change in bowel or bladder habits. A persistent sore throat, cough or hoarseness. Persistent indigestion. Unexplained weight loss. Obvious change in size or bleeding of a mole. Unusual bleeding or discharge. Thickening or lump in the breast, testicle or elsewhere. WHAT CAUSES CANCER? Cancer is not just one disease. There are hundreds of different types, but they all occur when cells multiply in an uncontrolled way. Cancer has many different causes. The biggest known risk factor is smoking, which causes over a third of cancers and is responsible for a similar number of cancer deaths. THE AGE CONNECTION However, cancer is mainly a disease of old age. Though the overall risk of death from cancer has actually gone up by six per cent over the past 30 years, this is largely because, thanks to modern medicine, better diet, sanitation and hygiene, we are living long enough to reach an age when we are at a high risk of cancer. This risk varies and depends on certain factors such as age, inherited characteristics such as a fair skin, which increases the risk of skin cancer, and inherited faulty genes, which will increase the background risk of certain types of cancer. In the race for a cancer cure, early diagnosis is vital - a small cancer tumour is usually easier to treat than a well­developed one. The first step in the diagnostic process is for you to be alert to any suspicious symptoms, particularly bleeding, and report them to your doctor as soon as possible. Of course, these symptoms will probably turn out not to be cancer, but it's better to be safe than sorry. For most of us, a diagnosis of cancer is devastating news, but it is no longer an inevitable death sentence. There has been a vast improvement in diagnosis and treatment in recent years. Far fewer children now die of cancer than they did 20 years ago; there has been a significant decrease in stomach and bowel cancer in adults, and lung cancer among men has also gone down. BETTER CHANCES At the same time, improved treatments have led to people with other sorts of cancer surviving longer. For example, the discovery of hormonal or cell-killing drugs, plus a new awareness of the best time to perform surgery, has led to more women living longer with breast cancer. POSSIBLE SIGNS You should never ignore suspicious symptoms such as: Bleeding from the anus, which can be a sign of bowel cancer. Bleeding from the vagina, either between periods or after the menopause, can be a symptom of both cervical or uterine cancer, especially in older women. Blood in the urine could be a clue to kidney or bowel cancer. Blood in vomit should never be ignored, unless you have had a recent nosebleed, as it can be a sign of stomach cancer. A persistent cough or hoarseness that isn't associated with a cold or chest infection and goes on for longer than two weeks can be a sign of cancer of the larynx or cancer of the lung. Many forms of cancer can be treated by means of radiotherapy. Here, a woman cancer patient is being prepared for treatment. The white device behind the radiographer rotates around the patient's head, delivering penetrating rays which are beamed towards the tumour. A change in bowel habits, for example going to the toilet more or less frequently than usual, having alternate constipation or diarrhoea, dark streaks in the stools or having black, tarry stools, are signs of bleeding in the intestine. See the doctor, too, if you are losing weight without dieting - the loss could be around 22kg (l0lbs) over 10 weeks or less - especially if this is combined with abdominal pain or a change in bowel habits. TESTING TIMES If the doctor suspects you may have cancer, he will refer you to your local hospital for tests and diagnosis. Initial tests may involve investigations such as X-rays and ultrasound, which can reveal the presence of a lump. A part of the suspicious tissue will then be examined under the microscope. This can be done either by biopsy - snipping off a small piece of the tissue for examination - or by cytology, which is studying cells from body fluids such as sputum or cervical mucus for cancer cells. The doctor will then perform a thorough clinical examination, taking particular care to check the lymph nodes adjacent to the tumour to see whether the cancer has spread. Simple blood tests are then run to check liver and bone function and a chest X-ray looks for evidence of spread to these sites. If the doctor suspects cancer has spread elsewhere in the body, this area may also be scanned. HOW SCANS WORK The scanning technique used is usually isotope scanning, where a small amount of a radioactive substance is injected into the body and the blood carries it to the suspected organ or area of tissue. Here, it is scanned using a special instrument which detects radiation. Cancerous cells are clearly visible because they take up a different amount of radioactivity than healthy tissue. Once the doctor has detailed knowledge of the type of cancer, its stage of development and its likely progress, he can then plan a treatment regime with the patient. The aim of cancer treatment is to kill or remove every cancer cell from the patient. There are several different forms of treatment, which may be used alone or may be combined, depending on the nature of the cancer. REMOVING THE TUMOUR Surgery is most often used to treat cancer of the skin, stomach, bowel, uterus, breast and testicle. It may also be used to cut out cancers in the face and neck, including the thyroid gland and larynx, or voice box, as well as cancers of the ovary and the prostate gland.                           As it is vital to remove all the cancerous tissue, the surgeon will cut out the tumour together with some surrounding normal tissue. Since cancer usually spreads first to lymph glands in the area near the tumour, the surgeon may need to remove these too. Where possible, the surgeon will also reconstruct the area in which the cancerous tissue has been surgically removed. For example, if you have had a mastectomy, or breast removal, there are various techniques for giving you a new breast These include using muscle from other parts of the body, such as the shoulder, and inserting a breast implant. In many cases, surgery alone is all that is required. However, additional forms of treatment may be given before or after surgery to make it easier and more effective. Doctors call this way of giving treatment adjuvant therapy. RADIOTHERAPY High energy rays are used to damage the genetic material of cancer cells so they are unable to divide. These might be X-rays, or beta or gamma rays from a radioactive source. The rays are beamed carefully at the area to be treated. Cancer cells are more sensitive to radiotherapy than normal cells, and so are killed at a greater rate. Inevitably, radiotherapy also damages normal cells close to the tumour. But, thanks to the body's ability to repair itself, quite large doses of radiation can usually safely be given, provided the treatment is given slowly. Treatment only lasts a few minutes, is painless and is usually given daily on an out-patient basis for five to six weeks. VARIOUS TECHNIQUES Radiotherapy treatment may also be given externally, using special X-ray machines which direct the rays to the body. In some cases radioactive implants, such as special wires, are inserted into the cancer, allowing large doses of radioactivity to be delivered to the tumour itself with only a small amount directed to the surrounding normal tissue. In cancer of the thyroid gland, a radioactive drink of iodine is sometimes used to destroy cancerous cells painlessly. Chemotherapy is usually given by injection, through an infusion, or drip, or occasionally as tablets and capsules. Some people experience few side-effects from radiotherapy apart from tiredness. However, radiotherapy can make you feel unwell, particularly if you have been feeling ill beforehand as a result of the cancer. Other side-effects may include nausea, vomiting, headaches, diarrhoea and, where radiation is aimed at the stomach or head, a sore mouth. Hair loss may also occur if the head is treated but hair usually regrows within six months. Radiotherapy may also be used to relieve symptoms of cancer, particularly pain, in cases where a cure is not possible. CHEMOTHERAPY Chemotherapy involves treating cancer with cytotoxic, or cell­poisoning, drugs. These destroy cancer cells by combining with and damaging the genetic material of the cells so that they cannot divide. Unfortunately, these drugs poison all rapidly dividing cells, causing side-effects such as hair loss, nausea and a lowered blood count. Damage to normal cells can be minimized by giving large doses of drugs all at once, then leaving a gap of a few weeks before the next treatment to allow normal cells to recover. Chemotherapy may be given intravenously, injected into a muscle, or by mouth. Where there is a risk of relapse after surgery and/or radiotherapy, chemotherapy is given even when there is no sign of cancer present. This treatment technique is known as adjuvant chemotherapy. Some cancers are affected by hormonal levels in the body. Hormone therapy involves either blocking, reducing or increasing hormone levels to act on the cancer. The main types of cancer treated in this way include certain types of breast cancer as well as prostate, thyroid and uterine cancers. Leukaemia, lymphomas and cancers of the lymphatic system, such as Hodgkin's disease, can also be treated. NATURAL DEFENCES Biological therapies are a group of treatments which use natural substances made by the body's immune system, such as cytokines, in order to control cell growth, to increase the body's defences against cancer cells or to boost the production of antibodies to fight cancer cells. Substances known as colony­stimulating factors are also used to help the body recover from the effects of treatment. The therapies are given by injection. At present, most of them are still being tested in clinical trials. More effective therapy As scientists discover more about how cells work, they are developing better treatments. These include drugs attached to antibodies, designed to 'recognize' cancer cells; drugs that block growth factors - substances which encourage cells to grow; and drugs that prevent cancer cells from invading other tissues. Scientists are also beginning to understand how cancer cells turn on and switch off enzymes in the body, which should lead to more effective anti-cancer drugs. Doctors are also working on better ways of detecting cancer. For example, a blood test for a gene thought to lie behind clusters of cancers of the breast, cervix and bowel may be available within the next few years. SIDE-EFFECTS Though all types of cancer therapy create side-effects, with modern methods of management these need not be too troublesome. Common side-effects, such as nausea and vomiting, can be managed with anti-sickness drugs. Mouth ulcers can be prevented by the use of mouth washes and a pain-killing gel. Unfortunately, the embarrassment of hair loss is usually only avoided by wearing a wig, though the hair will grow back. A HELPING HAND Complementary therapies, such as homeopathy, herbalism, healing and acupuncture, are often used in conjunction with conventional medical treatments for cancer. And, today, some cancer units actually offer these treatments to patients. They can help you to relax and to cope with the strain of treatment. At the same time, they may give you back a feeling of being in control of your own body. Screening is performed for common cancers which affect a large number of people. It may also be worthwhile if you know you have a high risk of contracting cancer, for example if your work exposes you to substances known to cause cancer, or if you come from a family with a history of cancers. Screening is a means of detecting early cancers even before there are any signs and symptoms. This means that the cancer can be treated without delay, enhancing the patient's chances of survival. At present, the only national screening programmes are the cervical smear test and mammography ­both for women. A national bowel screening programme for both men and women may be set up, which tests for hidden blood in the stools. In the meantime, people at higher risk of the disease, for example because it runs in their families, can ask to be screened by their doctor or at one of the family cancer clinics for ovarian, testicular or prostate cancer. Cellular facts All cancer cells share certain characteristics: They are long-lived and not subject to the normal bodily influences that control cell growth. They can invade, or grow into, normal tissue. They can migrate to distant tissue and form new tumours. They may divide faster than normal. The body tolerates the presence of cancer without rejecting it as a foreign invader.   Laser treatment is used to activate a cancer-killing drug. Cancerous cells from a prostate tumour  have spread to form metastases, or secondary cancers, in the vertebrae. The orange shadows on a chest X-ray reveal cancer in both lungs. Radiotherapy  is a mainstay of cancer treatment. Accurate planning using aids such as scans  is vital in order to cause minimal damage to the surrounding tissue. A scan reveals cancerous cells which have formed a large tumour in the brain. A natural killer cell attacks a cancer cell. Derived from the Pacific yew tree, Taxol is proving effective against breast and ovarian cancers. A doctor plans radiotherapy treatment with the aid of a computer. Treatment can sometimes cause unpleasant side effects, such as nausea, vomiting and hair loss.     Taken from THE HEALTH FILE  A Complete Medical Encyclopedia, A MARSHALL CAVENDISH REFERENCE COLLECTION by DR JOHN CORMACK, WEEKLY Australia, New Zealand, Malaysia Singapore Malta RSA Other Countries Namibia. DR JOHN CORMACK, BDS MB BS MRCS LRCP, is the medical consultant to The Health File. The senior partner in an Essex­ based practice, he is also a member of the General Medical Council and has written for numerous magazines and news­papers as well as for the medical press. He is a regular broadcaster on television and radio and has scripted a number of award-winning educational videos.   Note: Where gender is unspecified, individuals are referred to as 'he', This usage is for convenience only and not intended to imply that all doctors and patients are male. Medicheck charts are only a rough guide to diagnosis, Always seek medical advice if you have worrying symptoms. Copyright Marshall Cavendish 1995, Printed in Great Britain, Published by Marshall Cavendish Partworks Ltd, 119 Wardour Street, London WIV 3TD , Sexual research in recent years, has established that many of the beliefs which surround sexuality are untrue, and today a better attitude towards sexuality is evident, especially amongst younger people. The research has shown, amongst other things, the following important findings: The 'double standard' of sexual behaviour has diminished, and today women can behave sexually much more freely. Some people regret this sexual 'permissiveness', but they are usually wrong. The change does not mean that most sexual relationships are a sequence of 'one-night stands' (which are unusual, except in certain groups) but that women, as well as men, now feel free to express their sexuality in any way they choose. Many more unmarried men and women are living together, and most of these relationships, which may last for a longer or shorter period, are sharing, one to one relationships. This is something which those people who are anxcious about today's sexual permissiveness and decadence fail to notice. Although some men and women may still feel uncomfortable about explaining their sexual and emotional needs to their partner, this inhibition is beginning to diminish. There is more open discussion about sex between men and women so that each becomes aware of the other's sexual desires and needs. This is good. Only when there is open discussion between lovers, will they become aware of each other's sexual desires and needs. There are several other facets of sexuality which I believe should be emphasised. Many women have known about them, but male dominated society has largely rejected them until recently. They include the following: 1) Women have no less enthusiasm for sex, no less enjoyment of sex and no less sexual drive than men. (2) A woman's sexual response is not intrinsically different from that of a man, but many women are slower to reach full sexual arousal than men, probably because of the sexual attitudes they learned during childhood. (3) Women should be able to say 'yes' without shame, and 'no' without guilt, to a request for sexual intercourse. A woman need no longer be anxious that she may lose the man's love if she refuses his request and should be able to talk with the man about her decision. (4) Women should be encouraged to expect that their relationship with a man is one in which mutual respect for the woman as a person replaces the older expectation that a woman should be dependent financially, emotionally and socially upon him. It is a relationship in which the mutual respect extends to each person's sexuality. Taken from EVERYWOMAN A Gynaecological Guide for Life (Second Edition)   Tags  year sex sensual researching researchers encourage established especially amongst evident people relationship needs desire woman man relationship dominate emphasise discussions lover facet partners inhibitions including responses learn requests refuse loving decisions talks talking attitude arousing old replace replacing social sociology expectations dependents emotional emotion emotions financial extend extending encourage Gynaecology guides lifes seconds editions SEO Sexual research recent years encourage establish sexuality today better attitude towards younger surround untrue many important other behave regret change relationships anxcious emotional beginning notice discussion desires needs women certain groups men recently free living together usually wrong express last longer shorter period choose relationships something unmarried dominated findings following society emphasized explaining sex discussion lovers largely enthusiasm drive several other facets partner inhibition each  between good open known male largely include drive enjoyment enthusiasm less response intrinsically different reach full arousal during childhood learned probably slower woman's able shame without guilt request intercourse lose love refuses decision talk attitudes arousal older mutual replaces socially expectation dependent emotionally financially extends mutual encouraged EVERYWOMAN Gynaecological Guide Life Second Edition, Tips on Personal Appearance & Hygiene - Personal hygiene and appearance are the first things that people notice By David Arnold, eHow Contributor      When meeting someone for the first time, the first impression you make will leave an imprint of your appearance to the other party. The way you look in terms of style and hygiene are the biggest factors with an initial impression. Although it may seem shallow to concentrate on personal appearance only, it is one of the most essential facets of making a good impression. In utilizing a few tips and tricks, you can put your best face forward everyday. Exfoliate the Skin Although bathing seems like an elementary part of hygiene, most people do not understand that bathing in conjunction with exfoliation is essential to keep skin clean and rejuvenated. By exfoliating the skin with face and body scrubs, it reduces blackheads, blemishes and sloughs off dead skin cells. If left untreated, skin can have a dull appearance. Exfoliating with a skin or body scrub can turn skin from muddy to ruddy. If you are not able to purchase expensive body scrubs, simple household items such as baking soda are great ways to exfoliate on a budget. Pure baking soda is a natural product and can be used with or without your favorite soaps and body washes. In utilizing exfoliators, you will reveal glowing, healthy skin. Dress Appropriately Although current trends may suggest certain styles of clothing, every body type cannot accommodate those styles, therefore, it important to select clothing that is appropriate for your body type. For example if you're a woman or man that has a larger bottom half, don't opt for clothing that will accentuate larger hips such as low rise jeans or skinny leg jeans. In order to gain a better grasp of your body type, simply stand in front of a mirror and look at the size and proportions of your body to figure out your body type. Once you have done so, you can then begin to dress it accordingly. Choosing Appropriate Hairstyle When choosing a hairstyle, take into consideration the type of lifestyle that you lead. For example, if you are a public speaker, red and green streaks will not showcase a qualified professional. Choose hairstyle options that fit your lifestyle. Oval shapes can wear virtually any hairstyle, both long and short. Rectangle or square face shapes should opt for styles that create layers and curves to fill any linear areas of the face. Round faces may appear too full and pudgy in the cheek areas, therefore styles that add volume to the top should be employed to make the face appear slighter longer. Triangle and diamond shaped faces should opt for sweeping bangs and fringes to soften harsh lines. Nevertheless, choose hairstyles that will enhance your features while creating the illusion of an oval face. Remain Clean-shaven First, it is important to keep a clean-shaven appearance. Although this may seem directed towards men, women also have amounts of facial hair that can be seen by other people. Excess amount of body hair are also unsightly and may cause sweating and body odor. Therefore, keep the face and body neat and clean. Try Different Deodorants You may notice that at different times of the year, your favorite deodorant may not be working for you as well. Changes in climate as well as hormonal changes can cause a deodorant's odor and wetness fighting ability to slowly taper off. This is the time to try different deodorants. After you have found a few that work, keep them in your arsenal for those times when change is needed.   ·        Eczema Need Helpwww.reitzer.co.za Use Pure Cream- Recommended by Dermatologists-email for a sample ·        Aging Skin TreatmentsThermage.com/FindADoctor No Surgery, Injections or Downtime Find an Official Thermage® Doctor References ·        Health911.com: Remedies for Body Odor ·        Greatestlook.com: Face Shapes ·        Moneyinstructor.com: Good Personal Hygiene Read more: Tips on Personal Appearance & Hygiene | eHow.com ttp://www.ehow.com/list_6384206_tips-personal-appearance-hygiene.html#ixzz1TQmnTeeK , , WHAT IS OCCUPATIONAL THERAPY? It is a creative and dynamic means of assisting a child to process and interpret information. Information is received from sensa­tions in the body and the environ­ment. This includes what the child sees, how he moves, as well as what he hears and feels. How a child responds to, interprets, acts on and reacts to this information will determine his ability to reach his maximum potential in his physical, psychological and functional devel­opment. When these processes are lacking, an individual's performance is com­promised in terms of his learning development. Assessment and treatment during the early childhood phase (between three and nine years) is key to a child reach­ing their maximum potential in their learning development. This reduces the possibility of more severe complications later in develop­ment, behaviour and daily functional abilities. The medical, neurological and psycho­logical background of an occupational therapist gives in-depth insight into assessment and therapy processes used to diagnose and treat children with specific learning disorders.   When does one refer a child for occupational therapy? ·        Visual perceptual difficulties. ·        Difficulty focusing on specific units of information, when there is a lot of information on a written page . ·        The child appears disorganised. ·        Confusing words and letters with a similar appearance. ·        Writing letters in a word in the incorrect order. ·        Difficulty understanding positional concepts of left and right. ·        Frequent reversal of letters. ·        Difficulty working from left to right in reading and writing. ·        Transferring of the pencil to the opposite hand when the midline is reached in writing. ·        Constant postural adjustments or extreme shifting of the book when writing. ·          Difficulty recalling single visual stimuli or an organized sequence of visual stimuli. ·          Difficulty copying from the board as well as spelling difficulties. Problems in visually distinguishing letters and words. Frequent errors and erasing. ·          Difficulty in analysing problems and forming a whole concept.   Sensory motor difficulties ·        Slouched posture when sitting. ·        Inability to keep head in an upright position when seated at a desk. ·        Difficulty planning out a task or action. ·        Slow, clumsy and awkward in the use of their body. ·        Difficulty using both sides of the body simultaneously. ·        Oversensitivity to touch, move­ment, sights and sounds. ·        Easily distracted. ·        Activity level that is either abnor­mally high or low. ·        Impulsive, lacking self-control. ·        Inability to unwind or calm self. ·        Under-reactive to touch, movement, sights and sounds. ·        Physical clumsiness and apparent carelessness. ·        Difficulty making a transition from one situation to another. ·        Difficulties in catching and throw­ing a ball. ·        Difficulties in writing, drawing, cutting, and copying. ·        Difficulty performing fine motor activities, fine finger movements, eye movements, grasping and controlling a pencil. ·        Difficulty performing gross motor and balance activities.   All the above difficulties lead to de­lays in learning development, motor skills, and emotional and/or social behaviour. (Information supplied by Rowena Joseph). , DEFINITION Sport psychology is the science in which the principles of psychology applies in a sport setting - it is often applied to enhance performance.However, the true sport psychologist is interested in much more than performance enhancement.Support is the vehicle for human enrichment.The win-at-all-costs attention is inconsistent with the goals and aspirations of the best sport psychologist.The true sport psychologist is nterested in helping every sport participant reach his or her potential as an athlete.The sport psychologist helps a young athlete develop self-control and confidence - superior athletic performance.A quality sport experience can enhance the athlete's intrinsic motivation without winning.As a whole the sport psychologist is dedicated to enhancement of both the athletic performance and the social psychological aspects of human enrichment.Mind and body work together to achieve maximum performance.   (Taken from SPORT PSYCHOLOGY - CONCEPTS AND APPLICATIONS, DEFINITION by RICHARD H. COX, (THIRD EDITION), , The Single Most Important Thing You Can Do for Your Health The powerful, natural immune-system boosting programme helps you: prevent disease • enhance vitality • live a longer and healthier life Nothing science has discovered can match the power and effectiveness of your own immune system. That's why boosting it is the single most important thing you can do for your health.   TH E MOST IMPORTANT THING YOU CAN DO FOR YOUR HEALTH WHY IS IT THAT SOME PEOPLE SEEM TO HAVE AN ENDLESS SUPPLY of energy and others can hardly drag themselves out of bed in the morning? Or that some people seem to have one cold after another all winter long, while others are out there skiing and snowboarding without even a sniffle? Is it all just a matter of luck? The right genes? Genes certainly are a part of the answer. But even genes no longer mean that we must be passive victims of fate. Today, we can measure our risk of getting various diseases that may run in our families and take prac­tical steps to avoid them or lessen their effect. Some of these steps are as simple as avoiding certain foods and environmental toxins, and taking reg­ular screening tests. In addition to using knowledge of our genetic risk factors to safeguard our health, there are many other aspects of health that are in our own hands. In fact, there is nothing more powerful than the potential weapons of wellness that lie within us all. We are all born with an extraordinary system of immunity that serves as a natural defence against bacteria, viruses and other invaders. Your family tree may tell you a lot, but scientists now say that the strength of your immune system depends on your lifestyle choices: eating well, exercising, reducing stress and even taking a moment, perhaps, to say a prayer or simply think about the good things in life. It is that basic. That is why we believe that boosting your immune system is the most important thing you can do for your health. If you take away nothing else from reading this book, remember this: you can take charge of your health and make simple lifestyle changes that might have a crucial effect on the quality - and perhaps even the length ­of your life. Researchers say that it is never too late to boost your immune system. Scientists have proved that people who take steps to eat healthily show huge improvements in their daily lives, and that exercise is a kind of elixir of youth - a dramatic means of rejuvenating muscles and overall strength. As you adjust your lifestyle to reduce your risk of getting life­shortening diseases such as cancer and heart disease, you will increase your odds of living to a ripe old age. You may not have been able to select your genes, but you certainly can make lifestyle choices that will put your health in your own hands.   How to Take Command of Your HeaIth To understand how your immune system works, think of it as an army. Imagine your cells as the soldiers gearing up for battle to defend against and attack invading germs and viruses. At all times, your immune system operates as a powerful defence, shielding you from the most common cold and the most deadly cancer. It is a magnificent machine that works with military timing and precision, with trillions of cells throughout your body moving in harmony through cooperation and communication. Yet despite the awe-inspiring efficiency with which our immune sys­tems work, they can also benefit from our help. This book will show you how to increase your defences with the Top 20 Immune Boosters, and what to avoid with the Top 10 Immune Busters. It will demonstrate how easy it will be to display a rainbow of fruits and vegetables on your dinner plate - a delicious way of making sure that you and your family consume the rich combination of phytochemicals that your immune system craves to protect it from the assault of free radicals. You will find out why it is so critical to wash your hands frequently, yet avoid common antibacterial products. We will show you how to protect yourself from environmental hazards that can weaken your immune system - including steps as simple as washing your new clothes before wearing them. You will also find out why parking your car at the far end of the carpark and taking the stairs to the office lavatory on another floor will add years to your life. In fact, we will supply you with dozens of simple strategies that will help you live longer, including the most important supplements to take, the most promising stress-relieving techniques and some top exercises to boost your overall health and immunity. If you should experience health problems - perhaps you come down with the flu or pneumonia, get a sex­ually transmitted disease or experience chronic fatigue - we will show you how to work with your immune system so that your body best uses its in­nate healing ability to make you well once again. Sometimes, your immune system can become confused and attack it­self. In this book, you will learn how to care for yourself and your family when dealing with autoimmune disorders such as insulin-dependent dia­betes, rheumatoid arthritis, lupus and multiple sclerosis.   The Vitality Diamond Even when you are faced with immune-related diseases, you will dis­cover the amazing power you have to enhance your immune system. You will learn how you can make your immune system shine -like the facets of a diamond. Rather than bore you with a regimented plan, we instead will give you health elements that you can easily incorporate into your life to ultimately create, for yourself and your family, a Vitality Diamond. With the guidance of Dr Keith Berndtson, medical director at Integra­tive Care Centers in Chicago and Glenview, Illinois, you will learn about all the ways in which you can boost your immune system for a long and healthy life.   Our Hidden Weapon Would you ever have put peanut butter at the top of your immune­-enhancing list? For years, diet books advised us to avoid peanut butter because of its high fat content. In fact, nuts and seeds are loaded with good fats, such as essential fatty acids, that actually help your cells to do their jobs. (Of course, if you have an allergy to peanuts, peanut butter is not suitable for you.) In this book, we give you the reasons why you should incorporate essential fatty acids and lots of other tasty nutrients into your eating plan to keep your immune system strong.   The EmotionaI Connection Your immune system is more than what you consume. A relatively new scientific field, psychoneuroimmunology, ex­plains how your mind and body are inextricably linked. Your thoughts and emotions and your immune system are intertwined. What this means is that when you are tired, stressed, or depressed, you tax your immune system. Hormones are secreted that block your immune cells so that they cannot fight off bacteria and viruses. You become ill. Your immune system responds to you, to your choices. Caring for yourself is the most important thing you can do for your health.   TO FOLLOW from THE IMMUNE ADVANTAGE:  Take advantage of the immune-boosting secrets of more than 95 experts including herbalists, nutritionists, doctors and a wide spectrum of alternative practitioners Prevent colds and flu all year round Guard against cancer, diabetes and heart disease Overcome allergies and fight environmental toxins Avoid the pain of arthritis Raise your energy to new levels Nourish your immune system (with a special diet and 50 delicious recipes) Tap into the source of stress reduction   Taken from 'THE IMMUNE ADVANTAGE'  - ELLEN MAZO and DR KEITH BERNDTSON Ellen Mazo is an award-winning health writer. Copyright © 2002 Rodale Inc.     www.rodale.co.uk  , , I.              The child below the age of five can absorb tremendous amounts of information. 2.           The child below five can accept information at a remarkable rate. 3.           The more information a child absorbs below the age of five, the more he retains. 4.           The child below five has a tremendous amount of energy. 5.           The child below five has a monumental desire to learn. 6.           The child below five can learn to read and wants to learn to read. 7.           The child belows five learns an entire language and can learn almost as many as are presented to him. He can learn to read one language or several just as readily as he understands the spoken language. How to teach your baby to read AT WHAT AGE TO BEGIN The question as to when to begin to teach a child to read is a fascinating one. When is a child ready to learn anything? Once a mother asked a famous child-develop­mentalist at what age she should begin to train her child. 'When', he asked, 'will your child be born?' 'Oh, he is five years old now,' said the mother. 'Madam, run home quickly. You have wasted the best five years of his life,' said the expert. Beyond two years of age, reading gets harder every year. If your child is five, it will be easier for him than it would be if he were six. At four it is easier still, and at three it is even easier. Two years of age is the best time to begin if you want to expend the least amount of time and energy in teaching your child to read. (Should you be will­ing to go to a little trouble you can begin at eighteen months, or if you are very clever, as early as ten months of age.) There are two vital points involved in teaching your child: a.            Your attitude and approach. b.            The size and orderliness of the reading matter. if the child has been naughty, it will not do for the parent to tell the child he has been a good boy and may therefore play the game, just because the parent wants to play it himself. The child won't be fooled for an instant. He knows that he has been naughty and he may come to the conclusion that reading must be a punishment rather than a reward. If the child is naughty three days running he simply must not be allowed to play the game for that period of time, no matter how much the parent may look forward to it. The second important thing is to make sure that the length of time you play the game is very short. At first it may be played as often as five times a day, but each session will involve only a few minutes. In determining when to end each session of learn­ing, the parent should exercise great ingenuity. The parent must know what the child is thinking a little bit before the child knows it, and must stop each session well before the child wants to stop. If the parent always observes this fact, the child will beg the parent to play the reading game and the parent will be nurturing rather than destroying the child's natural desire to learn. To sum up, the parent should consistently re­member two things: I. Learning is more fun than anything else. 2.            Sessions should always end before the child wants to stop. I. Parent Attitude and Approach Learning is the greatest adventure in life. Learn­ing is desirable, vital, unavoidable and, above all, life's greatest and most stimulating game. The child believes this and will always believe this - unless we persuade him that it isn't true. The cardinal rule is that both parent and child must joyously approach learning to read. The parent must never forget that learning is life's most exciting game - it is not work. Learning is a reward, not a punishment; a pleasure, not a chore; a privilege, not a denial. The parent must always remember this, and he must never do anything to destroy this natural attitude in the child. Only good children should be given the oppor­tunity to play the reading game; badly behaved chil­dren should be denied the opportunity. Therefore, The materials used should contain the following components: I.             The words mummy and daddy on separate cards, 6" high by 24" long. The letters should be 5" by 4" with approximately t/l between letters; they should be red and printed in lower case. 2. Suitable Materials* The materials used in teaching your child to read are extremely simple. They are based on many years of work on the part of a very large team of scientists who were studying how the human brain grows and functions. They are designed in complete recogni­tion of the fact that reading is a brain function. They recognize the capabilities and limitations of the tiny child's visual apparatus and are designed to meet all his needs from visual crudeness to visual sophistica­tion and from brain function to brain learning. All materials should be made on fairly stiff white cardboard so that they will stand up to the not always gentle handling they will receive. Such stiff cardboard can be obtained at stationers'. It can be bought in large sheets and cut to shape. The words used should be lettered in Indian ink with ballpoint pens or with the ink-filled cartridges with felt tips which are now on the market under various trade names. The printing should be neat and clear and have a consistent, plain lettering style. At least a t/l margin should be maintained all round the various cards.   2.The twenty basic 'self' words (listed under the Second Step, p. 122) on white cards 5/1 high, approximately 24/1 long, in red lower-case letters 4" high.   'ltY ou can get from any bookshop the Teach Your Baby to Read kit, which includes all the vocabularies prescribed in this chapter, printed in the recommended manner and sizes, as well as all the sentences in Who Are You? (see p. 133) - and a bound copy of the book itself, with pictures. 3.The basic words of the child's immediate world (listed under the Third Step, pp. 127-30) on white cards 3" high, in red lower-case letters 2/1 high.   4.         The sentence-structure vocabulary: single­word cards 3" high, with black lower-case words 2" high (p. 131).   6.       A book using a limited vocabulary printed in black upper- and lower-case letters i" high (p. 133).   The materials begin with large red lower-case letters and progressively change to normal-size black lower-case letters. This is done so that the child's visual pathway may mature and gradually appreciate the material which is being presented to his brain. The large letters are used initially for the very simple reason that they are most easily seen. They are red simply because red attracts a small child. 5.The structured-phrase vocabulary: phrase cards with words printed in black lower-case letters I" high. These should be punched and assembled into a book by the use of I" loose-leaf rings. The cards must therefore be large enough to ac­commodate the text of each page (pp. 133-4). THE FIRST STEP (Visual differentiation) The first step in teaching the child to read begins with the use of just two words. When the child has learned these two words he is ready to progress to the vocabularies themselves, but not before. Initially, do not let the child see any of the materials except the word mummy. Begin at a time of day when the child is receptive, rested and in a good mood. Use a part of the house that has as few distracting factors as possible, in both an auditory and visual sense; for instance, do not have the radio playing and avoid other sources of noise. Use a corner of a room which does not have a great deal of furniture, pictures or other objects which might distract the child's vision. Now simply hold up the word mummy, just beyond his reach, and say to him clearly, 'This says "MUIl1ll1Y".' Give the child no more description and do not elaborate. Permit him to see it for no more than ten seconds. Now play with him, give him your undivided affection for a minute or two, then present the word again for the second time. Again allow him to see it for ten seconds, again tell him just once in a clear voice, 'This says "MUIl1ll1Y".' Now play with him again for two minutes. Again show him the word for ten seconds, again repeat that it is 'MUIl1ll1Y'. Do not ask him what it is. The first session is now over and you have spent slightly less than five minutes. Repeat this five times during the first day, in exactly the manner described above. Sessions should be at least one half-hour apart. The first day is now over and you have tal,en the first step in teaching your child to read. (You have thus far invested at most twenty-five minutes.) The second day, repeat the basic session twice. When you are ready to begin the third session, hold the word up to the child and say very clearly, 'What is this ?' You count to ten slowly and silently. If the child says 'MUIl1ll1Y', you must then be delighted and make a great fuss. Tell the child he is very good and very clever, and that you are very proud of him. Tell him that you love him very much. It is wise to hug him and to express your love for him physically. Do not bribe him or reward him with sweets or anything. At the rate he will be learning in a very :;hort time, you will not be able to afford enough sweets for his rewards, and he will not be able to eat all he has earned. Besides, sweets are a meagre reward for such a major accomplishment compared with love and respect. If he does not say 'MUIl1ll1Y' after you have pre­sented the word and counted to ten slowly (to your­self), you must not be discouraged. Even more importantly, you must be very careful not to show disappointment in your voice, manner or facial expression. There would be no need; he is only beginning. Instead you say clearly and happily, 'It is "Mummy", isn't it?' Simply continue to teach him as you did the first day, repeating the question only once each day on the third session of the day. It may take the child one day to learn mummy or it may take him a week. If he has not learned at the end of a week (which is most unlikely), put the materials away for a week and then begin again. The chances are quite strong that he will learn them very quickly. When he has learned mummy yo1;l simply show him the word five more times during the same day, asking him each time what it is. Make a large­scale fuss When you are confident he knows mummy you are ready to proceed to the next word. Introduce daddy in exactly the same manner and just as carefully as you taught him mummy. When you are sure he knows daddy you may test him exactly as you did with mummy. Now the child knows the words mummy and daddy. He has .not seen them at the same time. It is important that he should not see the words mummy and daddy simultaneously before this. Going too slowly is more likely to bore him than going too quickly. Remember that this bright baby can be learning, say, Portuguese at this time, so don't bore him. When he knows mummy from daddy, put the cards away and consider the splendid thing you have just accomplished. Your child has just conquered the most difficult thing he will have to do in the entire business of reading. He has done, with your help, two most extra­ordinary things: I.             He has trained his visual pathway and, more importantly, his brain sufficiently to differentiate between one written symbol and another. 2.           He has mastered one of the most staggering abstractions he will ever have to deal with in life: he can read words. He will have to master only one greater abstraction, and that is the individual letters of the alphabet. A word about the alphabet. Why have we not begun by teaching this child the alphabet? The answer to this question is most important. It is a basic tenet of all teaching that it should begin with the known and the concrete, and pro­gress from this to the new and unknown, and last of all, to what is abstract. Nothing could be more .abstract to the five-year­old brain than the letter A. It is a tribute to the intelligence of children that they can ever learn it. It is obvious that if only the five-year-old were more capable of reasoned argument he would long since have made this situation clear to adults. In the next session the parent begins as usual by presenting the word mummy and asking the child to identify it. When the child has identified this word, the parents then continues to hold the word mummy before him and picks up the word daddy in the other hand. She asks the child to identify this word .as well. The game of learning now changes, although the sessions remain only five minutes or less in length. Now the parent plays the game of putting both words before the child and asking the child to point to mummy or to point to daddy. When the parent is positive the child not only knows mummy and daddy but, more importantly, can differentiate between mummy and daddy, the first major step of learning to read is over. Do not linger over mummy arid daddy too long, or the child will quickly become bored .. The only warning ii:1 the entire process of learning to read is against boredom. Never bore the child. If such were the case, when we presented him with the letter a, he would ask, 'Why is that thing "a"?' What would we answer?     'W 11 '     uld     , .. " "b     uh          e , we wo             say, It IS a ecause                   . because, don't you see it's "a" because              well,       because it was necessary to invent this              ah ... SYmbol to ... ah ... stand for the sound "a" which •.• ah •.. we also invented so that ... ah ... ' And soon. In the end most of us would surely say, 'It is "a" because I'm bigger than you, that's why it's "a"!' And perhaps that's as good a reason as any as to why 'a' is 'a'. Happily, we haven't had to explain it to the chil­dren because, while perhaps they could not under­stand historically why 'a' is 'a', they do know that we are bigger than they, and this reason they would feel to be sufficient. At any rate, they have managed to learn these twenty-six visual abstractions and, what is more, twenty-six auditory abstractions to go with them. This does not add up to fifty-two possible combina­tions of sound and picture but to 676 possible combinations of abstractions. All this they learn even though we usually teach them at five or six, when it's getting a lot harder for them to learn. Thank goodness we are wise enough not to try to start law students, medical students or engineering students with any such wild abstractions, because, HOW TO TEACH YOUR BABY TO READ' 121 being young grown-ups, they would never survive it. What your youngster has managed in the first step, visual differentiation, is very important. Reading letters is very difficult since nobody ever caught an a or wore an a or opened an a. One can catch a ball, wear a shirt or open a book. While the letters that make up the word 'ball' are abstract, the ball itself is not and thus it is easier to learn the word 'ball' than it is to learn the letter b. Also the word 'ball' is much more different from the word 'nose' than the letter a is different from the letter b. These two facts make words much easier to read than letters. The letters of the alphabet are not the units of reading and writing any more than isolated sounds are the units of hearing and speaking. Words are the units of language. Letters are simply technical con­struction materials within words as clay, wood and rock are construction materials of a building. It is the bricks, boards and stones which are the true units of house construction. Much later, when the child reads well, we shall teach him the alphabet. By that time he will be able to see why it was necessary for man to invent an alphabet and why we need letters. THE SECOND STEP (The 'self' vocabulary) We begin teaching a small child to read words by using the 'self' words because the child learns first about his own body. His world begins inside and works gradually outside, a fact which educators have known for a long tUne. A number of years' ago a gifted educator expressed by some letters something which did much to im­prove education. These letters were V.A.T. - visual, auditory and tactile. It was pointed out that children learned through a combination of seeing (V), hear­ing (A) and feeling (T). And yet, mothers have always been playing and saying things like, 'This little piggy went to market and this little piggy stayed at home ... ', holding the toes up so the child could see them (visual), saying the words so the child could hear them (auditory), and squeezing the toes so the child could feel them (tactile). In any event, we begin with the 'self' words. They are smaller than the first words but still big, still lower case, and still red. Like the previous words, these are introduced one at a time with the rest of the set concealed. Again the child should be in a good mood and his immediate environment as free from distracting factors as possible. The 'self' vocabulary contains the following twenty words, each on a white card 5" high, in red lower-case letters 4" high.     hand nose leg teeth     finger shoulder knee hair eye tummy tongue foot lips ear mouth head toes arm elbow thumb We begin with the body-image word 'hand'. The mother first takes the child's hand and says clearly, 'This is "hand".' She lets the child see the hand; she says 'hand' again clearly; and she squeezes the hand. She then holds up the word hand, and again says, 'This is "hand".' The parent then follows exactly the same pro­cedure she did in teaching the words mummy and daddy. When the mother is sure that the child knows the word hand, and only then, she may proceed to the next word. As with the previous words, the child may only see the words he has learned and no others, since his exposure to all of them simultaneously will con­fuse him. This last point is very important. In the materials there are 8 four-letter body­image words. The parent should teach all the four­letter body-image words before introducing the others. This will prevent the child's distinguishing the words merely by their length, as he might other­wise do. Present all 8 of the four-letter words to him first; next present the 4 three-letter body-image words. Mter that, the 5 five-letter words. Now, teach him the 2 six-letter words Finally, teach him the only seven-letter word, which is 'shoulder'. A void presenting consecutively two words that begin with the same letter. 'Hair', 'hand' and 'head' all begin with 'h' and therefore should not be taught consecutively. Occasionally a child will leap to the conclusion that hair is hand because the words begin with 'h' and are similar in appearance. Children who have already been taught the entire alphabet are much more lil,ely to commit this error than children who do not know the alphabet. Knowing the alpha­bet causes minor confusion to the child. In teaching the word 'arm', for example, mothers may experi­ence the problem of a child's recognizing his old friend a and exclaiming over it, instead of reading the word arm. When each new word is added, all the previous words are reviewed. Again one must remember the supreme rule of never boring the child. If he is bored there is a strong likelihood that you are going too slowly. He should be learning quickly and pushing you to play the game more. If you have done it well he should be averaging a new word every two days. He may average a word a day. If you are clever enough and enthusiastic enough, he may learn more. When your child has learned the 'self' words, you are ready to move to the next step in the process of reading. He now has two of the most difficult steps in learning to read behind him. If he has succeeded up to now, you will find it difficult to prevent him from reading much longer. However, before we move to the next step in teaching your child to read it is necessary to say something about the one-year-old who is learning to read but who does not yet talk. If you start your child at one year old or before, he may not yet talk, or may say only 'Mummy' and one or two other words. It is quite possible to be able to read before one is able to speak. We have seen several children who can read many words they cannot say. Among adults it is almost always true that an adult can read a great deal more of a new language than he can understand of that language through his ear. Remember that a baby is learning a new lang­uage. Let us suppose that you have decided to teach your eleven-month-old child to read. Absolutely fine, go right ahead. Do it in exactly the same manner in which you would teach a child who talks. It will be harder for you, but not for the child. The obstacle here, of course, is that of testing. It is obvious that if a child is unable to say 'hand\ you will not be able to test him the same way you can an older child. When such is the case the parent will have to resort to more indirect testing measures and say to the child, 'Where is the word "hand"?' or 'Give me the word "hand".' If the parent of the non-talldng child is willing to go to this small amount of extra effort he will find it rewarding. Indeed such investments in teaching the baby to read will not delay his talking but will, in all likelihood, speed his talking and broaden his vocabu­lary. Remember that language is language whether transmitted to the brain via the eye or via the ear. At The Institutes for the Achievement of Human Potential we use reading as one of the important means of teaching brain-injured children to speak. John Ciardi, writing in the May 11th, 1963 issue of the Saturday Review, says that a child should be fed new knowledge 'at the rate determined by her own happy hunger'. This, I think, sums up the situation beautifully. Don't be afraid to follow the child's lead in this matter. You may be astonished at the size of his happy hunger and at the rate at which he learns. THE THIRD STEP (The 'home' vocabulary) When the parent is sure that the tiny child is reading the 'self' words, she is ready to begin the third step in reading. By now both parent and child should be approach •• ing this game of reading with great pleasure and anticipation. Remember, you are building into your child a love of learning that will multiply throughout his life. More accurately, you are reinforcing a built­in urge to learn which will not be denied, but which can certainly be twisted into useless or even very negative channels in a child. Play the game with joy and enthusiasm. The third step, teaching your child the 'home' words, is merely a matter of continuing with addi­tional nouns except that now they are words which name the familiar objects of his surroundings, such as 'chair' and 'wall'. The 'home' words are smaller than the 'self' words. They are still red, still lower-case letters, but now half the size of the 'self' words. They are 2" high on cards 3" high. The words should be taught at the rate of approxi­matelyone new word a day. It is wise at this point to talk about the rate at which each individual child should learn to read or, for that matter, learn anything. The 'home' vocabulary is actually divided into several sub-vocabularies. These are family, objects, possessions and 'doing' groups. They contain words like the following (mummy and daddy have, of course, already been taught, but in larger letters): A. Family mummy sister fish daddy dog bird brother cat baby There should be deletions and additions to this list to reflect the child's own family. If the child does not have a brother, a cat or a fish, these words should not be introduced. If, on the other hand, the child does have a sister, a dog and a bird, these words should be printed. On separate cards, print the proper names of each of them, such as Mary, Rover and Pete, as well as the child's own name. Proper names which normally begin with a capital letter should be capitalized. It is neither necessary nor wise to bring the capital letter to the child's attention in any way. He will not question the capital letter unless he already knows the alphabet. If he already knows the alphabet and questions the capital letter, it will be necessary to explain briefly that names begin with capital letters. Again the words are taught singly as before, but as each word is taught the mother points to the person or animal being named. By this time the child will have a reading vocabu­lary of twenty-five to thirty words and it will no longer be wise to review all the words he has learned. He will find this boring. Children love to learn but they do not love to be tested. Testing invariably intro­duces some degree of tension into the situation, on the part of the parent, and children perceive this readily. They are likely to associate tension and un­pleasantness with learning. The parent should therefore spot-check by re­viewing, at the most, five words before each session. Be. sure to praise the child warmly for each success. HOW TO TEACH YOUR BABY TO READ· 129 family-owned items which are special to his parti­cular family. Here again, the child is taught the words in the same manner as before, with the mother pointing to the objects as the child learns to read the word. Each new word should obviously now be taught in the room where that object normally appears or in the particular room which is named. Now continue to feed the child's happy hunger with the possessions words. c. Possessions (objects that belong to the child himself) plate cup shoes orange dress spoon hat ball sock pyjamas B. Objects (these are family-owned objects)                 chair                 table                 door                 window           wall                 bed                 bath                 kitchen            book picture As in the previous sub-vocabularies this list should be altered to reflect a child's own particular possessions and those things he or she loves most. Obviously, the list will vary somewhat, depending upon whether the child learning to read is eighteen months old or five years old, and whether the child is a boy or a girl. The child is taught the words in exactly the same way he has been taught up to now. This list can vary from ten words to fifty words, as the parent and the child choose. The reading list (which up to this point may be This list should also be added to or subtracted from to reflect the child's home surroundings and approximately fifty words) has been composed entirely of nouns. The next grouping in the home vocabulary reflects action and consequently intro­duces verbs for the first time. sitting standing runmng laughing climbing crawling walking jumping throwing reading HOW TO TEACH YOUR BABY TO READ' 131 in the end is not a good enough reason), then both the parent and child should be enjoying themselves immensely in the daily sessions. John Ciardi, in the editorial which has already been mentioned, says of the child, 'If he has been loved (which is basically to say, if he has been played with by parents who found honest pleasure in the play) ... ' This is a superb description of love - play and learning with a child - and it should never be far from a parent's mind while teaching a child to read. The next point for a parent to remember is that children are vastly curious about words, whether written or spoken. When a child expresses interest in a word, for whatever reason, it is now wise to print it for him and add it to his vocabulary. He will read very quickly and easily any word that he has asked about. Therefore, if a child should ask, 'Mummy, what is a rhinoceros?' or 'What does microscopic mean?' it is very wise to answer the question carefully and then print the word immediately, and so add it to his reading vocabulary. He will feel a special pride and get additional pleasure from learning to read words which he himself generated. D. Doing As each new word is taught the mother first illustrates the act by, let us say, jumping, and she says, 'Mummy is jumping.' She then has the child jump and says, 'Billy is jumping.' The mother now shows the child the word and says, 'This word says "jumping".' In this way she goes through all the 'doing' words. The child will particularly enjoy this, since it involves him, his mother (or father), action and learning. When the child has learned the basic 'home' words he is ready to move ahead. By now the child is reading more than sixty words and both parent and child should be delighted. Two points should be made before continuing to the next step, which is the beginning of the end in the process of learning to read. If the parent has approached teaching his or her child to read as sheer pleasure (as should ideally be the case) rather than as a duty or obligation (which THE FOURTH STEP (The sentence-structure vocabulary) It is conceivable that a chimpanzee could be conditioned to sit every time the word 'sit' was shown to him. While this would not be evidence that the chimpanzee could read the word 'sit', it would indicate that he could be commanded through being shown a specific group of letters which he recognizes .. However, if this same chimpanzee were sent to Yale for ten years, with intensive training in reading for that period, he would not then, or ever, be able to respond correctly to a sentence in which words were used in a combination he had never seen before. If we could understand only sentences that we had seen and known before, our 'reading' would indeed be limited. All the anticipation of opening a new book lies in finding what the book is going to say that we have never read before. To recognize individual words and to realize that they represent an object or an idea is a basic step in learning to read. To recognize that words, when used in a sentence, can represent a more complicated idea is an additional and vitally important step. Up to this time the child has been exposed only to individual words, and since, as we have said, a primary method in learning is to go from the familiar to the unfamiliar, we begin this step also with individual words. These are even more important, because although the· child does not know it, the individual words he learns now are those which in the Fifth Step will compose sentences. The same sentences will in the Sixth Step compose a book. The parent will now need to procure the· book HOW TO TEACH YOUR BABY TO READ' 133 which he will use to teach the child to read and from which he must work backward from the Sixth Step to the Fourth Step. The choice of the book to be used is very important and should meet the follow­ing standards: a.            It should have a vocabulary of not more than 150 different words. b.           It should present no more than a total of 15 or 20 words on a single page. c.           The printing should be no less than in high. d.           Text and illustrations should be separated as much as possible. Because few books meet all these requirements, my colleague Lindley Boyer has written two which seem to me to come close to meeting most of them. These are: Who Are You?* by Lindley Boyer (Jonathan Cape) Who am It by Lindley Boyer (J onathan Cape) Now cards must be prepared for the Fourth, Fifth and Sixth Steps. The parent takes each individual page of the book he has chosen and prints all the words on that page on one card, in black lower-case letters I" high. These become the 'structured-phrase' cards which *The beginning book chosen for inclusion in the Teach Your Baby to Read kit (see p. 143). will be used in the Fifth Step. The parent ~i11, as a result of having done this, end up with the same number of cards as there are written pages in the book. All the cards should be the same size, even though they don't all contain the same nwnber of words. The parent then prepares a card 3" high and as long as required for the longest word used in the text (the Fourth Step). The letters should be black, lower case and 2" in height. Now the parent has the materials ready for the next steps. Using the pages of the book to be read as a guide, the parent takes the individual words which appear on the first page of the book, and which are now in 2" letters, and teaches them to the child in the order they appear. The parent uses the same method of teaching which was used with the other words up to this time. Each word is taught separately, and a new word is not taught until the previous word has been mastered. Do not comment on the fact that these words are black instead of red. It is also important not to try to explain or define the words to the child. While he uses the word 'the' correctly in ordinary speech and therefore under­stands it, he does not deal with it as an isolated word. It is, of course, vital to reading that he recog­nize and read it as a separate word, but it is not necessary that he be able to define it. In the same way, all children speak correctly long before they know the rules of grammar. Besides, how would you like to explain what 'the' means, even to a HOW TO TEACH YOUR BABY TO READ.: 135 ten-year-old? So don't. Just be sure he can read it. Assuming that the parent had decided to use the book Who Are You? he would find that the first page contains the words 'I am me. Who could you be?' Therefore, these seven words each appear in 2"_ high, black lower-case letters on white cards 3" high. The parent starts with the word I and teaches the child this word in the same way that has been used before. Remember not to mention its definition. Just teach it as a new word. When the parent is confident that the child can identify this word the child is then ready to read the word am. Following this the child is taught the word me. When the parent is confident that the child knows these three words we are ready for an important new step, the reading of words in relationship to one another. The parent now takes the three words and places them, side by side and in their proper order, on the floor or on a table. The parent then points to the word I and asks, 'What word is this?' When the child answers cor­rectly the parent then points to the second word and asks, 'What word is this?' When the child answers correctly, the parent points to the third word and again asks the question. When the child succeeds the parent gives an enthusiastic demonstration of what she thinks about his ability to read these words. The parent then says slowly and clearly, 'These three words together say "I am me".' She points to each of them as she says it. She then says to the child, 'Tell me once more what they say.' When the child repeats the words she again praises him enthusiastically. Reading several words together is a real challenge to the young child. It is most important that this step be carried out both carefully and joyfully. It is worth every bit of the effort required. Some children accomplish this effortlessly and easily, others require a little longer, but if you are patient and very loud in your praise the child will win. I t is important that the child recognize the words individually before he recognizes them in a group­ing. Just as it is true that words and not letters are the basic unit of language, it is also true that sentences are not the basic units of language. Sentences are language. It is not possible to understand written or spoken language without understanding the basic words which comprise language, but it is possible to understand language without defining individually the letters of the alphabet or the individual sounds that make up words. Your child is a splendid example of this since by this stage of the game he has successfully done both these things. The caution that must be inserted here is against teaching him to read sentences without first teaching him to read the words within the sentences. The child is now ready to learn the individual words which appear in the second sentence of the book the parent is using. The child, of course, has not seen the book and will not see it until a good dea1later. HOW TO TEACH YOUR BABY TO READ· 137 In the book Who Are You? the words which ap­pear in the second sentence are 'Who could you be?' In the same manner in which she taught the words of the first sentence, the mother then teaches the child the words of the second sentence. Now the mother continues through the book, teaching the child every word individually that is contained in the text and then presenting all the words contained on each page together and in their proper order before advancing to the next page. The time this takes per page will vary with the child, the mother and the number of words on the individual page. It should proceed no slower than the learning of one new word per day and probably should not be faster than one full page a day. The book Who Are You? contains a total of 43 different words, of which several are already familiar to the child, since they are words from the previous vocabulary. Therefore, in the entire book there are only about 35 words which are new to him. These 43 words are the 'sentence-structure' vocabulary, if this is the book that the parent chooses. There is no question that unless children can read individual words they are not reading. Be sure that your child reads the individual words as well as the groupings before continuing to the next step. THE FIFTH STEP (Structured phrases and sentences) This step is quite easy because, in a sense, it is already accomplished. It is exciting, too, because   I38'TEACH YOUR BABY TO READ when it is finished the child will have actually read a book. It will be a little book and a make-it-yourself book, but a book nevertheless. In the book Who Are You? there are 28 pages containing a single word, a phrase, a sentence, or two sentences. Therefore, there will now be 28 cards, each listing the words that appear on each page of the book. In addition, the cards have three holes punched at one end in order that they may be placed on loose­leaf rings, which may be purchased in any stationery shop. The child has actually already read everyone of these phrases and sentences except that he has read the words on individual cards and in letters twice as large. Now the real fun begins. Starting with the first card the parent teaches in exactly the same manner she has employed in the past. She should proceed at the rate of one new card a day. The first card contains the words I am me. Who could you be?; the second card, You could be who? I wzsh I knew; the third card, I want to know, please tell me so, and so on through all the pages of the book. Holding up the first card the parent reads it aloud, slowly and clearly. She then asks the child what the card says, pointing to each individual word. When the parent is certain that the child actually reads the words individually and collectively, it is again time for a celebration. The parent then explains to the HOW TO TEACH YOUR BABY TO READ 139 child that he has read the first page of his first book and with appropriate ceremony places it in the three loose-leaf rings. In this way the child's book multiplies at the rate of about a page each day, and if all goes well at the end of twenty-eight days, the child will have a complete make-it-yourself book. If this proves to be too fast or too slow for a particular child, the rate should by all means be changed. As each new page is added the previous pages are re-read. The last page of the make-it-yourself book should contain a certificate for the mother's notes and signature testifying that on this date and at this age her child has completed reading his first book. It is quite an accomplishment. You may properly be very proud of each other ­you and your child. THE SIXTH STEP (Reading a real book) Now the child is ready to read a real book. The fact is that he has already done so twice, once with the separate words on cards and once with the com­plete sentences on loose card pages. The only thing that is different really is that the words, phrases and sentences of the book which he already knows are now in black upper- and lower-case letters and only i" high. However, the difference between the 2" -letters of the Fourth Step, the I" -letters of the Fifth Step and the t" letters of the Sixth Step can be a very important one if the child is very young. Remember that as you have taught him to read, you have actually been helping to mature and improve his visual pathway. If you are moving faster than your child's visual apparatus is able to mature, you will have a clear-cut indication of this during the Fourth, Fifth and Sixth Steps. Since the words he is using in these last three steps are exactly the same words but differ only in that they become smaller with each step, you can now see quite clearly if a child is learning faster than his visual pathway is able to mature. As an example, suppose that a child completes the Fourth and Fifth Steps successfully but has difficulty in reading the identical words in the book itself. The solution is simple. We know that the child can read I" words easily. Now the parent simply prepares additional words and simple sentences I" in height. Use simple, imaginative words and sentences which the child will enjoy reading, and after two months of this, return again to the book. Remember that if the print were made too small you would also have trouble reading it. If the child is three years of age by the time you get to the tIt print of the book itself, you will prob­ably not be held up at all at this point. If the child is less than two years old by the time you get to the book, there is a fairly good chance that you will need to obtain or create additional I" or 2" letters for the HOW TO TEACH YOUR BABY TO READ' 141 child. Fine, it is all reading, and real reading at that: it will mature his brain growth. Now have your child read the real book to you ­word, phrase, sentence and page at a time - making no effort to conceal your delight with the fact that he can do so. The child will seldom accomplish a more important act in all the life that is ahead of him. Believe it or not, your child has read a book, and if you started early enough and were properly appreciative, joyful and enthusiastic he may not yet have reached his third birthday. 'THE SEVENTH STEP (The alphabet) You are now an expert teacher - you have taught a tiny child to read - and up to the time of publi­cation of this book only" a small percentage of people have done so. Come to think of it, who are we to tell you how to teach a child to learn the alphabet? Using whatever system and materials you think are wise, teach him the alphabet - both upper and lower case. It will be far easier now. It is also quite possible that by now he has learned much of the alphabet, or even all of it, without any help from us or you. There isn't a great deal more that needs saying in this chapter except to give you a list of books for further reading (they can of course be obtained from the local bookshop). The child began the first book with a reading   I. Large enough print. 2.                           Print not intertwined with pictUres. 3.                           Size of vocabulary. 4.                           Subject matter. Little Black, A Pony by Walter Farley (Collins, 8s.6d.) Sam and the Firefly by P. D. Eastman (Collins, 8s.6d.) Who's a Pest? by Crosby Newell Bonsall (Worlds Work, 10S. 6d.) A Big Ball of String by Marion Holland (Collins, 8s.6d.) The Cat in the Hat by Dr Seuss (Collins, 8s. 6d.) Book of Riddles by Bennett Cerf (Collins, 8s. 6d.) The Dragon and the Clock Box by M. Jean Craig (Worlds Work, 12S. 6d.) and the Teach Your Baby to Read Kit, including a copy of Who Are You? (Cape, 18s. complete)   vocabulary of about 50 words. By now he should have a reading vocabulary of close to 100 words or possibly even more. The books on the list which follows were chosen for several characteristics: They are listed in the order in which they should be read, that is, the ones at the beginning have the simplest vocabularies. READING LIST (with prices in U.K.) Who Are You? by Lindley C. Boyer (Cape, 8s. 6d.) Nose Is Not Toes by Glenn Doman (Cape, 8s. 6d.) Who Am I? by Lindley C. Boyer (Cape, 8s. 6d.) Green Eggs and Ham by Dr Seuss (Collins, 8s. 6d.) Hop On Pop by Dr Seuss (Collins, 8s. 6d.) Are You My Mother? by P. D. Eastman (Collins, 8s.6d.) Put Me in the Zoo by Robert Lopshire (Collins, 8s.6d.) Nobody Listens to Andrew by Elizabeth Fuilfoile (Benn,5s.) The Very Little Girl by Phyllis Krasilovsky (Worlds Work, 9S. 6d.) Little Runner of the Long House by Betty Baker (Worlds Work, IOS. 6d.) There are three distinct levels of understanding in the process of learning how to read. As the child conquers each of them he will show exuberance at his new and very exciting discovery. Naturally, his first pleasure and delight is in the disclosure that words have meaning. To the child this is almost like a secret code which he shares with grown-ups. He will enjoy this vastly and visibly. Next he notices that the words he reads can be used together and are therefore more than merely labels for objects. This is also a new and wonderful revelation. The last discovery he makes will probably be very noticeable to the parent. This, the greatest of them all, is· that the book which he is reading represents more than the simple fun of translating secret names into objects, and more even than the decoding of strings of words into comments about objects and people. Suddenly and delightfully the big secret bursts upon the child that this book is actually talking to him, and to him alone. When the child comes to this realization (and this does not necessarily happen in his first or second book), there will be no stopping him. He will now be a reader in every sense of the word. He now realizes that the words he already knows can be re­arranged to mal{e entirely new ideas. He does not have to learn a new set of words every time he has to read something. What a discovery this is! Few things will compare to it in later life. He can now have an adult talking to him in a new conversation any time he wants, simply by picking up a new book. All man's knowledge is now available to him. Not only the knowledge of people he knows in his home and neighbourhood, but people far away whom he will never see. Even more than that, he can be approached by people who lived long ago in other places and in other ages. Human beings are the only creatures on earth who can alter the evolutionary pathway. Most creatures in the evolutionary march towards man are now extinct. Others played their roles and did not dis­appear, but remained, to mark time in place for ever. This power to control our own fate began, as we shall see, with our ability to write and read. Because man has been able to write and read he has been able to pass on to other men centuries later and in remote places the knowledge he has gained. Man's knowledge is cumulative. Man is man essentially because he can read and write. This is the true importance of what your child discovers when he learns to read. The child may even try, in his own way, to tell you about his great discovery, lest you, his parent, miss it. If he does, listen to him respectfully and with love. What he has to say is important. TAKEN FROM TEACH YOUR BABY TO READ BY GLENN DOMAN. COPYRIGHT 1964 BY GLENN DOMAN, 1963 BY THE CURTIS PUBLISHING COMPANY.  PAGE 108 - 165, 'Thou shalt not kill; but need'st not strive ... Officiously to keep alive.' FOR years, controversy has been raging over the rights and wrongs of a legal­ized system to enable the chronically sick to request that their lives should be painlessly terminated. Arthur Hugh Clough who wrote the words quoted above over a hundred years ago, expressed exactly the problems and dilemmas of those who now wish to introduce a workable system of euthanasia - and he could hardly have put it better. In Britain, the influen- 'A dying woman, aged over a hundred, was given a blood transfusion, and a very old man, senile for a long time, was kept just alive with artificial feeding and urinary apparatus well after he had become "a thing of horror due to advanced gangrene". If these two wretched persons were not fully conscious, it could be argued that they were not suffering; but is it civilized or compassionate behaviour to lengthen the course of dying in this way?' (A geriatric nurse) tial Euthanasia Society has been putting pressure on the government to promote legislation permitting voluntary eutha­nasia, but so far without success, even though the cases under consideration are those tragic cases in which death alone can bring release from suffering. The word euthanasia is derived from the Greek, meaning a 'good' death - that is to say a comfortable, easy death such as we would all wish for when our time to die comes round. Most efforts in this direc­tion have been directed towards legalizing voluntary euthanasia - the termination of life based on a written, formal, and duly witnessed request by the patient that his life should be ended. This pre-supposes that the patient's mind is clear, and that he understands what he is requesting. The position is quite different when one con­siders what may be called compulsory euthanasia. Some of the advocates of com­pulsory euthanasia would give legal sanc­tion to the 'mercy killing' of congenital mental defectives, helplessly senile, insane patients with permanent brain damage, and perhaps even such tragic cases as the thalidomide children. It is most unlikely that Parliament would ever approve com­pulsory euthanasia or any similar act. Certainly this will not be done before voluntary euthanasia is approved, and this is not yet the case. Naturally, euthanasia is already prac­tised in certain cultures or circumstances. Some doctors use their discretion to pres­cribe drugs which have the practical effect of painlessly ending the suffering of an incurable patient, or may achieve the same result by withholding drugs in a case where the patient is only kept alive by heavy drug treatment. On the battlefield, it has not been unknown for a gravely wounded soldier to request a comrade to dispatch him, and this has been done. In some primitive societies such as that of the Australian aborigines, when the aged and infirm are no longer able to make any further contribution to the tribal economy, it is customary for them to go out into the bush to die. In Great Britain there have been several attempts to put on the Statute Book an Act permitting voluntary eutha­nasia. It seems however that public opinion is not yet ready for such a step, and so far they have all failed. The case presented by supporters of euthanasia is simple. They urge that anybody who is suffering from an incurable condition should have the right to ask for 'Since the passing of the Abortion A ct I have realized that there is no folly of which our politicians are not capable. Already authorities are having difficulty in finding enough doctors to act as executioners on the National Health Service. So it has been suggested that government abortion centres should be set up.' (Professor Ian Donald speaking at a meeting of the Human Rights Association held to protest against the possibility of euthanasia being introduced) his life to be ended in a peaceful and dignified way rather than continuing to suffer constant pain, and face what has become nothing but a distressing, purpose­less, or irrational existence. It is sug­gested that the old, the infirm, and the chronically diseased are, by their very nature and situation, not in a position to press a vigorous campaign for a change ir: the law. On the other hand, and for d::e same reasons, it could be argued that those patients who might be thought to be suit­able cases for euthanasia are precisely those who are not in a fit mental condition to make the voluntary written request that must be made before euthanasia can take place. The attitude of most people towards death is conditioned by a number offactors - by religious teaching, by a sense of the convimtional attitude towards death, by sentiment, and by the simple fear of dying. Others accept that death need not neces­sarily be an enemy to be feared, but may, in certain circumstances come as a friend. It is easy to have the utmost sympathy with those who seek a way, within the law,       'Under any euthanasia programme, the consequences of mistake, of course, are always fatal. ' (Professor Yale Kamisar) to bring a merciful release to those who are racked with the pain and distress of incurable disease. It is said, with con­siderable force, that it is the quality of life that matters, and not its length. In other words, say the advocates of eutha­nasia, what, for practical purposes, is really being kept alive in such a case? Efforts to introduce a workable system of euthanasia into law have, almost exclu­sively, been confined to the British Par­liament. In 1936 a Bill was moved to legalize voluntary euthanasia, but it failed hopelessly. The process was repeated in 1950, again without success. As recently as 1969, a third attempt was made to promote such a Bill in the House of Lmds. The British Parliament has. howeyer. made two significant changes in the law, which supporters of euthanasia see as pro­gressive, while its opponents nac.rco1\ think the reverse. But the\' were cc~a:.'::.>: notable changes. By the fir~t - Tr.e ~-..:..:::~:.~ Act of 1961 - it was enacted c.::.5.: S'~:::'.o was no longer a crime, FCTI::.o:-::: :: "':5.8 ::. crime - indeed a felony change in the law, and therefore the 1969 Voluntary Euthanasia Bill was read and debated in the House of Lords. The Bill proposed to legalize the 'pain­less inducement of death'. It would have made it legal for any person to ask for this release and lawful for a physician to administer euthanasia to a patient who had made the appropriate declaration in writing. The patient must have reached the age of majority, and two physicians - one 'I still recoilfrom the sight of old people being kept alive bya constant monitoring of their heart-beat and the team of nurses and doctors ready to pounce upon them when it stops. For my own part, when my time has come to die by natural causes I hope I shall be allowed todoso.' (Sir George Pickering, Regius Professor of Medicine, Oxford University) of consultant status - would have certified in writing that the patient was suffering from an irremediable condition. The cases provided for were described as serious physical illness thought to be incurable, and expected to cause severe distress and render incapable of rational existence. It may be that sooner or later society will readjust its attitude towards death and therefore towards volunt~ry euthanasia, but the House of Lords in 1969 rejected the Bill and its proposals. Undoubtedly public opinion is moving slowly, not only in Great Britain but else­where, towards the realization that the problems posed by the continued, and as some would say unnecessary, suffering of the very ill and the very old must sooner or later be faced. Undoubtedly euthanasia should be carefully considered as a possible solution to this problem. In Britain, there are obviously certain practical difficulties which would have to be overcome if ever voluntary euthanasia became legal in the sense which the Bill envisaged. Who would perform the act of 'So we arrive almost insensibly at the same point as the Nazis who, let it never be forgotten, were great pioneers in this field of euthanasia and organ transplanting. ' (Malcolm Muggeridge speaking on euthanasia) 2024 euthanasia? Clearly, no doctor whose reli­gious or other objections were against the measure would be expected to take part in it. How would it be done? Would it be available as part of the National Health Service? These are all serious questions which were left unanswered in the Bill as it was introduced in Parliament. It is possible to envisage the occasion when the appropriate official, be he doctor or otherwise, calls at the house of the patient on his unusual mission. The Bill would in fact have permitted the 'authorized hos­pital doctor' to delegate his administration of euthanasia to a nurse. Many would find this situation - the visit of the 'eutha­nasia man' - utterly repugnant. The main objection to the euthanasia campaign, in the view of many doctors, is that the issue is an unreal one. There are not, in reality, dozens of dying persons of 'Slowly but inexorably the patient was forced to bed and was ultimately unable to leave it because of paralysis of the lower limbs. Soon, control of the bladder and anal muscles led to incontinence of urine and faeces. Bed sores developed and were so large and so deep that the underlying bones of the pelvis were eroded as well. This abject image of misery and pain was kept going by the frequent administration of antibiotic and pain-relieving drugs. Is it justifiable to prolong such a life, iflife it be? In this question we are faced with the fundamental problem of the meaning of man's existence.' (G. A. Gresham) sound mind clamouring to be set free ­in fact, those who have to deal with ter­minal illness find that a wish to die quickly on the part of the patient, cases of patho­logical depression excluded, is very rare ­the demand usually comes from the rela­tives, who 'cannot bear to see him suffer' and because often their own suffering is greater than the sick man's. In fact, the patients who most actively desire to die are the pathologically depressed, and one needs here to distinguish between the gloom inevitably induced by incurable sickness, and depression which can be relieved by medication even if the basic disease cannot. Indeed, it is arguable that all those cases which really fill the terms of the proposed legislation in Britain already receive, informally, the help which they need in shortening their suffering. Even the Catholic Church, which regards suicide as a grave sin, agrees that a patient in incurable suffering may be kept uncon­scious once he has made his peace with God, even though the drugs used could shorten his life. Many doctors would prefer the retention of the present position, in which they may use their skill to limit the pain and shorten the duration of dying, without the heavy-footed intervention of legislators and the harassment of the sick man to sign forms. The real question, for them, is not whether this or that legisla­tion is needed, but whether the issue raised by the euthanasia lobby is a real one at all. It is certainly one that they rarely en­counter. What is undoubtedly true is that the handling of the dying is an art, calling on all the resources of the doctor's own character, and many avoid it for personal reasons. One task of medical psychiatric education is to remedy this. In 1968, a British hospital consultant posted a notice recommending his staff to withhold resuscitation from certain groups of seriously ill patients. This provoked considerable comment, but there was obviously much sympathy with the view that some people should be allowed to die peacefully without heroic attempts at revival being made. The opposite policy, it is argued, would result in the abler mem­bers of the community devoting their lives to preserving the existence of the decrepit. Since the advent of antibiotics the fatal pneumonia which used to be described as 'the old man's friend' because it usually brought easy death for the old, has ceased to remove the aged from the cares of their existence: Some feel that the risk to us all is not of dying, but of living too long. Obviously hospitals are never going to be able to provide all the beds, all the kidney machines, all the transplants, and all the intensive care units which would be required to keep alive a population con­sisting of increasing numbers of old and 'Mercifully enough, this determined battle wasfought in vain. When at a later time my friend asked the doctor what had been the point ofit all, he received a very significant reply. The casualty officer admitted that, even if it had been possible to preserve the patient's life, only the shell ofa human being -speechless, paralyzed and demented - would have remained. Yet, he maintained, it was not within his discretion to think of what the ultimate issue would be. He had one duty, and one duty only, to do all that lay within his powers to ward off death. ' (Eliot Slater)   'The pain that Ifee! has come to dominate my existence, and at times I wish there was some way of ending it. But I could never really consider euthanasia, because I cannot escape from the belief that while there is life there is hope, however bad the pain. ' (Cancer sufferer) infirm people. Such facilities will be granted to some, but not to others. The burden of these decisions will inevitably fall upon the shoulders of doctors. In constrast with that in the United Kingdom, the problem in the United States is one of rather different proportions. In America, many people successfully devote their lives to acquiring sufficient money to enable them to exist in comfort for as long as possible after their retirement. Their views on the subject of euthanasia must be highly important and relevant, but, so far as is known, these views are unascer­tained. However, there is no reason to suppose that their reaction to intense pain will be any different from anybody else's. The question must also be to some extent affected by the very large private fees which are paid to doctors for their services in the United States, as against the fact that in Great Britain the greater propor­tion of illness is treated, without individual charge to the patient, under the National Health Service. There may be special factors of this kind which would have to be related to any consideration of euthanasia in the United States. Cancer is frequently mentioned as an example of the class of incurable disease in which euthanasia would be appropriate. But many thousands of cancer patients are treated, recover, enjoy a long life, and die of something else. In medical science what is incurable this year may become curable next year. But many cancer patients do suffer great pain, and eventually die in agony and misery. There is a popular belief that in such cases the doctor 'helps the patient over the last hurdle'. The good doctor, it is said, knows the difference between prolonging life and prolonging the act of dying. Cer­tainly it is true that in a condition of ever­increasing pain it will be necessary to administer larger and larger doses of pain­killing and sedative drugs, even though it will be known that in doing so the patient's life may be shortened. Is there a difference between shortening a life and actively terminating it? Most doctors will maintain that there is. We, as patients, would per­haps hope that if ever we found ourselves in that situation, that our doctor would treat us in this humane and compassionate way. Yet one might have to be 'lucky' in one's doctor, and there is no guarantee from the patient's point of view that such a desirable outcome would result. In many distressing and incurable conditions, however, pain itself may not be a significant symptom, and in these cases even the final merciful release of increasing doses of drugs cannot reasonably be expected. No country in the world, it is believed, has yet legalized euthanasia, and both the World Medical Association and the British Medical Association are against it. As we have seen, doctors are not sym­pathetic to a change in the law, nor would they welcome a law which installed some doctors in the new and macabre role of the terminators of life. Certainly there would be no doctors volunteering for this post, were it available. But is this attitude on the part of doc­tors somewhat illogical? They are in effect saying that they have no objection to euthanasia so long as they administer it themselves in the humane way which results from the care of terminal patients 'When it comes to it, I hope I will be allowed to go peacefully. My wife has been gone for five years now, and my son is in Canada. Life has been good to me, and I would like it to stay that way to the end. In the face of acute painfrom incurable illness, I truly believe I would wish for euthanasia, if that were possible. ' (Retired min er) with increasingly large doses of drugs, yet that they would object to doing it on behalf of society. But is it fair to them that doc­tors should act on their professional judge­ment regardless of the criminal law? A doctor should not have to face the possible risk of criminal prosecution, or of black­mail, simply because he does what he believes to be right in the best interests of a distressed and incurable patient. It may be equally fair to the patient who believes that he has a right to die before he has lost all human dignity, if his doctor happens to have religious or conscientious scruples which oblige him to let his patient's illness take its natural course. Also, the possibilities of a merciful release might well depend on a patient's means, or whether he was in a public ward or a private nursing home. The complex problems involved in this highly sensitive area are legal, ethical, medical and religious; and what remains to be seen is whether these difficulties can be resolved, and safely codified in satis­factory legislation. Although the recent attempt to do so in Great Britain has for the moment failed, it seems certain that we shall inevitably have to consider these questions again in the future and, per­haps reorientate our conventional attitudes towards life and death. Society will have to make up its mind. Ultimately, however, every individual has to determine his own personal attitude to euthanasia, which in itself is the most powerful argument in 'The classical deathbed scene, with its loving partings and solemn last words, is practically a thing of the past. In its stead is a sedated, comatose, betubed object, manipulated and subconscious, if not subhuman.' (Joseph Fletcher) favour of voluntary euthanasia. Providing that a satisfactory system can be evolved that cannot easily be abused, there can be no reason why any person should be denied the right to authorize the termina­tion of his own life - which is already per­mitted by law if the individual himself performs the act of termination. After all, those who do not wish to permit eutha­nasia could not, under any of the schemes seriously proposed, be forced to accept death against their will. Nineteenth century cartoon: Dr. Scalpel. 'J admit, my dear Stethoscope, the truth of your rernarks, but it is clearly my opinion there is no hopefor him. We are three, but he must sink under it, he stands no chance.' The artist of this sketch ventures to suggest, there is no doubt the reader's opinion coincides exactly with the Doctor's. Many of the above quotations are repro­duced from Euthanasia and the right to death, edited by A. B. Downing. by kind permission of the publishers, Peter Owen Limited, London S. W. 7. England.   Taken from The Marshall Cavendish Encyclopedia of the Human Mind and Body – Life Together -  BOOK OF LIFE In 105 weekly parts- part 73, The Right to Die, Page 2023 – 2025.   Due to the urgency of education on this site, spelling will be corrected at a later stage…..  , Hardly a morsel of food passes your lips that has not been preserved or processed. Food processing has become a major industry. What are its methods? WHEN Man first threw a morsel of meat onto the fire and then rescued it to eat a portion he had missed, he started to process his foods, for cooking is the simplest and most wide­spread form of food processing. And when he first noticed that meat hung in the smoke from his fire or fruit left in the sun to dry did not go rotten for a long time, he had taken the first step towards producing the tinned, packaged, processed, chemically-treated and artificially-flavour­ed foods that weigh down today's super­market shelves. Without processed foods, the modern housewife would be lost. Able to buy only locally-produced food, and then only during its particular season, she would find it hard to give her family the balanced diet they need for health and growth, let alone the variety they have come to expect. There would be no exotic fruits from half way round the world, no summer vegetables in the depths of winter, no tasty kippers or smoked ham. Nor could she open a con­venient tin of soup, fry a few sausages, or warm up some baked beans. She might manage to get by, but even more of the world's population than at present would go hungry for much of the year, while piles of unwanted food would rot at other times. For the most important effect of food processing has been to even out the seasonal supply and demand for food. For centuries, Man has salted and dried meat and fish to make sure that there was enough to eat in the lean months of winter. Now, food processing is a vast industry that spends huge amounts of money on research into new and more effective methods of giving the housewife convenient, nutritious and tasty foods. Preservation from spoilage - caused by chemicals or by micro-organisms such as bacteria (germs) and fungi (moulds) ­is, of course, the principal aim of any type of food processing, whether it is carried out at home or in a huge factory. This can be done by sterilizing the food (generally with heat) and then sealing it in a jar or can so that no new micro-organisms can enter, by changing the state of the food itself by drying, or by slowing drastically the growth and action of the micro­organisms through freezing or chemical treatment. The oldest preservatives, salt and sugar, are thought to work by 'binding' water in the food so that bacteria and fungi cannot use it for growth. (Drying, of course, has the same effect.) The snag with salt and sugar is that we can taste them, and salted fruit or sugared meat would not be to most people's taste! But recently manu­facturers have started using non-sweet sugar, which acts chemically like any other sugar, but has little taste. It is being used for preserving so-called semi-moist, chewy 2026 pet foods for dogs and cats. Apart from the 'traditional' substances, many modern chemical preservatives are used to increase the life of perishable foods. An example is the addition of calcium pro­pionate, in very small quantities, to baked goods to prevent for days the growth of moulds. Sulphur dioxide has been used for much longer for preserving fruit. And fresh fruit is transported in ships' holds con­taining an atmosphere of 60 per cent car­bon dioxide. This stops mould growing and makes sure the fruit does not ripen before reaching its destination. The greatest leap forward in food pre­servation took place some 150 years ago, however, when a Frenchman called Nicolas Appert developed the process of 'Apper­tizing' - the preservation of heated food in glass jars. This was the forerunner of the great food-canning industry of today, but Appert developed his process in response to the need for fresh food for the army. In 1810, Napoleon (who once said that an army marches on its stomach) rewarded Appert with a prize of 12,000 francs. In the same year, an Englishman called Peter Durand took out the first patent for the canning offood. Later, Appert too switched from glass jars to tinplate cans. PROVIDING the micro-organisms in the container are killed efficiently, and providing the can or jar remains tightly sealed so that no more germs can leak in, then the food will keep for a very long time. Appert himself supplied canned food to Sir Edward Parry's expedition to find the North-West Passage in 1824. In 1938, several of Parry's cans were opened. The food in them was unfit for human consumption, but was still edible by animals - after 114 years. Yet Appert developed his process 50 years before the discovery of bacteria by Louis Pasteur. The importance of the absolute need for a perfect seal was well illustrated by the outbreak of typhoid in Britain in 1964. The cause was traced to a consignment of South American corned beef that was not perfectly sealed in the can. It is thought that, after processing, the cans were cooled in contaminated water, which seeped in through minute leaks. Generally, however, the problem is simply to kill all the germs in the food when it is put into the can. Some germs can form spores that are extremely heat-resistant. Among them are the Clostridium group, which include Clostridium botulinum, whose toxins (poisons) cause the rare but deadly condition called botulism, and Clostridium welchii, a much more common cause of food poisoning. Another heat­resistant germ is Bacillus stearother­mophilus. One minute's cooking at 120°C (250°F) is enough to reduce the numbers of this organism 10 -fold, and two minutes' 100-fold. But the food must be cooked long enough for the bacteria to be reduced by many million times their original number, otherwise they will soon grow again. Different foods heat up at different speeds; generally liquid foods like soups are quicker than solids like meat or fish. The size and shape of the can obviously also affects the speed. And, in any case, the centre is always the last part to get hot. So manufacturers have to experiment with each new product to find out how long and at what temperature it needs to be h~ated to thoroughly sterilize the food in its can. Killing the micro-organisms may not, in fact, be enough on its own. Some germs - the Staphylococci - can produce heat­resistant toxins. Although the germs them­selves are killed, any remaining toxins can cause food poisoning. For this reason, food to be canned must be sampled and tested before use and rejected if it contains too many bacteria. The actual process of canning has advanced greatly over the years. At first, cans were simply stacked in containers ­called retorts - filled with steam. The pro­cessing was slow because of the poor heat transfer into the closely-packed cans. An Many of today's l11ethods of preserving foods are based on centuries-old tradi­tions. Far right Drying is one of the oldest processes of all; these Portuguese fishermen have laid out sardines to dry in the hot sun for scores of generations. Without water for sustenance, bacteria cannot grow and spoil the food. Right Pickling in vinegar kills the bacteria, but is suitable only for certain foods, where the flavour of the vinegar does not matter. Above, above right The same restriction applies to salting and smoking, in which chemicals 'bind' the water so that bacteria cannot use it. improvement was the rotary retort, where baskets of cans turned slowly within the steam chamber. This meant that foods which used to burn onto the insides of the cans - spaghetti, for example - no longer did so. Now the larger canning factories have sterilizers in which cans move indi­vidually on belts and the steam is kept at a high temperature and pressure. One new development may result in can­ned food with a much more natural flavour than before. It is called aseptic canning, and simply involves sterilizing the can and food separately and filling and sealing the can under germ-free conditions. Instead of sterilizing the food at a relatively low temperature for an hour or more, it is heated to 150°C (300°F) for a few seconds, under high pressure. This kills the bacteria just as efficiently, and it does not spoil the food's flavour. 'Long­life' milk and some desserts, such as cus­tard and sauces, are already processed in this way. PRESERVING food by freezing is today second in importance only to canning, but it has a much shorter history than canning. The Ancient Romans used snow from the Alps to keep food cool, and thus fresh, for a period, but freezing cmly started on an industrial scale when Thomas Mort set up the world's first meat­freezing plant in Sydney, Australia, in 1851. In 1879, a shipment of 40 tons of frozen meat reached London from Australia in good condition. But it was not until an American, Clarence Birdseye, developed the quick-freezing process in the 1920s that frozen foods became really important. When food is frozen, ice crystals grow within it. If the freezing is slow, the needle­sharp crystals grow too large and puncture the walls of the cells in the food. The result is mushy, unpleasant food. Foods vary greatly in their 'freezability', and plant breeders have developed special strains particularly suited to freezing. The great advantage of freezing is that it can preserve the eating qualities of the basic' food commodities - whole fish, meat and vegetables - better than canning. Indeed, it is possible to freeze many foods that cannot be canned successfully. Unlike canning, freezing does not remove or des­troy bacteria; it merely slows down their growth to a rate where the food remains fresh for weeks or even months. This limitation is important, because a few micro-organisms actually grow fastest at low temperatures. Freezing itself can be achieved in a number of ways. A blast of cold air is probably the most widely used method. Some products - fish and meat, for example - are frozen by contact with cold metal plates. A recent and increasingly used method is to simply pour liquid nitro­gen - at a temperature of -196°C (-320°F) - over the food. Freezing is instantaneous, and - more important ­the equipment needed is cheap. So liquid nitrogen freezing is ideal for seasonal crops such as strawberries where it would not be economic to invest in the normal type of freezing plant. After canning and freezing, the third 2028 major method of preserving food today is dehydration (drying). As already men­tioned, it is the oldest of the three methods, and many conventional foods have been dried in large quantities. But the most interesting use of drying today is in con­nection with so-called 'convenience' foods. An example is 'instant' porridge. This is made by roller-drying: simply drying the liquid porridge on single or twin rollers heated by steam. The porridge forms a thin film on the roller surface, and the heat quickly drives off the water. The dried porridge is removed as a powder. Instant coffee is the best-known spray­dried product. Coffee is made in the usual way, and is pumped through an atomizer at the top of a drying tower. The fine spray of coffee falls down the tower while hot air is driven upwards. Drying is very rapid, and the powder is removed from the bottom of the tower. The cooling effect of rapid evaporation means that the actual tem­perature of the coffee during drying is quite low. Nevertheless, some flavour is lost with both spray and roller drying. This is much less of a problem with freeze-drying. If the air is pumped out of a chamber . containing frozen food, the ice sublimes ­that is, it turns directly into water vapour without becoming liquid water in between. As a result, the complex substances that give foods their subtle flavours are retained better. The structure of the food is also preserved, so it tastes better when it is re­hydrated with water. Freeze-drying is a complicated process, however. The food has to be frozen to about -40°C (-40°F). The vacuum chamber must be leak-free and the vacuum pumps reliable - or thou­sands of pounds' worth of the food may be ruined. Among the freeze-dried products in the shops are the new granular type of instant coffee and some components of packet meals. At the other end of the scale, meat is freeze-dried for the United States army and for American astronauts. But for ordinary consumption, frozen meat is more convenient. t\0NGSIDE modern developments in food preservation have come even more diverse developments in food additives. Common salt is the oldest and best known of a group of substances called flavour enhancers or potentiators. These act, not by giving a flavour of their own, but by bringing out or magnifying the natural flavours of food. The most widely used, apart from salt, are monosodium glu­tamate (or simply MSG) and a group of compounds called ribotides. There are true artificial flavourings, too. They include artificial sweeteners and even laboratory-made replicas of many fruit flavours. Many foods are coloured during processing with natural or artificial substances. Most orange and yellow colour­ings, for example, are natural and are related to the substance that gives carrots their colour. Many red colourings, on the other hand, are artificial dyes made from coal-tar. Other additives do nothing to preserve food, or to give it flavour or colour, but alter or improve its texture. There are scores of these, among them the stabilizers and thickeners, such as various kinds of starch, alginates (which are extracted from sea­weed), and cellulose gum derivatives. A housewife who uses cornflour to thicken her home-made soup is using this kind of additive. In the same way, alginates give a smooth texture to ice cream ana the powdered desserts tbat are whipped with milk to make a kind of mousse. Related to these stabilizers are the emulsifiers, which create the creamy texture of desserts and other products by stopping the oils and water in them from separating. National and international organiza­tions and government departments keep a close watch on the use of food additives, and food manufacturers are allowed to use only those which are safe. In 1969, most countries limited or banned altogether the use of artificial sweeteners called cyclamates. The reason for the ban was that some animals fed large amounts of cyclamates developed cancer. Similar bans have been placed on a number of dyes. In recent years, food packaging has developed just as fast as processing. tech­niques .. Attractive packaging clearly helps to sell a manufacturer's product, and pre-packing is obviously necessary for super­market-style shopping. But packaging also protects food. Powders, dried foods and such products as corn flakes become damp very easily. They need a good seal against the air and - more important - the.package must re-seal efficiently in the home when part used. Some products contain certain oils that cause unpleasant flavours if exposed to light; some dry out quickly if not packaged; some get sticky; and so on. New materials and new packages are constantly being developed. Examples include lightweight glass bottles and tetra­hedral (four-cornered) cartons for milk, ring-pull cans for beer and soft drinks, plastic bottles and jars to replace an ever­growing number of glass containers, poly­ethylene bags for boil-in-the-bag foods, and so on. From time to time, people express the fear that the advance of technology will limit the range of foods available to the housewife in the street or the gourmet. Yet, thanks to the general wealth, agri­cultural chemistry and engineering, and food science and technology, civilized com­munities have never been better fed than they are now. Modern preservation methods have brought the produce of every country and season to the nearest super­market all the year round. Food can remain preserved forremarkably long periods. Top The tombs of ancient Egyptian pharaohs-such as that of Khafre in oneoftheGreatPyramidsofGiza-were stocked with food for the pharaoh to eat in the afterlife. When the tombs were opened in recent times, some of the dried food, including cobs of corn, was still preserved after some 4,500 years. Bottom Many explorers in the last 150 years have relied on canned food, among them Captain Scott's ill-fated Antarctic expedition of 1910 to 1912. Canned food from Edward Parry's 1824 expedition was found to be edible byanimals in 1938.   Taken from The Marshall Cavendish Encyclopedia of the Human Mind  BOOK OF LIFE – Living Body - In 105 weekly parts- part 73, Factory fresh foods, Page 2026 – 2028.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….) , As more and more 'miracle drugs' are discovered, the steady, continuous part that a proper diet plays in the cure of disease tends to be forgotten THERE is a lot of nonsense talked about dieting and diseases. One man will swear that he can cure a cold by eating nothing but grapefruit; another advocates a cider and honey mixture to cure practically anything. Yet a well­planned diet, even in these days of wonder­drugs and miracle cures, still has a large part to play in the treatment of many diseases. Although in the world at large, millions of people suffer from malnutrition, in the industrialized nations of the world overnutrition is more common. In Great Britain in 1939 itwasestimated that only one in 15 people in England were seriously overweight. Yet the late nineteen­sixties were to see this figure increase to one in five. Today, doctors know that being overweight tends to shorten life and may lead to the development of serious illness such as coronary thrombosis, diabetes or a stroke - cerebral damage. Even though. malnutrition is relatively rare in Western Europe and North America, it does occur in certain vulnerable groups of people, usually the very young or the very old. Milk, although an excellent food, is rather short of certain vitamins ­vitamins A, D and C - and also iron. Young babies' diets are usually supple­mented with vitamin drops and orange JUIce, and most powdered milk contains small amounts of extra iron. In certain countries where breast feeding is com­monly continued for the whole of the first year of life, anaemia may develop due to the lack of iron in the mother's milk. Older people may also suffer from poor nutrition. It is easier and cheaper for some. older people living on a tiny pension to live on a diet of bread, jam and tea or coffee. Although this is a satisfying diet it is very short of vitamins and protein and this deficiency may contribute to the brittle bones and anaemia which so commonly occur in old people. Even the young may neglect their diet for one reason or another. Teenagers or young students - living away from home and often with little money - may find it more attractive to spend money on records and clothes rather than food . Some malnutrition is even self-imposed. Strict vegetarians - or Vegans as they call themselves - live on a diet without meat, chicken, fish or even eggs. Although some protein can be found in nuts and vegetables, these people are likely to develop a protein deficiency and can, unless they take great care, develop anaemia or weakness of the bones. Alcoholics too are another group who unwittingly impose malnutrition upon themselves. In the later stages of the disease, they care only for alcohol and have no desire at all for food. Eating the wrong foods can cause as much trouble as too little ofthe rightfoods. Although treatment by drugs has largely superseded treatment by diet, special foods still play an important part in the prevention or cure of diseases today. The figures for coronary heart disease show that in England and Wales alone, the annual death rate from heart disease was nearly doubled in ten years - from 55 ,834 deaths in 1950 to 91,961 by 1960. Even allowing for the fact that this figure is partly accounted for by improved diagnosis, the increase is still staggering. Heart disease now accounts for over 50 per cent of all recorded deaths compared to only 18 per cent for deaths from all types of cancer combined. This alarming increase in the incidence of coronary heart disease triggered off an urg~nt search into pos­sible causes - and more important - some means of prevention. One fact soon became clear. The death rate from coronary heart disease varies greatly from country to country. A World Health Organization report in 1962 for example showed the· death rate per 100,000 for men between the ages of 45-54 was 359 in the United States, 223 in England and W ales and only 52 in Japan. Could it be that the population of some countries such as Japan had a built­in immunity to heart disease? A study by Dr Frederick J. Stone of Harvard University on 500 pairs of Irish brothers provided a valuable clue. In each case one of the pair had emigrated to Boston, United States, and lived there for ten years, whilst the other had remained in Eire. He found the brothers in Boston took much less exercise and also had much higher levels of a certain fatty substance, Left Dietetics is a comparatively new science and more and more students are now specializing in this field. Here, they watch the dietician plan a meal. Right The individual dishes are set out on a trolley, ready to be taken to the wards. cholesterol, in their bloodstreams. A further study of Japanese men living in the United States also showed the death rate of the Japanese men was much the same as for other Americans. It seemed to be not so much a hereditary factor as something that appears in the diet. In other studies it was shown that there seemed to be a close relationship between average serum cholesterol levels in different coun­tries and the frequency of heart disease in those countries. For example the average level in Japan is 190 mg/100 ml, whilst in America the average is 260 mg/100 mlfor adult males. Further studies by Life Insur­ance Companies added further to the mounting stack of evidence linking serum cholesterol with coronary heart disease. Furthermore it had been fairly conclusively shown that serum cholesterol levels depended on different national eating habits and different dietary composition. 1\ this point in the story a notable contri bution was made by a success­ful businessman, Roy Hurley. In 1958 Hurley - at that time aged 62 - had been chairman of a vast £200 million company in America. He had become increasingly alarmed by the sudden death of three of his friends from coronaries in one year. With great determination he set out to discover whether these could be predicted and, if possible, prevented. Examination by his doctors showed him to be about 30 pounds overweight, and his serum cholosterollevel was 310 mg/ 100 ml. That is nearly 25 per cent above the average for Americans. The National Heart Institute of America, having investi­gated the lives and deaths of 5,000 Americans over a 12 -year period, indicated that the coronary rate was five times higher in people with raised cholesterols and ten times higher if they were also overweight. With redoubled energy Hurley set out to tour the country, visiting nutritional laboratories and scanning every available journal for further information. By May 1959 - having sifted through a mountain of conflicting evidence - he had settled on a diet. Within a year he had reduced his weight by 30 pounds and his serum cholesterol had dropped to an enviable 160 mg per 100 ml. The basic principles of his diet rested upon the work of a distinguished American nutritionist Dr Ansel Keys. Keys based his diet on the finding that there are in fact two entirely different types of fat - polyunsaturated fats found in some vegetable oils and fish­and saturated fats found in meat, poultry and dairy products. Furthermore, diets high in polyunsaturated fats tend to lower serum cholesterol whilst diets high in saturated fats tend to raise the level of serum cholesterol. The diet Roy Hurley followed was developed along these lines and had already been used by Dr Theodore Van Itallie in his Anti-Coronary Club in New York. The diet consisted in eating fish five times a week and not more than six four-ounce portions of fatty meats per week. At least five tablespoons of unsaturated fats in vegetable oils, special margarine or mayonnaise per day had to 2034 The restricted Calorie diet is used for patients, particularly diabetic patients, who need to lose weight. Allowing no potatoes, carrots are used to increase bulk. The semi-solid diet is for people who have difficulty in swallowing, those with burns, a fractured jaw or a restricted oesophagus. All the food is liquidized. The low protein diet, for patients with kidney failure, contains food with the most easily-utilized protein, such as eggs. The bread is special low-protein bread. be eaten. Cheese, butter and other dairy products were forbidden, as were pastries, ice cream, bacon, sausages and gravies. The diet allowed four slices of bread per day, only skimmed milk and not more than five eggs per week, as eggs are one of the biggest sources of dietary cholesterol. WITH this diet Roy Hurley had proved that it was possible to .. ' lower serum cholesterol levels by diet. But did this prove that you could reduce the likelihood of coronary thrombosis? Part of the answer to this question was provided by Dr George Christakis of New York. In 1964 he reported the results of the Anti-Coronary Club and showed that the number of heart attacks in a 'control' group of men was 400 per cent higher than amongst members of the Anti-Coronary Club. He also showed how, by sticking to his diet - sometimes known as the Roy' Hurley Diet or the 'Prudent Diet' - serum cholesterol levels were significantly reduced. Since that time controversy has raged within the medical profession as to the significance of these results. If we accept them at face value then most of our normal eating habits are dangerously wrong. It will also mean that coronary heart disease may even be avoidable. The question of the validity of these results can only be resolved when the results of massive controlled trials on both sides of the Atlantic are completed. But dietary fat is not the only suspect in the causation of heart disease. In 1964 Professor Yudkin in London produced figures demonstrating that, in each of the 34 countries he studied, the dietaryintaite of sugar closely paralleled that of animal fats - and of heart disease. It has been shown that an increased intake of sugar causes a rise in serum cholesterol and other fatty substances in the blood. At the present time we can state with certainty that there is a definite link between diet and heart disease and that a reasonable reduction in our intake of both animal fat and sugar can do us nothing but good. The role of diet in heart disease is a good example of correct diet as a means of preventing disease. Diet can also be of great value as a means of curing disease ­especially diseases of the digestive tract. Duodenal ulcer is one of the commonest disorders affecting the gut. As many as one man in ten is likely to suffer from a duodenal ulcer at some time in his life, and men are affected approximately eight times as often as women. Only a tiny minority of those with duodenal ulcers will ever require surgery, and treatment in the great majority of cases is usually with diet and antacid medicines and tablets. Tense people and those who smoke are more pr0ll.P to ulcers. It is thought that worry or anxiety can lead to stimulation of the acid-producing cells in the stomach, which produce an excess of acid - which erodes the mucosa - or lining of the duodenum and produces an ulcer. The aim of dietary treatment is to neutralize this excess acid and rest the stomach, thus allowing the ulcer to heal itself. Dietary treatment does 2036 not actually promote healing but simply permits it to take place unhindered. During the twentieth century innumer­able diets have been suggested. They fall into three main types. One of the most com­monly used is the Hurst diet. This consists essentially of hourly feeds of small quan­tities of milk, cream or other milky foods such as milk puddings. The Len Hartz diet also mainly consists of fluids but with some protein added in the form of eggs. Finally ,the Meulengracht diet contains a much wider variety of foods such as meat, chicken, vegetables and fruit, all of which are pounded or sieved into semi-solid purees before consumption. The advantage of this type of diet is its greater acceptability to the patient because of its variety and also the fact that these 'purees' tend to remain longer in the stomach, thus more effectively neutralizing hydrochloric acid. These types of diet are suitable for the treatment of acute ulcers. Once healed, it is always important for the ulcer patient to remember to eat regular small meals and to chew his food thoroughly. Certain foods are usually best avoided such as fried food, pickled onions or raw vegetables. Unfort,unately ulcers, even when healed, have a habit of breaking down again, although many ulcer sufferers have learnt to live with their ulcers by adhering to this advice. The best treatment for attacks of vomiting and diarrhoea is usually fluids by mouth for the first 24 hours, followed bya gradual resumption of normal eating. This will usually cure simple attacks but if symptoms persist or become very severe medical advice should be sought. Unlike duodenal ulcers, gall stones tend to be far more common in women. In fact the classical gall stone sufferer is por­trayed to medical students as being a 'fat, fertile, flatulent female of fifty'. However, this is a little deceptive, as gall stones may occur in both sexes and in a much wider age range. The gall bladder is linked to the lower part of the duodenum and stores secretions and enzymes which help in fat digestion. The gall bladder is stimulated to contract and empty its contents into the duodenum by the presence of fat in the stomach. So if overstimulation of a diseased gall bladder is to be avoided it is necessary to reduce the amount of fat in the diet. A suitable diet would therefore omit fried or fatty foods together with a sensible reduction of dairy products. As has already been stated, these patients are often over­weight and weight reduction will frequently cause a greater degree of symptomatic relief than any other dietary measures. IXOTHER common condition affecting . the gut which can be greatly relieved by a special diet is diverticulosis. This disorder affects five to ten per cent of all adults. In this condition many small blind pouches develop in the lower part of the intestines where material may become lodged and cause pain and discomfort. For this condition, diet is low in roughage and avoids the sorts of foods which are likely to become stuck in these pouches. It there­fore omits any fruit or vegetables contain­ing pips - such as raspberries or tomatoes, together with a general reduction in the amount of fresh fruit and vegetables. Occasionally these measures fail and an operation may be necessary. Some types of kidney stones may be partly prevented by a careful diet. There are several different types of kidney stones, of which the two commonest may be affected by diet. Oxalate stones consist of oxalate salts which are found in considerable quantities in rhubarb, spinach, beetroot and parsley. Urate stones are composed of breakdown pro­ducts of nucleoproteins which are found in large quantities in liver, kidneys, sweetbreads, roe and sardines. These same foods containing nucleoproteins may also cause gout, as uric acid is another breakdown product of such foods and excessive levels of uric acid in the blood are associated with attacks of gout. Heavy drinking, especially of 'fortified' wines such as port, and eating of rich meats, such as sweetbreads, should also be avoided by gout sufferers and they should, if overweight, attempt to reduce. Despite the dramatic discovery of insulin in the 1920s, diet remains one of the key­stones to the successful treatment of diabetes mellitus. In diabetes, a shortage of the hormone insulin prevents the proper usage and breakdown of sugar, which tends to accumulate to an abnormally high level in the blood. As the amount of sugar in the blood is very much influenced by our consumption of sugar and carbohydrates such as bread, jam, biscuits and cakes, in order to establish a correct daily dose of insulin it is essential that the level of carbohydrate intake should remain the same from day to day. Otherwise insulin dosage would have to be altered each day. So if a diabetic is to obtain the best results he must be prepared to take care not to exceed his carbohydrate allowance. AspeCial diet may be necessary if the body develops an allergy to certain kinds of food. One of the most notable examples of this is coeliac disease, which frequently affects young children. In 1950 two workers in Holland discovered that the inflammation of the gut produced in coeliac disease is caused by a substance called gluten which is found in flour. Prior to this discovery, only one third of affected children recovered completely. By com­pletely excluding wheat flour from the diet, a rapid return to health could be accom­plished for children who formerly would have died. Other types of food allergy can occur, usually to shellfish, milk, eggs or wheat products and occasionally straw­berries. The affected individual may break out into an itching 'nettle-rash' or develop an attack of hay fever or asthma shortly after eating the offending food. Careful skin testing by specialists can usually identify the causative food and subsequent omission of such foods will result in a cure. Diets have a part to play in the treat­ment of diseases, albeit usually a supple­mentary one. If a certain type of food irritates the body, then it should be cut out. In other words, diets in disease are usually a matter of common sense.   Taken from The Marshall Cavendish Encyclopedia of the Human Mind BOOK OF LIFE – the Child and his World - In 105 weekly parts- part 73, For all the World's Children, Page 2017 – 2021.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….), - Bizarre though they may Magic and common-sense a living part of medical history. edicine can learn a lot from them In spite of the advances in modern medicine, folk remedies are still followed by a great of people. Here. the patient a live snail on a wart in make it go away. reason why it should but it just might. A traditional method to stop bleeding is to put cobwebs over the cut. This idea may have grown up because the fine filaments of the spider's web look very like the sticky fibrin threads that appear in newly-clotted blood TODAY, in spite of the proved efficacy of modern medicine, people have all - sorts of bizarre remedies for illnesses. This is perhaps not so strange when we consider that it was only about a hundred years ago that the majority of the popula­tion lived away from the towns, far from any qualified medical aid - which, at that time, would probably not have been very effective anyway. A patient suffering from pneumonia stood almost as good a chance of recovery 3,000 years ago as he did in 1935, assuming that he had a reasonable environment and good nursing care. Even the comparatively well-off and well ­educated had to depend on home remedies, some of which had been proved by long experience. It was often the practice to collect and write down various medical 'recipes'. Most countries, and regions within countries, have such books in their libraries and museums. A wide range of substances appear in folk medicine, but the main traditional remedies have usually been based on the use of plants and herbs. These have a long and distinguished history. The Bible is full of references to the use of herbs for the prevention and treatment of disease. In the East, herbal treatment was studied long before Hippocrates, the Greek physician on whose thinking a great deal of modern medicine is based. The Pen Tsao, or Great Herbal of China, appeared around 3000 BC, givirig details of many herbal remedies, and an Egyptian papyrus discovered by the archaeologist Georg Ebers lists about 700 medicinal plants, including castor oil, senna and aloes, still used widely today. In the Middle Ages, however, herbal lore was reinforced by two other factors ­magic and astrology. It became more im­portant to use, or pick, herbs under certain conditions stated to be most favourable by the magicians and astrologers. By the end of the eighteenth century., however, the in­fluence of magic and astrology was declin­ing, and that of science ascending. This was the time that herbalism proper, folk remedies and orthodox medicine went off on their separate ways, although of course they still overlapped in certain areas. In assessing the value of folk medicine, one of the main difficulties is separating the myth from the genuine lore. Folk remedies are partly medical treatment and partly sympathetic magic. There are clear: cut cases where these rer.:,edie~ 'ire :)p,~ec on first-hand observations of sick animals and their natural means of self-treatment. Experimentation has proved that many of the same measures are effective in humans. This is a type of science. On the other hand, there are cases where the distinction between medical treatment and pure magic is likely to break down. Behind a great many folk prescriptions there is, or has been, a faith that they will work. And this same faith is present in a number of the modern drugs and surgical techniques used by the medical profession today. It is sobering to recall several examples of folk remedies which have evolved to play an important role in medical practice today. In 1775 William Withering, an English student of botany, learned of a family secret guarded by an old woman in Shropshire. This secret concerned a 'cure' for dropsy. It was apparent however, that this secret was known to others, for Wither­ing found it to be an old wives' remedy in Yorkshire. Although the old Shropshire woman brewed her potion from 20 dif­ferent herbs, Withering realized that the actiw one was foxglove. Dried leaves c foxglo\-e - Digitalis - and the subsequent>,­isc:ated acti\'e principle. digoxin. are still extensively used for heart disease. The anti-malarial quinine, a drug which can be said to have changed the course of history, was obtained from an infusion of Cinchona bark. The Jesuit priests learned of its use from the fudians in Peru in 1638. It was also called Peruvian bark. The root of Rauwolfia serpentina, a common plant of South-East Asia, was used for thousands of years in Brahman medicine. Two Dutchmen noticed this in 1887, and now the antihypertensive and tranquillizer, reserpine, has been isolated and is in common use today. The bark of the willow tree, Salix, was used to treat rheumatism by the eighteenth ­century Reverend Edward Stone. illtima­tely, this bark was purified, and salicyclic acid extracted. This is the basis of the aspirin tablet, used for so many ailments today. The list can be extended. Captain Cook was the first to observe the beneficial effects of lime or lemon juice for the pre­vention of scurvy. Even penicillin could be held to have some affinity with the mould poultices and cheese-eating prac­tices of rural tradition. Extracts of ergot, a fungus which grows on rye, were used by midwives for controlling haemorrhage associated with childbirth long before the medical profession had ever heard of it. Today, it is difficult to discern whether folk remedies are currently practised and believed in, or just 'old wives' tales'. Some people doubtless believe in folk medicine for minor complaints but turn to orthodox medicine for help when there is something seriously wrong. Some take folk remedies either before the doctor is called in, or dur­ing his treatment, as an insurance against his failure, or to give a helping hand to his medicine, or after his treatment has failed. For all our scientific and medical knowledge, a good deal of camphorated oil and goose grease is still rubbed on chests today. Old customs die hard and there is some evidence to suggest that there is an upsurge of interest in folk medicine. The reason for this awakened interest is not clear. Perhaps the increasing disillusion with science as the cure-all for society, and new knowledge about side-effects of modern drugs has something to do with it. Mter all, the essential distinction between standard medicine and herbalism is that orthodox treatment relies mainly on fight­ing illness with the help of drugs or surgery, whereas herbalism concentrates on stimu­lating the patient's constitution to fight on its own behalf. Whatever the reason, the interest in folk and herbal medicine has been remarkably demonstrated in the United States by the staggering success of several books on the subject in the 1960s. The expression 'a change of air will do you good' is often heard when referring to the remedy for an illness. An eighteenth- The breath of a cow was just one of the remedies for whooping cough, one of the greatest killers of children before the advent of modern drugs and vaccination. Also used were natural and man-made gases, from the local gas-works to the smell of newly-ploughed earth. century Scottish physician, one William Buchan, writing on whooping cough in 1772 is on record as having recommended it. These views on a change of air were widely accepted and became, if they were not already, a part of folk medical treat­ment of whooping cough in the British Isles. Faith in the efficacy of high ground, whether mountain, hill, tower or even a viaduct, was also believed to be efficacious for the treatment of whooping cough and croup in children, as is seen from various parts of Europe. Often, a bit of mystique crept in. For example, the high ground had to be near a spot 'where three roads meet', or the child had to be carried 'into three parishes on a Sunday morning'. Even now many children with whooping cough are taken up in aeroplanes to expose them to the low barometric pressure when flying at high altitudes. JUST as a change of air supposedly brought relief to sufferers of respira­. tory ailments, so also were natural earth fumes and gases thought to be bene­ficial. Inhalation of the smell of newly ploughed earth was considered to be good for whooping cough in many parts of Britain. During the latter half of the nine­teenth century, sufferers from pulmonary tuberculosis in Kentucky were taken into caves for relief of this illness. It is interest­ing to note that today the Russians are sending asthma patients to the salt mines to alleviate their condition. It had been noticed that salt mine workers did not suffer from bronchial asthma, probably the result of breathing salt-saturated air. Man-made gases, too, are part of folk treatment of whooping cough, tuberculosis and croup. Patients had to breathe the escaping air from mines, charcoal pits and open lime kilns. Such practices were com­mon in a few states of America and also in Britain. The custom of taking children to the gas works has been reported from dif­ferent parts of the United States, Britain and Spain. This practice is not so ridicu­lous as it might at first appear, for when an outbreak of whooping cough occurred in Fife, Scotland, in 1891, it was observed that the gas works keeper did not catch the complaint. The possible explanation is that air from a gas works, albeit un­pleasant smelling, has bactericidal pro­perties. Polluted air in the form of smoke from a railway train, or from a mine. W&S Tuberculosis, or consumption as it used to be called, was a disease which was very rarely cured. A change of air was usually the only thing prescribed People were taken into caves, and up into the mountains to attempt a cure believed to be beneficial for children's respiratory disorders in such areas as Spain and the Pennsylvania German country. More widely known geographically than any treatment involving mines, kilns or gas works, is the custom of taking a child into a grist mill and holding him over the hopper, the device that feeds in the com, to inhale the dust. This folk remedy for whooping cough was again common in the United States, Britain and Spain. Early in the nineteenth century, the in­halation of tar vapour was successfully used for children's respiratory ailments in such widely scattered areas as Fulham, England and Alabama and Texas in the United States. Although relegated to the realm of folk medicine, this practice has continued in use until our time. Apart from gases and vapours of this kind a change of air was also taken as a recom­mendation to inhale various human and animal vapours. Widely known as a cure for respiratory ailments was the air in a stable. This is reported in folk remedies from Britain, America, Germany, Holland and the Slavic countries. The breath and smell of a cow or sheep was considered to be good for consumption and whooping 2076 cough in many regions of Britain. Less well known cures relating to animal odours involved the breathing of the unpleasant smell of a goat" fox or pig. In the Bradford-Shipley district of Yorkshire, the smell of a maggot farm was thought to be beneficial for tuberculosis, and during the First World War, soldiers were marched through it to strengthen their resistance to this disease. There are reports from the United States and Britain of treating respiratory disorders by inhaling the breath of horses, mules and donkeys. Holding a child with whooping cough to a horse's mouth is reported from both Mary­land and Louisiana in the mid-1920s. Even human breath was pressed into ser­vice. Here however, the inhalation of such breath was of little value unless it came from a seventh son of a seventh son, or person with similar magical connotations! MOST folk medicine from various lands, includes records of the belief in fumigation and heat a~ a means of protection against infection. The inhalation of water yapour and the L;;::e~ of such unrelated commC'D ':::i'-'~er..:,ld material~ a~ '.-;:-:ega;·. :;:cate:i :-. r;;e-:·2.~~C':. turpentine, creosote and kerosene, were frequently used for respiratory ailments in much the same way as they are used in some countries today. It is still commonly held that draughts are bad for health and, in particular, likely to cause colds, though there is no real evidence for this. The concept of illness­inducing draughts is derived from the malevolent demonic influences, a cultural inheritance from the ancient Middle East. The word 'draught' has been used in the context of a current of air only since the eighteenth century. Its origin is in the ancient Teutonic dragan (to draw) but its idea stems from older traditions, probably in Babylonia and Sumeria, where the chief draught was the chief demon, Lilith, whose name in Sumerian, lilitu, meant wind. It is widely believed that women sing a lullaby (a lili-aby) to soothe their infants but the real origin is to keep lili (Lilith) at bay. Her influence, wind, was considered to penetrate an infant's stomach to cause colic. In the ancient Middle East, infants ,\'ere kept indoors for the first 40 days of liie to preyent injury by draughts. It is not 30 long ago that a similar practice existed :::1 America and Europe. Over the years, a dread of draughts as a cause of illness has become part of folk medicine. It is interest­ing to note, however, that those cultures not indebted to Semitic demonic in­fluences, such as the Bantu tribes of Africa, do not share this fear of draughts. Warts, though not very serious ail­ments, are nevertheless often extremely difficult to cure even by skilled physicians. Around them there has collected a wealth of folk lore on the best way to cure them. One way is to apply castor oil night and morning and to rub the wart 20 times with each application. Another is to wipe the wart with saliva first thing in the morning before speaking to anyone. Some people wipe the wart with the juice of a snail at regular intervals of time, while others will place the same number of pebbles as they have warts on a milestone - the warts will then be transferred to whoever picks up the pebbles. Other people swear that the only way to get rid of them is to steal a piece of meat from a butcher's shop and bury it- as the meat rots so will the wart fade away. There are many more examples. They are probably all as effective as each other, since the very belief that warts will go away often does seem to make them go away. Your great-grandmother probably put cobwebs on a bleeding cut. Perhaps this was because newly clotted blood in a gaping wound shows sticky fibrin threads. In the gap of the wound, they could look rather like the strands of a spider's web. This cobweb tradition is found in many rural European communities. It goes back a long way, probably 2000 years. Dioscorides, a Greek surgeon in Nero's army, wrote in his medical books: 'The cobweb of it being layd on doth stanch bloud ... '. Another remedy for a bleeding wound was to cover it with brown wrapping paper. This suggestion is included in the English nursey rhyme Jack and Jill. After Jack fell down and broke his crown, Up Jack got. and home did trot, As fast os he criu1d caper, Went to bec' ,'} ,'i7end his head HTzth Linegar ci'1d orou'l1paper, Appl~ing r:eat or cold to relieve pain is a centurie:.:-c:c: tradition. Ice-packs and other col6 ap,Lca::,:m:.: haw been used for sprain:.: a:1G :r:e',:m2,:i(' conditions in much the :.:an:e C,','2': 2.:': :he\' are today. Recent scientiric :ne:'e-: ::1 :he use of cold water to relie\'e :l:e of burns followed obselTatic':-, : ,:-,e -:aditional cold water treatment": [:,:::::.: ::: Iceland. The cw'e ': ::-,e ,I: ,,:neon cold has eluded scientiSTS ',:'::::: :::e ::resent day. Yet it has             'p' not pre\'e:::eo ::-e::: -:-:.lDg, atlents were told to :::1::a:e ,:~,:::,)r:cr 130metimes in a linen bs.z :',: c:"'1:: :::e :;eek i: to \Year brown paper 'J1&5;:e,'- ',: -~,::(;\\' or of mustard, or po<..L~:ce:.:: ':':01:5 or linseed: to take a brew       ;::c,c:-:c_::':·~.::',: :eaw3. wild pepper                ,               'd             I mmt '::·:'.~,C,-::',::'T~.:;:. lemon an treac e; Honey is perhaps the most tenacious of all folk remedies, It has been recommended to cure assorted ailments, by such varied people as Mohammed, the founder of Islam, the ancient Greeks and Persians, and even some writers today, eat Friar's balsam on a piece of sugar; swallow elder syrup or a mixture of butter, honey and vinegar; drink tea made of cayenne pepper and sugar. THE wearing of ground-up onion or asafoetida - which has a garlic-like odour - round the neck was con­sidered to protect the wearer against cer­tain common communicable diseases. A closer look at this practice reveals that this constitutes a rather effective preventive medicine, since the odour would discourage friends from close contact. However, the carrying of a pocket-full of herbs (posies) was certainly not much good during the Great Plague of London in 1665, if one believes the nursery rhyme: 'Ring-a-ring a rosies A pocketful of posies Atishoo, atishoo, All fall down'. (dead). Some remarkable suggestions have been made as a cure for tuberculosis. These include - a diet of snails; a decoction of lichens; a course of raw egg in lemon juice with rum. For rheumatism, rheumatic fen,' and lumbago the principal folk remed\' is the potato, worn about the per30n. ar:e,' which nutmeg, sulphur lumps, or red flannel are worn; stinging nettles, turpentine, or a hot iron on brown paper may be applied for local pain and stiffness. Copper bracelets, or more recently magnets, are frequently worn by sufferers from rheumatism and arthritis. A universal folk treatment for a sore throat is to wear a sweaty stocking around the neck instead of a necktie. Honey appears in the folk remedies of practically every country in the world. It has been used either alone or in combina­tion with other substances such as apple cider-vinegar. to feed infants. to cure bed­wetting, as a sleeping draught, to cure coughs, mU3cle cramps. burns and hay fever - and e\'en a3 an aphrodisiac. As late as 19 -; 1.1. a book \\,&S brought out extolling the \'alues 'If no'ney. in a blaze of publicity. In 3D:-e :,f :'ecent discoveries in the rield "f mxiern medicine, it seems un­like:'. -::a: :::e recipes of folk medicine will e':e::::le ': ut completely, whether because 3-:oJ::e a:'e e:ncient or because of the super­:':'IiT::'::', -haT clings to them. We must not be :e:::pted to reject the experience of -he :Ja5~: ,,}any of our present-day medica­:-::e:::5 :::ss be looked on as useless b\' :',::,::'e "enerations.   Taken from The Marshall Cavendish Encyclopedia of the Human Mind  BOOK OF LIFE - In 105 weekly parts- part 75, Century Cure, Page 2074 – 2077.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….), - It can scre"c; as fast as Man can travel: pandemics of influenza still threaten world nea!:r, Jo animals act as virus reservoirs and harbour new strains? A Doctor Willis of Oxford, in 1658. decided to put on record the story of a strange epidemic that had swept aCrOSS the land. 'About the end of April,' he wrote, 'suddenly a Distemper arose, as if sent by some blast of the stars, which laid hold on very many together; that in some towns, in the space of a week, above a thousand people fell sick together. The particular symptoms of this disease and which first invaded the sick, was a troublesome cough ... also ... a feaverish Distemper, joined with heat and thirst, want of appetite, a spontaneous weariness and a grievous pain in the back and limbs.' Doctor Willis had witnessed influenza in action - a virus disease that again and again in history seems to wake, like a sleeping volcano, to upset the lives of nations. In 1918-19, an epidemic ofthe disease 'destroyed more human lives in a few months than did the European war in four years', noted an official report of the time. Dr. Willis had observed the enemy in one of its less damaging sorties. He wrote: ' ... such as were indued with an infirm body or men of a more declining age, that were taken with this disease, not a few died from it but the more strong, and almost all of a healthful constitution recovered. ' Why does influenza lie dormant, then explode into action? Why does it bring no more than a few days' misery atone time, and at another kill the young and healthy? The answers began to be understood only recently. For doctors of earlier times, influenza's sudden visits, each time.in a new guise, misled them into christening the disease anew at each appearance. In 1555 it was 'the new acquaintance'; in 1581 'the new burning ague'. Men of the 1600s called it the 'strange fever', 'the jolly rant'. Our name for it, influenza, derives from the notion that an 'influence' from the stars may have caused it. Researchers of the 1890s erroneously defined the illness as the work of a bacterium, which is still called haemophilus influenza. Now, we know that influenza is the work of a virus. We also know that this virus has the knack, every few years, of changing itself, to produce new strains. In that lies much of the explanation for influenza's 'cam­paign strategy' as an enemy of Man. As a rule, once attacked, the human body 'learns' about the attacking agent of disease. Antibodies are created to serve as guardians against a retmn visit from the enemy. But influenza's frequent changes of guise often render 'old model' antibodies useless - and vacc::1es prepared from pre­viously current 3tr8.::1s ,A no avail against the new form of tr,e ::l'.8.c.er. Today, medical e:ge:-:3 throughout the world watch the ,0:1,0:11:."3 progress and Top: a diagrammatic drawing of an influenza virus. whose behaviour can be varied and unpredictable. Inthe 1918-19 pandemic it caused more deaths than did the Great War. Below. an electron micrograph of Hong Kong flu virus. changes of face - for even an epidemic mild in its physiological effects can cost a country many millions of pounds in terms of lost man-hours and production. The major epidemic in Britain in 1957, for example, cost 100 million pounds in medical expenses alone. World-wide, laboratories are engaged in comparing new strains of the \irus, as they emerge, against strains aheady familiar. Working in close concert \\ith the World Influ­enza Centre at the :\ational Institute for Medical Re3eE.:'Cr., London, these medical detectives :1: :3, c:ecide the best way to change ~.::':'~,,: ':~,ccines to keep up with the ,iT>' U-:',: ',,,,0:':101' development.      0,:-, :'C~,         : <-:3 close attention has bee:: ',:. > ,::.:':e:1za \irus - just one of th _    ",:3,03 capable of infecting .\L' -   u ,0:': -,',Titten-up life story. .\i , .. ' ,'C ~me knowledge of the major appearances the virus has made in our century - Asian Flu and Mao Flu became headline winners across the world's newspapers. Yet, curiously enough, it is still notor­iously difficult to diagnose individual cases of 'flu'. The symptoms can be mis­taken for those of other afflictions. Here, in brief, is how a mild bout takes its course: incubation period for the illness lasts some 48 hours: then there is an onset, often abrupt, of a fever - with the patient running a temperature between 100 degrees and 102 degrees. This lasts for three or '~four days, then declines. Headache. ~ malaise, shivering, dizziness, sore throat. ~ nasal obstruction, cough and hoarseness ~ may bedevil the victim. (Occasionally, ~ nausea and vomiting are among the symptoms - leading some people to imagine, incorrectly, that a special kind of 'gastric flu' is at work.) The aftermath of the disease brings its own problems. Even in uncomplicated cases, the period of re­covery may be prolonged by severe depres­sion - delaying the return to health and work for quite some time. FOR victims of uncomplicated flu, the best path to recovery lies through good nursing. For, although there are a number of anti-viral drugs, all are too toxic to use against what is essentially a 11 mild illness. '~ First step for the patient is to go to ~ bed. He should need little persuading: but ~ the foolhardy who attempt to carryon at "iii work are a hazard to others. (In a closed :§ community, such as a school. flu, during an epidemic, will affect some "; 0 per cent of the population. Flu sufferers v,ho belie\'e their work contribution is so important that they simply must keep on their feet. often end by costing their employers many thousands oflost man hours. ) Once in bed, the patient's headache. malaise, sore throat and insomnia can be helped by soluble aspirin, hypnotics and soothing gargles. If his condition does not improve within two or three days, or if it becomes worse, a doctor should be called. Severe sore throat, with enlarged glands. or signs of complications such as bronchitis or pneumonia are good indications for the doctor to prescribe appropriate antibiotics, The rare individual who becomes des­perately ill may need aid in hospital \\ith intravenous corticosteroids (a group of hormones) and other supporting treatment. Although most cases of influenza are mild, doctors have two good reasons to pursue research that will aid them in pre­venting outbreaks of the disease. In the first place, some people run more risk than others if they catch flu - pregnant women. elderly people, individuals who already suffer from chronic bronchitis or heart disease. Secondly, major epidemics are costly - and, if the virus appears in a yiru­lent strain, take a heavy toll of life .                           RESEARCH has today eyoh-ed vac­cines that give a certain amount of protection against influenza. But the battle is by no means won, and the story of medicine's fight to master influenza is a fascinating one. The epidemics of the past bewildered doctors of the time. Medieval reports which have survived are fragmentary: was the epidemic of 839 AD that laid waste the army of Charlemagne influenza? Was the 'English Sweat', first seen in that land in the summer of 1485, and a return visitor in 1508,1517,1528 and 1551?Ifso,the English ;;: 'eat was a particularly virulent strain. An observer of 1528 described its course: 'a little pain in head and heart, suddenly a sweat begins, and a physician is useless for, in four hours, sometimes in two or three, you are despatched without languishing. ' But, with the passing of the centuries, a clet;lrer picture of influenza took shape. Doctors took note of the outbreaks that struck throughout the 1600s and 1700s. Brisk outbreaks in the 1800s (in 1837 and 1848) were followed by 4 0 years quiescence. Then a pandemic marked by successive waves of infection broke out - and it became apparent that something had happened to change the nature of influenza - from 1889 onwards until the murderous pestilence of 1918, influenza struck more often than it had in the past. And, with the coming of the twentieth century, medical science was enough advanced to begin to probe some of its mysteries. It was through the work of three scien­tists, in 1933, that the virus agent of influenza was first demonstrated. These men, Smith, Andrewes and Laidlaw, suc­ceeded in giving the illness to ferrets in their laboratory - by inoculating the animals with throat washings from eight human victims of influenza. The ferrets ran temperatures, suffered catarrh - and sneezed. In one investigation of this period, an infected ferret sneezed in the face of a young research doctor. Forty-eight hours 3 later he too had flu, confirming that the disease had indeed been experimentally transmitted. One important lesson learnt from the ferrets was that, having been infected, the creatures became immune to subsequent challenges from the same virus. They had developed antibodies. GRADE~LL Y, research showed (as the collection of different strains of \-irus from human patients built up) that in.\'1'.lenza circulated in strains that fell into "l-..:'ee distinct groups. In 1940, scien­tis" cbJ'istened 'Influenza A' and '1.11­flue:lZa E': in 1949, 'Influenza C'. In­fluenza .-\ ,itself a changeable character I is ::~t- ·:::c-.;s :mplicated in major epidemics of t:·~ '::ii-twentieth century, including 6f ~·,-::·,c. :c::nary pandemic of 1957. E,~:::. ;:: Ffbruary that year, a focus of intL;~:---=_~ a:Jpeared in Central China. 1 Influenza spreads fast. Victims who insist on working a normal routine can spread infection and so help to lose their country millions of man-hours. 2 It makes the headlines time and again. Newspapers relish the sensational statis­tics involved when an epidemic's course of action sweeps world frontiers. 3 In 1922, queues waited for the distribu­tion of 'flu fluid', given as a precaution against the illness. Preventive methods still struggle to win the fight. 4 Alarmingly, this graph of the 1957 pandemic shows the heights that claims on sickness benefits reached in Britain in that year. 5 In 1919, during the most lethal pan­demic of influenza, 'flu masks' were worn in the hope of preventing infection. 6 Today, virologists search ceaselessly to produce vaccines that will be effective against the evolving flu virus. Shown here: a research worker testing the quantity of virus present in the viral fluid. probably in Kweichow province. Wide­spread epidemics occurred throughout the mainland of China during March, and refugees crossing from Communist China to Hong Kong carried the virus with them. From Hong Kong, the epidemic spread to cover almost the entire world. Its spread was as fast as Man's methods of transport COO Pakistani naval ratings, arriv­ing from Karachi on June 13, brought the first of the flu to Britain. More scattered outbreaks. between mid-June and late August. ,,-ere also the unwitting work of travellers. Fron::. then on, the epidemic gathered ::1i,:memum. In the end, between ~ 30 and = ' ,: s c' CSl'.t of the population were ~ infece:: - :,'c:::::eath rates were up 30,000 ~ a):.,:,·:e ::.e ~: = -= ,0 a,'erages.          <i:                 P,::" •.. ::.::-.stened 'Asian flu', the                       = -                           :--::...: ""s the work of a strain of '''.~_- :-=-:',< ,,- :..::luenza A 2'. It was the ~ s',:: -" :.:"~e=a A 1, prevalent ~ : e -':::: ~~'.s -;- . itself successor to ever achieve the same e. u u                                  "                                                 ,. __ , , '" ' that they have today e~ ':-~~:', _. diseases such as polioI"c:,'e:':: c. s .:...::.: :...:. theria. The influenza ,iT'~s 's-:=-e::::..... A strain) is too trick;; a c:~s:: :::.e~ : to simple measures, sucl: as :::'2SS ':", .. : . .' , tion against a single stra:"''1. Ep:::'e=:..=, 'C'._ continue to occur and each :':-.e 'O",:,,:,,~ c as 'a strange fever'. New vaccines have to be de·.e::'::-:-':' ­protect people against new strarr.s .:..::- . .:. 'O'.'~ each pandemic, virologists bee,::::.e :::. ~c adept. Should a new strain 0: i.=:'~e::~.' arise as virulent as that of 191':. :2::,:'.e' exist for the widescale production :: '", cine in quantities sufficient to pc: :e-:' groups of individuals who are at spe:.:.... risk. For the rest of us, conse::--:2:.-C measures can mitigate the unpleasan:::-.e" ofthe acute attack, whilst for those 1e:<: 'C::, suffer bacterial complications, e':::.·. e:.' tional antibiotic treatment has disp-e:':'e: much of the threat to life and health.   Taken from The Marshall Cavendish Encyclopedia of the Human Mind and Body - BOOK OF LIFE - In 105 weekly parts, on the track of influenza.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….), It usually takes a doctor at least six years to learn how to cure us. Yet we prescribe ourselves medicine all the time Do we really know what does us good? THE health services of the world would almost certainly collapse if people were not, to a certain extent, their own doctors. Pharmaceutical companies depend on this fact; a very large part of their sales are taken up by over-the­counter purchases by people who have diagnosed their own illnesses, and who prescribe themselves their own treatment. In fact, the use of medicines varies con­siderably from country to country. In one survey undertaken in selected towns in different countries, 48 per cent of adults in the United States had used a medicine compared with 19 per cent in Yugoslavia and 38 per cent in England during the same period of time. It is not unusual for the average house­hold to have 20 to 30 different medications on its bathroom shelf, all of which were self-prescribed. The most frequently used are: cough and cold preparations, vitamins and tonics, analgesic preparations for the relief of pain, antacids, antiseptics, and skin preparations. Such medications may be purchased for the entire family, or for the use of specific individuals. Quite often, such medications become part of the family furniture and may be moved when a household is re-Iocated. And, in this pre­packaged age, it seems that the home-made remedies of the past are being replaced by over-the-counter branded proprietary preparations. There is considerable public interest in, and knowledge about, matters of health. The public gets its information from magazines ~ particularly women's magazines - newspapers, books, consumer reports, radio and television. Indeed the communication media bear, sometimes unwittingly, considerable responsibility for the dissemination of correct information in their articles and programmes. Advertising too, plays a big part in influencing both the pharmacist and his customers, as the drug manufacturers can well testify. The fact that self-treatment still appears to be important is perhaps somewhat sur­prising in an age when most English­speaking and European countries have national health schemes sponsored either by government or private insurance agencies. Provision is generally made in these health schemes for the total cost of drugs. Certainly, in Great Britain, the makers of branded over-the-counter remedies expected their sales to drop drastically with the establishment of the National Health Service. Obviously, how­ever, a lot of people prefer to use household medicines rather than visit their doctor. As well as using drugs to treat ailments, people often prescribe themselves drugs to prevent illness. Vitamin tablets or injec­tions are widely taken in the belief that they will fortify the body against infection. Some women consider that they become anaemic during menstruation and con­sequently they need iron tablets to prevent this. There are those preparations which are taken for their 'tonic' properties. There are a wide variety of these preparations ­from the tonic wines taken as a 'pick-me­up' following influenza, to those which are considered by some to rejuvenate old tissues of the body. What do people really think about their health? Various surveys have been under­taken, but the results are by no means similar. In 1951, the government Survey of Sickness undertaken in Great Britain found that 75 per cent of the women and 67 per cent of the men interviewed con­sidered that they had been suffering from some symptom during the previous month. Much of this ill-health is never seen by the medical profession, either in general practice or in hospital. Studies carried out in Britain and the United States indicate that two-thirds to three-quarters of all illnesses never reach the doctor. Naturally, a lot depends on the subjective measurement of ill-health, and this will vary between different individuals and different communities. The decision to undertake self­treatment, seek medical advice, or simply to ignore symptoms of illness is usually a personal one. Many contributory factors playa part in the reaching of this decision. It may be influenced by the different pain­tolerance of individuals. Those who feel most pain are obviously more likely to seek medical assistance. Prevailing ideas of health and disease, and social and economic factors are undoubtedly also important. Other factors which influence the practice of self-medication are the quality and quantity of available medical services, the frequency with which illness occurs, the familiarity of the symptoms to members of a family, and the predictability of the outcome of any illness. The age and composition of the family, educational level of the household and the threat ofloss that may result from an illness, also con­tribute to the decision as to what action to take. Minor ailments produce symptoms which are marginal and which are usually readily recognizable. Consequently, indi­viduals treat themselves. Often people do not trouble to see the doctor if they know their previous prescription and are able to get it without difficulty over the counter at the pharmacy. Some are loath to waste their doctor's time and their own time waiting in a surgery if they consider their illness to be minor. Indeed, many doctors either consciously or unconsciously en­courage self-medication because of their attitude to minor complaints. The location of the doctor's surgery or office may also determine whether a visit is made. The fact that roughly two-thirds of all illness is never seen by the medical pro­fession might seem strange. However, if everyone presented himself at his doctor every time he had the slightest thing wrong with him, the doctor would soon collapse through overwork. Minor injuries like some burns, cuts, insect bites and nettle rashes can all be dealt with by first aid at home. Typical examples of complaints generally treated by the individual rather than the doctor are worry, nervousness, headaches, tummy upsets, including indigestion and constipation, respiratory complaints including coughs and colds, and influenza. Most doctors would probably agree that these ailments are suitable for self-treatment. On the other hand, they could be early symptoms of more serious disease and if they persist after a reason­able period of self-medication, the patient should always go to the doctor. About only one person in a hundred with a cold visits the doctor. Most turn to proprietary medicines, take folk remedies or just ignore it. Nearly all individuals believe in some kind of personal rules for remaining healthy and resisting illness. Whether they practise these rules is another matter. The ideas usually include some of the following: regular bowel action; personal cleanliness; plenty of exercise and fresh air; varied diet; and not too much 'high living'. Does self-medication safely take a burden off the medical profession? Does it result in an extension of minor ailments or lead to the development of serious complications which could otherwise be avoided? The' answer to these questions must concern the early diagnosis of serious disease. On the evidence available at present, self-medication does not appear to be an alternative to medical consultation. In fact, it is the patients who visit their doctor the most frequently who also pres­cribe preparations for themselves. Also, it has by no means been proved that self­treatment leads to delay in dealing with serious disease. It seems that self-treatment is complementary to rather than competi­tive with medical attention. Some innovators argue that people should be allowed to buy more prepara­tions over the counter, provided the public is educated to a greater extent in health matters. Undoubtedly it would be an advantage for the public to be instructed about which ailments may be considered as minor, and which effective remedies to use. However, it seems unlikely that the government health agencies and the medical profession would be prepared to extend the range of drugs at present available through pharmacists for self­treatment. It is hard for example, to imagine any other country following Japan's example of selling antibiotics without a prescription. Indeed this facility is not used to a great extent even in Japan, because of the cost. There is however a case for a front line of medical auxiliaries who could sift patients with apparently minor ailments and pass the more serious cases to the medical practitioner. That self-medication plays a useful role in the overall pattern of medical care was recognized in Britain - in the 1968 Medicines Act of Parliament, provision is made for the purchase of certain prepara­tions without prescription. Nevertheless, self-treatment should only be applied in cases where it can be safe and effective. Whenever in doubt, one should seek medical opinion. The medical profession which has fre­quently to deal with the abuses of self­medication has often been hostile to the principle of encouraging self-treatment. The chronic use of laxatives is one of the main abuses in the Western world, obsessed with cleanliness. This is not uncommon in elderly people, and can lead to severe loss of potassium from the body, and then require hospital attention. Also hazardous is the use of nasal decongestants for excessive periods of time. It is well known that the common and easilyobtain­able aspirin tablets are used in a large number of suicide attempts. Cough and cold preparation containing anti­histamines and atropine-like alkaloids can be abused. 'Chlorodyne', too, is dangerous as some people have become addicted to it. THE medical profession could help to educate the public by giving the necessary encouragement and guid­ance. The drug industry itself can playa useful role by combining some of its This diagram shows the proportion of self-treated ailments (in blue) to those the doctor sees (in green) to those cases which reach a hospital (in yellow). advertising· campaign with an educational programme. All new preparations, whether for self-medication or for prescription have to be vetted for safety by the govern­ment health authorities that exist in the various countries. With the stricter regula­tions that are in force in most countries, the number of new preparations for self­medication is likely to be very few. It seems probable that many individuals will continue to use the old long-established remedies, even though these may repre­sent levels of knowledge and forms of treatment now out of date. Advertising undoubtedly has a pro­found effect on influencing public attitudes to the treatment of their own ailments. A glance at some of the old advertisements for home medication pro­ducts will reveal the extent to which ethical standards have now been raised. It is perhaps appropriate to mention that there is legislation in most countries to provide statutory control over advertising. In Great Britain for example, manufac­turers of proprietary preparations - that is branded non-prescription drugs - are required to submit all advertisements for inspection by their association before release. These advertisements have to comply with certain codes of practice. The codes are aimed at limiting the offer of products to conditions thought suitable for self-medication and to ensuring that state­ments in advertisements are correct. These codes also require medical evidence to sup­port any advertisements and give guidance on such matters as reference to doctors and hospitals and use of testimonials and offer of samples. The main concern of both government and pharmaceutical agencies is to ensure that the public is not misled by unjustified claims. Nevertheless, there is often a problem in evaluating certain advertising statements. Doctors them­selves differ in opinion on the value of certain products. It is frequently accepted that safety rather than efficacy is more important with regard to remedies for self-medication as people are far more likely to over-prescribe for themselves, even though the instructions on the label are carefully worded. With these products prescribable only by the medical profes­sion, the efficacy of the product is more likely to be taken into consideration. The pharmacist can also play a useful role in any education programme on the use of medicines. Although it is possible to purchase certain drugs from non­pharmaceutical establishments, there is a fairly strong case for seeking advice from a pharmacist when self-medication is considered. He is trained to understand drugs and should know if there is any incompatibility between the over-the­counter product and any prescription drug the person happens to be taking. Also, he should be able to advise his customers when he considers it is necessary to seek medical advice. We all know people who have bathroom shelves overflowing with every new medical preparation. This is the ridiculous extreme; most of us will use just enough self-medi­cation to cure minor ailments and injuries without wasting the doctor's time. EVERY chemist relies for a large part of ills business on preparations that people over the counter without a prescription. These preparations fall Into a number of groups. ANALGESICS are one of the main groups and are taken for the relief of pain. The three main preparations are aspirin, codeine and paracetamol. ANTACIDS may be used In two ways, either to relieve pain between meals, in which case they are taken only when the pain IS present or to relieve gastric acidity throughout the day, when they are taken in the form of tablets to suck or chew. The antaCids available contain either magnesium salts, calCium carbonate, aluminium hydroxide or sodium bicarbonate. Often these different ingredients are combined in one preparation Mixtures containing aromatic bitters are traditional remedies for the loss of appetite accompanying many ailments. Pain, whether superficial or deep-seated, is relieved by any method which itself produces Irritation of the skin, for example., heat or mustard oil. Such COUNTER-IRRITANTS are of some value in the treatment of painful muscles, tendons, Joints and some types of rheumatic pain. There are a large number of substances used as counter-irritants and many contain either methyl sallq/la!te or its derivatives They probably all act differ mainlv in the the same way al-: and duration c'   action. COUGH MIXTURES are widely usee although there is a body of opinion whle' doubts their value Domestic remedies sue­as honey, lemon and hot help tc loosen a cough. Codeine is a traditlonc: remedy for suppression of coughs, and .~ usually presented In the form of a linctus Preparations containing adsorbents such c:~ kaolin and chalk give relief of DIARRHOE,L, and codeine may reduce bowel movements However, for children, the best treatment is simply to withhold food for. 24hour~ and give plenty of water Widespread misconceptions about con­stipation have led to excessive use of LAX A TlVES, particularly m the United States, to cure constipation. Often a change of diet IS all that is required. Saline purgatives such as magnesium sulphate and sodium sul­phate are useful occasional purgatives Liquid paraffin acts mainly as a lubricant whereas methyl cellulose is a bulk purgative. Cascara, rhubarb and senna contam active principles which are absorbed and act on the bowel muscle 8-12 hours later The action of phenolphthalem is similar but more pro­longed, A number of MOUTH WASHES, gargles and lozenges are sold over the counter. These contain antiseptics and, occasionally, lozenges will have present a small quantity of local anaesthetiC People use them to relieve mild throat infections. SKIN PREPARATIONS may be presented as dusting powders, lotions, creams, oint­ments or aerosols Antiseptics are mcor­porated in dusting powders and creams for use in athlete's foot Calamine lotion is useful to relieve sunburn, and there are many proprietary preparations containing sun­screen ingredients. Zinc and castor oil oint­ment IS very popular in most countries to protect a baby's skin against napkin rash Tincture of iodine, chlorhexidine cream and cetrimide cream are bought as antiseptics for Immediate use on superficial wounds. People also preparations from the pharmacist to counter TRAVEL SICKNESS, rather than go to the doctor Cyclizlne, hyoscine and the antihistamine drugs are very effective for this purpose. All these drugs may, however, cause drowsiness and the user must be extremely careful If he has to a car or work machinery. The normal diet in Western countries usually ensures an adequate supply of VITAMINS. Yet people continue to buy extra vitamins In the belief that more means better Halibut liver oil and cod liver oil capsules contain vitamins A and D. There are numerous multiple vitamin tablets on the market. Taken from The Marshall Cavendish Encyclopedia of the Human Mind  BOOK OF LIFE - In 105 weekly parts- part 74, Do-it-yourself Doctors, Page 2056 – 2059.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….)    , The fearful fact is that every year, more and more people in the West fall victim to a coronary. But current research suggests this fate may be avoidable NEITHER Julius Caesar, Napoleon Bonaparte, nor Benjamin Disraeli ever ran the risk of being told by his doctor, 'You've had a coron;ry'. A late ­starter among medically-recognized con­ditions, it was not until 1912 that coronary thrombosis was first recognized as a diag­nosis, not until 1925 that it was generally known to doctors in England. Yet, by 1964, this disease was in many countries taking a greater toll of deaths than all forms of cancer combined, Coron­ary thrombosis has rapidly become an important problem. How can we account for this extra­ordinary increase? One explanation offered is that the increase is apparent rather than real: that people have always succumbed to coronary thrombosis in large numbers, but that doctors had not yet learned to identify the disease. Another explanation is that, because modern drugs have rendered less danger­ous the more common infectious diseases, people are living longer and reaching the age when they are more vulnerable to coronaries. Both these explanations seem inade­quate, however, when we realize that the frequency of coronary thrombosis is con­tinuing to rise yearly, while life-expectancy is now fairly steady. Some other factor or factors must be responsible for the increase. Perhaps the victims of coronary throm­bosis themselves can provide some clues. Who, then, is most likely to get a coronary? Before the Second World War, the con­dition was most common among profes­sional men like doctors and lawyers, and 3 high-powered business men, very uncom­mon among unskilled labourers doing heavy manual work. Men were more fre­quently victims of coronaries than women. This pattern persisted through the war and early post-war period. Since the mid­1950 s, however, more and more coronaries have occurred among the relatively lower­paid part of the population. The condition now attacks younger men and, increas­ingly, women. What can have brought about these changes? Perhaps they are related to general changes in living standards. Certainly, before the 1930s, the rich lived - and ate - very differently from the poor. AI). Edwardian handbook for hostes­ses suggests the following menu for a little dinner party: oysters in the shell with thin slices of brown bread and butter; tomato soup; fried fillets of plaice with anchovy sauce; fried sweetbreads; roast sirloin of beef with baked potatoes, York­shire pudding, and cauliflower; roast chicken and lettuce; apple trifle with whip­ped cream; cheese; ices. All this, of course, would be accompanied by a suitable selection of wines, and followed by coffee, liqueurs, and cigars for the men. Obviously not everyone could afford such rich fare. Only the well-to-do were feasting on such menus, at a time when the lower social classes were making do with much simpler fare, fewer luxuries of all kinds. During the Second World War and the post-war period of rationing, food con­sumption was limited, everybody's stand­ard of living was lowered. But from the early 1950s onwards, living standards began to rise and have coritinued rising ever since. Everyone - not just the upper classes - started consuming more sugar and fats, bought more motor cars and television sets, smoked more cigarettes. And it was just from this time that the incidence of coronary thrombosis among the less well-to-do began to rise. WHY should this higher standard of living have brought such a rapid increase in the incidence of coronaries? Medical researchers have worked hard at answering this question. In the United States, the Metropolitan Life Insurance Company, observing a group of apparently healthy people over a period of years, noted that coronary thrombosis was frequently accompanied by overweight. Their study showed that men whose weight was 40 per cent or more above the average for their age, height, and body type were three times more likely to suffer a coronary than other people. Too much good food and drink, the rewards of affluence, would seem to bring their own dangers to health. Two other important factors have also Many causes work together to make a coronary. The careers of Tom Lean and Jack Fatt contrast on all the points known to be involved in the making of a heart attack. Lean's family tree, 1, is well stocked with octogenarians, Fatt's forbears, 2, more often lived a short life and a merry one. But though long-lived ancestors statistically heighten Lean's chances, his frugal diet, 3, helps too. Fatt could work himself wonders by taking additional care over hisfood. Alas, his diet 4 is dreadful. The man who is 40 per cent above normal weight for his age and height runs three times the risk of a coronary than frugal Lean. Excess weight raises the blood pressure and makes the heart work harder. Animal fat in the diet has been blamed for causing a high level of blood cholesterol and a tendency to coronaries. through final proof is lacking. Mrs Lean. 5. has-like otherwomen-a head start in the survival stakes over both Lean and Jack Fatt. 6. been recognized: the height of the blood pressure and the level of cholesterol in the blood serum. This association of an increased level of serum cholesterol with an increased risk of coronary thrombosis has led to much speculation over the past few years. Cholesterol is a fatty substance which is found in large quantities in, among other places, the bile, blood cells, egg yolks. What could be more reasonable than to assume that a raised level of fatty substances in the blood - and thus a high incidence of coronary thrombosis - might well be due to too much fat in the diet? This idea became even more plausible when comparisons of fat intake in different parts of the world showed that those popu­lations which ate the least fats - the South African Bantus and the Japanese, for example - had the lowest incidence of coronary disease. FURTHER investigation showed that there are two main chemical types of dietary fat. The first type is known as 'saturated' fats. These mainly animal fats - such as butter, beef dripping, and lard - raise the level of the serum choles­terol. On the other hand, the second type ­the 'unsaturated' fats - actually lower the cholesterol level. These unsaturated fats, mainly vegetable in origin, include corn oil, sunflower-seed oil, and peanut oil. It seemed logical, therefore, to advise people who had suffered a coronary to avoid animal fats and to consume more wgetable fats. Diets of this sort have been wry popular, especially in the United States. Unfortunately, patients who have followed such diets do not appear to be less prone to further attacks of coronary throm­bosis than are those who follow a normal diet. Of course, the reason for this may be simply that the arteries have already been damaged over a period of many years. Per­haps starting such a diet after having already had a coronary is too late. But we do not yet have enough information to know whether putting healthy men of 30 on such diets will prevent them from having coronaries in their 40s, 50s and 60s. Medical research is looking into the matter but it will necessarily take many years. before we have the answer. More recently, a British nutritional expert has pointed out that mortality from coronary disease in various countries has risen step by step with the increase in sugar consumption in those countries (measured by the amount of sugar they import). It is true that in countries where coronary disease is common, people consume large numbers of cups of tea or coffee, well laced with spoonfuls of sugar - as well as quanti­ties of cakes, puddings, and ice-cream. But there is not yet sufficient evidence to reach any firm conclusions about the Mrs Lean also keeps a close watch on her husband's intake of sugar in tea, coffee, rich cakes and puddings. Some experts link sugar consumption rates with cholesterol levels. It may be mainly to escape Mrs Lean that Tom, 7, spends relationship between sugar consumption and coronary disease, apart from the fact that sugar often contributes to overweight. Yet another consequence of affluence is that more people smoke more cigarettes. St'ldies in both the United States and Britain have shown that cigarette smoking is linked with increased mortality from coronary thrombosis. The American research, carried out between 1952 and 1955 and based on a study of 190,000 men between the ages of 50 and 70, showed that the death rate in those smoking up to ten cigarettes a day was nearly one-third higher than in non-smokers. The death rate in those smoking between 20 and 40 cigarettes a day doubled, and for those smoking over 40 cigarettes a day the rate was two and a half times as high. Aseparate British study carried out . among doctors confirmed the asso­ciation of raised death rate with cigarette smoking, and also showed that those who had formerly smoked but who had given up cigarettes had a lower death rate than those who continued. Two interesting studies, both conducted in London, hint at yet another risk asso­ciated with changing patterns of life. The first study showed that drivers of double­decker buses are more likely to die from coronary thrombosis than are conductors on the same buses. The second study revealed that clerks in government offices suffer a greater mortality from coronary thrombosis than do postmen working from the same department. The factor common to both the postmen and the bus conductors would seem to be physical activity. It has been therefore suggested that exercise partially protects these workers from coronary thrombosis. Evidence suggests that lack of exercise may encourage the narrowing of the coron­ary arteries. Some of this evidence was 522 long hours walking the dog while Fatt, 8, 13 snores atthe fireside. But sensible regular exercise is a powerful factor in forestalling a heart attack. Up-and-about bus conductors have fewer coronaries than sedentary bus drivers. obtained as a result of 5,000 post-mortem· examinations carried out on men aged between 45 and 70 years during the years 1954 to 1956. Those men who had worked in jobs requiring physical activity had suffered fewer, and less severe, coronary attacks than had those in sedentary jobs. A more recent autopsy was performed on a famous athlete who had continued running one hour a day until the age of 69. The examination revealed his coronary arteries to be still as open and healthy as those of a 20-year-old boy. Thus affluence, in providing us with more and more gadgets to simplify our· lives and to minimize our physical exertions, would seem to be an enemy to health. Increasingly, people are driving cars to work instead of walking or cycling, more and more are watching the ubiquitous television set instead of spending their leisure hours actively, and pr,esent studies seem to indicate that these developments lead to a greater risk of coronary disease. What of the often-mentioned 'pres­sures' of modern life, the competitiveness of urban surroundings? These, too, would seem to play a part. Very often, men who suffer a coronary attack have, for a few weeks or months previously, been working long hours on some important and demand­ing job, bringing home work from the office or putting in an excessive amount of overtime. It is usually the type of stress that one puts on oneself, rather than that caused from outside - like a series of air­raids or life on the battlefield - which seems to lead to a coronary. It is often the tense, self-driving type of individual of whom people say, 'If he doesn't take it a bit easier, he's going to get a coronary'. Of course, not all the factors relating to coronary disease can be blamed on afflu­ence. For example, the Framingham study has shown that increasing blood pressure leads to a progressive increase in mortality from coronary disease. Similarly, diabetics have long been known to have an increased risk of coronary thrombosis. (Although it could be argued that diabetes itself has become more prevalent since more people have been able to afford to over-eat!) Sex is another factor affecting the inci­dence of coronaries. A woman before the change of life is in a particularly favoured position, since her chances of having a coronary are very small. (They have risen slightly since the Pill came into general use, since the Pill slightly increases the possibility of all forms of thrombosis) . Once past the change of life, women are increasingly liable to suffer coronaries. Even so, their risk is much lower than that of men of the same age, and corresponds to that of men 10 to 15 years younger. Finally, there does seem to be an heredi­tary element in some cases of coronary thrombosis. In certain families, one or more brothers may have coronaries. Further enquiries often disclose the fact that various grandparents, uncles and cousins have had attacks, too. This does not mean that if one member of a family suffers a coronary, others must necessarily go on to have one as well. But in families where more than one blood relation has had an attack, the chances of others having one are correspondingly higher. Of course, the development of coronary disease cannot be attributed in each individual to only one cause; many factors may act together. For example, a fat man may well have a raised blood pressure, may ride in a car rather than walk, and may smoke countless cigarettes. Such a man will have a far greater chance of developing a coronary than a lean, physic­ally active non-smoker with a normal blood pressure. The more of these adverse fac­tors the individual has, the greater are his chances of a coronary attack. But living sensibly need not mean putting Mr Lean's long face on daily life. Eat wisely and not too well; cut down on smoking; take half an hour's exercise a day; try to keep stresses to a minimum. The future is all in front of you. IT we are going to prevent coronaries, therefore - and the same applies to prevent­ing recurrences in those who have already had an attack - we must deal with those adverse factors which are under our con­trol. We must watch what we eat and keep our weight down. Sweets and pastries, cream sauces and rich soups all put on weight fast. Alcohol, too, is fattening - a beer or whisky contains as many calories as an ice cream or chocolate bar. WE must take regular physical exer­cise - and the emphasis should be on regularity. Sharp bursts of excessive exercise at infrequent intervals may do more harm than good. A fast game of tennis singles once a month could even be dangerous in some cases, whereas a daily walk would be a very health-giving habit. We must go easy on cigarettes. Indeed, if we have already had one coronary, we must not smoke at all. We should try to organize our work in order to reduce .. the element of stress. We should take work home from the office ! only under exceptional circumstances, and 11 we should take proper holidays away from &: our ordinary working surroundings. For control of certain factors, we must consult a doctor. For persistently raised blood pressure, he will advise treatment. He may also be able to control an excep­tionally high serum cholesterol level by prescribing tablets. Diabetics must, of course, strictly follow their doctor's recommendations. Some of the factors influencing the likelihood of an attack of coronary throm­bosis are beyond the individual's control. But that should not lead us to a fatalistic view 'what will be will be'. A careful diet, combined with a sensible way of life can minimize the risk of an attack for anyone ­and could add years to life.   Taken from The Marshall Cavendish Encyclopedia of the Human Mind  BOOK OF LIFE - In 105 weekly parts- Is your Coronary Necessary?, Page 520 – 523.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out), Blood transfusions save millions of lives every year. An ever-increasing :=C"::; of donors give this vital fluid by the pint for use when accident strkss By the year 1492, Pope Innocent VIII was feeling his age. He ordered his physician to make him feel younger. The doctor decided that the administration of young blood might relieve His Holiness' complaint. Three boys were bled to provide it. The experiment was not a success. Much remained to be learnt before blood trans­fusion could become the everyday life­saving technique it is in the twentieth century. It was not until 1615 that Andreas Libavius, a chemist of Halle, described the principle of transfusion, and in 1656, Sir Christopher Wren, more famous for architecture than medicine, experimented with intravenous injections. These experi­ments stimulated Dr. Richard Lower into transfusing blood from one dog into another. He used two quills for insertion into the respective blood vessels and an animal bladder as an intervening recept­acle. These experiments were successful: dogs' blood does not suffer the serious incompatibilities which may exist between human beings. Unaware of the incom­patibility problem, Lower suggested that blood transfusion could be used to aid Man. Other early theorists proposed that animal blood should be tried in the first instance. Diarist Samuel Pepys paid 20 shillings in 1667 for a pint of sheep's blood. For obvious reasons this method of treatment rapidly fell into disrepute, and was banned in France in 1678. For the next 150 years nothing more was heard of blood transfusion. Then, in 1829, Dr. James Blundell in the Lancet reported that he had carried out ten trans­fusions with human blood, six of which had been successful, particularly when given to women after childbirth. In the nineteenth century blood transfusion was still con­siderably hampered because methods of preventing blood from clotting - anticoagu­lation - were unknown. Therefore speed was the essence of success, because all blood normally clots within a matter of minutes. And so physicians decided to connect the donor to the recipient by a direct pipeline, through which the blood would pass in a few seconds. Obviously the amount of blood available by this method was limited, and unless careful watch was carried out, the donor might suffer more than the patient! Anti-coagulation was made easier when the association between clotting and fibrin, a protein in the blood, was discovered ­blood clotting is substantially reduced when the fibrin is removed. But the corner was not really turned until, just before the First World War, it was discovered that blood mixed with a 3.8 per cent solution of sodium citrate would remain liquid for an indefinite length oftime. Moreover, sodium citrate could be injected into the circulation without harming the patient.     In Britain, an army of donors, over a million strong, give their blood. Above, this medal was awarded to a woman who has given over 30 pints of blood. Below, a badge given by the British National Blood Transfusion Service to donors. Another important advance in the establishment of safe transfusion was Karl Landsteiner's discovery of the main human blood groups, the ABO system, in 1901. For this achievement he was awarded a Nobel prize in 1930. It was Landsteiner, a Viennese physician, who worked out that the world's population could be classified into four different blood groups. He showed that transfusion of blood from one individual to another was hazardous if done unscientifically, but reasonably safe when carried out between members of the same blood group. During the carnage of the First World War these advances were not utilized, nor was it known how necessary and effective the massive transfusion of blood to the severely injured could be. F,::c:·.:.:- . .:'-~.: : ... -:­establishment of blood JaT~:~. :~.::_o development of the ffiert.Cc. transfusion in 1936. preee~ce:: ::-.,0 ~-:- --. World War sufficiently for ::-.,0 "e:-.e:::~ : blood transfusion to be f~\' -:-:':;::::-:-: during this conflict. On :l:e:{:-.e: :.:':.: civilian air-raid casualties mac.e -0;:::':-:-=-.' the need of blood for the ei\ili2..::1:;:': ::-=-:.0-:-: ':. and demonstrated that a large J: :.:.:: :: :.:.~. fusion service was an essential pa:: ::. :.'-:­treatment of the sick both in \"2..,2..:-.:: :: -:-.0:-:- OUR blood consists of a 1l'_.:: :-'-0" .. pla.sma, slightly yello\:' ~~. c .•• ~.:.:=­whIch are suspendec .L._ .. __ ~ blood cells, called red corpuscle~ a::::: ": __ '~ corpuscles according to their ee,:,: ''':': -=--:.-:­blood is red because the red eo:::,:;·..:.~::e~ ~ greatly outnumber the \"hite e:'::::~:.-:-~ The red corpuscles are importae ':e::. ~ ~ they provide all our tissues '.',~:::-, :::~ oxygen, picked up in the luni'~, "C':':'::. bones, muscles and all the othe:c ;:a:-:~ : the body need to carryon their ';'::~: =: .~ the oxygen-carrying capacity e,f :::-:- .':..: which is so often the principal re..:'~:-. :: carrying out a blood transfusi::- .. -=--=-.-:­patient who has lost a lot of blc",.:: :.":':' ] matically has his oxygen-carr:'-ing- c..:':;::.::­B diminished. ~ Among Landsteiner's major ..:'c:-_:-:-'.-:-· lc ments was an explanation of the :::'..:"::-:­.~ that occurs when 'incompatib:e' ':: .. ::.~ ~mix. Visible even without a EC: ~: :::-7 :] what happens is that the red co:c-::·..:~c:e; .: ~ the donor's blood clump together ';':::,0::: ::-.-:-: icontact the serum of the patient' ~ ~:.:.:: ':"-. ~ a clump, the red cells "ill block 1.:[' ::-.,0 :'~.-:­~ capillaries of the circulatory sYs~e::::, ::-7:­f haps with fatal results. Trigier~ c::' ::-.-:­8 clumping activity are the speei&: :;::::-:-:.:- .. ~ called agglutinogens on the sc-:'ace :: :'_.-:­red cells. When these meet up "C'::::-. :'_.-:­special proteins in the alien sen:=- -: c'-:-c agglutinins, clumping occurs, L,-::::i~:-:-::-~: framed a rule to summarize the :":-.:02: .:'::: =-.~ between agglutinogens a..'1G ai';:·"::::_:.~ that could occur. 'The serum of..:'::1 ~:i:'-: ':. c. contains the agglutinim whic:: ,,0:':: the agglutinogens absent free :-.~ ~ : ','-=-. :-:-: blood cells.' Most red· eeL ai'i':·"::.:-. :-:-=-.' are present at birth, aggh: tir:.~::~: a:. C"_ be detected in about half ci 0" ::-:--;o'~ :-: babies. Agglutinins begin te ..:':;:::~:.: .'.:.~: the first ten days of life. The red-cell factors - tDe az::..:::=-. :~=-.' - .. - are referred to as A ar.G. B" :'C".:: :._. ~ serum factors as anti-A. ii::1G ..:'::1:::.::; -=--._.~ red cells contain either A. ,c,:' B. :-.-:-:::'.-:-:­these are group O. or both - t::~~e .0.::-:-;:-:. ".' AB.They are distributed in t;--.e :;:-. as shown in the table on page i' :.; BLOOD from each STouP La::-. '" --:::e::..:-. fused to a patient of ,::,0 ~.:.::::e ~ _­In addition. because tr"e ~c:: _,,_~ . group 0 possess no ag;:u~: i'-:-:::'.   name of agglutinins per cent of blood group present population 0 anti-A 46 and anti-B A anti-B 42 B anti-A 9 AB neither 3 cells can be transfused into patients 2 belonging to all other groups besides their own. These people are thus called universal donors. On the other hand, members of group AB have serum which will not initiate the clumping reaction when mixed with blood from any other group. These are the universal recipients. In practice, however, Landsteiner's con­clusions do not work out as simply as this. Both the A and the B factors have sub­groups - discovered in 1911 - which may lead to clumping when the principles of the ABO group system suggest that it should not occur. In addition there are com­patibility systems in the blood entirely distinct from the ABO classification, but 3 these are of theoretical rather than practical importance to the doctor con­sidering blood transfusions, because they do not affect life and death directly. But there is one system, discovered by Landsteiner and his colleague, Wiener, in 1940, which is important. Called the rhesus or Rh factor, it is identical with the antibody discovered by Levine and Stetson, in 1939, in the serum of a woman delivered of a child with jaundice. Father was Rh positive, mother was Rh negative. As the baby began to manufacture father's red cells, owing to partial mixing of mother's and baby's circulations in the womb, the Rh positive cells were destroyed by anti­bodies in the maternal serum. Thejaundice was due to the destruction ofthe red cells. Since 1939, it has been found that the Rh factor is present in as many as 85 per cent of all human beings, and special precautions need only be taken in the special circumstances when father is Rh positive and mother Rh negative. But the important lesson has also been learnt that Rh positive blood should not be transfused to Rh negative patients. The larger blood transfusion centres in Britain, America and Europe provide, for the use of hospitals and laboratories, bottles of both anti-A and anti-B serum. By placing a drop of each serum on a white tile, and by adding to each drop samples of a donor's red cells suspended in saline solution, it is possible, in a few minutes, to see with the naked eye whether these cells clump together or not. The process of agglutination is even more easily observed under a· microscope. If the clump­ing occurs in both sera, then the donor belongs to group AB. If in neither serum, he belongs to group 0, the universal donors. 1 Stored in disposable plastic bags. blood stays in the refrigerator for three weeks. Each pint is stamped with the date by which it must be used. 2 On the left. a pint of whole blood. on the right a jar of dried plasma and the sterile water needed to return it to liquid form. Plasma can be kept for long periods. 3 Blood for an emergency. each pint from the 0 group. is moved round the hospital in crates. grouping, but that there are also no abnormal proteins present in the recipient's serum, which could trigger off the clump­ing reaction. The direct matching takes much longer, maybe three hours. In an emergency it may be justifiable to dis­pense with it, and to rely on the quick ABO grouping tests as the only guide to success. If clumping occurs in serum anti-A, he belongs to group A, ifin anti-B, to groupB. By making these preliminary tests, much safety is brought to the practice of blood transfusion, but by no means all risks can be eliminated. To see if the patient who is to be transfused can really accept the blood offered to him, it is best to perform a direct '1latching test with his own serum after the main grouping tests have been carried out. This will ensure that, sup­posing the patient's blood group is already known, no error has been made in the ABO WHEN the oxygen-carrying capa­city has been reduced, either because the patient has lost a lot of blood, or because his blood has too few red blood corpuscles - he is anaemic - the most sensible course of action is to replace what is missing. The effects of blood loss are often underestimated. In the last war soldiers sometimes required transfusions of 18 pints. And this was a war when the average haemoglobin value - that is the 'thinness' or the degree of anaemia of the blood - after injury. was around 60 per cent of normal. In the First W orId War it had been nearer 30 per cent. After severe bleeding or haemorrhage.     everyone can call up certain blood and fluid reserves from within his 0"-''11 body. But if these reserves are insufficient, or too slow in being mobilized, a blood trans­fusion is essential. Most major surgical operations are conducted with a transfusion going on at the same time, and some two to four pints may be required. In exceptional cases of gastro-intestinal haemorrhage as many as 80 pints are known to have been trans­fused over a period of time. In very rapid bleeding as many as 24 pints have been transfused in a single hour. A human adult has about 11 pints of blood in his circu­lation, and his whole blood volume may thus be exchanged several times. BLOOD for transfusion must pass many tests, and among the import­ant ones are freedom from such diseases as malaria, syphilis and hepa­titis, an inflammation of the liver. Hepati­tis in particular has been rather easily transmitted by transfusion, whether of whole blood or of plasma - blood from which the red cells have been removed. In the United States the National Institutes of Health reported that as many as 53 per cent of patients given blood from paid donors developed some degree of hepatitis. It is interesting that voluntary donors did not seem to furnish this risk. In the United States of America some four and a half million transfusions of blood are carried out annually. The results show unfavourable reactions in approxi­mately four per cent of cases and a death once in every three thousand transfusions. In Great Britain about 1.3 million pints of blood are bottled every year. In Moscow the hospitals have 30 years' experience of obtaining blood from people who have just died. Thirty thousand transfusions have been performed with this 'cadaveric' blood. Each body has provided between four and eight pints of blood suitable for up to 25 days of storage. When a particular bottle of blood has been delivered for transfusion, its label 4 Another life is being saved bv b Ice: transfusion. This patient has had an a"te-. reconstructed. The transfusion begar ::: the start of the operation, and may g: :­for another 24 hours. 5 A nev\' pin::; blood is clipped into position. On the sl:e of the bottle is a small sample that ca r t e used to match the groups of donor a-: recipient directly. 6 Drop by drop, b:oo: passes through a chamber in the tra'lS­fusion apparatus. Here, the doctor cae­regulate the rate of flow. If blood ente-s the circulation too quickly, the heart ma. fail. 7 Blood reaches the patient through a vein. The nurse will do all she can to keef: him quiet and comfortable during the long transfusion process. 6 must carefully be checked 1': c patibility with the patient's '::,::: -=-:c: suitable vein, usually iL ~::t- ,'~ C arm, is located, and the ski:: "E: :- ,'C ized and infiltrated "itr- E. ::~~:E anaesthetic to numb all funher :::.'.:'._:: .~: tions. A sterile 'giving set'. cr: :1':"~::',':: length of tubing, a drip cha:::r:E: c.:::. "'.' able cannulae (hollO'\' needlEe end, is set up. One of t:,t- . c.::::._ > inserted into the patient's -,'t-:::. ~::-.E . into the bung of the bot::e c::: ~ .'o.':: ,~ blood. The bottle is susper:c:e:: " patient and the blood fe',-:" ::-~ system by gravity. It is ':~:.c:~ ' __ .'. air is allowed to ente the ':e:::, E.'::C: the beginning, or at :he E:::: fusion, for fear of' air em':' :::"c':'.' '.'.-:'.'c:' bottle is almost empty. a::-.': ::-:ec ." ::: E.: and the cannulae cha:'l:ze:: :c' :'.: ':'-.E -                bottle to the second. 1: a ·:ec' .. c.::.:         .                                                             fusion is necesse.l:", -::e ",            :::: to be pumped iL may simultanee,u,,:y ::'e :C:oc. wins in dirferen )E.cT" Transfused blood passes to the heart, and then to the rest of the body. If the doctor suspects that the patient's heart is not thoroughly fit, the blood may be made to bypass the heart by a transfusion into an artery instead of a vein. With every trans­fusion the condition of the heart must carefully be monitored, so that there is no risk of straining it unduly. If the blood is given too quickly, or in too great a quantity, the heart may not be able to cope. There­fore regular checks of the pulse rate, the blood pressure and the pressure in the jugular vein need to be carried out. They will be recorded on a chart. No single test or reading is accurate enough for the doctor to assess the success of transfusion in every particular case. When a transfusion is likely to go on for a long time, the intravenous cannula may have to be tied in place so that it does not drop out with the patient's movements. An arm which has to be kept still for a long time can become very uncomfortable, and the vein selected for transfusion may become inflamed. For these reasons, every­thing must be done to keep the patient quiet and comfortable. Patients who do not require whole blood transfusions because the oxygen-carrying capacity of their blood is not materially reduced, may have their blood volume increased by the intravenous transfusion of saline (a solution of salt in water), glucose, lactate, or other physiological fluid. These fluids, however, soon escape from the circulation. For a more permanent result, doctors use plasma or artificial                                                                                blood substitutes. 2 Plasma is obtained from whole blood by a process called plasmapheresis. Blood that has been collected is centrifuged, so that the red cells are pushed into one end of the glass vessel. They can then be returned to the donor, or kept for special 'packed cell' transfusions. The donors thus escape any possible iron deficiency, for iron is needed for blood formation, and they may provide more fluid for transfusion than if they lose the red cells. The advantage of plasma is that it can be dried into a powder, and kept as such almost indefinitely. Its transport is also less hazardous, and when it is required for transfusion, all that need be done is to add to it some sterile water suitable for injection. Pla;;ma is specially useful in the treatment of severe burns, when large areas of the body ooze fluid rich in protein. And this is just what reconstituted plasma con;;ists of. An artificial blood substitute used very widely is called dextran, which, like starch, is a complex sugar of high molecular weight, and which in the body is metabolized only slowly. Unfortunately medicine still does not possess a blood substitute which can resemble whole hlood in its oxygen-carry­ing capacity. A vast organization subserves the needs of the patient who requires a blood trans­fusion. An army of blood donors, over a million in strength, have been vetted for their blood groups. Detailed records have to be kept. Blood donations have to be arranged. A single donation, best from a young person between the ages of 20 and 30, will result in a pint of blood. Two to 1 Mixing and matching in the laboratory is vital to successful blood transfusion. 2 When blood from the same group is mixed, the red cells float freely in the plasma. 3 Red cells may clump like this three pints may be obtained from the same donor in one year, and some donors have given many tens of pints. Donors' blood is taken to the blood banks. These banks are in constant touch with hospitals and have special vans to take the blood there. Once the blood has been collected it must be kept cool under carefully controlled temperatures of between four and six degrees centigrade. Freezing the blood destroys its red cells. The blood is suitable for use for the next three weeks, and, as on a photographic film, an expiry date is printed on the bottles. Recent improvements in blood storage when blood from different groups comes together. Special proteins on the cor­puscle surface react with others in the alien serum. If this process took place in the body. it could cause death. include the provision of plastic bags which allow more economy in space than bottles, and long-term preservation of blood is being tried by adding to the blood a sub­stance called glycerol. This chemical pro­tects the red cells from destruction during freezing, so that blood can be preserved, frozen at -1950 C. in liquid nitrogen. Although the idea of blood transfusion is 500 years old at the very least, only one tenth of this time has been spent in active development of suitable techniques. By any standard of technological advance, therefore, we are merely on the threshold of the story of blood transfusion.   Taken from The Marshall Cavendish Encyclopedia of the Human Mind  BOOK OF LIFE – The Living Body - In 105 weekly parts – MEDICINE OF MAN – BLOOD FOR OTHERS (BLOOD TRANSFUSIONS) - Page 613 – 616.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out) , In an average lifespan, man takes 500 million breaths of air. His lungs are designed to ensure that oxygen, the gas vital to life, reaches every cell in his body.   Apparently unperturbed by its fishy neighbours and watery environment, this rabbit lives and breathes entirely surrounded by water. Oxygen flows in through a special membrane that makes up the right-hand side of its air-filled box. Experiments similar to this one are being done to build a diver’s base on the sea bed.   TEN to 14 times a minute we breathe in and out, and as we do so, shift a total of between nine and 12 pints of air. A normal day's breathing involves around 3,300 gallons of air, the amount that would fill a cube measuring eight feet by eight feet by eight feet. The purpose of this air-moving activity is to bring oxygen from the atmosphere into the internal environment of the body, for this gas is needed by every cell to take part in the chemical reactions responsible for releas­ing energy. The energy is needed for every process of human life, including the very act of breathing itself. Before we can use the oxygen in the air we breathe, we must first extract it from the environment. For a single-celled creature like the amoeba, that lives in water, the problems are few. Oxygen dissolves in water and diffuses into the animal through its cell wall. Carbon dioxide diffuses out in the reverse direction. Because there is more oxygen in the environment than inside the amoeba, and less carbon dioxide outside the animal than in it, the process of diffu­sion is one that is simply accomplished. In higher animals, the same principle of diffusion is at work, but their bodies are so complex that oxygen cannot pass straight from the air to the cells. The gills of fish, for example, have a rich supply of blood vessels, and oxygen from the water they live in diffuses into these vessels and then round the bloodstream. In Man the design of the lungs and the blood system ensures that oxygen is absorbed into the blood system from the lungs, and that it is pumped round the body by the heart through a cir­culatory system whose capillaries penetrate to every cell. Air reaches human lungs through the passages of the nose and mouth. In the nose a membrane richly supplied with blood vessels, and from which mucus is secreted, warms and moistens the air. On a cold morn­ing, when the air you breathe in is only six degrees centigrade, by the time it reaches the back of the nose it has been warmed to 30 degrees. Minute hairs in the nose, called cilia, trap particles such as dust. They always beat in the opposite direction to the flow of air. Mucus also helps trap impurities from the atmosphere. From the nose, air passes through the pharynx, where it meets any air breathed in via the mouth, through the voice box or larynx and on into the wind­pipe or trachea. Cilia are at work here, too, and more mucus immobilizes bacteria. The trachea is a tube that is nearly circular. It is about four and a half inches long and some two-thirds of an inch in diameter. At the front and sides are incomplete rings of car­tilage which keep the tube stiff, but not rigid. Its back surface is made of fibrous tissue and muscle. From the trachea branch two large bronchi which carry air to each lung. They then subdivide into tubes of ever lessen­ing diameter, known as the bronchioles and respiratory bronchioles. The two larger bronchi and their main branches have an outer layer of fibrous tissue which covers irregular plates of cartilage. Within this there is a layer of smooth muscle which runs across the tubes in bands. Between them is still more tissue, this time the   elastic kind. Because the right lung is larger than the left one, the right bronchus is shorter and lies in a position more vertical than that of the left one. The bronchioles have no cartilage band­ing, but are well supplied with muscles. The smallest of them open into small pas­sages, the alveolar ducts, from which the air sacs of the lungs, the alveoli, arise. Each one is lined with flat cells called the squamous epithelium, and has much elastic tissue in its wall. In all, about 14,000,000 of these alveolar ducts open into 300,000,000 alveoli. (Estimates vary widely: some authorities put the total at 750 million.) And it is in the alveoli that the oxygen from the air breathed in passes into the bloodstream, for the alveoli are profusely supplied with capillaries. The air is separated from the blood by two mem­branes, each just a single cell thick. One layer is made by the lining of the alveoli, the other by the wall of the capillary. For the body to receive all the oxygen it needs, the alveoli of the lungs have to pro­vide an enormous surface for the exchange of oxygen and carbon dioxide. The total area of the lungs is estimated to be about 1,000 square feet, more than 40 times the surface area of the body's skin. Blood flows through this area at a rate of 17 pints per minute which allows for rapid exchange of gases. Because the lungs are so richly supplied with elastic tissue, particularly in the alveoli, they have an inherent tendency to collapse when this elastic tissue contracts. Three animals obtain oxygen by different methods. The goldfish swallows water and pushes it out over its gills. Close to the surface of the gills are blood vessels: oxygen diffuses into them from the water. The butterfly breathes through a system of tubes that form a maze within its body. Air enters and leaves via holes arranged But the body is designed in a way that naturally combats this tendency. The lungs are enveloped in a thin, closed sac. The outer wall of the sac, known as the parietal pleura, lines the chest wall. Where lungs and trachea join, the sac curves round on itself, and the inner wall of the sac, the visceral pleura, surrounds the surface of each lung. The space between the two parts of the membrane is very small, and con­tains a little fluid which acts as a lubricant. Inside the lungs, the air pressure is the same as that in the normal atmosphere. But because the lungs always have a ten­dency to collapse, they exercise a pull C~ the walls of the chest and lower the pre-­sure between the two layers of the sac. =­is this lowered pressure that actively pe-:-­vents lung collapse. THE lungs expand and fill with a:: everytime we breathe in. The first r:: does not move, but the front ends c the ribs move up and out, particularly the second to seventh ones. The breast­bone moves forwards, and the thorax en­larges sideways. At the same time, the diaphragm contracts and moves dO\m­wards, so increasing the internal volume of the thorax from above downwards. Air is drawn in through the trachea. As you breathe out, air is expelled partly by the elastic recoil of the wall of the chest, and partly by the upward movements of the diaphragm as it relaxes. Breathing out is an entirely passive process, but it lasts longer than breathing in. Try measuring in rows along the abdomen, and is pumped as the abdomen moves in and out. Oxygen enters the human body with the help of the lungs. On these pages, the mechanism is traced out. In the light, plants deal with oxygen by a process that is the reverse of the animal system. They take in carbon dioxide and release oxygen. pulmora~. artery bronchus cartilage The complex tube that forms the French horn is mirrored by the intricate design ofthe human lungs. Air reaches the depths of each lung via a tube called the bronchus. The bronchus is strengthened with plates of cartilage and is supplied with mucus glands: their secretions help to immobilize foreign particles. Branching from the bronchus are many bronchioles, and each of these divides and subdivides until it finally penetrates to the alveolar canals. From these canals arise the millions of minute air sacs in which exchange of gases goes on. Every sac is supplied with a network of capillaries. Shown in red is the pulmonary artery and its ramifications which carry blood rich in carbon dioxide and poor in oxygen. In the alveoli. oxygen enters the blood in return for carbon dioxide. I n blue, the pulmonary vein returns to the heart. mucus gland cartilage bronchiole :' . ?Oiar pulmonary vein Unlike the fish he photographs, the under­water cameraman could not survive with­out his extra air supply. Man's lungs cannot use the oxygen dissolved in water. the difference. You will find that expiration lasts about one and a half times longer than the inspiration that precedes it. USING a stethoscope, it is easy to hear definite sounds that corres­pond to the movements of air during respiration. During inspiration, and at the start of expiration, a rustling noise is heard. When the instrument is put over one of the large air passages, the ear can detect a loud, rather rough sound, as if someone were saying 'hah' in a loud whisper. There is an interesting difference in the way men and women breathe. In men, the main movement that increases thor­acic volume is that of the diaphragm. In women, the ribs contribute most to changes in thoracic capacity. But in men and women alike, the rate of respiration rises during exercise and diminishes slightly from the normal 10 to 14 breaths a minute during sleep. The lungs are not filled and emptied entirely every time a breath is taken. Because air enters and leaves via the mouth, complete exchange is impossible. In fact, only one sixth of the air changes at each breath, so when the next breath starts, there is still five-sixths of it left in the lungs. Physiologists use a piece of equip­ment called a spirometer to measure the different ways the air in the lungs is divi­ded up. Air is blown through a volume recorder which traces out the changes with a pen that moves up and down against a rotating drum. The si2e of each breath is usually the first measurement to be taken. This varies from individual to individual, but when breath­ing is quiet and unforced, between 21 and 36 cubic inches of air are breathed in at each inspiration. Physiologists call this --Iaryr· The remarkable teamwork of lungs and heart ensures that every cell in the body is supplied with oxygen and has its waste product, carbon dioxide, removed. Deoxygenated blood reaches the right atrium of the heart via the body's main veins. It passes into the right ventricle, and from there is pumped up the pulmonary trunk. This trunk divides into two pulmonary arteries, and -.- - .. ---trac- ~,                           right ventricle through them, blood arrives at the lungs at the rate of 17 pints per minute. Exchange of gases takes place in the network of capillaries that supplies the 300 million minute air sacs of the lungs. Oxygen enters them in return for carbon dioxide, and the newly oxygenated blood is carried back to the left atrium of the heart by the pulmonary veins. left lung   1 Deep inside :he lungs. oxygen enters the bloodstream and combines with haemoglobin. the red pigment of the corpuscles. Scie'ws:s have estimated that the exchange takes a hundredth of a second. 2 The cilia or :he inner surface of the trachea, tcgether with the mucus secreted by the ce Is below them, help trap bacteria. viruses and dust particles. 3 The elastic tissue of the alveoli allows for lung contrac:ic'1 ane expansion as air enters and leaves a: e. sr. :Jrea:r measuremeC1~ ~:.c. . it is easy to r:c~ r: . ~ in every miL:~~ '.' .~ the number ':: ::c.. ! value of be:c.''-~< ~ behveen tr.ch' _ .. '                                    i one and ~ l:a~ z c.      _                :;; Mter IJc'f2.~ . __ ~ 3 find that \ ~ air. Simi:~::: after a :~ knO\\l1 cfC:C. inSpIre;: . to a :~~c-'~. capc",·::.· be fX::'c::~. tion. :_ tion. =~ .~ .. ll1l1§.'3. the:-e Taken from The Marshall Cavendish Encyclopedia of the Human Mind  BOOK OF LIFE – The Living Body - In 105 weekly parts – The Breath of Life -  Page 505 – 510.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out), Three times in every thousand, a child is born with a heart defect. Modern methods of diagnosis and surgery mean that most of them will lead completely normal lives DURING the first ten weeks of preg­nancy, the human heart develops in the embryo from a simple tube into something much like its final form - a highly complex muscular pump with four chambers and two main blood vessels leading from it. In so complicated and swift a transition, it is not surprising that faults sometimes appear. In fact, about three babies in every 1,000 are born with a congenital heart disease - most commonly a 'hole in the heart', or the well-known 'blue baby' malformation. Since many of these malformations are severe, two out of three such babies die before their first birthday. Only one in three will reach the age of 10 without receiving medical attention. However, advances in the treatment of congenital heart disease, especially by surgery, mean that more and more babies will survive; the picture is not so gloomy as it was even in the early 1950s. Several causes of congenital heart disease have now been established. One of the more common is the german measles virus, or rubella. For this reason, doctors are happy to see girls contracting german measles before they reach child-bearing age, since one attack gives lasting immunity from further attacks. If an expectant mother who is not immune to german measles comes into contact with the disease during the first four months of pregnancy, how- 2 ever, she and her baby can be temporarily protected. The doctor injects the mother­to-be with a special protein, containing substances to destroy the virus. This will neutralize the virus and is obtained from people· who have already contracted the infection. One type of mentally-defective infant, known as a mongol, has a very high chance of having congenital heart disease. Several extremely rare conditions of infancy, often associated with mental retardation, have a high incidence of congenital heart defects. This does not mean that the converse is true and that babies with congenital heart disease are intellectually retarded: many are very bright. Of other factors at work in the causation of congenital heart disease there is one ­heredity - about which doctors so far know little. Such diseases do occur more often in some families, compared with the population as a whole, so that inherited factors must play a part. But so do many other factors - environmental and nutri­tional deficiencies, infectious diseases and certain drugs. The parents of a baby with congenital heart disease often ask what the chances are of further children being affected. Luckily, the risks are relatively low, geneticists rate them at about two in every 100 births. The expression 'congenital heart disease'                           The human heart develops in the foetus from a muscular tube to a complex pump with four chambers. Sometimes faults occur during this process, and a child is born with a congenital heart defect. 1 The aortic valve prevents blood from flowing back into the left ventricle. When the valve is narrowed - stenotic -.,. the con­genital defect is known as an aortic stenosis, or A.S. for short. Because the left side of the heart has to pump harder its walls may thicken. 2 In this view, the aortic valve is behind and below the pul­monary artery. 3 A hole in the partition between the two ventricles is known as a ventricular septal defect or V.S.D. 4 This is the partition the hole would penetrate. 5. 6 Before birth. a small tube. the ductus arteriosus. connects the aorta and the pulmonary artery. The lungs are bypassed because the mother is supplying the foetus with oxygen. Normally. the channel closes soon after birth. but if it fails to do so. blood is pushed into the pulmonary artery and floods the lungs. 7 A child may be born with a hole in the muscle wall which separates the atria. the chambers which collect blood from the body and lungs. This malformation. called atrial septal defect - A.S. D .. may be undetected for years. 8 The septum ­not visible - is adjacent to the cavity which the doctor is demonstrating. covers a great many different malforma­tions of the infant heart. Heart specialists - cardiologists - divide them into two groups, depending on the colour of the baby. Some babies with heart defects are cyanosed - they look blue, and are, for this reason called 'blue babies'. Some are normal in colour, and cardiologists call them acyanotic. Any blue colour is due to a lack of oxygen in the blood flowing through the arteries. Blood containing oxygen is bright red in colour, but blood lacking this vital gas looks blue. The bluer the colour, the lower the oxygen content of the arterial blood. Cyanosis - the presence of a blue coloration - is most noticeable in the mouth, lips and nail-beds ofthe fingers and toes. As blue babies grow, the tips of their fingers and toes tend to change shape, their nails become more convexly curved, and the tips of their fingers and toes become expanded, a condition the doctor refers to as 'clubbing' of the fingers and toes. Often the babies are bluer at some times than at others, particularly during some form of exertion such as crying or running. In general, the forms of congenital heart disease that lead to cyanosis are far more serious than conditions that produce no marked change in the colour of the blood, because in cyanosis there is more than one major defect in the heart. Acommon form of cyanotic disease is called Fallot's Tetralogy. The heart develops with an opening or com­munication between the two ventricle chambers, one on either side of the heart. In addition, the main blood vessel leading from the heart to the lungs - the puhnonary artery - is very narrow, and less blood than normal goes through the lungs. These defects result in a mixing of blood from both sides of the heart in the ventricles and an insufficient amount of blood flowing through the lungs to be recharged with oxygen. Some of the blood that is pumped from the left ventricle into the aorta and round the body arteries is lacking in oxygen, the blood in the arteries is less well oxygen­ated, and as a result the child is blue. Often, a baby with Fallot's Tetralogy is not obviously blue at birth, and does not become noticeably blue until he is several months or, occasionally, several years old. These cyanotic children tend to grow less well than normal children, and are often much smaller than their brothers or sisters. The lack of oxygen in the arterial blood results in breathlessness when they run, as they try to raise the oxygen level in the blood. Severely affected children even suffer from a lack of breath when walking. Another characteristic of some 9 A 'blue' baby may have Fallot's Tetra- 12 logy. This is serious because there is a defect in the septum dividing the ven­tricles, 10, and the pulmonary artery is narrowed, 11. 12 This patient is one of the youngest ever treated with a heart­pacemaker. The battery is inserted into his chest cavity just beneath the skin. The pacemaker is connected to the inside of his heart by a wire inserted into a vein through the neck. The battery must be replaced every 18 months, and as the child grows the wire into the heart must be frequently lengthened. cyanotic children is that, after an unusual amount of activity, they will suddenly squat down on their haunches for a few seconds' rest. Occasionally, the most severely affected children have bad 'attacks' of blueness - cyanotic spells - and even be­come unconscious for a few seconds. The non-cyanotic, or acyanotic, forms of congenital heart disease are far more common than the 'blue baby' forms. Non­cyanotic children have one feature in com­mon: there is a direct communication between the left and right sides of the heart, and this results in too much blood being pUmped to the lungs. These children do not suffer from lack of oxygen in the blood. But because the blood vessels of the lungs may be flooded with blood, the lungs become stiffer and more difficult to expand and the children have difficulty in breath­ing. Tbeir reaction is to breathe rapidly and shallowly. This rapid breathing, with the lower part of the chest sucked in, is often most noticeable. IT a baby has to breathe rapidly, even when at rest, then feeding becomes dif­ficult, since the baby may be unable to suck for very long. It is not unusual for one of these babies to spend an hour or more trying to take a feed which a normal baby would take in 20 minutes, and this results in poor weight gain. Apart from the dif­ficulty that some of these babies have with breathing, they are also more liable to repeated chest infections. Of the acyanotic forms of congenital heart disease, one common form is a small passage between the aorta and pulmonary artery, called apatent ductus arteriosus, or P.D.A. This link between the aorta and pulmonary artery is present in all babies before birth. It short-circuits the blood passing through the baby's lungs, which are, of course, not functioning because the mother is supplying all the necessary oxygen and nutrient substances. Normally it closes after birth when the baby breathes and its lungs expand. But occasionally it fails to close, leaving a direct connection between the artery taking deoxygenated blood to the lung and the main artery of the body, the aorta, containing blood rich in oxygen. The extra blood floods the lung vessels. Other common 'hole in the heart' con­ditions are known to doctors as 'V.S.D.' and 'A.S.D.' respectively. These are openings which remain when the heart tube divides into four separate chambers during the first few weeks after fertiliza­tion of the ovum. V.S.D. is an opening between the two ventricles, a ventricular septal defect. A.S.D. is an opening between the two upper collecting chambers of the heart, an atrial septal defect. Either of these defects results in an excessive quantity of blood passing through the lung vessels, but the ventricular defect is more likely to produce symptoms in the first few months of life. Many children with the atrial defect do not have symptoms for many years; then a doctor notices a heart noise - or murmur - perhaps at a routine examination at a welfare clinic or school. Symptoms of breatWessness at rest or during exertion, failure to thrive, and recurrent chest infections, generally occur in children with big 'holes' in the heart or a large patent ductus arteriosus. In many children, such defects of the heart are quite small, there are no symptoms charac­teristic of heart disease, the child develops normally and leads an active life. A signi­ficant proportion of children with con­genital heart disease are diagnosed quite by chance at a routine medical examina­tion; in fact, one of the purposes of these check-ups is to detect and diagnose condi­tions that may previously not have been apparent. Another type of congenital heart disease has nothing to do with 'holes'. This is when the valves controlling blood flow, particu­larly those in the great blood vessels, are malformed or narrowed. The main blood vessel leading to the lungs, the pulmonary artery, has a valve called the pulmonary valve, and the main artery of the body leading off from the left ventricle, the aorta, has a valve called the aortic valve. When these valves, usually the pulmonary valve, less often the aortic valve, are nar" rowed, or stenotic, the heart muscle has to work harder to push blood through the arteries. Because the heart muscle is so powerful, even the most severe narrowing of the valves may be overcome for many years: the child or adult may show no sYmptoms, and lead a normal life. If the valve narrowing is severe, and left un­treated, the patient at 30 or 40 years of age may have suffered irreparable damage to the heart muscle, producing heartfailure. Should the trouble be found in time ­here is another reason for regular medical examinations - the specialist will often advise an operation to relieve the stenosis, although his patient is relatively fit. Correct diagnosis of a congenital heart disease may be extremely difficult without special tests. The heart specialist, when he first sees an infant with congenital heart disease, has to assess whether the baby is thriving or not. If the baby is obviously not thriving - if he is failing to gain weight or even losing it - and appears to be very breathless at rest, then diagnostic investi~ gations may have to be carried out. The same routine will automatically be carried out if he shows signs of 'blueness'. If the baby is thriving, the usual practice is to see the baby at frequent intervals, since every doctor will hope to avoid surgical treatment in the first year or two oflife. As the child gets older, diagnosis of the under­lying heart trouble is usually more easily made by means of physical examination, chest X-rays and electrocardiograms. MOST defects of the heart cause characteristic noises, called mur­murs, which the doctor can hear through his stethoscope. Indeed, some heart murmurs are so loud that a stetho­scope may not be required; they can be felt with the flat of the hand placed on the chest wall overlying the heart. (The doctor's name for these is 'thrills'.) When the heart has to work harder than usual, the most common result of congenital heart disease, then the forceful action of the heart can often be felt through the chest wall, and even the chamber which is working the hardest can be identified. First the doctor inspects the baby, listens to the heart and lungs, and examines the arterial pulses. Then he turns to the special examinations. The chest X-ray is of tremendous help, because from it can immediately be seen the size of the heart, which chamber or chambers of the heart are enlarged, and the degree of filling of the blood vessels in the lungs. The electrocardiogram gives infor­mation about the electrical activity of the heart, and indicates which chamber is enlarged. Indeed, some forms of con­genital heart disease identify themselves immediately by projecting abnormalities onto the electrocardiogram. If the diagnosis is in doubt, or the specialist is considering surgical correc­tion of the heart defect, he may carry out a cardiac catheterization. A fine tube is passed into the heart chambers from an arm or leg vein, or from an artery. This investigation enables the pressures to be measured within the heart chambers, and through these tubes can be injected a fluid which is opaque to X-rays and gives an outline picture of each heart chamber. This X-ray procedure is known as angio­cardiography. With these investigations the surgeon builds up a picture of the heart's defects. Surgeons can deal quite easily with some defects of the heart, especially the patent ductus arteriosus. However, most of the other defects require special tech­niques. Since the 'holes' in the heart have to be closed by exposing them, the surgeon has to use some form of artificial circula­tion to maintain the blood flow while he operates on the open heart. If the surgeon has to use one of these artificial pumps on small babies, the operative riskis increased; so surgery is postponed until the baby is fairly well grown and weighs perhaps 25 pounds. If surgery is required at an early age, then often a minor operation on the heart, involving a small risk, is carried out, to help the baby to grow. Total correction of the defects of the heart can then be postponed until he is four or five years old. Some minor congenital defects of the heart never require surgical treatment, nor alter the life expectancy of their possessor. Other defects, particularly the ventricular septal defect, may close spontaneously; this is another reason for postponing any sur­gical treatment for as long as possible, provided that the child is progressing satisfactorily. If surgery is necessary, then the average stay in hospital, even for major cardiac surgery, is rarely more than three to four weeks from the day of operation.   Taken from The Marshall Cavendish Encyclopedia of the Human Mind  BOOK OF LIFE – The Living Body - In 105 weekly parts – ENEMIES OF MAN – THE HEART AT FAULT - Page 604 – 607.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out) , Hydrocephalus means, literally, water on the brain and it refers to an excessive build-up of fluid in and around the brain. With modern surgery, very effective treatment is now possible. Q My baby's head is an odd shape as if the top of the skull were coming up to a point. Could this be a sign that he has hydrocephalus? A This does not sound like the shape of head found in hydrocephalus. Often odd head shapes have no special significance, but occasionally it may be that some of the bones of the skull have joined together too early. A particularly pointed skull may result from this. It is most likely that as long as your child's head is of normal size, and he has no other symptoms, then all is well. However, if his head is growing very fast and the forehead is very large in relation to the rest of the face, then he should be seen by a doctor. Q When I was a child I had meningitis. Is there a danger that I could develop hydrocephalus later in life? A Hydrocephalus following meningitis will come on soon after the meningitis if it is going to develop at all. If some years have passed since your attack of meningitis, it is unlikely that you will get any more trouble from it. Q My little boy of five is bright and lively and seems perfectly well but his head is larger than average. Does this matter? A No. It is not likely that he has hydrocephalus unless there was an increase in his head size when he was younger. Some people just have bigger heads than others and these people have always had heads above average size. The important thing is that your son sounds extremely healthy. Q I have one child with hydrocephalus. What is the chance of having another child with it? A If you have had one child with hydrocephalus or spina bifida the chances of having another child with one of these defects is about one in 40. After two such children the chance is one in eight and after three the chance is one in four. Cerebrospinal fluid is a clear, watery fluid that flows round the meninges, the membranes that cover the brain, and spinal cord, and through the brain's ven­tricles \ cavities). The fluid has a cushioning effect and so helps to protect the vital brain tissue from injury. The fluid is made continuously from the blood by specialized cells of the choroid plexus in the brain ventricles. Unlike the heart ventricles which have names. the brain ventricles have num­bers. The numbering goes from the topmost to the bottom, and the first and second ventricles (known as the lateral ventricles I are the largest. The fluid flows from the lateral ven­tricles, through a narrow hole into the small third ventricle and then through an even narrower channel, the cerebral aqueduct, into the slightly wider fourth ventricle. From here it escapes through holes in the roof of the ventricle into the fluid-filled spaces (cisterns) which sur­round the brain stem at the base of the brain. Then the fluid flows up over the top of the brain (the cerebral hemispheres) and is reabsorbed by special outgrowths, called arachnoid villi, on the arachnoid membrane, one of three membranes (meninges) covering the brain. Hydrocephalus, which is a rare con­dition, occurs when something interferes with the circulation of the cerebrospinal fluid. The effect this has on children depends on whether the bones of the skull haw finally joined together before the pressure inside begins to rise. In young children, whose skull bones haw not joined together, the increased pressure forces the bones apart and the head increases in size. In older children and adults the increased pressure cannot do this and the expanding fluid presses on the brain, causing progressive damage. Causes Various conditions can affect the cir­culation of cerebrospinal fluid. Some con­ditions are congenital (present at birth) though not necessarily inherited. But other causes may be acquired later in life. Hydrocephalus is divided into ob­structive hydrocephalus, where there is something which obstructs the cir­culation of the fluid, and communicating hydrocephalus where there is something wrong with the reabsorption of the fluid by the arachnoid membrane. Obstructive hydrocephalus This is the commoner type and it may occur in either adults or children for a variety of reasons. An obstruction anywhere in the cir­culation of the cerebrospinal fluid means This child, suffering from hydrocephalus, has a very distinctive skull shape, with prominent forehead and small face in relation to the rest of the head. After treatment to drain off the excess fluid in the brain, the child's head has returned to a normal size with the face in proportion to the rest of the head. Circulation of cerebrospinal fluid Choroid plexus Cerebral hemispheres ,First and second (lateral) ventricles Third ventricle Cist8ms Fourth ventricle Brain stem One of exit holes from fourth ventricle Arnold-Chiari malformation Cerebellum Build up of fluid Normal position of exit hole from fourth ventricle Abnormally low position of part of brain stem and cerebellum   Abnormal, blocked exit hole Top picture shows the flow of cerebrospinal fluid around a nonnal brain. Above: an i5 abnonnally developed cerebellum and lower brain stem have obstructed the normal ~ flow and caused a build-up of fluid in the brain. HYDROCEPHALUS that the fluid will dam up behind the obstruction, gradually increasing the pressure in the brain and squeezing the delicate tissues inside the skull. Children born with spina bifida (a con­genital defect of the spine) may also have an abnormality of the spinal cord in the neck or back (meningomyelocoele) and an abnormality of the structure of the lqwer brain stem and lower part of the cere­bellum (area of brain in charge ofbalimce and co-ordination). This is known as an Arnold-Chiari malformation and it has the effect of blocking off the exit hole at the bottom of the fourth ventricle, thus causing hydrocephalus. Another less common congenital ab­normality is called the Dandy-Walker. The exit holes from the fourth ventricle do not form and this causes an obstructive hydrocephalus. The fourth ventricle bal­loons out into a large cyst and the cere­bellum cannot form properly. In other congenital hydrocephalus cases there may be obstruction, or failure in the formation of the cerebral aqueduct, and this causes the third and lateral ven­tricles to swell up. If there is a collection of abnormal blood vessels or a swelling in one of the cerebral veins near the narrow cerebral aqueduct these may press on the channel and block it off. Sometimes obstructive hydrocephalus is caused by an acquired condition, such as a tumour growing within the brain pressing on the cerebral aqueduct or third ventricle enough to block the out­flow of cerebrospinal fluid. Very small tumours or benign cysts can cause considerable hydrocephalus if they are in particular places and block aqueducts or exit holes. Communicating hydrocephalus Communicating hydrocephalus can be caused by a congenital abnormality of the arachnoid membrane, if it has not deve­loped properly and so cannot reabsorb the fluid when it reaches the membrane. Other causes of communicating hydro­cephalus include infections of the meninges by bacteria (meningitis) and bleeding into the space around the brain (sub-arachnoid haemorrhage). In both these cases fibrous scarring occurs which prevents the proper reabsorption of the cerebrospinal fluid. Communicating hydrocephalus may also be a complication of head injuries which result in small haemorrhages. Symptoms in children The most noticeable change that occurs in children is an increase in head size, the bones of the skull normally join between the age of six and ten years, so head expansion with hydrocephalus mainly HYDROCEPHALUS occurs in younger children. Children's heads vary enormously and if a child's head is large it doesn't neces­sarily mean he has hydrocephalus. If hydrocephalus is the cause, the growth of the head size will be much faster and the shape of the skull quite distinctive, the forehead being prominent and the face being conspicuously small in relation to the rest of the head. Also, the eyes are pushed down so that a so-called 'setting­sun' face is seen with the whites of the eyes visible above the coloured irises of the eyes. If the condition is not treated it can lead to double vision or even blindness. If the hydrocephalus is rapidly developing it may cause mental deterioration, paraly­sis and stiffness of limbs. Symptoms in adults Once the bones of the skull have finally joined together, hydrocephalus cannot cause an increase in head size and this A small hole is made in the skull and a tube is inserted which runs from the brain, through the jugular vein to the heart, where the excess fluid on the brain is absorbed into the bloodstream. means that the brain becomes squashed against the unyielding skull as the ven­tricles expand. Progressive mental deterioration is a prominent symptom and may take the form of dementia (deterioration of mental faculties) and deterioration of intel­lectual functions and memory. As the pressure in the skull increases, damage to brain tissue becomes obvious as the patient has difficulty walking. The retina may swell at the back of the eye and this can be seen by a doctor using an ophthalmoscope. There is a particular form of hydro­cephalus called normal pressure hydro­cephalus which occurs in older people. As the ventricles expand, the brain shrinks away so the pressure does not rise con­sistently. This causes a fairly rapidly developing dementia, and walking dif­ficulties and incontinence which appear out of proportion to the degree of dementia. Dangers Many of the symptoms of hydrocephalus can be reversed or arrested by treatment, and the earlier it is started the less risk there is of lasting damage to the brain. The Spitz-Holter shunt operation Lateral ventricle Tube Jugular vein Right atrium of heart If the increased pressure is allowed to press on the brain and its nerves for too long irreversible damage occurs. Diagnosis Diagnosis is made using a CT scan which is a form of X-ray scan linked to a com­puter which enables the fluid-filled cavities of the brain to be clearly seen. The CT scan involves no risk to the patient and is quite painless. The scan will show up small tumours and cysts so the cause of the hydro­cephalus may also be obvious from the scan. Further special X-ray investigations of the neck may be necessary if there are congenital abnormalities, such as the Arnold-Chiari malformation, which may need correction. Occasionally :opecial studies are done-­using the CT scan and injected marker dyes-of the pattern of flow of the cere­brospinal fluid; their studies show those cases where the hydrocephalus is due to defective absorption of the fluid by the arachnoid membranes. Treatment and outlook In most types of hydrocephalus surgical treatment is necessary. The ventricles can be drained by the insertion of a tube between the ventricles and the spaces at the base of the brain (this is called the Torkildsen procedure) if there is an ob­struction in the fourth ventricle or a nar­rowing of the aqueduct. In other types of hydrocephalus-in­cluding most of the congenital sorts and normal pressure hydrocephalus-the cerebrospinal fluid is shunted from the ventricles to the bloodstream or the peritoneal cavity in the abdomen. A valve is necessary to prevent the flow going the wrong way and these may be of two types, the Spitz-Holter and the Pudenz- Heyer. A small hole is made in the skull and a tube is inserted which runs from the ven­tricles to either the jugular vein or the abdomen. These shunts, as they are called, often have to stay in place for the rest of the patient's life. The outcome of hydrocephalus after treatment varies considerably and is mainly dependent on what caused the hydrocephalus in the first place, whether damage to the brain occurred before the hydrocephalus was discovered and whether there were any other congenital abnormalities. A child with a shunt in place has a good chance of developing normally in terms of mental ability if there has been no other brain damage. Treated hydrocephalies have gone to university and have held down good jobs just like other people.   Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS -   DOCTOR’S ANSWERS – PART 27, HYDROCEPHALUS, Page 750 – 752.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out), What's a topflight manager? Let's turn now to ways we might use some of the ideas about groups discussed in the preceding chapters on a practical problem, the develop­ment of managers (if managers can be developed at all! ) A problem for the reader: You are the VP for human resources of a large, multi-product company. You are lucky because your C.B.O. is intensely aware of the need for training at all levels. Top management also thinks well of you. You are called to a meeting in the president's office one day, whcre you find the president, the executive vice-presidents, and some of the senior line officers of the company. The president says: "Joe, as a consequence of your arguments we've decided to go all out on intensive management development. We've spotted a dozen younger people around the company, every one of whom looks like at least vice-presidential timber. Right now they're in third- or fourth-level jobs, as assistant department heads or department heads in some of the smaller departments. They'rc lightweights now, and we want to make heavies out of them. And Wl' have to speed up the process. We're going to need several top-Icvel people in a year or two. We're willing to stand the salaries of thesl' people up to six months, even if they don't do any productive work, You can have them. Do anything you have to do to make topflight managers out of them. You can keep them here or take them out illt! I the country somewhere. You can hire consultants and experts; YOIl can send them off to a university if you think that's best. Just turn them into competent managers who can take over our top spots." This is the assignment-you've been given a carte hlanchc. Now what would you do? A problem like this can be brokcn down into a cOllplL' of major «ill'S I'. ilL'.;. These seem to be the questions a human resources director II. '1IId, sooner or later, have to answer. I. What is a "topflight" manager anyway? ), What are some of the good and bad ways of trying to teach people 1" Ill.: topflight managers? What's a topflight manager? 1I11S first question is a terribly difficult one. If we can answer that one, \ .' can set the goals of our development program. But how does one l'llt I an answer to such a question? <;lll11e people used to think one answer lay in finding the common I" I :;onality characteristics of successful business leaders. They were '""king for the ideal managerial personality. But as the concept of I, ,It krship became more sophisticated, most people abandoned that ,,1";1, having found as many different personal characteristics as they did I, ,Iders. Besides, our engineering methods for changing personalities ," pretty poor; so even if we wanted to build people who are just like ,I" 'ady-successful managers, we probably couldn't do it very well. \ Ilother direction to search for answers is through job analysis, I ,llln than analysis of managers themselves. Once we have located and ,1,lllled the significant aspects of managers' jobs, we can go on to imbue "III acolytes with the knowledge and skills that are appropriate for 1I,,,:,t' jobs. This strategy leads us toward a formal analysis of the duties II It I lesponsibilities of job X, the skills and knowledge needed to per­I,,, 111 those duties. The process becomes deductive; we determine the 1'.1> Il'quirements, and deduce from those the requirements we'd want II" person filling the job to meet. :\ third approach is a much more pragmatic one, a managerial \ ." k approach. It says: Let's follow managers around and see what Iii, v do, Maybe that will tell us what their jobs are really like and give ".1 lix on the kinds of skills they need to do those jobs. One big danger "I l'lli Ilg that way is that we may end up training managers of the future I" Ill'have like managers of the present. And it's likely, of course, that lilt world of the future will require different skills. <;" ;Igai n it's not surprising that some people have looked for another ",IV or lrying to decide what a polished, finished, developed manager Iltlilid he like, The fourth strategy is a future problems approach, 1',1,,('(1,111 the notion that anything we do now to develop young man­11'1'" is not likely to payoff until ten or twenty years from now. So IIl.lvllL' we should try to forecast what managerial work will look like III 11'11 10 Iwellty years and then train people for that target. The real 1\I';Iklll·S,'.; ill this approach is that most of us are lousy forecasters. It's People in threes to twenties fun to forecast, and most of us are happily seduced by other people's projections about the future. But most of the time those projections turll out to be wrong, or at least to generate unforeseen second- and third~ order consequences that turn out to be more important than what was forecast. That leaves at least one other approach. A continuous learnin/', strategy, a plan to train flexible people, people who are capable of dealing with whatever comes along. The trained manager is thus secil as a self-adjusting, continuously learning person. This view leads, nol to teaching specific skills, but to teaching people to recognize when thcy need to learn new skills. In recent years the search for the one and only managerial personal ity has slowed down. So has formal job analysis. So has the future problems model. What seems to be emerging more and more is a two pronged combination of the managerial work and continuous learnin)'. strategies. These two blend nicely because careful observation of man agerial work points to flexibility and continous change as key charae teristics of the work itself, and, consequently, characteristics requil'l'd of the people who will perform it. As we go on in this chapter to consider several programs for manage ment development, these different perspectives will surface again. hll instance, if you think the most important thing to teach prospectiVl' managers is to behave like present managers, some form of apprentice­ship program begins to look good. If you think future managers will have to deal with some specific futures, then you will have to teach then I about those futures in, perhaps, a much more academic program. If you're trying to turn them into flexible learners, then you may want to set up a wide range of different (and perhaps surprising) tasks, alon/', with frequent opportunities to assess and analyze their performances on those tasks. What's different about being a manager? Despite what we have just said, we still have to worry a little right here and now about the critical and unique aspects of "managing," about how managing differs from a lot of other activities in the world. Many people have put forward many different models of the "esscn­tial" nature of the managing process. We have one too. We shall Ill' describing it in more detail in the last section. The key ideas are thesl': 1. Managing always includes some influencing and implementing activities. Somehow managers always have to get other people to do things. Which means that managing always includes a lot of power problems. Which is also to say that managers have 10 know a lot about dealing with human beings. 2. Managing also always includes a lot of problem solving. Some of I Ill' problems managers have to solve are not very different from the IIIl'C, neat problems that all of us had to solve at the end of each chapter "lOur math books in school. Those are the easy ones for managers, the 'lIl'e, clear problems that the boss occasionally assigns. All we have I" do, as managers, is put our minds and our educations to work on III:t1yzing the problem and coming up with the solution. But most managerial problem solving is much messier than final­, \:i m problem solving. For one thing, managerial problems have to be • dved under far from ideal conditions. Managers not only have to work 1I,:tinst tight deadlines, but must also work on a dozen problems at the ,IIIIC time-like taking exams in five subjects all in one three-hour I" 'riod. And that's one thing that is likely to get worse in the future. The I,. 'dic, overloaded setting in which the manager works will not improve. Illl're will be tight deadlines. There will be limited, imperfect informa­l'tlll. There will be high levels of uncertainty and high levels or risk in II ';1 I lagerial problem solving. Most problems will not even have a nicely "I ist'ying outcome, like getting an A on the exam. The manager may I",vc to make a decision today and perhaps never know for sure " Ill't her his decision was a good one or a bad one. Sometimes, of course, I", will know very quickly about the outcomes of his decisions, but ,d Il'n he will be blamed for outcomes that his decisions did not cause, ," praised for outcomes that had nothing to do with his decisions. \ _ The manager has to be a problem finder. Most managers might 1'lIllaw at that one. They might well argue that finding problems is the I,;,~;t of their problems. There are plenty of problems sitting on the d"c:k every morning. And yet every manager also knows that he dare '" Ii spend all his time putting out the fires springing up around him. He .1',11 needs to take an active rather than an entirely reactive stance. I It- has to decide which problems are really the important ones to solve ,1I1l1 which ones aren't. He has to create problems, to set goals, to d"l'ide where he wants to go, even though he may have lots of trouble I'" II i ng there and he may have to make painful compromises and many ,1.'I"urs along the way. This problem-finding element in managing, this ,1"lllent of purposiveness, makes mapaging an effort to move the world '11',ll'ad of just being moved by it. It will probably continue to be critical Itll Illanagers in the future. It also happens to be an element that we dtlil" know very much about. ,I. There is still, of course, another central issue that differentiates 1IJ:11laging from most of the rest of living. Managing occurs within an tlq',ani/',ational selting. Unlike most other people, the manager operates Iltllll a power position within a pyramidal structure. He is blessed (or 1"'1 haps cursed) wilh thl' aulhority we discussed earlier. Those below  People in threes to twenties him in the pyramid usually see themselves as being more dependclll on him than he is on them. And whether he likes the power positioll or not, he is in it, and many forces in his environment operate to keep him in it. But though he appears to have great and independclll power, the actual balance of power in the industrial world seems to have shifted rapidly downward, making the manager's position some. what awkward. The paralyzed brother has recovered the use of SOIlll' of his muscles. Where once he knew every operation in his business better than anyone else, the manager cannot now come close to such sagacity. Where he once may have needed help only in the informa tion-gathering and executing phases of his operation, he now of tell needs it even in the analyzing phase. He operates in a position that is peculiarly dependent while seeming to be independent. From that position he must somehow perform his functions through his influence on other people. For his task is not a one-shot task hili must be performed in a way that will permit him always to return I'or more. Nor is the typical manager the top manager; he is dependent nol only on subordinates but also on his peers and superiors. He expccts. and is expected, to act as an extension of his superior's ego. He is ex pected to think creatively and originally but also to act as his hos', would act in a similar situation. All these factors flow from the hierarchy, and they all complicall' the managing process. If this characterization of managing is approximately correct, llH'n management-development programs ought to be devoted to helping people to learn how to influence people and implement change throlll',h people, how to solve complex, ill-defined problems under tight dead lines and high risks, and how to find purpose and fulfillment whill' working in a battering, hierarchical environment. Notice that so far we have put our emphasis on developing mana~~l'I'. who can manage. We have said nothing about developing managl'ls who can live full and happy lives while managing. Indeed, if we succeed in developing a manager who does everything we have just descrilll'd, he will surely confront a hectic, overloaded, and not necessarily 1'111 filling life. It won't be an empty life, certainly, but how can we hdp make it something better than a harried one? Anyone who takes on Ih(' job of "developing" managers must, we propose, be concerned willi the souls as well as the skills of his students. Then how shall we do it? If we're approximately on target with our notions ahoul what Il1al1a~~illg is all about, the next question hecollles how 10 Il'ad! people 10 dll il well. And here modesly is in order. II is 1101 de;lr Ih;11 ;llIyhody reallv k 1I0WS how to do it. But as we move from the conceptual to the engi­Ileering phase of the manager-developing process, at least these kinds or ideas seem to emerge: 1. Most manager development ought to take place inside, not out­':ide, the managerial world. It could usefully be an interactive, back­;lI1d-forth process between outside educational programs and inside ;Idive experience. We talked in earlier chapters about alternation be­Iween content and process in groups. We now suggest a similar inter­;Ictive alternation between "studying" managing and doing it. That ;Irgument runs counter to the notion that sending people to manage­Illent-education programs at universities is management development. II is also opposed to one-shot programs which take place for a week 'II' a month at a resort and are then finished. It supports a long-term vicw of managing as a continuing learning process, and learning as a ('ontinuing managing process. Incidentally, one of the reasons that we so often use one- or two­IVcek off-site programs and so seldom design continuous development programs is that we use the university as our model of what education :;hould be. But universities do not run two-year MBA programs be­"ause they have found that two contiguous years is just right to edu­";Ife a manager for life. They do it because they are pretty much forced I,) do it, because they are physically and geographically set up so that ';llIdents must come to the campus and stay there. A few colleges h;lve tried, with some success, programs that alternate between educa­IIl1il and work, but such programs have not become commonplace even III management education. I t is not so much the validity of the continuous-learning model that h;IS limited the diffusion; it is the logistical difficulties of implementa­11l1i1. But if our task is to develop managers within one organization, lliosc logistical difficulties become much less troublesome. 2. Let's try to teach methods and attitudes more than knowledge. Ihis is not to say that knowledge is irrelevant in managing, but much k Ilowledge about managing is transient. Consequently, we ought to be ,Il'veloping in our managers a set of attitudes that makes them want III llIaintain, update, and thirst after new knowledge. We ought to teach .111 aspiring manager to develop an experimental turn of mind; an ;11 t it ude that makes him innovative about the managing process itself; ;1 "scientific" curiosity about the management process, a learning atti­Ilide that scnds him searching for new ideas and methods that might Il(' applil'ahle to managing; and an open attitude that encourages him III seck counsel I'mlll diverse sources. Some of these attitudes are Illllh;lhly teadl;lhil'; SOIlIl' are beyond our reach by any presently kllown edlll'atiouallul'llllllls, Hul. l'ulld;llul'nlally, we should he trying Prohahly the hest kll"Wll W:IY 10 :IJ'p"la{'1t Iltat larget is hy rl' quiring student managers to take Oil v:lglie :lssignJllellts relJuirillg 101'; of exploration and interaction with others, accompanied by nil il':d discussion and review. 3. A good deal of emphasis in management development needs I" be given to the manager's self, his ego. At least three important issul's seem to arise here. First, we might try to help the manager to vallll' himself as a problem-working instrument. If managing involves proh lem finding, it must also require reasonable self-confidence, tenacily. belief that one's own ideas are worth something. We need to try I" help managers become at least somewhat "inner-directed." Second, we probably need to try to teach managers to take their own needs seriously; to look always at themselves as well as at their external tasks; to be consciously concerned with questions of what they believe in, what they feel is ethical, what they themselves walll to accomplish. This is not a matter of self-indulgence; it is an aware­ness that one is himself a significant part of managing. Thirdly, and perhaps most importantly, we have to teach managers to value and use their "gut feelings." For despite our advanced state of knowledge, despite our sophisticated models and methods, a large chunk of managing still has to be done with "feel," "judgment," "intuition." These often unconscious inner feelings are important and valuable tools, especially since so much of managing must be done in real time, on the fly, with no time available to use other, more elabo­rate tools. So we should be teaching our managers how to read small signals and how to listen to (rather than ignore) their own feelings; and we should do this not to the exclusion of reason, but as the com­panion of reason. Some alternative techniques With this sort of framework in mind, the developer can begin to select some combination of methods and techniques to use as his training tools. Most training directors wouid doubtless, at this point, begin to consider the available alternatives currently in use in industry. They include job-rotation plans, classroom-education plans, apprentice­ship plans, and various problem-solving plans. They can be found in varying degrees and combinations because they are not entirely inde­pendent of one another. Some are techniques that can be used within others; some are primarily administrative devices that leave training itself largely to other people. Consequently, it is not proper to try to label any of these mechanisms as better or worse than any others. Any I'" .h:ihly tlte 11IOSt widespread fonllal method or management de- , I. '1'IIIelll, cvell today, is joh rotation, An executive-in-training is 1l'llI:tlieally (or unsystematically) rotated through many jobs at "'lilY kvcls of the organization. In some plans he simply observes the 1,,1,., in others he may work actively in them for a period of several ",.,"llts or a year. llnderlying these plans is the belief that a variety of job experiences I'" ,,,ides the trainee with an opportunity to learn "all about the I" I', IIICSS" and is therefore good preparation for managership. The ad­IIllage to a manager of knowing his own business is obvious. It is 'l'I<'stionable, however, whether independent experience in each of 'Yl'I'al jobs provides a candidate with knowledge of the relationships ,[ III lIlg the jobs, a kind of knowledge probably more useful to a man­11'.1'1' than knowledge of any specific operation. Moreover, rotation I d:lI1s may-although they do not necessarily-suffer from a kind of 1 .. lSsivity and aimlessness resulting from the absence of a clear-cut , I'lltral goal. Thus, for example, when one works in a department for Iii rce months, one, may learn quite different things from what he would learn either as a regular employee or as a manager who had I" look into the department to solve some specific managerial prob­kIll. The rotated trainee is in danger of learning superficially, like a lourist in a foreign land. Organizations that use rotation systems often heeome aware of this difficulty. Then they either lengthen the rotation schedule or set up special assignments which require trainees in rota­tion to be more concerned with the managerial aspects of the job than with its operational aspects. It is sometimes claimed that a simple rotation plan is a good way of separating the leaders from the followers. Those trainees who are poor tourists, who learn only the minimum, can be differentiated readily from those who take initiative and find things to learn, even if those things have not been defined for them. It may well be true that a rotation plan is a useful selection method. The people who take initiative, who think up problems on their own, may stand out quickly. But that is selection, not training. If there is a great strength in rotation schemes, it is an ambiguous one we have not yet mentioned-rotation can multiply and fragment the manager's loyalties so that he is part of all groups, not just one. While split loyalties will increase the probability of ulcers, they also increase the likelihood of intergroup cooperation. Classroom training, including lectures and discussions; is, like rotation, both useful and incomplete. As the rotation system emphasizes experience, most classroom training emphasizes the prOVISIon '" knowledge. Both knowledge and experience are relevant to the d,' velopment of management. Both add to the trainee's breadth of Ill" ception of the world. But like rotation, classroom courses are like" to be psychologically sealed off from the solution of managerial pIli" lems. For in the classroom, learning is tied largely to the traincc'., desire to be Successful in the class. Only later, when he is faced Willi managerial problems in which classroom knowledge would h:II" helped, is he likely to be fully aware of how many really useful lI,ill'''' he could have learned if he had known then what he knows now. "'11/ ,', months of reading and lectures are likely to train inefficiently IInl( .... , they accompany rather than precede the need tensions that Come 1'" 1111 having to solve a management problem. It is paradoxical that indusl' \ which in the eyes of many educators presents an ideal training groulld should be turning to the classroom as an educational device while Cdll cators themselves are complaining that the classroom is an inadcqu:ll. educational mechanism. One kind offormal management education that has become parlilll larly popular in recent years is the university executive program . .,., It"" programs are typically conducted for large groups of executives galh ered from many different cultures. The programs vary in length frolll II couple of weeks to a couple of months. Although they are often IIscd :1'. a sort of reward for the good executive, or as a way of showing thai 1111 organization thinks well of him, they also do seem to have an impollalll broadening effect, an especially valuable contribution for senior 111:111 agers who have grown up within the narrow confines of one orgalli/ll tion. Such programs also socialize people into a feeling that they :111' members of a profession called "management." These are not at all trivial matters for people in senior managclIll'lIl positions. They are the ones who especially need a broad understand ing of the nature of the larger world around them, as well as an undl'l standing of the implications of alternative. financial, control, and at' counting practices, They are the ones, too, who need the sense (,f being professionals, of maintaining high standards of ethics and t" skill. They need also to perceive both the uniqueness and the IIni versality of the problems they face. University programs also provid,' a pause, a breather in the hectic life of the manager. There is evidenl'l' from many different fields that such pauses yield useful fallout for f he individual himself and for his contributions to his managerial world It does appear to be true that getting away for a while recharges 0111 batteries. Again it is worth pointing out Ihal Ihe adeqllal'Y of lhl' univn.sily classroom must be judged 1101 on/y a)'.:lillSf Ihl' 1"lnll'lIl alld 1I11'Ihlld Ill' .Iassroom teaching but also against the motivation of the student. If .1 manager-in-training goes to a classroom in search of help with a prob­lem he has already defined for himself, then the classroom, like the AA Illeeting, can be extremely helpful. But if the student is the passive party in the classroom relationship while the teachers pump him full • d' knowledge, it is likely to be an inefficient method. For learning can­lIot be exclusive of the needs of the learner. And what is learned best ,.; what is relevant to the current needs of the learner, not what may I,,' relevant to his future needs. Such off-the-job, one-shot executive programs are far from perfect. Il1ey show a sharp wash-out effect after people leave them and return III the workaday world. They are not very good means for developing .pccific managerial skills. So they are best seen as useful modules to II(' combined with others over the course of a career. Apprenticeship systems, often combined with rotational systems, are ,II1other base for developing managers. Sometimes trainees are attached I II I' extended periods to a particular executive, to serve as his assistant, 1., live in his office, and, insofar as possible, to do his work. Such systems 1I1:IY provide good opportunities for the trainee to practice working on 1I1:1I1agerial problems. They may also provide the motivation for acting 111,,' an executive, But the quality of the coaching is variable. Political 11111 personality factors limit their usefulness, for the variety of execu­11\'(' problems the trainee is given is left largely up to the executive to "l1l1m he is attached. If the executive is either uninterested in the 1/ 'prentice or feels threatened by him, that particular apprenticeship 1\ 11 I provide few learning opportunities. Slill another effort to provide motivation and opportunities for I" :\("t ice in a group setting is the junior management "board," A "'"IIJl of lower-level people is elected or appointed to a kind of second I" ':1Il1 of directors which meets periodically to consider any business 1'lIIhkms it chooses to consider, to gather information about those I" IIhkms, to analyze them, to come to decisions, and to make recom­""',"la(ions to the senior board. While holding their lower-level jobs, \ ""11)', people thus get an opportunity both to tax their own brains on ''''('lIlivc problems and to work at the peer level with a group of other 1':1111 illle" managers. This approach has the advantage of giving Y' '"I'I',n people an opportunity to view the world as a manager, to be 1,II('d with and wade through problems of impending change, and to ",';iI"l'l1anges of their own. r IlHk-group-based development programs III 1("('111 Yl'ars :1 whoit' snil's of dinnell! forms of task-group de­\1-1111'"1('111 IlIodl'ls have hl'l'Ill'volvill)'" They deserve special considera- lioll, III 1I1l' p;I~;I, Sllllll' III 111l'1I1 11'('1" ("III('llll'd 1"11I1:llllv willi !'IIIIIII" alld very liuk witli 1:lsks, III I iiI' liltl(,~; alill ~,i,lil'~; tlien' IWII' a 1lIIIIdlii of experiments based Oil sellsilivily traillillg carried out witliill pal ticular companies. Most evolved over time into Illore task-oriclltl'" directions and became centrally concerned with what is 1I0W l';dlrd "team building." A few remained primarily "humanistic," eOlln'rll,'d almost exclusively with personal and interpersonal sensitivity. SOliit' are quite clearly delineated in space and time. Others are mucli k~.·( separable from the ongoing work of the organization. Here, to provid(' the reader with a picture of how such a program might work, is a brief description of one recent program of the latter sort. Company A is a rapidly growing organization staffed largely by technical and professional people, The organization is loosely alld flexibly structured, Indeed, until recently it was very hard to )',el answers to questions like "Whom do you report to?" With growth, IiiI' pressure to "get organizated" also grew. So the president increasl'd the number of vice presidents and organized them, together with kl'V administrative and planning people, into what he called a manageml'lIl committee, Almost all members hold Ph.D.s in one of the hard sciences or engineering. The functions of the management committee, though not clearly delineated, were to design company policy and to make SUIT that policy was communicated and implemented. A consultant had been brought in to help the company become a little more organized. He proposed that some management develop­ment ought to accompany the formation of the management committee. With the president's agreement, the following plan was devised: The management committee members would meet together for two days just prior to their next scheduled meeting. During those two days, a two-person faculty designated by the consultant (but checked out by the company) would conduct a management-development "work­shop." The faculty designed the workshop. After interviewing a number of members of the organization, the faculty members felt they were dealing with strongly "cognitive types." These. were people who were used to using their heads, and using them critically. Second, many of the important problems of the company centered around coordination among divisions. Third, beginning rumblings of discontent could be heard among newer (but not brand new) members of the organization. So the faculty decided that its initial training inputs should focus cognitively, on people and coordination issues. The faculty also felt that management development should blend as much as possible into the ongoing work of the organization. The line between them should be a blurry one. So management development 1 •• ,"I.1L1I .. ,' pl:II'" Clllltlllll.!llv. ,111.1 1'11111:11 ('(IlIl';ltiollal illpllis and real­,,1,1111:11'111'1' ~;II(l\J1d Ill" cllI',,' SIIII'" !',10IlpS are sucli powl,;rfulmeeha­"', Illi 1IIIIIIIai kamilll'. :llld probklll solving, thc programs should .11' '1I!'.ly group-basel!. II,,' plogram that cvolved for the first two-day workshop con- , I" I "I ;\ sl,;ril,;s of lectures, cases, and simulation exercises selected I", Ilwir relevance to this group. These were duly presented at an off- il,. I wo-day meeting. Illl'sc formal inputs were alternated with "relevancy sessions." One I" lilt I' member would offer an exercise, lecture, or case discussion, I, ,11<\wcd by a break into small groups to consider implications for the , . '111\,aIlY and then a general discussion. The process was then repeated 1111 a new input by faculty. Sometimes the relevancy sessions pin­I" ,'tlled some company problems that needed action, sometimes not. \s the workshop progressed, several clear issues surfaced, some "<Jlliring further study before implementation action. Task forces ".i'll~ set up by the group to deal with some of these problems, and ,lI\11,; were put on the agenda for regular management committee meet- The group decided that a one-day session fonowing the regular Illl'ding should focus on a few selected issues. Over the next several 1I10nths, this process continued, though not in a regular or formal 1:lshion. Several short input sessions took place, along with several I eporting-back sessions and several self-study activities. The president and some committee members felt that something ~;i1l1ilar would be useful at other levels of the organization. Some similar two-day management-development workshops were therefore designed and carried out. As this process went on, a new problem emerged. The second-level people felt that, while they were beginning to communicate with one another better, and while the management committee members felt that their own interpersonal communication and coordination was improving rapidly, the communication between levels continued to be weak. The typical complaint voiced by second-level managers went like this: "The vice-presidents may be able to talk to each other, but they sure as hen don't know how to talk to us! We never know what's going on around here." The consultant and staff then organized some vertical sessions within major divisions of the company. And these activities go on. They are partially self-generating and highly contingent on what preceded. Some intradivisional activities are spinning off from them; task forces and partial reorganizations are taking place. The faculty's role is rapidly being phased out. They may be useful again at some later time. Notice Ihal IIll' lille hl'lwlTII ,~II('h "lIlall;I}',l'IIIl'lIt dl'\'l'ioflll Il'II I 1'111 grams" and "reorganization" is 1101 al all l'ka!. Alld ri)',hlly ~;o, 'IIII' starting point is, in this case, SOIlIC Jllall,lgclllcnl-cdueatioll aeli\'ltl' Because they are intentionally tied in 10 the ongoing pJ"()hklll~; III work, such programs-when they work-spill over into Jllany olhel areas of the organization's life, In the case described here, this loose, spreading style may be particularly relevant because of the org;11I1 zation's commitment to remaining relatively loose. The organizatillil does not seek a tight, hierarchical structure. It wants to be peopk based, But as it grows larger, it will be forced to become more slnll' tured, though this will surely involve some sacrificing of the presellt do-your-own-thing style. Nevertheless if we can increase the quality III interactions among members of the organization, we can at Ieasl counterbalance some of the need for formal structural controls. But are such programs appropriate only for loose, fluid, and rapidly growing organizations? Not necessarily, Here is another example: Company B has about 17,000 members. It is also a high technology organization, also staffed by bright, cognitive, technical types. It is much older and more stable than the company in the first example. It has about nine levels in its hierarchy, and everyone knows exactly to whom he reports and how he is evaluated. Top management in organization B also felt that in its rapidly changing environment, more managerial skill was needed among its technical managers, and a somewhat more entrepreneurial attitude might be needed too, as competition stiffened. The consulting faculty and management group concluded that this program, too, should carry a strongly cognitive flavor, that it should be extended over at least a six-month period, and that it should be concerned very heavily with people management. But this program was to be organized around a tight schedule, consonant with the much more schedule-oriented organization. It was to consist of a three-day "kick-off session" for groups of thirty middle-level people, with a series of five one-day "re­inforcement" sessions, one per month, in which visiting experts would present a day's worth of input on specifically relevant issues, like performance appraisal methods. And it wo~ld close with a two-day "wrap-up" session. The reader will notice that although so far we have met the criterion of continuity in this program, we have not yet managed to get much interaction with the workaday world. That was done in two ways: The first group and all succeeding groups were charged with using the program as a base for experimentation with any ideas they found potentially relevant to the management of their own departments. They were by no means required to take a sympathetic view of the ideas ,III' III ,':;"lllL'd, hili IIII'Y W,'I(' ,I',k,'d III ,1(1, III II Y lIUI, III experlllll'1I1 ,Il, th<'11 1II,III''1',I'llall1l'I1;IVIIII 'IIII' 1 "lIl1l1l1'l'llIl'lIl sessiolls WCTL' prac­I", ,'III'IIlL'd, a\l\l tl1e wr;'p "I' :;C;Sllllll'lIllsisted in part of a show-and­I II ,II !Ivily ill wl1ich the participants talked a little bit about what ii,,' ILld tried to liSe, what had failed and what had worked. I hi:; program was repeated with a large number of middle-manage­"" "t I'll )lIpS and later with a smaller number of higher-management "1\11 ,:;, I \1 this program, measurements were taken by the company ,1111 i1ldicated modest but positive changes in the behavior of partici­I ,,,ii', ill their interaction with one another and in their concern with ,I" II IIwn management skills. Thus far, all groups have continued to ,," ,I periodically (some over the course of several years). Many spin- ,1\ ;Idivities have developed: subsidiary workshops within subunits; ,,,,,'Iings between subunit managers to try to resolve difficulties; the "i1I11duction of specialized consultants on special projects; and the ,10 \'t'\opment of a small in-house staff resource group. Tl1e reader will have to decide for himself whether or not such pro- ,",lll1S are valuable. They certainly do not cover the educational spec­II 11111. They are certainly not substitutes for course work in accounting ," Iinance. They certainly do not guarantee that all participants will , 'lIl1e out polished, topflight managers. But they do seem to contribute llilicthing to the development of the individual and to the smoother IllIlning and greater flexibility of the organization. In summary \nyone concerned with developing managers must deal with three LI'y questions: How do people learn? How can a trainer train? And what is a manager? Learning is defined here as a process of reorganizing perceptions so Ihat new patterns of relationships are formed. Training, therefore, Ilecessitates providing trainees with problems that require perceptual reorganization for their solutions and providing these problems in a situation in which relevant knowledge and experience are also avail­able-including knowledge and experience about groups. The "ideal" manager can be defined in many ways. The emphasis here has been on those phases of the manager's job involving the gathering and analyzing of information, decision making, and action, with a recognition of the unprogrammed nature of his problems, his continuous dependence on other people, and the pressures imposed upon him by his position in a hierarchy.   Taken from MANAGERIAL PSYCHOLOGY – An introduction to individuals, pairs, and groups in organizations, by HAROLD J. LEAVITT is Walker Kenneth Kilpatrick, Professsor of Organizational Behavior and Psychology in the Graduate School of Business, Stanford University;  Copyright 1958, 1964, 1972, 1978 by The University of Chicago, THE UNIVERSITY OF CHICAGO PRESS LTD., CHICAGO AND LONDON, 4th Edition,       , Page 244 – 257.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out)   , BUT it is possible to protect yourself and your family by taking sensible precautions. Q Is it possible to be protected against rabies before I go abroad? A Protection is given when someone has bee" r con­tact with the disease. You snoc;ld teach children to avoid all anima,s when abroad, and not to stroke stray cats and dogs because they may be infected by the rabies virus. As the virus is present in the saliva of infected animals, even a lick from an animal is potentially dangerous. Rabies can be a killer, so you should take no chances. If you are bitten, scratched or licked by an animal, wash the wound immediately, with soap and water and go to the nearest doctor or hospital for a course of injections. Becoming ill on holiday can be a serious matter. Everyone knows that foreign holidays can play havoc with the digestive system. If it is not diarrhoea, it is constipation and then, of course, there are the unaccountable fiu-type symptoms that some holiday-makers succumb to. You could run up high doctor's fees as well as a high temperature. Perfect health on holiday can never be guar­anteed, but you can take precautions which will reduce the chances of illness. What you can do in advance If you have an illness or condition which requires continuous drug treatment, you can get a reasonable supply of medication from your doctor-plus a check-up if necessary. You may need more drugs on holiday, so make sure you have all the details of the drugs written down. Anyone with a serious disease who is holidaying abroad should obtain the ad­dress of their country's embassy or the Children's skin burns easily in the sun so a sun-hat, sun-top and sun-tan lotion are necessary precautions. mission nearest to where they will be staying. There just might be an emer­gency requiring perhaps special medical supplies or transport home. The travel agent or passport office will have these addresses, or you can obtain them on arrival from a tourist office or police station. It is always worth having a dental check before going abroad just to reduce the chances of unexpected toothache. Dental treatment may be difficult to come by or expensive in some countries. Travel sickness Children are more vulnerable to travel sickness than adults, the worst ages being between four and ten. Some people, of course, never grow out of it and there is little they can do except buy travel sick- HOLIDAY HEALTH Q Can you have more than one vaccination at a time? A You are supposed to leave three weeks between polio, smallpox and yellow fever, but two can be done together if time is short. Boosters, if you have have been vac­cinated before, can usually be done at the last minute. Q How late in pregnancy is it safe to travel in an aero­plane? A Many airlines will not normally accept passengers who are more than 36 weeks preg­nant Anyone who has had bleeding in early pregnancy should not travel by plane at any stage of pregnancy. It is possible to get private insurance for travel when pregnant, but this will not usually cover the last two months. It is not a good idea, anyway, to travel very far during the last six weeks of pregnancy Q Is it wise to get an anti­tetanus injection if I receive a cut or scratch while on holiday? A Yes, particularly if camping or in the country. Children can have a course of three injections, usually as part of the general vaccination service in the UK and are protected up to the age of about 15, if they have completed the programme A repeat booster is needed every five years after that. and it is sensible to get this done as a matter of course. If an injUry occurs, you can get a single injection to give temporary protec­tion, and it should be done as soon as possible after the injury at the nearest hospital. Q Could you get heat stroke from having your head and the back of your neck uncovered in the very hot sunshine? A No, though you might get a headache and also sunburn on your neck and shoulder Heat stroke is caused by loss of fluid which can happen when you are active and sweat a lot in a hot climate. Symp­toms are fainting, cramps, dizziness but the condition can be prevented by taking extra salt in the diet and drinking plenty of fluid. ness pills and take them before travel­ling, always following the instructions on the label carefully and keeping to the stated doses. Remember, if driving, that they cause drowsiness. Children need junior-strength travel pills. Food and water precautions Most places have healthy drinking water, but if you have any doubt inquire at the hotel reception or ask the agent, if you are renting a cottage or villa. At camp sites you will be told which taps to use, but it is useful to take water-purifying tablets; these are available from chemists. If the water is impure, use the tablets even when rinsing your teeth. Do not drink from local fountains or use the water to dilute fruit squash unless you know it is pure. Use bottled mineral water instead. Wash any fruit and salad vegetables that you buy in pure water just before you eat them; or, alternatively, wash them when you bring them back from the shop and store them away from flies. Protect other food similarly and keep perishables in a cool place. If you are reheating food, make sure it is done very thoroughly. Fresh cooked food is safer than reheated food. Keep cooked and uncooked meats separately and wash utensils and work tops thoroughly. In places where the hygiene leaves something to be desired, the most dan­gerous foods are raw vegetables, salads. shellfish, cream, ice cream and underdone meat or fish. Avoiding sunburn A certain amount of sunshine is good for the skin, but too much will cause burning and coarsening. Avoid the strong midday sun. Fair skinned people need special pro­tection. Use plenty of sun oil and remember after swimming always to re­apply it. Protect children's heads and shoulders with a sun-hat and cotton top while they are playing on the beach; and remember that sunlight is reflected from the sea and sand so do not neglect to apply their sun oil either. Snow and high altitudes combine to create a similar hazard. Medical treatment abroad Those in the UK paying national insurance contributions, and their dependents. are entitled to free medical treatment in countries belonging to the EEC (European Economic Community). There are also reciprocal arrangements with other countries which are not part of the EEC. Your travel agent will give you details. Treatment can be very expensive in countries which do not have a reciprocal agreement and it makes sense to take out private medical insurance. Travel agents will arrange this for you and your family or it can be done at airport terminals. Alternatively, you can go direct to an insurance broker; this will be slightly more expensive, but more thorough coverage is offered. In some resorts abroad, it is best to drink bottled drinks or mineral water. HOLIDAY HEALTH What you should be immunized against before you travel Areas prevalent Period of immunity Disease Cholera Vaccination advised for Asia, Middle East, Africa (including Mediterranean coast). Check if going to any Mediterranean country, as some countries may insist on evidence of vaccination on entry. Six months. Two injections given 14-28 days apart. Validity of certificate starts six days after injection Infective hepatitis All places except northern Europe, North America, Australia, New Zealand A gamma-globulin injection provides immunity for six months. Particularly necessary if you are going off the beaten track, where hygiene may be poor Malaria Take anti-malarial tablets one week before departing and during time abroad. Continue to take one month after return Poliomyelitis Central and South America, Central and East Africa, India, Pakistan, Bangladesh, South East Asia Advised for anywhere outside northern Europe, North America, Australia, New Zealand Five years. One oral dose only. Must be given seven days before or after any other vaCCination. But three oral doses at monthly intervals are necessary initially, if you have never been immunized. Reinforcing dose (one only) needed every five years. Smallpox Vaccination cur'e~t: compG:sorv :'1 Chad, Kampuchea, Madagascar oni'. Three years. Validity of certificate starts eight days after successful first injection when your doctor will check that vaccination has taken and give you your certificate Typhoid Paratyphoid Vacclnato~ aJ. see 'm any"here outside northern Europe -:-' ':;me',ca .ustra,:a. New Zealand About three years. Two injections four to SIX weeks in between: can be reduced to 10 days in urgent cases. Immunity begins six days after first injection Yellow fever 10 years. Validity of certificate starts 10 days after vaccination LAXATIVE Useful medications when travelling abroad: Tablets (vitamins, medications, travel sickness pills, asprin or pain relievers, indigestion tablets). Kaolin and morphine mixture for diarrhoea. Mild laxative. Insect repellent. Sun oil. Lotion for sunburn (e.g. calamine lotion) Also useful: thermometer, plasters, tweezers, water-purifying tablets, throat lozenges for sore throats. KAOLIN, & OR PHI TANNING Oil Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS - DOCTOR’S ANSWERS – PART 26, HOLIDAY HEALTH, Page 715 – 717. (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out) , Who believe it can succeed where conventional medicine has failed. Doctors, however, remain sceptical in the absence of scientific proof. But what methods do faith healers use? Q Are faith healers an alternative to doctors? A No, and few would claim to be. If you are ill you should always consult your doctor first to get treatment. Some people, according to their belief, may find an additional source of strength through healing, though many doctors would say that this is purely psychological. Q Can faith healing or other forms of healing provide a permanent cure? A Some patients do get better after visiting a healer but whether this would have happened anyway is impossible to test. Others feel better or, in the case of people throwing away their crutches after a healing session, have a 'miraculous'cure, only to have their illness or disability return in a few days. Doctors are often concerned because they feel that their patients' hopes have been falsely raised: that such people's 'enthusiasm' could only effect a brief and illusory cure which would be followed by deep disappointment-and this might create psychological problems. Q Why does healing sometimes work, even if healers have no special powers? A Even doctors who do not believe in healing recognize the placebo, or dummy drug, effect. Many patients, when given a placebo, will experience genuine relief from pain, just because they believe in it. A healer may affect some people in the same way and, because of this, they will feel that they are getting better. Q Must you believe in healing for it to work? A Not all healers consider it necessary for patients to accept their particular beliefs. However, it is likely that a good healer, just like a good doctor, gives the patient confidence. This may help the patient relax and thus ease pain and tension. Additionally a sympathetic healer, like a sympathetic doctor, can often incidentally aid recovery by boosting a patient's morale. Faith healers beliE','C' ::".C':: :-,a':C' been chosen to act as (:'2.'.:-.E:S :':!' :'Ealing powers which comE :"'CT:'. G:d. These powers can be tranST:'.:t:E'j, :c ::".E patient in a variety of \\'avs. ,an,,::-." :r'cc. direct physical c~ntact. ~ftEn k~.O"ZC1 as 'laving on of hands'. to distant heajr.g. \':!lere the healer concentrates on :!lE ;J!-:o:ogTaph or name of the sick person. 0, a ;ock of his or her hair. or e\'en a tiny sample of blood. The oldest examples of faith healings in the Western \vorld are the 'miracles' of Jesus which are described in the :\"ew Testament. Jesus used many different methods to cure the sick. from touching them to simply commanding their recovery. He is described as possessing a healing force, or virtue, which was transmitted both to individuals and to large crowds. Modern faith healers have strong religious convictions, but not all of them insist that the patient must share their Healers perform laying on of hands by touching the affected area and allowing their healing energy to flow into it. belief for the cure to be successful. Non­religious people have claimed to have been cured by faith healing, while some of the most fervent believers have re­mained ill in spite of all the efforts of these healers. Many faith healers also try to persuade patients to seek orthodox medical treat­ment in addition to getting help from the healers themselves. How it works The most common technique used by faith healers, laying on of hands, consists of the healer placing his or her hands on the affected area, sometimes accom­panied by prayer, allowing the healing energy to flow into the patient. Some faith healers, particularly when they are dealing with cancer, use the technique of meditation and also ask the patient to visualize the affected parts being healed. When such a technique is performed, many patients attest to intense sensa­tions of heat, cold or tingling, far more than they would experience from ordi­nary hand contact. Patients also claim to feel immensely relaxed, and this is particularly useful when treating condi­tions which are psychosomatic in origin. When faith healing is done in front of a mass audience, laying on of hands is sometimes incorporated into prayer ser­vices led by a healer. Faith healing can also be done when the patient is not present: this is called distant healing. Sometimes this is com­bined with the ancient art of dow­sing-where a pendulum is held over a patient's 'witness', such as a photograph, lock of hair or blood spot, and diagnosis and treatment are effected. In distant healing, a prayer for a person's health is made while the healer mentally concentrates on the witness. Some patients attest to feeling better, although whether this occurs because they know that someone is 'thinking' of them, or whether their health would have improved anyway is not known. Even if such faith healing methods do not cure patients, they will usually do no physical harm.It is debatable, however, if mental harm results, particularly when a seriously ill person, or what doctors would call a 'hopeless case', places such faith in a healer'3 po\\'ers. only to find that nothing can be done to help them. Other healing methods Healing can a130 take the form of other non-medical technique3. but the practi­tioners do not claim religious inspiration. These technique3 include spiritual heal­ing, which hea13 the mind and as a con­sequence hea13 the body; psychic healing, where the healer calls on spirit guides to heal the sick; and natural healing where, by tapping the universal healing energy, a cure can be effected. Often these cate­gories overlap, as do the techniques, but laying on of hands is common to nearly all. Self-healing is a method of healing which is gaining ground. It is psycho­analytically based and may be used in conjunction with faith healing. Often it is used for a number of psychosomatic com­plaints such as depression, insomnia, asthma, high blood pressure and skin disorders, but increasingly it is being employed by cancer patients. The patient repeats phrases that sug­gest that the body parts are becoming warm and heavy, and this will make them feel deeply relaxed. Such a tech- FAITH HEALING nique can be practised on its own to keep the body systems 'balanced' and check any illness that might occur. With some cancers, which are thought to be brought on by mental or emotional disturbance which alters the body's im­mune system, the patient is taught such meditative techniques. In addition the patient tries to imagine that the cancer is being overcome by the body's immune system and, in doing so, they 'will' themselves to good health. Again, patients whose cancer has been cured this way have claimed that such a technique works, especially if it is sup­plemented by conventional medical treatment. Fact or fiction? Faith healers claim many successes, and it must be said that some people do indeed gst better after treatment, though why this should be is a matter of controversy. Sceptics argue that they would have got better anyway. Time, rather than medicine, provides many cures and even in serious illnesses, such as cancer. cases of spontaneous remission (sudden im­provement for no apparent reason) are well documented. That such improve­ments take place after visits to a healer is, they insist, coincidental. Healers, on the other hand, claim they are able to transmit a healing energy to the patient which effects or accelerates a Every year thousands of ill and handicapped people go to the Roman Catholic shrine at Lourdes, hoping and praying for a cure. cure, Though thi3 energy has not been identified by science. and is not fully understood by the healers themselves, they assert that there are definite indi­cations of its existence. Healers \\'ho have been scientifically tested have been shown to have unusual brainwave patterns, and when both healers and patients \vere tested together during healing 3e3sions, it was found that these brainwave patterns were trans­ferred to the patient. Further, other laboratory tests have shown that healers could make the skin wounds in mice heal more rapidly or 'heal' flasks of enzymes damaged by ultraviolet rays. Tests such as these, and others, are not always successful, thus prompting re­searchers to say that the 'loss' of healer's powers merely exposes healers as char­latans. Healers counter that such a dis­play of healing energy does not lend itself to scientific examination; at other times they have been known to attribute their lack of success during these tests to various reasons, among them boredom, ill health or a recent bereavement. However, more conclusive evidence will be needed to persuade the majority of doctors to take faith healing seriously.   Taken from The Marshall Cavendish A – Z Guide in Weekly Parts DOCTOR’S ANSWERS - part 18, FAITH HEALING, Page 494 – 495.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out), Mineral waters not only have health giving properties, which most other beverages lack, but are also pleasant to drink. What we drink is determined more by social habit than by bodily needs. Yet coffee, tea and alcohol may do more harm than good, either because they do not relieve our thirst, or because they remove vital vitamins from our systems. Water, on the other hand, is a natural thirst-quencher. It quickly replaces body fluid lost through sweating, eating salty food or frequent urinating. Water is an essential part of the body tissue: drinking it it essential to the functioning of the digestive system and ensures rapid removal of poisonous substances through the kidneys. Finally, water has no harmful side-effects. There is an increasing trend nowa­days towards drinking 'mineral waters' for taste and for health. In fact, this custom started with the ancient Romans, who discovered that water occurring naturally in some regions had curative powers. They called the loca­tions 'spas', and people with digestive problems caused by overeating and drinking would spend weeks there, bathing and 'taking the waters'. The tradition was revived in Europe in the 18th century and led to the growth of bathing resorts such as Brighton and spas like Bath in England. Though people no longer 'take the waters', the tradition has survived, and mineral waters from certain regions are now bottled and sold Health giving properties Although medical opinion differs as to the efficacy of these bottled waters, there is much to be said in their favour. Mineral waters are often more pleasant to drink than tap water. There are some situations where they are definitely pre­ferable, such as when water has been polluted by bacteria. Mineral waters are thought to contain less lead than tap water. Research has shown that lead is becoming a major pollutant of the human body, resulting in health problems such as blood dis­orders, weakness and lethargy. Addi­tionally the purified water in many cities is often artificially softened, and while this makes laundering easier, soft water may contribute to heart disease. Most mineral waters come from regions where the underlying rock is limestone, giving rise to hard water containing calcium salts and trace minerals. You can get these minerals in a balanced diet, but there is little harm in having extra. Probably the most important health­giving properties of mineral waters are that they provide a good substitute for other drinks. Those who want to avoid taking too much tea, coffee or alcohol can find a socially acceptable substitute in mineral water which can be drunk on any occasion with no harmful effects. Many people now order it instead of wine with a meal, and guests are often pleased to find it along with other beverages in a drinks cabinet. Mineral waters are far more thirst-quenching than hot drinks or fruit juices. And they can also be used as a gentle and harm­less purgative in place of harsher reme­dies such as laxatives. From now on, when you want a beverage during a break, or to give you a lift or to quench your thirst, take mineral water ... and do your body some good at the same time.   Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS -   DOCTOR’S ANSWERS – LIVE BETTER NATURALLY - PART 22, DRINKING MINERAL WATERS FOR HEALTH, Page 614.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out)   , Q Would a health farm do me some good even if I do not want to lose weight? A It depends on your other needs. If you feel flabby and lacking in energy, the exercise and massage you can get at a health farm could be useful to you, especially if you need supervision. Also, if you feel very tense and need to find a way to unwind, the soothing, quiet atmosphere will help. On the other hand, you can get exercise much more cheaply at a local tennis court or keep fit classes, and a comfortable country hotel might offer the peace and some of the sports facilities at a lower cost. Q How much weight can I expect to lose after a week at a health farm? A It is very difficult to say Someone very overweight and used to an extremely high calorie diet couId lose 3.17 kg (7 Ibs) or even more in a week. A less overweight person will show a smaller weight loss. For women, the menstrual cycle has an effect on weight and if you are at a health farm during the last part of the cycle, or at the beginning of a period, there may be no apparent weight loss, though perhaps it will show a week or so later if careful eating is maintained. Much initial weight loss in dieting is due to loss of fluid which is all too easily regained unless the dieting is continued at least in a moderate form. Q I was planning to go to a health farm but have been told that it would be a waste of time and money. Can this really be true? A You may not get very far in dieting or adjusting to new eating habits, but you will benefit from the rest and other benefits like supervised exercise if that is what you want. Although even a week or a fortnight won't make you completely fit, you should be in better shape than when you started. But you have to be prepared to go on taking the good advice you have received or else you will be back where you started. A health farm will not completely transform you within a week, but the rest, controlled exercise and dieting could make you feel much more fit and help you lose weight. Health farms have something in common with luxury hotels, convalescent homes and religious retreats. You are oUered comfort, a blueprint for healthy living and a chance to get away from it all. It is not everyone's idea of a holiday and it is expensive, but a health farm can help you lose weight and make you feel a lot better in a very short time. Health farms in the UK vary very much in the facilities they offer, and in the prices they charge. A reasonably general programme should include a sauna, steam treatment, underwater massage, swimming pool, gym facilities, plus diet supervision. You may find 'extras' offered which add to the cost. Health farms may improve your habits and sense of well-being, but they won't cure you of any basic illnesses and, unless they state otherwise, they do not offer cures or treatments for specific problems. What happens at a health farm In the first place you are expected to go to bed at a reasonable time and to rise fairly early in the morning, and to give up The sauna, with its combination of quietness and various soothing techniques, leaves you feeling totally relaxed and refreshed. cigarettes and alcohol---at least while you are there. The first day should start with your being weighed and having your blood pressure taken by a qualified nurse. Then there should be a general check with a doctor who will want to know about any illnesses and also about your current life­style, worries and stresses. A dietician should then talk to you about your eating habits and should ask about any allergies or reactions to foods. From all this you should be offered a programme tailored especially to suit you--including a course of carefully graduated exercises in the gym and recommendations for what you should do when you get home. It is at this point that expensive extras might appear-vitamin B injections, for instance, to compensate for taking too much alcohol, and special massages not included in the ordinary programme. All these items should be set out in the brochure, so you get some idea of the cost involved. Many health farms start you off with a couple of days of fasting, to purify the system. It probably will not be total fasting, but you will not be offered much more than fruit juice. This tends to be delivered to your room, so you don't have the agony of watching others eating their slightly more substantial fare. Usually there is a choice of double and single rooms, with bathrooms attached. and meals may be served in the main dining room or in the bedrooms. Lunch i~ usually the main meal of the day, and the menu will be fairly limited with. ut course, a strong bias towards natura.: foods. Some health farms are vegetar:",: .. and all meals will be less than '-'.: . .:.::: normally satisfy hearty a.ppeL::c~ Muesli, yogurt, honey, cottage ~r.:c:c~:c fruit juices and salads wi!: p".': c.: feature on the menu. How you spend the day The day will probably beS-::. '''.::: .. '. :.~:--.c breakfast being bruugh: : '._: whether you are fa~tlG': .:':' .:- __ : -=-:--.:c':-. ::.:c restofthe morning \''-:.: 'tee- <:c':-.:::' .-.~ ::.:c rounds of the va:':'.'':':' :::c.::':'.:c':.> c.':-.=­taking advantage '.t c:--.:c :". __ .:.:c~ :::c::c::'                                 During thi~ time \.'':' ..                                 .~,.                                 bathrobe or perhap:, ''- .'':': ..                                 .' .c.:-.·._ Later, after you:' :.:c".::. :.' can walk and ~win:. u:' --_:': .c.:::c : ... '':'':-.= alone or in the compar,''- ::.:c. - :.:c . .:-.:.                                 health farms are in uk                                 -. _o:c~ with grounds which are :::.:c: __ : : ":c':-.C.:c walks. There may be __ :c 0 .c''- c. __ 'Co':C' and possibly stable~ ar::: :.,::':c .. ::.:::g. though this is not usua:':->':c . _.:: te tennis and squash cuurt:' What you \von't be I.:::c:e::'.o :"'.'.::.2e:1 entertainment--nu to. u:'~, .:- __ c :c''-e':-. -8.:-:.'               bl         d               ..          -' es, an certaInly :11_,t ~c.:-':~'::"~ _:-.'::" .C .. e:" ~~ to read, reftE:ct a:'le. :':c.c.x '.'.:::: t'.e minimum ufmE:nta1 ~tl:-::'~.2.:1-,:. On the \\'h01e. it i~ tleIte:' c,. keep outings to the uutside \\'urld ce, tho: minimum, steering well dear uf pubs. restaurants and grocery shops. It is d~ well to remember that if you are fasting you may feel lightheaded and have dif­ficulty in concentrating, so don't drive during this phase. Fasting makes you constipated too, so tell the resident doctor if you have such troubles as diverticular disease or piles which may be affected by constipation. Finding the right health farm Start by collecting several brochures. Health farms advertise in the backs of many glossy magazines, and if you tele­phone or write they will send printed literature. Compare prices, basic treat-   HEALTH FARMS Listen carefully to the person who answers the telephone. You can learn quite a lot about the efficiency, friendli­ness and regimentation of a place by hearing how the questions are answered. On the whole the larger and longer ­established places are likely to be the most reliable and have the widest range of facilities. But some smaller and newer places might offer nteditation, yoga or other specialities which may appeal. Don't be taken in by claims that the treatments can cure you of smoking or drinking. This is impossible in the space of a week or two. If you have a medical condition you should tell your own doctor of your plans to go to a health farm, so that he can advise whether certain treatments are safe or appropriate. Every effort is made to tone-and seemingly pamper-the body. Here (inset) the benefits of swimming pool and jacuzzi are enjoyed; and a trained beauty technician gives a vibra-massage treatment. .-ill of the food served at this health farm is produced naturally in its own gardens or purchased from special farms. rnents and facilities, such as sauna or swimming pool, and of course note any extra treatments and consider whether they would be of particular use to you. Check whether medically qualified staff are employed, as well as a professional s:.'1l1 instructor. If you cannot find out from the brochures what you want to know, then telephone for more details. Write down ,-,.-hat you want to ask beforehand, and do Cut be shy about specific enquiries. If they ::,In't like being asked questions, then it is probably not the place for you anyway.  , TO  a number of people at the same time. But can it ever replace individual treatment? Q Is group therapy ever harmful? A In the early days of group therapy when there were few properly trained group organizers, some people were psychologically harmed by it and this affected its image. But now that there are professional facilitators (organizers). or specialized therapists who can monitor those who are accepted into any particular type of group, and can look after the group's functioning without interfering unless absolutely necessary, the dangers are virtually non-existent. Q Can anybody run a group therapy session? A Looking after a group looks easy, for the really good facilitator hardly seems to be anything more than just another group member. But, in fact, a group leader should either have professional psychological qualifications, or a great deal of group experience, or­ preferably both. If you are thinking of attending group therapy sessions, make sure beforehand that the organization running the group has some sort of professional standing. Q I have heard that some groups take off all their clothes and have an orgy as a form of therapy. Is this true? A Nudity has been used as a technique to lower people's defences in some cases. Touching and stroking, either while clothed or unclothed, has also been used to make people more aware of feelings and relationships. However, groups do not indulge in orgies, as these would' be unlikely to help anyone, In any'case, nothing ever happens at a session without the express. agreement of all the members. Q Does group therapy always benefit all the members of a group? A This is very difficult to answer, sometimes the benefits are subtle and recognized less by the person than by those around him. It is probably fairer to say that most people benefit from most of the sessions, but to different extents. Group therapy is used to help people with mental problems, those with difficulty in relating to other people, or those who simply want to try and understand them­selves better. Many of the peoflle who undergo treatment are attracted by the reassuring informality in the approach used and by the wide range of help that group therapy can give. Types of group therapy Therapy groups are set up for various purposes. The form they take depends on the reason why they were set up. An assertion group, for instance, might be set up for people who feel that they back down too easily in arguments. The members of such a group will help each other by role-playing-acting out situa­tions similar to those with which they have difficulty coping. They can thus learn and practise argument-winning techniques. In this way they will be able to project confidence into their approach to such confrontations. Groups run to help people improve the way in which they relate to others, or just to help them understand themselves, are sometimes known as encounter groups or T-groups. People who suffer from particular phobias or anxieties may be treated in groups by desensitization. With the help of the therapist, members of the group can learn to overcome their fears. The motivation to succeed becomes greater when others are present. It has also been found that in spite of the reticence many people have about speaking of their sex lives, many sexual problems can be successfully treated in a group situation. Who needs group therapy? People with marital problems who go to a family planning or family therapy clinic may take part in group therapy. Doctors and hospitals may refer a patient for group therapy and put him or her in touch with a group. It may also be used in situations where individuals are ha\'ing difficulty in inter­grating with society. such as delinquent centres, open prisons or addiction rehabilitation centres. Sometimes it is used on some fairly sewrely mentally disturbed patients in hospital-though often the communication in these cases is more between therapist and patient than between patient and patient. It could be said that group therapy is good for anyone because it can be used as a process for enha!1cing life-style as well as for remedial purposes. Certainly it A tug of war is used to teach teamwork and organized effort and to dispel feelings of frustration and hostilit)·. GROUP THERAPY seems to have particularly good results with people who have no specific problem but wish to have a better understanding of themselves or want to improve their ability to communicate with others. Where it takes place A group therapy session may take place in a hospital, a prison or a psychiatric centre. It might take place in a doctor's consulting rooms after surgery hours. Sometimes group therapy sessions are advertised in magazines which feature forthcoming events, or they may be advertised on Town Hall or family planning clinic notice boards. Often these sessions take place in a room specially hired for the purpose, anything from a church hall to a hotel suite. Sometimes they are held at the home of one of the group members, generally an unmarried person so that there are no interruptions. When a session is advertised like this it is always a good idea to check that it is being run by a reputable person. Mostly they are run by societies, who are quite used to people checking up and do not mind. What happens What actually happens at a group therapy session depends on why it was set up. A typical encounter group session starts with exercises to help members to Revertion to childlike behaviour is common when a person is under stress. Possible group therapy exercises and their purpose One member breaks into the circle formed by members interlocking arms. To enable a new group member or a member who feels shut out to feel part of the group. Making noises, playing tag, imitating the play­ground activity of children To reduce anxiety and shyness in a beginning group; to warm up a group; to produce a return to childhood which allows members to lose their adult inhibitions. Arm wrestling, tussling and other 'combat' games. To eliminate hostile tensions between members and to teach very shy people to be more aggressive. Members acting in pairs confront each other with their exact feelings towards each other. To teach emotional assertiveness; to get rid of anxiety attached to being assertive. Tug of war. To teach teamwork and organized effort; to teach instant response to others; to dispel frustration and hostility. Fantasy and pretend games. To arouse emotions and to give members the opportunity to work through a difficult rela­tionship emotionally. Miming affectionate attitudes to another group member To teach people how to show and how to accept affection. Members acting in pairs sum up and para­phrase partner's statements before making their own statements. To teach each member to listen carefully to what others say before responding; to teach understanding of other's points of view. get to know each other and work on their problems (other groups restrict them­selves to talking about problems I. K 0 lead is given as to the purpose of the group or how it should work. Not even the group organizer, or facilitator, as he or she is generally Clllled, tries to resolye this uncertainty, for it is up to the group itselfto work out its own purpose. The group begins to discover whether not being told what to do is unnerving and that sometimes people like or dislike one another for no good reason. Members often start by expressing very positive statements to each other. These positive sentiments are very much surface pleasantries but they help to build a web of trust around the group. Support That web of trust nevertheless gives a certain right to say less pleasant things to each other and this stage is both natural and inevitable. A marked feature of the group is it powerful ability to support and heal any member of the group who seems to be under excessive pressure. The benefits Some critics of group therapy have sug­gested that the skill learned within the group do not transfer to the real world and that any advantages gained from group therapy do not last. However, when a specific aim, such as curing a phobia or helping a person to become more asser­tive, is involved the effects are as good as individual therapy. With encounter and other life-style enhancing groups, effects vary from person to person but some people enjoy the experience so much that they will attend sessions just for pleasure.   Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS -   DOCTOR’S ANSWERS – PART 22, GROUP THERAPY, Page 599 – 600.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out) , When both are infected by a virus, the resulting condition is known as gastro-enteritis. Q My husband had gastritis and now has enteritis. What is the difference between them? A Gastritis is an inflammation of the stomach, whereas enteritis affects the lower bowel. The two may be part of an infection of the intestinal tract and the symptoms of gastric upset may be combined with diarrhoea. However, they usually have separate causes: gastritis is often due to eating or drinking something which irritates the stomach lining, whereas gastro­enteritis can result from food­poisoning, food allergies, and adverse reactions to certain drugs Q What do I do if I suspect that         .         someone in the family has gastro-enteritis as a result of food poisoning? A Pack the""' isolated ar:. "::::ss:: e :: _ ~ someone respors:: a - s:: a ::-:'"~a This person mustv,as- - s ::" -e" hands thoroughly afte' ar'. :::: -~:'::~ Give the patient nothing co -:: _~­except sips of water. Get 'r ~:: _::­with your doctor, who \\ ac. se ::­howto proceed. Give rc -ac :: -e:: except those which a-a:: "e::::" :: e = by the doctor. Do not th rO':. a ... a. :' -. :: _:::: e:: ~ food thatsa"~ = .e" :: _- ~:':: =e -:' sealed c "st:: :::'c - :::'::e ~-e =:: :~::" wishes-c -".e ~~a::~e= ::'. ".-e"e ~ wasotta-ac ~-:'.:'::::ca necess,,-. t= e,:,- -e ::::e: -e-s ::­the pa- art s c:'e:a:: :".::- ~ . aec these -:: ::sac :::-t" -a":: Q My son is a trainee chef. How soon can he return to normal active life after an attack of gastro­enteritis? Can he continue working while he has treatment? A Iftheworkenta s -,,-c -~ '=c: in anyway, he mL.st -:t "at_"r tc workuntilpermittedbv- sc:::t=" "s the bowel maycontinL.e t= :""-. t-e offending bacteria after ere" :t_" symptoms have subsideo -ests c­the faeces will show wher -e s "-88 of infection. If there were no ouestc- c" handling food, a patient -ecoverng from gastro-enterts n-av be aliowed back to work, provided he or she is meticulously careful about hygiene. An attack of gastritis is usually caused by eating or drinking something that irritates the lining of the stomach and causes inflammation, pain and sickness. Highly spiced foods or an excess of alcohol are most commonly responsible, though smoking can also be a culprit. Some drugs seem to have a similar effect: aspirin is particularly irritating. The causes of gastro-enteritis are more complex. Microbes are by far the major To avoid stomach infection, use great care in preparing feeding bottles. source of the condition, especially those that cause food poisoning. Bacteria con­taminate food in one of two ways~ They either produce toxins (poisons) which interfere with the absorption of food and the normal digestive processes of the bowel and result in inflammation, or they work more directly by attacking the lining of the stomach and the intestines. Here they cause minute ulcers, resulting in bleeding and loss of the fluids, salts and proteins that the body needs. GASTRO-ENTERITIS Close-up of the rod bacilli that attack directly if they are swallowed in food. Poisonous mushrooms and berries can have serious ill-effects and large quan­tities of alcohol, aspirin, laxatives or over-spiced food are also possible causes. A few people are allergic to certain foods, and these, too, can cause an attack. Symptoms An early symptom of gastritis is loss of appetite. Nausea and vomiting may ensue, and there may also be a good deal of discomfort from 'heartburn', a burning sensation behind the breastbone. There may be profuse vomiting, including blood in severe cases. This can occur after a heavy drinking session. If the patient suffers from diarrhoea and pain in the abdomen as well, the attack could be caused by infective gastro-enteritis. The stools (faeces) may be very liquid; sometimes they contain blood and slimy material called mucus; and these symptoms should be reported to a doctor. Suspicion that harmful food has been responsible becomes stronger when there 'are a number of victims at the same time. Even so, to pinpoint the precise cause can be difficult. Symptoms may appear within a few hours of eating the food, but where there is infection by bacteria or viruses, this may take time to develop and the illness may not show itself until a day or two later. Dangers If an excessive intake of alcohol has produced an attack of gastritis, an especial danger lies in taking aspirin­because the two enhance each other's irritation of the stomach lining. The main danger, with acute alcoholic gastritis, is that the inflammation may progress to Staphylococci work indirectly by producing toxins in food, causing gastro-enteritis. cause several minute ulcers (erosions I into the stomach wall. These may per­forate into a blood vessel and cause vomiting of blood, which will need treatment in hospital. The diarrhoea and vomiting that occur in an attack of gastro-enteritis cause the rapid loss of a number of chemical ele­ments such as sodium and potassium. This sudden deprivation can bring about serious biochemical changes in the body and may even lead to kidney or Eyer damage. The effect may also be serious if the patient is already unwell, elderly or wry young. Babies, in particular, can becoc.e seriously ill. The sick child is wry thirsty, but can suck only feebly and tr-.E-L be unable to retain what has been taken in. The result is dehydration loss of water), a situation that needs immediate ­medical help. Treatment In gastritis, a light diet for a couple tl: days, consisting mainly of fluids wT allow the stomach to rest and is all that :s needed in most cases. But where compli­cations arise, such as vomiting of blood. the doctor may feel it necessary to send the patient to hospital. In gastro-enteritis, too, the first aiIT'. of treatment is restoring fluids to the body. Vomiting may be overcome by taking tepid drinks in very slow sips. This can be followed by well-diluted meat or yeast extracts, weak sweetened tea or citrus fruit juices. If the attack has been caused by a bacterial organism, an antibiotic may be necessary. Rest in bed is important, iind an easily digested diet with plain foods like milk or strained broths, once the main symptoms have eased. A seriously ill baby or small child, however, may need urgent hospital care to restore their fluid balance. Streptococci work in much the same way as staphylococci. Prevention of gastro-enteritis The majority of gastro-enteritis attacks are due to infection by bacteria or viruses entering the mouth and reaching the bowel. This is often due to inadequate care with food or poor hygiene in the lavatory. Hygiene in the kitchen • Forlow manufacturers' recommendations about dates by which foods should be used Many packed foods have date stamps to guide you • Wash hands and scrub fingernails before handling food. • Keep work areas scrupulously :!ean. • Do not allow pets near where food s being prepared.Prevent cats ~r'lping on to tables. • <2ep food cool in summer. Use a '2c';:e's:o" whenever possible. • ':'.:0 ""eats which have stood a os. =' ~ore at room temperature S"':2" ::::elng cooked: recooking may ~ =: er,sure safety. ·   :: iminate flies. ·   <eep all food covered. • Dispose of food scraps, wrapped in plastic or paper. Keep waste bins covered and lined with a plastic bag. Do not allow children to play near waste bins. In the lavatory • Wash hands thoroughly and scrub fingernails after using the lavatory Remember that microbes could be transferred from the flush handle and the seat of a lavatory previously usee by an infected person. Clean these with household disinfectant if :~we is an infected person in the house. Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS -   DOCTOR’S ANSWERS – PART 21, GASTRO-ENTERITIS, Page 565 – 566.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out), Most of us have no idea what real hunger is. Eating is a social occasion, part of our daily schedule, and this makes us out of touch with the body signals that tell us when our stomachs heed to be filled. Constant food craving is a sign that your body and mind are not working in harmony. It arises when eating fails to satisfy your appetite even though it may fulfil your bodily needs. In its most extreme form it entails stuffing yourself for hours, followed by feelings of self­disgust and self-punishment which lead you to starve yourself afterwards. Very seldom do victims of food crav­ings long for healthy food. Most often they crave 'forbidden' foods such as sweets, chocolate, cakes and foods that give a sensation of fullness, such as potatoes and bread What causes food craving? Psycho­logists believe that food craving origi­nates in childhood, in eating patterns developed within the family. Good behaviour might have been rewarded with a sweet or chips, a practice we revert to in adulthood when we want to give ourselves a treat and relive the pleasure of reward we felt many years before. Similarly pain and misery in childhood are often consoled by giving the infant something to put in his or her mouth, and so in later life we eat to satisfy this need for oral gratification when we want to forget our sorrows and our problems. Controlling the craving Eating craved foods does not satisfy needs and therefore cannot solve the problems Indeed, they usually create further problems You need to eat more food to get any satisfaction, .and this leads to weight gain: thus a vicious circle of binges and remorseful self­punishment is created. Those who suffer severely from food cravings must consult their doctor. Food craving is an addiction, and even more difficult to deal with than alcohol or drugs, as it is impossible to give up food Jitogether Self-help groups, particularly for women who appear to be more frequent sufferers, put participants in touch with the reasons for their addic­tion and encourage the development of new and healthier eating patterns. The key is to locate the roots of the craving whichJie in emotional and psychological disturbances. These can be caused by lack of self-confidence or inability to come tOlermswith yoU' personality; by severe shock such as the death of a close friend or relative; or by temporary hormonal changes such as those in pregnancy which upset normal eating patterns . Which then become difficult to recover. The basic symptom, however,is depression, for which eating craved food· seems to be the instant cure. Once you try. to get youremotional difficulties and. food cravings under control, you should not totally deny yourself craved foods as eventually you will begin to stuff yourself again. It is better to give in to the occasional whim and feel that you are able to control your eating habits. Above all try to get in contact with your body's needs for food. Do this by fasting and then eating a simple and unrefined diet; in time the urge to eat 'empty foods' like sugar, cake and ice cream will cease. Try substituting better foods for those you crave. A handful of nuts or a piece of fresh fruit is preferable to eating bread and other foods high in carbohydrates when you do feel that urge to nibble. Remember: the younger people start with good eating habits, the less they will need to eat for comfort later. ThiS IS a lesson which all parents must learn so they can pass it on to their children   Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS -   DOCTOR’S ANSWERS – PART 23, LIVE BETTER NATURALLY – FOOD CRAVINGS, Page 642.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out), Gynaecology is the Investigation and treatment of those conditions which involve women's reproductive organs. Q I have had an ovary removed. Is it possible for me to become pregnant? A Provided one ovary is still present and the other reproductive organs are normal, then a woman with one ovary has an extremely good chance of becoming pregnant. Current research shows that the remaining ovary enlarges and compensates often for the missing ovary. Q I am about to have a hysterectomy. Will it ruin my sex life? A No. The only effect is that you will stop having periods and can no longer become pregnant. Some women say they have a more enjoyable sex life as they no longer have to consider the possibility of an unwanted pregnancy. Sex can usually be resumed three to four weeks after the operation. Q How long after the menopause should I continue to use a contraceptive? A. In theory it is possible to become pregnant two years after the menopause has finished. In practice, this is very rare, and you are probably quite safe after six months. Q I have been trying to become pregnant for the last year _ Could I possibly be having intercourse at the wrong time? A That is one possibility The egg is usually released fourteen days before a period starts. So if you have a 30 day cycle, the best chance of becoming pregnant is about 16 days after your period begins. Doctors suggest that the couple try for a pregnancy for two years before having investigations to see if there are other reasons for non-pregnancy. Q Willi have to have an internal examination every time I go to the doctor with a gynaecological problem? A You will probably need this examination at your first visit, but this may not be necessary at follow-up appointments. 610 Women consult gynaecologists for a wide variety of problems, and for advice and support, throughout their lives. At puberty, they may be concerned about the late onset of periods, or periods which are absent, irregular or painful. During the reproductive years, women may require advice about sexual dif­ficulties, abnormal periods, contra­ception, an unwanted pregnancy or the possibility of infertility. Later in life, women may consult a gynaecologist about difficulties arising from menopause, both psychological and medical. The gynaecological examination Gynaecologists are usually aware that women may be anxious and they will spend some time talking to them about general topics to put them at their ease. They will then enquire about specific problems. They will ask for certain information, and it will make the inter­view easier if a record is kept about the dates of the last few periods or dates of any pain, discomfort or blood spotting. A nurse will then weigh the patient, who will also give a urine sample. The blood pressure may also be checked. The doctor will then examine the A bimanual internal examination Fallopian tube Ovary Cervix patient's breasts. The breasts will be looked at as the patient sits with her arms at her side, with her arms raised or while lying on her back. Inverted (turned in) nipples, dimples in the breast skin, un­usual sagging, or the presence of cysts or tumours, if any, will be noted. Provided that the patient has had intercourse at some stage in her life, the doctor may perform an internal (pelvic) examination to assess the state of her reproductive organs. Many women feel shy or embarrassed about internal examinations: rest assured there is nothing to worry about. Others may be afraid of pain. In fact, such an exami­nation causes only a minimum amount of discomfort for a short time, and it is much better to \be relaxed when it is performed. During the internal e~amination, the patient lies down on an examining couch on her back. She will be asked to bend her legs and let them fall comfortably apart. The doctor inserts two fingers of one hand into the vagina and places the other hand on the lower abdomen. This way the womb, tubes and ovaries can be felt and checkedfor normal size, shape and mobility. The bones of the pelvis can also be examined in this manner. Questions a gynaecologist will ask Question What past illnesses and operations have you had? Reason May be responsible "c' ;::"e~e-:     example a chroniC co~gr ~e. ____ _ womb lose its normal supcc"":~ ,,-c ::.= =::~e (become displaced) What medicines, if any, are you taking? Certain drugs can affect ferti't-.' a~ c ::~- ='C~ What form of contraception do you use? An IUD in the wrong place ma\ ~e·.e ~e' painful. Taking the Pill at incorrec: :~e" =e" cause bleeding between periods When did you have your first period? May suggest a hormonal or de\8c::-e":= abnormality When was the first day of your last period? To find out whether patient is preg-,,-: =. menopausal How many days do your periods last? To see if very long or heavy and pre~e-: position in menstrual cycle What is the average length of time from the first day of one period to the first day of the next? If very long, for example 3·4 months. :he'e may be decreased fertility Do you bleed between periods or after sex7 A cervical smear and a 0 & C may be neeaec to diagnose the problem Is sex painful? Can suggest infection or endometrios.~ (fragments of mucous membrane embedded in uterine muscle or ovaries) How frequently and at what time during the monthly cycle does sex take place 7 Infertility may occur because a patient doe~ not have sex at her most fertile time Unpleasant vaginal discharge? Can suggest a possible infection Do you leak urine when running or coughing? Possible prolapsed womb Some couches have stirrups for feet. The gynaecologist first examines the internal genitals (vulva). Deficiencies of the hormone oestrogen as well as anaemia can be detected by the appear­ance, shape and colour of the labia (vaginal lips) and clitoris. The colour and texture of the vulva indicate general healthiness or signs of infection. The doctor will then insert one or two fingers inside the vagina to hold the cervix (neck of the womb) in place while examining the lower abdomen with the other hand, This is to check the position of the womb and ovaries and look for any abnormal lumps which may indicate tumours or possible pregnancy. The doctor may then need to do a recto­vaginal examination where one finger is inserted into the anus and one into the vagina: this will make the ovaries and the back wall of the womb easier to feel. The doctor will then take a closer look at the vagina and cervix with the help of an instrument called a speculum and a strong light. A speculum is shaped like a duck's bill and is used to separate the walls of the vagina. It has two moveable parts and can be warmed and lubricated before insertion. The closed speculum i::: inserted and then gently opened. ju:::t wide enough to reveal the cervix. The colour and texture of the vaginal walls and cervix will be checked, plus the smell and appearance of the vagina' secretions. The cervix may show varioc.::: changes it} appearance and this may be due to pregnancy, infection, erosion or. very rarely, early cancer. The colour .::' the vagina and cervix changes sligh:::. during the menstrual cycle and the ex-.­sistency of secretions. Doctors recommend that a cen-::::. smear (Pap test) be taken at regula:- :::-.­tervals which will be recommende:' =:. your doctor. The doctor inser-:~ :::-.:' speculum and, using a wooder_ ::::::::''':'::: scrapes tissue from the cen'ix EI_:' ;:''':':~ .' on a glass slide to be exami:-."":'~_:':':- _ mIcroscope. Once the examination i~ :'::,:­doctor will discuss hi::: :'i:-.:::~.~~ _ .. arrange treatment or ~:-t::-.e:- :~.'.-:,~::. gation where necessary.   GYNAECOLOGY Part of repro­ductive system Vulva (Area surrounding front passage) Common gynaecological problems Condition Warts Pruritis vulvae Candida infection Symptoms Raised areas of skin Irritation Irritation and thick white discharge Treatment Painted with podophyllin (a wart solvent) or removed surgically under aneasthetic Take a small area of skin or sample of vaginal secretion to examine. Cortisone cream applied to area may be necessary Vagina (Front passage) Apply antifungal cream to the area Discharge-due to chemical irritants -trichomonas infection -candida infection Bartholin glands abscess Vaginal prolapse (displacement of vagina) Clear discharge Green frothy discharge Thick white discharge and irritation Hot, tender swelling at lower end of the vagina due to infection or blockage Heaviness in vagina, leakage of urine when coughing or lifting heavy objects Avoid irritants such as harsh soap or vaginal deodorants Tablets taken by mouth Antifungal pessary or cream Course of antibiotics, but may need to drain the abscess under anaesthetic None if no inconvenience caused. Alter­natively, plastic ring worn as womb support, removal of womb, or stitching womb back into place under anaesthetic Cervix (Neck of the womb) Polyp Erosion or ectropion (red area at the neck of the womb caused by cervical cells growing outside cervix) Dysplasias and carcinoma in situ Cancer Bleeding from vagina after sex Occasionally a watery discharge Tumours which gradually progress to cancer. Many types of dysplasia can also disappear. Often no symptoms Blood stained, watery and un­expected discharge Removed under anaesthetic (minor operation) Cervical smear to exclude tumour, often no treatment necessary but persistent cases may need minor operations (cauterization) Regular cervical smears. Examination of neck of the womb with an endoscope and removal of severely abnormal areas of tissue Uterus (Body of the womb) Hysterectomy (removing the womb) and/or radiotherapy Fibroids (tumours of muscle and fibrous tissue in the wall of the womb) Abnormal lining of the womb (Endometrium) Heavy periods, bleeding between periods, discomfort in abdomen. Sometimes no symptoms Abnormal periods No treatment if fibroids are small and give no trouble. Otherwise hysterectomy (womb removal) or myomectomy (fibroids surgically removed) Diagnostic D & C (dilation and curettage) to remove womb lining for examination. Treatment depends on findings Fallopian tubes Removal of the tube containing the pregnancy Ectopic pregnancy (preg­nancy in the tubes) Salpingitis (infected Fallopian tubes) Blocked Fallopian tubes Severe sharp lower abdominal pain shortly after missing a period See doctor urgently Pain during sexual intercourse. Lower abdominal pain, often with an unpleasant smelling discharge Infertility Antiobotics, occasionally bed rest and pain-killing tablets Ovaries (Eggs) Possible surgical removal of blockage Ovarian cysts and tumours Failure of hormone produc­tion in later life (menopause) Lower abdominal pain and swelling, sometimes menstrual irregularities Hot flushes. Loss of periods If small and composed of normal cells (follicular cyst) no treatment. Otherwise surgical removal May require hormone replacement therapy Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS -   DOCTOR’S ANSWERS – PART 22, GYNAECOLOGY, Page 610 – 612.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out), AS  just a painful inflammation of the big toe resulting from over-indulgence in food and drink. In fact, the causes are more complex and if left untreated gout can lead to serious bone and kidney damage. Fortunately, drugs can keep it well under control. Q My husband has just had an attack of gout. I have heard that gout is connected with rich food. Should he go on a diet? A It is true that certain foods rich in the chemicals known as purines will, after digestion, produce uric acid, an excess of which can lead to gout if the body does not excrete it efficiently. High purine foods include sweetbreads, liver, kidney, brain, venison, heart, meat extracts, goose, duck, turkey, fish roe, whitebait, sardines, herring, bloater and sprats. These foods are best avoided in large amounts, but if eaten in moderation their contribution is relatively slight. Alcohol in moderation is all right, but an alcoholic 'binge' may temporarily decrease the power of the kidneys to pass out uric acid and so provoke an attack. Q Does gout have anything to do with cancer? A Only very indirectly. Gout certainly will not cause cancer but sometimes cancer can cause gout. In some cancerous growths the creating and degeneration of tissues increases and this can lead to an increased production of uric acid. Also, certain tumours which are treated with deep X-ray therapy or drugs may produce uric acid. Q After my last attack of gout the doctor advised long-term treatment with drugs to reduce the formation of uric acid. But he would not let me start the treatment for over a month. Why was this? A The drug used in this type of treatment must have its dose built up gradually. It is important to start this treatment when the body is well clear of an acute attack of gout, otherwise it might produce a counter-reaction which would mobilize uric acid in the body instead of decreasing it. Q If someone suffers from gout does it help to lose weight? A If the patient is grossly overweight and has gout then he or she should certainly lose weight, but it should be done gradually and. under medical supervision. Gout is caused by an abnormally high amount of uric acid in the tissue fluids. Uric acid is always present in the body as it is a product of certain foods when they are broken down and also of naturally worn out tissue cells. Normally the gut and the kidneys excrete uric acid so that the level in the body remains constant. In patients suffering from gout either too much uric acid is formed or it is inadequately excreted. Causes There are various reasons for an increase in uric acid formation. In the past the blame was put on over-indulgence in rich food-such as sweetbreads and goose­and alcohol, which produce uric acid after being digested. However, it is now known that the part played by diet is relatively small and other causes are far more likely. Long-term, chronic gout has developed in this big toe which may need treatment for the rest of the patient's life. The most common cause is the filtering process of the kidneys becoming inef­ficient at getting rid of uric acid. This can happen in some kidney troubles such as chronic nephritis (inflammation of the kidneys) or be due to the effect of certain drugs, such as diuretics. Sometimes gout is caused by diseases of the blood and tissues which involve an excessive breakdown of their cells. There are also certain congenital (existing from birth) conditions in which the body chemistry creates more uric acid than is normal. A person with a raised level of uric acid does not necessarily suffer from gout. However, in many cases the excess uric acid is deposited in the joints, skin or kidneys. When this happens the person may suffer either an acute (sudden) attack or a chronic (long-term) form. Acute attacks The first attack of gout is likely to be sudden and severe; it almost always involves the big toe. The condition used to be known as 'podagra' from the Greek words meaning a seizure of the foot. The patient may be woken in the middle of the night by intense pain. The toe is extremely tender and will hardly bear the weight of the bedclothes. Its base is swollen and the skin is dry, hot, red and shiny. The veins on the top of the foot may be distended. Sometimes the patient is feverish. Treatment If an acute attack is not treated the patient will suffer considerable pain for three to 10 days and then the symptoms will subside. However, treatment with anti ­inflammatory drugs work successfully and quickly. The digestive systems of a In a sudden, acute attack of gout the skin becomes red and shiny. The veins on the top of the foot may be distended. GOUT few patients are sensitive to these drugs and they cause vomiting and diarrhoea. If this happens they may be given as sup­positories or injections. They should be taken as soon as pos­sible as delay makes them less effective. Aspirin should be avoided as it tends to lessen the kidneys' filtering out of uric acid. Once the pain has gone the patient may think that that is the end of the matter. But the condition may be latent within the patient, making them prone to further acute attacks at unpredictable intervals of weeks or months. Other joints may then be involved besides the big toe-usually extremities of limbs such as fingers or wrists. It is unusual for more central ones like hips or shoulders, or several joints at the same time to be affected. The doctor will take blood tests and watch the patient's general condition to see whether further treatment is needed to try and prevent the gout developing into chronic gout. Patients who have had only a mild rise in their uric acid level, or have quite infrequent attacks, may not need further treatment. ends, roughening their smooth surfaces, causing swelling and stiffened movement similar to osteoarthritis. The skin may develop bumps at various points. These are formed of collections of salts and are known as tophi. Often they appear as small knobs on the rims of the ears but they may also form quite large swellings on the hands or the back of the elbows. Generally, they are more dis­figuring than harmful, but occasionally a tophus becomes so large and incon­venient that it needs to be removed surgically. Severe gout can cause kidney damage in two ways. Either deposits of uric acid can block the delicate filtering mechanism of the kidneys, leading to progressive damage, or the highly con­centrated uric acid may crystallize and form kidney stones. About one fifth of patients who are not treated for gout develop kidney stones. Chronic gout In chronic cases of gout, crystals of uric acid salts settle in joints, skin and kidneys causing permanent damage. At the joints, crystals of salts are deposited in the cartilage of the bone Long-term treatment Patients who suffer frequent acute attacks, joint changes, the appearance of tophi, kidney damage or consistently show a very high level of uric acid in blood tests, need long-term treatment. Treatment may be with drugs to reduce the amount of uric acid in the body by encouraging the kidneys to excrete more of it. However, there is a danger that with so much extra uric acid passing into the urine it could crystallize and form kidney stones. This risk is reduced ifthe patient keeps the salts dissolved by drinking plenty of water and taking preparations which make the urine alkaline as the crystals are then very much more soluble. Alternatively, the patient may be treated Collections of tophi, also known as chalk stones, may develop--usually on the hands or ears-in chronic cases of gout (above). The businessman (right), who also tends to live well, is particularly at risk from gout, especially if he is overweight. with a drug which prevents the formation of uric acid. Patients who start on long-term treat­ment are likely to have to continue for the rest of their lives. Blood tests will be taken from time to time to show how they are getting on and whether the drugs or the dosage needs altering. If the patient does not continue the treatment the uric acid level may rise again and there may be further attacks. With long-term treatment the attacks are likely to stop completely. If there are any they will not be as severe or as frequent as they would be without treatment. Those affected by gout Men are more likely to be affected by gout than women and older people are affected more than young people. For every 1,000 people in the 15-44 age group, 1.7 men will have gout in one form or another but only 0.1 women. In the age group 45-64, 11 men and one woman in every thousand people will be affected. In the age group 65 and over, 12 men and three women in every 1,000 will be affected. Occasionally an abnormality in the body's chemistry produces gout in a young person but these cases are very rare. About a quarter of gout sufferers have a family history of the disease, though gout seems to occur more among affluent people. The typical patient is described as an active man, a 'go-getter' of high intelligence, over the age of 50. People who are grossly overweight are more at risk, but this only plays a small part in causing gout.   Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS -   DOCTOR’S ANSWERS – PART 22, GOUT, Page 593 – 594.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out), , Experience hot flushes during the change of life. Many suffer in silence, thinking there is little that can be done for them, but in fact medical help is available to help them cope with the problem. Q I am 51 years old and still have my periods regularly every month. I have been having hot flushes for about four months. Is this the change of life? A The change of life (menopause) is the time when the periods stop. So, to be exact you have not yet reached the menopause. Nevertheless, sometimes the hot flushes associated with it start before the periods begin to alter. If you are worried, consult your doctor. Q I am 56. My periods stopped three years ago but I have never had any hot flushes. Am I normal or is something wrong? A There is no need to worry-you are one of the lucky ones! About 20 per cent of women never have hot flushes at the menopause. Q I have been waking up the last few nights feeling hot and sweaty. Could this be hot flushes? lam52. A Yes it could. But if it has only been happening for a few nights and you ache all over as well, it could be flu or some other infection. If it continues see your doctor. Q Can men get hot flushes or are women the only sufferers? A Yes, men do get hot flushes but it is now generally accepted that although men may slow down in many ways as they get older, they do not undergo a 'change of life' in exactly the same way as a woman does, so their hot flushes usually have some other cause. Q If women are told they should stop taking the contraceptive pill when they reach 35 why are they given the same hormones when they reach menopause? A The hormones are not exactly the same though similar and the dosage is smaller. When hormones are given at the menopause they are replacing ones the body is no longer making to lessen the effect of this loss, whereas hormones in the contraceptive pill are used to change the amount of hormones being released from the pituitary gland. The term 'hot flushes'-also known as 'hot sweats', 'the heats' or, in America, 'hot flashes'-is used to describe the sen­sation of heat that is felt spreading all over the upper part of the body and up the neck to the face. Hot flushes most commonly affect women at the menopause (change of life). This may occur before the age of 40 or not until the late 50s but in most women it happens between the ages of 45 and 55, the average age being 51. There may be little to see extemally during a hot flush, although blotchy red patches may appear on the skin. Hot flushes may last from only a few seconds to half an hour, and sometimes the skin becomes moist or drenched in sweat. A cold feeling with shivering may follow and this is sometimes accompanied by dizziness, palpitations and, occasionally, fainting. Hotfiushes can be acutely embarrassing to the sufferer, especially if the skin becomes moist or drenched in sweat. A hot flush is quite unlike a blush, which produces a milder, warm feeling that spreads over the face ar.d neck. Menopausal hot flushes rar:ge feCIT: the very mild that pass quickly. tc, :::c~e :::8.: are most distressing a."'1cl OC2ur ~\-eral times throughout the clay and night. Sometimes they can become continuous over many hour~ at a time. sleep may be disturbed and the 5ufferer throw off the bedclothes to try and cool down. Causes At the menopause the ovaries cease pro­duction of oestrogen and stop releasing eggs. Menstruation (periods) ceases and the body has to adapt to a new hormone balance. Until the menopause, oestrogen is secreted by ovarian follicles in response to follicle-stimulating hormone (FSH) released by the pituitary gland at the base of the skull. The follicles gradually run out of oestrogen, and wear out, so that when the menopause IS reached the ovaries no longer contain any of these follicles. Because there are no follicles to respond to the FSH there is a much higher level ofFSH in the body. This can lead to hot flushes as small blood vessels in the skin become more easily dilated, leading to an increase in skin tem­perature and, at times, a reddening of the skin. Over-stimulation of the sweatglands may also occur. However, although changes in hor­mone levels are thought to be res­ponsible for hot flushes, it is possible to have them with perfectly normal hor­mone levels several months. or eyen years, before the periods begin to altH. Other women may haye a hormo:1e deficiency yet have no hot flushes. Yet again, it is possible for hot flushes to persist in spite of the hormone replacement therapy which may be used to correct other symptoms due to the menopause, such as dryness of the vagina which makes sexual intercourse painful and difficult. Some women notice that some forms of stress bring on hot flushes. They are likely to be more irritable, get upset and cry more easily than usual. Simple day-­to-day tasks that previously caused no problem become difficult and can even lead to a sense of confusion. Other causes There are other very different causes of hot flushes which can occur in men as well as women. There is the feeling of going hot and cold with sweating and shivering, especially during the night, which occurs with many infections that produce a fever. Eating hot, spicy or curried foods can also produce a hot flush and sweating. Alcohol may also have the same effect. Hot flushes can particularly affect people who have a mild form of diabetes which can be treated with tablets instead of insulin injections. One sort of treat­ment-chlorpropamide-is known to interact with alcohol and about one in three diabetics treated with it will experience hot flushes if they drink even a small amount of alcohol. Another less common cause of hot flushes is a skin complaint, rosacea, which produces a ruddy discoloration of the forehead, nose, cheeks and chin. Occasionally a growth called a carcinoid tumour, can occur in the stomach or intestine. This produces excessive amounts of a hormone called serotonin which affects different body organs and causes symptoms such as asthma, loud rumblings in the abdomen and diarrhoea, as well as hot flushes which affect the whole body including the arms and legs. Treatment Some women's menopausal symptoms are very mild and transient and require no treatment other than encouragement to accept the natural changes that are taking place and to watch their weight. Reasonable exercise helps to safeguard good health, particularly at the time of the menopause. Walking, swimming, gardening and similar activities are well worthwhile. However. If the flushes are more severe and frequent, a woman should see her doctor so that proper diagnosis can be Coping with hot flushes .,', -;er ',OJ feel a hot flush coming on it s 2es, ~ VOll can stop whatever you are J2r-;j ariO, if possible, sit down quietly. If ,J~- "'0, f,Jshes are very mild and don't as, ::;r;j ,,,ere may not be time to do an\trrg'rore. If, however, you are one o~ ere v: JCKY ones whose hot flushes are severe and last more than a minute or tvvc Jnoo any tight clothing if possible-especially a high collar. If you are in a hot room, or with a lot of people, try and get out into the fresh air. .If you are driving a car, or working with dangerous machinery, and your hot flushes tend to make you feel faint or dizzy you should stop the car or move away from any moving parts of the machine with which you are working. • The discreet use of a small fan might be helpful unless this would make you feel more embarrassed. It is worth remembering that unless your hot flushes are severe, it is unlikely that anybody else will notice your discomfiture as the face seldom looks as hot and wet as it feels to you. .If you are very uncomfortable at night have a warm shower or bath before going to bed and use only the lightest of bed clothes and avoid nylon material altogether. .If night hot flushes are severe even after hormone replacement treatment tell your doctor as he might be able to prescribe a suitable sedative to take when you go to bed. • Tell your husband how you are feeling so that he can understand your problem and he may be able to help you to relax. HOT FLUSHES made, possibly by testing the hormone levels, and treatment given if necessary. The doctor may refer her to a gynae­cologist for a specialist's opinion if in doubt about the treatment. Hormone replacement therapy may be considered. Hormones are usually given to replace the body's normal ones if one of the glands responsible for secreting hor­mones stops working. In the case of the menopause, oestrogen is no longer being produced and if this is causing problems, such as severe hot flushes, the patient may be given oestrogen. It may be taken in tablet form, or given by injections or by implanting small amounts under the skin. Sometimes oestrogen is ~pplied to the vagina in the form of a cream or necessary, but this may not be effective in the control of severe hot flushes. A doctor may advise against hormone replacement therapy if the patient has a history of menstrual disorders, liver disease or a family history of cancer of the womb or breasts. It is now thought that it is safer for treatment with oestrogen to be combined with treatment with progesterone, but this leads to shedding of the lining of the womb each month, and this may not be acceptable to a woman who has been pleased to stop having periods and now faces the depressing prospect of having them return in exchange for losing the hot flushes. Also, statistics show that the risk of complications involving thrombosis (clot­ting of blood in arteries or veins) is multiplied about eight times when a woman takes oestrogen, either in the con­traceptive pill or to prevent hot flushes, and also continues to smoke. Outlook It is difficult to predict just how long hot flushes will continue, as various factors are involved and it differs from one woman to another. Usually hot flushes diminish in severity and number within two or three years of the menopause­ that is, from the time the periods stop completely. The treatment time for the use of hormone replacement therapy is initially one year and as long as there is medical supervision with follow-up examinations and tests, there is little risk of serious side-effects and symptoms should diminish quite considerably during this time. Very occasionally hot flushes persist into the 60s, but more intensive treat­ment can usually bring even these under control, although it may be necessary to continue with hormone replacement treatment for years if it is considered suitable for the patient.   Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS -   DOCTOR’S ANSWERS – PART 27, HOT FLUSHES, Page 746 – 747.   (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out), Without love, care and affection the world would be a miserable place to live in. Tenderness expressed between people is not only a pleasure to give and receive but also satisfies a deep and fundamental human need. Q My husband has just become unemployed. He is very edgy. How can I help? A The uncertainty of unemployment is hard for anyone to cope with. Until recently a job will have absorbed most of his time and energy. Now he is flung back on his own resources with the added worries of loss of income and trying to get another job. It is a time for special patience and understanding on your part to help your husband adjust and regain his confidence. Small gestures of affection and tenderness will reassure him that he is still loved and needed and help him through this difficult period. Q My wife is often tearful before her period and we frequently have rows. Can I prevent this? A Because of the change in hormone levels during the menstrual cycle many women feel tense and irritable, less attractive and lacking in energy in the days just before menstruation. You can't alter your wife's hormone pattern but you can accept it and try to be as loving as possible during these days, even if she seems unreasonable. Get her to put her feet up, cherish and spoil her a bit. And give her a hug if she tries to argue. She's not feeling herself any more than you are when you are feeling ill. Q Should I worry that we can't afford to buy our small children many toys? AThe love and affection you give your children is far more important than anything you can buy them. Besides, children don't need expensive toys. They need you to playwith them and you can all have a lot offun with bits of junk such as egg cartons, cotton reels and big cardboard boxes. Buy some paints and glue and see what you can invent together. The children will remember doing these sorts of things with you with far more affection than if you had bought them an expensive toy. We all have a gentle, tender side to O'.lr personalities, and a need to gi\'e a'1G. receive affection, but some people haH' far greater difficulty in showing this tl:a:-. others. They may want to express tr.e:r tenderness to those they care about. J'-,= they feel awkward and embarrassed aE'::: have no idea how to go about it. They 'ktc::: help and encouragement from those "'.':".': are close to them, since tenderness :s a:-, essential part of loving, and sometr.::-,~ we need to show in all our dee::tc: relationships. The real person Tenderness is a way of expressi:-.;'-'" feelings of warmth and caring for aE: =:... tc,' person as they inwardly are, not as =~ present themselves to the outside \'.: ,:: We may feel protective to\vards t:-,tc:,' vulnerability, affectionate about t:".tc:r idiosyncrasies and close to the rea: °tc.: which they have allowed us to see, Tenderness can sometimes seer..: t: ':tc far more deeply felt than, for exaE:::,7, tie pride we might have in our children or the sexual attraction we may feel to\-;ards a partner. And because we all \,'a:1: to be loved and understood for ,'m'se:';es. and not for what we look like or - ... hat \';e haw achieved, it is immensely reass'.lr:ng \\'hen others feel tender and a:tect:onate towards us. It gives us st:"tcEgth to get over hurts and dis­a:J::,ointments and fresh energy to face the ' .. ;,:.rld. Life without tenderness would be a ';er\' empty existence indeed. A loving childhood It is far easier to show tenderness to iJthers and to acknowledge our own needs for caring and affection if we have had a :)ving and secure childhood. We are then Affection, love, caring, warmth - call it :.;hat J!OU will- the essential need to communicate tenderness is fundamental to all relationships. A man and his baby, young hn'ers and an elderly person alone all nad to sho7.:': and share this feeling. able to act spontaneously in appropriate circumstances and because of the naturalness of our behaviour, others are likely to respond. A new baby responds with pleasure to gentle, caressing handling and a soft, loving voice. He is frightened by abrupt or rough movements and by loud or sudden noises. Gradually he becomes deeply attached to the person, usually the mother, who offers him most tenderness and affection. And his deep need for this kind of caring is clear. He does not become attached to her because she washes and feeds him and keeps him warm. If someone else took over these duties he would not transfer his affection to them. He becomes attached to his mother because she cuddles and plays with him and giws hi:n the tenderness TENDERNESS and emotional security he needs. Sadly, however, there are some babies whose parents do not realize that they need loving right from the very beginning. Because they are not shown tenderness and affection these babies do not learn how to respond. The parents, then faced with an unresponsive child, feel uncertain and unconfident about handling him. If they then try to be affectionate and the child cries or ignores them, this unexpected behaviour may make them feel too dis­couraged to persist and the opportunity to build a close, tender relationship with their child is lost. A child who has not been loved and cuddled and shown physical affection and tenderness, will not have learned to respond and will have less confidence in this side of his nature as he grows up. He may appear to react coldly to displays of affection from those who are fond of him, not because he doesn't care, but because he is puzzled as to what is expected of him. Will a similar show of affection on his part be welcomed or rebuffed? Someone who is used to giving and receiving affection since babyhood, on the " other hand, knows with confidence that .~ probably 75 per cent of the time it is ~ welcome, and when it's not it doesn't ~ really matter anyway. s We tend, as we grow older, to put a 2 premium on words. We listen carefully to ~ what people tell us about their ideas and feelings and come to conclusions accor­dingly. But there are means of communi­cation which are non-verbal which can tell us just as much about a person and his or her feelings towards us, if only we can delve back into our childhood and remem­ber how to read the signs learnt in the early, non-verbal years. Children are quick to interpret facial expressions and gestures. They pick up immediately whether a person is tense and angry, however well thpy appear to be hiding it, or whether they are relaxed and approachable. Quite rightly, they realize that an affectionate gesture is often more important than what someone is actually saying to them. It indicates how that person feels towards them at the time and invites them to be relaxed and open in return. For adults, too, tenderness and affection are ways of communicating feelings which are hard to put into words. In long-term relationships Of course, tenderness and caring are the qualities that enable a relationship to last. Physical attraction, intelligence or common interests may originally draw people together, but by themselves they won't take a relationship very far. The partners need to be aware of both their Sometimes, people find it hard to communicate with others much older or younger than themselves. Their lives would be richer if they made the effort to bridge the so-called generation gap. own and each other's sensitive and emotional side and allow opportunity for expressing it. It's all too easy to see one partner as immensely capable and rational and forget that they still have needs for tenderness and reassurance. A woman who has brought up a large family, coped with a job and with a succession of crises no longer seems as vulnerable as 20 years before, but she is just as much in need of caring and affection as ever. Similarly, the highly competitive man, who seems outwardly assured and confident, needs to show the caring side of his nature and to be able to admit to his anxieties and insecurities. Tenderness and affection thrive with use. The more you are able to show your affection. the more affectionate you will feel. But at times. of course. we have more outlets for our feelings than at others. Parents \\'ho haw delighted in small children. a!\\"ays \,"anting to be hugged and kissed. climbing on their laps and draping themse!\"es round them. find it hard to adjust as the children become older and more independent and shy away from such demonstrati'"eness. They will still need tenderness and affection. but it will have to be far more carefull~" timed and discreetly expressed. Those who have had a close. affection­ate long-term relationship will feel emotionally at a loss if their partner is absent for some period. This is much more acute in the case of a bereavement. Then hugs and affection from children and friends can be more reassuring and comforting than words of sympathy. Teaching tenderness Sometimes it seems as ifthose who have difficulty in expressing affection are caught in a vicious circle. Because they are undemonstrative and fail to respond, those who care about them may feel so hurt and rejected that they stop dis­playing their own affection and this makes it harder than ever for those with such problems to learn. It takes a very persistent and perceptive person to break down the barriers and enable such people to feel safe enough to explore that side of their nature. If you have a partner who you believe is basically caring but finds it hard to express affection you may be able to encourage him or her by discussing your needs. Tell your partner exactly what needs to be done - ask for the simple acts, like a hug, a kiss or sitting and holding hands. If necessary give justifications by saying why these things are so pleasing. It must be reassuring for your partner to find such an easy way of pleasing you, and once the barriers are broken he may be able to become more spontaneously affectionate himself. But of course people do vary enormously in their needs for affection and their capacIty to give it. If you are someone who needs constant physical contact and demonstrativeness you may be in for a lot of heartache if you select a genuine. self-contained type, satisfied with the odd h G2: Sex Of course, affectioc ar.d tenderness are what transform sex :\':,r:: a mechanical performance in v.'::-.:cr, eitr.er partner may feel they have beer Gsed. into something personal and deer;h satisfying. Unfor· tunately mec a"e :,:":e!'c too anxious at first about their prowess, not realizing :i2.: \"omen are more responsi"e to teClderness and caring than displays of virilin. That is why it can often take as much as a veal' for couples to adapt to each other's needs. \Vben both are relaxed and able to display affection, whatever is los: ir. initial excitement is more than made up far by caring and tenderness. We all ha"e 8e!':ods affeeling sexually inactive. PerhaDs '.':e are worried about work or reco"erir,g from an illness. But continuing to s".o'.': atTection and tender· It is obvious that children will only learn to express tenderness as a natural emotion if they are encouraged by example. A vulnerable neu' baby, a dependent and easily frightened pet, a close playmate - all these are natural outlets for the expression of this most human offeelings. ness to our partner during this time is particularly important. As long as the partner still feels loved and desirable, and realizes that the lack of drive is not because they have ceased to be attractive to us, they will be able to be more patient and understanding. New baby Everyone in the family needs tenderness and affection at the birth of a new baby, not just the baby himself The mother will be feeling particularly vulnerable after the emotional and physical changes that have taken place during pregnancy and the birth. She will obviously be tired and TENDERNESS perhaps depressed and cert2.i,.lc: need gentle handling and unders:a.,.:L,.~ support for several months. The father may be worried abo,~t a possible change in role and adcied responsibility. He will need under· standing and encouragement to feel a­fully involved in the baby from the start as the mother is. And of course ifthere are other children in the family they "'ill need special love, attention and affection if they are not to feel jealous and supplanted by the new arrival. Friends and relatives can be helpful here in concentrating on reassuring older children how lovable they are.   Taken from The Marshall Cavendish A  to Z GUIDE IN WEEKLY PARTS,  DOCTOR’S ANSWERS: PART 85, TENDERNESS, Page 2350 to 2353.   (Sorry. Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out) , As an insidious component of modern life, tension C2:1 occur during even the most mundane everyday aCriYlnE'S. Prolonged tension can lead to stress, that all too potent cause of serious physical and mental illness. Q Is tension always a destructive fo rce? A Not at ai' I ~ 'ei'v a construct. '"u-"ulating resoureefui~""" e~c ~.8ntiveness, and biologce . :::,::" r"a to promote survival. 1;\:yetty dull stiek-in-tho-~  :. ~,out tension in ou r lives:.::: ~d probably not survive.,.thout it to stimulct"~,, ,,~'sss that is destru::::~." S~Sion Q Is there any specific type of tension that is particularly insidious today? A Yes. " ;).,nd poisonous­rat~,::'e~ ~sidious-isthe right:,:: '~ :J8cause it is almost certai~ ', s:::~sble for more deatl-s ~~ ~e~v a more obvious cause. C::::" ~~e most serious featvE's::::" day is that it has becc~ E' e ~ :::st mpossible to achs. E' E' ordinary things like trave~;:: '..,ork, getting the shocc~g j-:ving the car, using a bus or ~'e~::Je~tlng repairs done -the list is e,aiess - without becoming un.\' involved in a nightmarish INec c" hassles every day of our lives. Tl-ess:::ompletely non-productive cor" :::~s give rise to high levels of ter,s :::~ "c- which, unless we are prece',:::: ~:::ose our temper twenty times e ce, ~,ere is no outlet, and whd' erE' . E'" cetent progenitors of stress Q What defences do people have against the build-up of tension? A Fortu.r ecE'. "E'. era. II First, the exarrc e e~c E'~couragement of havino h::wc E'::: C E'roS success"~. ~ Cces-. allied to the skills cf erE'" c::-:c_ e-t'ade Next, the cor" :::E'r CE' ~~e~::~S is able to sueeee::: e -E'S~ doing so. Third. ~::: c" e'.oldanee,                                 adaptao I:::. e~c E'"cecE'                                 recreation - all of thesE' ~ _ ~!zed to the full whene.E" C- r;: gets roughl Finally, the-s Of sOmebOdY ~:::t orly in lending a SV~ cece - c Jt also in helping to K~;:s ~ csrsoeetive and in giving SCJ. cess::: advice Tension and strain, in the emotional or mental sense rather than in the mecha­nical or physical, are often spoken of as though they were indistinguishable from stress. In fact, not only are they quite distinct, but the differences between them are very important. Tension and strain are things that happen to all of us, usually every day. They are the load, the pressure, the effect that is imposed on us by the inevitable confrontations that sometimes occur between us and our en­vironment in terms of the things, the people and the circumstances around us. Stress, however, is a disease which occurs when the tension or strain becc::,:, e­than we can cope with and ~::",-­breakdown in health develop~. Causes of tension Tensions occur in our lives for a variety 'J: reasons and in a variety of ways. The most basic and intense are the result of situations that inhibit expression of our instincts. This old gentleman's worry beads have obviously done him a power of good! In fact, it is well known that 'having something to do with your hands' can reduce tension. TENSION Q Do all people respond to tension in the same way? A No, they do not. One of the fascinating things about tension is the way in which its effects vary so widely. A challenge or conflict which turns out to be the stimulus that is the making of one person may spell doom, disaster and breakdown to another. In general, response to an episode of tension depends both on its intensity and duration, and on the personality and outlook of the person concerned. Q What happens if a person is subjected to too much tension to cope with? A If the tension proves to be too much for the person's 'coping' mechanisms a situation of stress will develop. This will lead to some form of stress illness or disorder such as raised blood pressure, heart attack, peptic ulcer, depression, addiction or a nervous breakdown. Q How does everyday tension turn into stress? A Simply, when there is more of it than the particular person can cope with. Tension or arousal is intended to lead to - and have its natural outlet in - some form of action or performance. If that does not happen - perhaps because the action is blocked in some way, or because the amount of tension is greater than the opportunity for actiVities in which it can be either utilized or 'worked off' - then it will build up, like steam in a kettle, until the lid blows off. This may result in something as serious as a coronary thrombosis, stroke or suicide. But the solution can be simple, just get a rest and change down to a more relaxed attitude and a full recovery can soon be made. Otherwise, a vicious circle can rapidly build up in which, as a person's ability to cope with his tension becomes inadequate, he pushes himself harder to try and achieve results that he cannot attain. Often, the person who is most in need of taking a rest­ the workaholic - finds it hardest to slow down and take a look at the problems that are facing him. The universal, primary instincts are concerned with self-protection and pre­servation of life, obtaining food and drink, and reproduction. These are re­garded as the primary instincts, since without them and the driving force that they supply, both we as individuals and mankind as a species would certainly perish. These, then, are the things which in most of us are inborn as driving forces that override all else. The secondary instincts are not quite so demanding as the primary, and are not so vital to man's survival. But for most people, they are vital to happiness. The first of them is the power instinct, which drives people to be competitive and am­bitious and to try to gain positions of superiority over others in terms of achievement, wealth, position or title. The second is the herd instinct, which leads people to think and act in groups and communities. Finally, denied by some psychologists, is the spiritual instinct which urges people towards goals which are non-selfish, idealistic and, at least materially, unrewarding. These primary and secondary instincts constitute the major basic driving forces in most people's lives; satisfying them without conflict or restraint gives people a sense of security and emotional hap­piness and contentment. If. on the other hand, the following of their demands is made impossible or difficult, mental tension and pain result. And this tension, if it is severe enough, will lead to some form of mental or physical stress illness. The likelihood of this occurring depends on the extent to which the instinct concerned has been frustrated, the mental 'strength' and capacity for adapting to a heavy tension load of the person involved, and whether or not an alternative area of satisfaction is available. Many feelings which appear as tension are related to particular instincts. Fear, for instance, is associated with concern about self-preservation and security; anger with the need for confrontation and combat; loneliness with the desire for company and protection of the 'herd'; appetite and hunger with the need for regular nourishment; sexual desire with the need to reproduce future generations. Thus, the satisfaction of instincts is associated with and results in pleasur­able, happy feelings; while their frustra­tion results in tension and unpleasant, painful feelings. Conflict But frustration of instincts and other desires leads not only to feelings of ten­sion and unhappiness, but also to some­thing which frequently accompanies tension - conflict. Tension and conflict, though born of frustration and dissatis­faction, are nevertheless the funda­mental mainsprings of human endeavour and progress. They occur whenever what we want to do is not immediately pos­sible. They can result from a wide variety of circumstances. What we want to do may involve us in a collision course with another person after the same goal. Or it may be incompatible with the interests of the herd or the rules of the community in which we live. Or it may represent a struggle with some limitation imposed by our own bodies such as illness or disa­bility, or with an obstacle in the world around us, such as drought or flood. Or the tension may be the result of the demands of rival instincts and emotions that are competing with each other for domination within ourselves. There are four possible outcomes to a situation of tension conflict: we may be successful and victorious; we may decide to submit; we may try to escape; or the tension may continue and interfere with the stability of our lives - in the form of stress - indefinite> 3Jr:':on nor­mally occurs \\'Jf' that to continue the conr'                 u!er m our interests, It ma           with    an element of u'cc f,:,;' instance,         most membe"~ :':,ubmit easily to the ;''::e,'d and never get into troct ~ e c,'-e always at odds and ir~ c:;c:" ~L:t, Generally, however. -' ',- ~ not submit easily '~'':'::e for new ideas and pro"rt, -"cc C- are driven to experin:e~,: ' possibilities_ Reaction" to ten"ion In all t;",ecc-          ' tension there are three e>,o-c : 1',:,e: those that we                can aeee:::      those that seem                     excess: ated: and those that All too oftEn, thE apparently simple events ofdaily lifE ,~an lEad ro a build-up in tension that nobod.\ nEds right}. The tension inherent in playing a skilled game for high stakes shrr..:.s up on~\ roo clearly on the face of the bril/zanr snooker player, world champion A,iEx Higgins (below). are definitely not normal and represent some form of mental illness. The dif­ference between them, however, is really only one of degree. The response which occurs depends partly on the importance and intensity ofthe conflict and partly on the personality and mentality of the person concerned. Thus it is not regarded as abnormal for us generally to submit to the conventions of our community with regard to accep­table behaviour. But we would regard persistent feelings of inferiority, un­worthiness, grovelling or guilt over small matters as inappropriately excessive. However, manifestations of persistent depression, prolonged melancholy or feelings of persecution are viewed as being definitely abnormal. In the realm of escape as a response to tension we regard jokes, hobbies, holidays, and fantasy as in plays and films as acceptable; we find heavy drinking, drug taking and out­bursts of temperamental behaviour ex­cessive; and we consider alcoholism, permanent running away, and suicide attempts as definitely abnormal. The kinds of situation that are most likely to give rise to tension in our lives today are quite different to the very much more basic and immediate threats of ~ hunger, thirst, cold, lack of shelter, S. fighting over food and rivalry for partners ~ to mate with that were sources of emo­~, tional and physical conflict in our distant ~ ancestors' time. But they operate and ~ affect us in very much the same way - and 2 we need to be able to cope with them IlO ::i' less effectively if we are going to survive.   Taken from The Marshall Cavendish A  to Z GUIDE IN WEEKLY PARTS,  DOCTOR’S ANSWERS: PART 86, TENSION, Page 2357 to 2359.   (Sorry. Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out), Touch is so fundamental to life that most of us never think of how the many sensations we feel are produced: how, for instance, we can tell silk from sandpaper, or recognize an object simply by the way it feels on the skin. Q Why do babies touch everything around them as well as looking at them? A As babies we train our brains to be able to match the sight of an object with its feel. When older, these earlier experiences enable us to predict what the texture of an object or surface is without touching. Q When someone has had a stroke and is paralyzed down one side, does this mean that he or she will have lost the sense of touch on that side? A Not necessarily. Some people who have been paralyzed by a stroke will have retained their sense of touch on that side, provided the damage has been confined to the movement control parts of the brain. If the area of damage is sufficiently large to have involved the touch analysers in the brain or their connections, then the sense of touch will be damaged. Q I have noticed that on very cold days my sense of touch is poor. Why is this? A In very cold weather two things are working against the touch receptors just below the skin in the fingers. First, the cold itself will be reducing their efficiency, and second, blood will have been diverted away from the skin in order to minimize heat loss; this relatively poor blood supply will further impair the ability of these nerve endings to send concise messages to your brain. Q Is it true that blind people have a better sense of touch than the sighted? A A blind person will have the same equipment in his or her nervous system for touch perception. What makes blind people able to use it more effectively than those with full sight is the practice that this sense has had in the absence of sight. The brain has come to rely on touch to a much greater extent, and so the analysis of touch has become more efficient, enabling, for example, the rapid reading of Braille. Touch is one of the first ways in which young babies explore their world, and it remains our most intimate way of rela­ting to our environment. It is through a wide range of receptors in our skin, sen­si ti ve to different types of pressure, that we are continually able to monitor our immediate surroundings and keep our brains 'in touch' with the surfaces on which we sit, the objects we grasp, and so on. However, our sensation of touch is complex and is therefore sensitive to disturbances in many parts of the ner­vous system. least sophisticated in structure and rapidly stop firing if the hair continues to be stimulated. Receptors found in greater numbers in the hairless part ofthe skin. for example on the fingertips and lips, are formed into tiny discs. Because the nerve fibres are embedded within these disc~ they respond more slowly to pressure and continue to fire when the pressure i~ maintained. Other more structurally complicated receptors are formed by many membranes being wrapped around a nerve ending like an onion skin, ane give responses to more maintainee pressure. In addition, all the receptor~ tend to be influenced as to what in­formation they send into the nervou~ system by the temperature at which the:. are operating. This explains why ow sense oftouch tends to be impaired in cold weather. The distribution of the different typeo of touch receptors reflects their particulc: job. The receptors around the base ofb06: hair send messages from large areas :: The sensory receptors Just below the surface of the skin there are many nerve. endings whose varying degrees of sensitivity allow the nervous system to be supplied with different types of touch sensations. Wrapped around the base of the fine hairs of the skin are the free nerve end­ings which respond to any stimulation of the hair. These touch receptors are the The touch receptors in our skin are sensitive enough to respond to the gentlest stroking of a blade of grass. From an early age we use our sense of touch to help us to become acquainted with the shape and feel of things around us - even a familiar object like Mum! the skin about the pressure stimulating them. They rapidly stop their flow of information once we have been warned of the presence of objects, for example, an insect on the skin. On the hairless skin the more sophisticated receptors give continuous information, allowing objects to be felt as the brain assembles this informHtion into a coherent picture. Parietal lobe Cerebral Touch pathways cortex   Touch receptors in the skin relay their messages to the cerebral cortex via two specific pathways in the spinal cord: one for well-localized touch sensations; the other more diffuse touch.   Hairless skin Midbrain Merkel's disc Iwell·localized touch) Analysis in the spinal cord Some of the fibres conveying touch in­formation pass into the spinal cord and, without stopping, go straight up to the brain-stem. These fibres deal mainly with sensations of pressure, particularly a specific point of pressure. They there­fore need to send their messages rather directly to the higher centres ofthe brain, so that this well-localized sensation can Brainstenl be assessed without confusion from any analysis in the spinal cord. Other nerve fibres bringing informa­tion of more diffuse touch enter the grey matter of the spinal cord, and there meet a network of cells which perform an initial analysis of their information. This is the same area which receives messages from the pain receptors in the skin and elsewhere. The meeting in the spinal cord of messages dealing with both touch and Spinal cord pain allows for the mixture of these two sensatioris and explains such events as the relief of painful stimuli by rubbing. This spinal cord analysis filters the Seeing is believing, but touching is twice the fun when you come face-to-face with a 'real-live' woolly sheep for the very firsr time (top left). The various touch receptors in our skin aTE very discerning. If a shape is drawn on thE hand,fur instance, we can often tell what ir is without looking (top). This is obvious ly important to someone who is blind, as the ability to define shapes is fundamental to reading Braille (above). We can all get enjoyment from the way " things feel- from the delicious sensation 0.1 i kneading soft, pliable modelling clay (lefr ~ to the decidedly more delicate sensuousnt 5 of soft, tactile material worn next to the ski:. (far left). sensations which are then sent upwards to the brain. The grey matter of the spinal cord here acts as an electronic gate, so that pain information can be suppressed by the advent into the cord of certain types of touch impulse, limiting the amount of trivial information that needs to be transmitted to the higher centres. This division of the touch pathways to the brain into two streams - one of which goes fairly directly up to the brain-stem and the other which is first analysed by the cells of the spinal cord - enables the fine discriminating aspects of touch to be preserved. We can, therefore, estimate accurately the amount of pressure in a touch and its position, but if the pressure is too great or too sharp. the pain ana­lysers become inyalwd through the con­nections in the spinal cord and tell us that the touch is painful as well. The sensory sorting house Whether the tauch sensations from the skin have came by the more direct route or after analysis in the spinal cord, they eventually end in the campact knot of grey matter deep in the centre of the brain, called the thal2mus. The direct toucr. fibres \\'ill have al­ready relayed once in the brain-stem and then will haw crassed a\'er to the other side, streaming ta' the thalamus in a compact bundle. H.e 'Other fibres will have crossed O\'er to the appasite side of the spinal cord afte,' their relay in the grey matter there: SD all 'Our touch sen­sations fram 'One side 'Of the body are ~. analysed by appasite sides 'Of the brain. ~ In the thalamus ~hese pieces of in­j formation from \'2riaus different types of ~ receptor in the ski:cl are assembled and ; co-ordinated. This e::-.ables the brain's if. highest centres i:cl ~l-.e cerebral cortex to put together a picture 'Of the sensations of touch of which \\'e became conscious. The final analYSis The area of the braiL \\'hich enables the complex array 'Of touch sensations entering the neryaus s\'stem to be con­sciously perceiwd is the middle section of the cerebral cortex. Like all other sensory information, touch is analysed by the cortex in a series 'Of steps. each increasing the complexity 'Of the sensory perception. From the thalamus. the raw data is projected to a narr,,\\' strip in the front of the parietal lobes. This primary sensory area of the cortex processes the infarmatian before passing it on to the secandary and tertiary sen­sory areas. In these latter areas the full picture ofthe site. type and significance of the touch sensations \ve feel is produced and correlated along with memories of previous sensatians. as well as sensory stimuli coming via the ears and eyes. The latter co-ordination is achieved easily since the areas for vision and hearing back on to the areas for touch. The touch sensations are also, and very importantly, co-ordinated at this point with the sensations of what position our limbs, joints and digits are in: this is of importance since it enables us to deter­mine an object's size and shape and helps us to distinguish one object from another. Problems Damage to the nervous system at many different levels can alter our ability to feel and notice things that touch our skin. How this affects us depends to a large extent on the exact place in the nervaus system that the damage occurs. Damage to the peripheral neD-es. which may happen in diabetes 'Or in alcoholism, to give twa camman examples, can affect the sense 'Of tauch. However it takes quite extensive damage for the sense of touch to be lost completely or severely diminished. Often people with such disorder'l notice pins and needles in their hands and feet for some time before any alteration in their sense of touch. The ability of the fingers to make fine touch discrimination may be involved, and sufferp~'s may report that it feels as if they have gloves on all the time. Instead of being lost or diminished, the sense of touch can also become distorted as a result of damage to the peripheral nerves, so that a sufferer may say that smooth surfaces feel like sandpaper or warm surfaces feel hot. Much greater distortion of the sense of touch, however, arises from disease in the spinal cord, for example in multiple sclerosis. The cross connections which arise in the spinal cord ifit is diseased or even pressed upon from the outside produce distortions oftouch which can be quite disabling and unpleasant. Apart from noticing a feeling of numbness, the hands may have lost their ability to make properly co-ordinated touch perception, for example in picking the correct coin from a pocket, or the feet may feel as if they are walking on cotton wool instead of firm ground. Similar types of symptoms can arise from damage to the same touch pathways through the brain-stem all the way to the thalamus. Thalamic damage, which happens after strokes, for example, can produce bizarre alterations of touch so that a simple pinprick produces un­pleasant spreading electric shock-like sensations or the gentle stroking of a finger may be felt as an unpleasant burning spreading over the skin. Damage to the parietal lobes of the cerebral cortex, common in strokes and tumours of the brain, may disrupt touch sensations in other ways. If the thalamus is still intact (it is often involved in the disease as well) then the touch will be felt, but the localization of the touch will not be accurate - it may, for example, be felt on the other side of the body. If the parietal lobe is not functioning, the cor­relation of different types of sensation will not occur. For instance, usually, when the hand or skin is drawn upon, a person will not have trouble in distinguishing letters and numbers, but someone with parietal lobe damage will not recognize the shape, although he or she will be aware that a touch has occurred.   Taken from The Marshall Cavendish A  to Z GUIDE IN WEEKLY PARTS,  DOCTOR’S ANSWERS: PART 88, TOUCH, Page 2420 to 2423.   (Sorry. Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out)   , We all know of people who are allergic to something. but the term total allergy syndrome has recently been coined to describe an allergic response to 'everything'. Does this condition really exist or is it a misnomer? Q Is total allergy syndrome a condition that appears suddenly, or does it develop over a period of time? A People with extensive allergies usually displayed some allergic tendencies in childhood, suffering from conditions such as eczema, asthma or hay fever. The number of foods and other environmental substances that they are allergic to may increase as they grow older. This of course produces a tremendous strain on even the most robust personality. It is hardly surprising that in some people other symptoms and patterns of behaviour which are not due to immune problems start to occur and these can be highly distressing Q How common is total allergy syndrome? A Doctors on the whole do not regard total allergy syndrome as a separate disease in itself, although there certainly are extreme forms of allergic susceptibility. The term 'total allergy' is a misnomer, since even the most severely affected patients can tolerate certain foods. But however the disease is classified, it is clear that only a very few people with allergic tendencies ever develop a sensitivity to more than one or two substances. Q Is total allergy syndrome a purely '20th century' disease as people have said? A People who have multiple allergies are sometimes said to be 'allergic to the 20th century'. That does not necessarily mean that severe allergy never existed before: its apparent novelty owes much to the fact that a term has only recently been coined by the media to describe it. In spite of this, however, it is possible to expect the increased numbers of additives in the food we eat, or the wide range of cosmetics available, to cause an increase in the incidence of allergic disease, if only because there are now many more substances for people to be allergic to. Sufferers with what is called total allergy seem to become severely ill when exposed to any of a wide range of substances in their environment. Causes, symptoms and dangers All types of allergic disease are a result of a defect in the body's immune system. When a substance recognized as 'foreign' enters the body. it provokes the pro­duction of substances called antibodies. When the foreign substance enters the body again, the antibodies bind to the intruder, rendering the body immune. Unfortunately. some people form anti­bodies to quite harmless substances, and the binding of antibody to intruder may inappropriately trigger off the release of a number of other chemicals concerned with the body's defence. These produce unpleasant effects such as asthma, runny nose, skin rashes and vomiting. Most people with an allergic predis­position become sensitized to just one or two substances. and their symptoms on re-exposure are generally quite mild. In the more severe cases of allergy, though, not only are the s:l11ptoms more alarm­ing, with such things as joint pains and bleeding from the large bowel, but people may become sensitive to a variety of substances. particularly foods. However. some symptoms in the so-called total allergy syndrome are ,,~:: likely to happen as a result of imIC':.lI:;:' disorders. In particular, allergy does no: make people lose consciousness, although it may certainly cause headaches and a disabling sense of ill-health. There is also an alarming range of substances that can produce allergies. and in the case of food allergy it is the rule rather than the exception to be allergic to more than one food. It seems very likely that multiple food allergy is at the basis of 'total allergy'. Yet some sections of the medical profession are sceptical. It is hardly surprising that some people may suffer from the stress of the situation, with the result that anxiety symptoms occur which are not directly related to any action of the immune system. Treatment It is very difficult to help people whose disease has made such an impact on their lives that they are thought to suffer from the 'total allergy syndrome'. Drugs have only a limited place in the treatment of allergy, and the basis of treating the food allergies is to identify the foods respon­sible and exclude them from the diet. Because she suffers from 'total allergy syndrome', Amanda Strang has retreated to the relative safety of her own home.   Taken from The Marshall Cavendish A  to Z GUIDE IN WEEKLY PARTS,  DOCTOR’S ANSWERS: PART 88, TOTAL ALLERGY SYNDROME, Page 2419.   (Sorry. Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out), The power of one mind to communicate directly with another without the aid of the five senses. Scientific proof for the existence of such powers is, however, difficult to obtain. Q I have heard people talk about ESP. What exactly does it stand for? A ESP stands for extrasensory perception - that is, knowledge which is acquired by means other than through the five senses It is also sometimes referred to as psychic power or paranormal activity. The term ESP is generally held to cover three main phenomena said to occur without the intervention of the senses or any previous knowledge. These are: telepathy, or the awareness of the thoughts or feelings of another person, perhaps at some distance; clairvoyance, or the visualization of an object or event out of sight as it is or as it is happening; and precognition, the foreseeing of an event in some detail before it takes place. Another ability sometimes included under the heading is psychometry, orthe ability to draw information about a person from some Inanimate object connected with him, such as a watch or a ring Q My friend and I spend a lot of time together and find we are frequently thinking the same things. Is this telepathy? A It may just be that you have grown to think very like one another because you share so many everyday experiences and conversations. Sometimes we can anticipate how another person will react to a situation and even the words they will use because we know them so well. Real telepathy is very hard to test. If you are interested in performing some experiments you can get a special pack of cards which will help you. Q I dreamt of a flood and a few days later there was one near where my parents live. Was this precognition? A Many drearY'ls ~:c~ seem precognit;.;o coincidental If t ~a::: ::::?:?~ "S ~ heavily you may rs.:? ::::?:?~ :.C about the possibii·t ::" a " ::::::: anyway - hence yov:::":?a~~ ... ~st about all your dreams c" :? :?~~s which have never actua. ~s <:? place? Just occasionally, you may have the strong feeling that someone you are close to emotionally is thinking about you, or that something has happened to him ­even though he is far away. You check, find it to be true and you wonder if it is an example of telepathy. Sometimes, too, it happens that you are considering telephoning someone you haven't spoken to for a long time and just as you are about to dial the telephone i'ings with a call from that very person; or you have an unusual idea which the per~ son you are talking to expresses the moment before you. Of course, all these occurrences could be ascribed to chance. We all conveniently forget the many times we were wrong or when such coinci ~ dences did not take place. Do we all have telepathic powers? There do seem to be some people with an extra sensitivity to what others are thinking and feeling at long distance and Dr Carl Sargent of Cambridge University prepares a subject for telepathic testing. The machine produces 'white noise', thus obliterating all disturbing sounds. who have come to rely on what they call their 'impressions', even if they cannot produce a rational explanation for what they have experienced. Some believe that we all have such a power buried in us but that we have mainly lost the ability to use it because there has been little need for it in the kind of world we live in. They point out that young children generally rely more heavily on intuition and are more recep~ tive to moods and atmospheres than adults because it is often all the infor~ mation they have to go on. Later. whe,~ they begin to acquire rational explar:.­at ions for events and behaviour :hev :: so: confidence in these intuitiw ~y .• ,'o:~­which almost always dirrjr:.is:". So :=-.7:' grow older, D. D. Home (top), a well-known Scots medium, held seances for many distinguished Europeans. He was expelled from Rome for sorcery in 1864 but subsequently found scientific approval in Britain. A classic test once widely used by scientists to try and determine telepathic powers involves Zener cards (above). Each card is printed with a symbol, which a 'sender' attempts to transmit to a 'receiver'. In a more modern experiment, a sender draws a picture which a receiver tries to reproduce. A typical result is shown right: the drawing transmitted is on the left; that received is on the right. Scientific testing There have been many attempts to test the powers of telepathy scientifically. One method which has been widely used is called the Ganzfeld technique. The as­sumption behind these experiments is that a person is likely to be more receptive to telepathic communication if distracting noises and visual stimuli can be excluded, leaving the subject's mind completely free to relax. In a typical Ganzfeld experiment two people are used as subjects, one to 'send' messages and the other to 'receive' them. They are each placed in rooms some dis­tance apart with no means of communi- cation between them. The 'receiver' has his eyes covered and through earphones hears 'white noise' - a soft, unobtrusive mixture of all sound frequencies. A red light in the room produces a pinkish background light; the area may also be surrounded by earthed wire mesh to keep out radio and television signals. English twins Freda and Greta Chaplin cannot bear to be separated; the extent of their interdependence includes speaking the same words simultaneously. This trait astounds and baffles everyone with whom they come into contact. Unfortunately for science, no-one has yet been able to investigate their means of communication, which is possibly due to telepathy. The 'sender', on the other hand, is not shielded in any way because it appears that the sending process is more suc­cessful when the sender is alert and re­acting normally. He might be given a series of connected words, for example, randomly selected to prevent the pos­sibility of fraud, and try to transmit thought 'pictures' based on the words. Al­ternatively, he might be given a number of pictures and try to convey what it is that he sees. The receiver tries to pick up the thoughts or images from the sender and then records his description. They can During his lifetime the famous Dutch psychic Gerard Croiset applied himself to helping the police of different countries in their investigations. Much of his work involved the search for missing persons. then be compared by an independent judge to see if there are any similarities. Of course, many scientists are sceptical about such experiments, however scrupu­lously they are carried out. Others are convinced that the large number of suc­cessful results, which they claim are statistically significant, show that tele­pathy does exist as a means of communi­cation. They believe it is an area which merits further research. Clairvoyance and precognition Another faculty which, it is claimed, operates independently of the five senses or of any previous knowledge is clair­voyance. It is the ability to visualize something accurately that is happening out of sight, perhaps many thousands of miles away. A case that is often quoted is that of Emmanuel Swedenborg, the 18th­century Swedish philosopher and scientist. While in Gothenburg he saw in his mind and described a fire 300 miles away in Stockholm. News of the fire - which had broken out at the time he visualized ~ it - reached Gothenburg two days later. E= A variety of tests has been devised to .g try to demonstrate scientifically the ~ existence of clairvoyance. In the 1930s a ~ special pack of cards was designed; these would be shuffled and placed face down­wards on a table without anyone seeing ~ them. The experimental subject would ~ then try to visualize the exact sequence. An allied power is that of precognition, or foreknowledge of an event. It appears that this sometimes takes the form of a vivid dream or very clear mental picture of something taking place. It differs from an imaginative fantasy in its clarity. This is the most difficult power to test unless the person writes or records a description of the event in the presence of an indepen­dent witness. Twins Many identical twill"; ar" ,,:- often seem to be able c ~: ~'.:-­without language. Where: because they have the S2~' . .c make-up or whether they are :r. communicating through telepad'"c ~' . .c.c~ not at all clear. Certainly a r .. -=.~:' strange things have occurred t': : :.cr.'. twins which to some people see~. ~. than just coincidence. For example, there is the case .: :. 60-year-old brothers, one in Eng-I8.~.::: : one in Australia, who each damage:: :: . .c Achilles tendon in the same we~: .~.-:. ~ perhaps strangest of all, anew ly r:'. ~.::'. c : identical twin living in London v;}-.: '_.' denly developed an agonizing pai:-.r - , side. His wife was contemplating CO": an ambulance when a friend tele:J::". > : to say the twin brother in Wales h8.G_ -' been rushed to hospital for an emer",er. appendix operation. The London t·.' pain then vanished. Recent studies in America of ider.::. twins who were separated at bi,,::". shortly after have thrown up so ;::C.r" coincidences that even the normally S~'-=~' tical have wondered whether there '."­not some other factor at work. One outstanding example is the . :'.e· can pair of twins, both called James. '.':::".' were separated at the age of five ee,> They had each married a girl ca: . .c::' Linda, divorced her and married so;::e:~ . .c called Betty. They had each called :::...-= first son by the same name, had "5~',,~. their boyhood dog the same name. c. .. dayed very close to each other as ad·-=..:' had had similar jobs and the same eE.::r.z and drinking habits, the same iE:-;e~sc' and mannerisms. And when the' ~' . .c­after so many years apart. they ye,'e 8. - . .c to finish each other's sentences. s'~ c were their ways of thinking. Taken from The Marshall Cavendish A to Z GUIDE IN WEEKLY PARTS, DOCTOR’S ANSWERS: PART 85, TELEPATHY, Page 2337 to 2339. (Sorry. Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out) ,       A well-balanced diet will in almost all instances, rule out the need for dietary supplements. Before you stock up on dietary supple­ments, stop to consider whether you could get similar benefits more cheaply by improving your diet. Under normal circumstances, a well­balanced Western diet contains all the necessary vitamins in sufficient quan­tities. Obviously, when you are suffering from certain illnesses, are on a re­stricted diet, are pregnant or breast feeding, extra vitamins may be recom­mended by your ·doctor. Otherwise, extra vitamins are unnecessary and can even be harmful, leading to poisonous overdoses called-hypervitaminosis I products. Ox liver, halibut and cod liver oil are particularly rich sources, as are carrots, tomatoes, spinach and watercress. Avoid taking vitamin !c.. supplements as an excess can cause fragile bones, liver and spleer enlargement and loss of appetite anc possibly even hair. The B vitamins affect blood, skir, nerves and growth, and the way YOlY body uses foods. To get sufficien~ quantities, your diet should regulariy include lean meats and/or pulses, offa fish, wholemeal bread and wholegrair vegetables like spinach. If you feel rur down, nervous, or develop skir ailments, your doctor may recommend a B complex supplement; some people take brewer's yeast, a rich source o~ several B vitamins, for extra energy. A Good Diet Vitamin A is necessary for healthy skin, bones and eyes; you can get enough by eating moderate amounts of dairy Doses of pyridoxine (B6) are used to treat acne, convulsions, premenstrual tension and period pains; both 86 and 812 are prescribed for anaemia. Generally the body quickly excretes any excess vitamin B, but undernourished Jeople should not take vitamin 8, on its Jwn, as this can impair the body's use of :::tner vitamins. vJJ should ensure that your diet::~tars generous daily amounts of ~a~r C-rich foods, as the body cannot 3~::: -et. and it is easily destroyed by ~ ~ e :::ooking and by cigarette smoking. ~ 3 essential for the health of blood, ::::: +eeth, and the body's connective ~ 33_e. ::eaoers, blackcurrants, parsley, :::-,,-;:83 a-occoli and many other fresh ~- ~::: vegetables are good sources, es::e:::" ",vren raw or lightly cooked. --ere 3 -0 conclusive evidence that . ~,,~ ~ ::: ::-events colds, but a 3_::: ot usually harm . . ~,,necessary for strong :::::~ ~e8~-. and prevents rickets in :::- ~s "':::Jnd mainly in fish liver :::.::: <: iver, fatty sea-fish and ~ e-:-:ents should be avoided as s ~;: can cause vomiting, - es. weight loss and calcium ::: s ~sr kidneys and arteries . . ~a~-;s E and K are both connected ,'e ":.,:-,ctioning of the blood. Many :,,~3 are made for vitamin E - ranging::~ \varding off heart attacks to -e e\' "g menopausal symptoms - but ~ c~e ras been proven. Vitamin E occurs - Tany foods, especially in oils of ,,,reatgerm, cottonseed and corn, and 1 oatmeal, margarine, eggs, meat, butter and peas. Vitamin K helps prevent excessive bleeding, Ample quantities can be obtained by eating pig's liver, green leafy vegetables, eggs and milk; supplements are largely unnecessary as the body makes up for any shortage by manufacturing it in the intestines, If you think you are suffering from vitamin deficiency, or that a supplement might help combat a particular ailment, you should consult your doctor. You will  also find it helpful to look at a nutrition ~ manual for the quantities required, how to achieve the correct balance and how  best to prepare food to make full use of the vitamins.   Taken from The Marshall Cavendish A  to Z GUIDE IN WEEKLY PARTS,  DOCTOR’S ANSWERS: PART 90, LIVE BETTER NATURALLY, GETTING YOUR VITAMINS – NATURE’S WAY, Page 2498.   (Sorry. Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out) , Some people have difficulty in sleeping soundly, and one of the hypnotic drugs can give them a good night's rest. But it must be prescribed and taken with care. Q Is there a danger in mixing my sleeping pills with a night­time alcoholic drink? A Yes. The effects of alcohol add to the effects of all hypnotic drugs and therefore to take both can produce excessive sedation, which may be dangerous. A (small) bedtime drink taken by itself may be the best form of hypnotic, although, of course, the regular use of alcohol can have its own dangers. Q Are hypnotic drugs dangerous if taken by children? A It is vital that all drugs, but especially sleeping tablets, be kept out of reach of children. Because of their small body size, children can be killed by even quite small overdoses of hypnotic drugs. There are occasions when a mild hypnotic is needed for a short period to correct a difficult sleep pattern in a child, but the dosage prescribed should be very carefully observed Q Are there some hypnotic drugs which make you too drowsy to drive? A Yes. Most of the commonly used hypnotic drugs cause significant drowsiness, lasting for some time after the person appears to have woken from sleep. For this reason anyone taking these drugs should take care not to drive while still under their influence. Q Is it a bad thing to take sleeping pills for years and years? A Yes. Through careless prescribing, many people in the past have become addicted, particularly to the barbiturate group of drugs. The problem is that over a period of time, the effects of a certain dose diminish so that more is required to obtain the required effect. In addition, the type of sleep induced by hypnotic drugs is not as refreshing as natural sleep, and so it is better to use a sleeping pill only for a strictly limited period while steps are taken to find out the causes and treat the fundamental cause of the Insomnia. Sleep difficulties are common and there is a great demand for drugs which will help those who suffer from such problems to have a good night's sleep. Although no hypnotic drug produces normal sleep, some induce sleep that is nearer to natural sleep than others. But some dif­ficulties in sleeping are not likely to be helped by hypnotic drugs at all. Different types of hypnotic drugs There are various types of sleep- inducing drugs available, but they all tend to have side-effects to some degree. Chloral derivatives: Chloral hydrate was one of the earliest drugs to be used specifically as a hypnotic. The original chemical is not much used nowadays, but chloral is the main ingredient in a drug called dichloralphenazone, widely pre­scribed in tablet form and especially use­ful to elderly people. Chloral hydrate it­self is rather irritating to the stomach and even the much less irritating dich­loralphenazone has to be avoided by people who have peptic ulcers or delicate stomachs. This group of drugs has an addictive effect when mixed with alcohol. Barbiturates: These used to be used very widely, but now that there are safer, less addictive drugs available, they are being prescribed less and less: their main use now is in injections to produce general anaesthesia. Barbiturates are significantly habit­forming, even addictive, and they pro­duce quite prolonged 'hangover' effects: anyone who takes them will not be at his or her best for most of the morning after a barbiturate-induced sleep. They are also dangerous in overdose (see Barbiturates, page 1391. Benzodiazepines: These are safe, even in large overdose and, considering how well they work, have remarkably few side-effects, although they may cause nightmares. However, even the benzo­diazepines can be habit-forming, and if they are withdrawn there may be a re­bound in sleeplessness. Other hypnotic drugs: A mixed group of non-barbiturate drugs has largely been replaced by the benzodiazepines. One drug which was popular a few years ago was a mixture of two others: a hypnotic, methaqualone, and a sedative anti­histamine, diphenhydramine. It was potent and effective but very dangerous in overdose. For children, on the rare occasions when they need a drug with some hypnotic effect, the most useful are the sedative antihistamines, including promethazine and trimeprazine, while for elderly people a safe hypnotic drug is chlormethiazole. How hypnotic drugs work The part of the brain responsible for the cycles of sleep and wakefulness is the reticular activating system, a widely spread network of brain cells and their nerve fibres which lace up and down the brain stem (see Brain, pp. 217-191, con­trolling the extent to which the brain is electrically active. Some drugs, such as the barbiturates, suppress the activity of considerable areas of the brain, causing hypnotic effects at low doses and com­plete general anaesthesia at higher doses. Others, such as the benzo­diazepines, do not produce general anaesthesia, even at very high doses. Dangers and side-effects The barbiturates are particularly prone to cause a hangover, and it is dangerous to drive until their effects have quite worn off because co-ordination and reflexes are significantly suppressed. The benzodiazepines were introduced as causing very little of a hangover effect, but, in fact, one of them, nitrazepam, has this side-effect, lasting for up to 20 hours after it is taken. Another serious side-effect occurs in people with chronic chest complaints: many of the hypnotics, especially the barbiturates. will interfere with their breathing in the night, often to a serious extent, and so it is best for them to avoid the use of all hypnotics. Some people are allergic to certain drugs in the hypnotic group. It is not usually possible to predict which one will cause the allergic reaction, but if a person has it to one drug in a particular group of hypnotics, he or she will probably be allergic to chemically similar drugs. The barbiturates can make people­particularly if they are elderly-feel confused, and this can be physically dangerous because it may cause falls. Another problem, again especially of the barbiturates but also of the chloral derivatives, is interaction with other drugs which a person may be taking. It is important for a doctor to know whether a patient is taking an hypnotic drug before prescribing any others. Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS - DOCTOR’S ANSWERS – PART 28, HYPNOTIC DRUGS, Page 770 – 771. (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out) otic drugs, their ~ses and possibl Drug Uses Phenobarluitone Pentobarbitone Hypnotic Qualbarbitone Hypnotic Hypnotic Promethazine Glutethimide Skin rashes Chlormethiazole Hypnotic, trElatrnelnt * Prescribed dosages sh'Juld alw,ays to and 771 , The beauty care we give the face and scalp helps to keep the skin clear and the hair healthy, but we need to supplement this by exercising facial and scalp muscles. We exercise our facial muscles almost every waking moment of the day, but this exercise is not necessarily the most beneficial. Just as movements of the body muscles can result in strain, habi­tual movements of the face can lead to tense areas, giving rise to headaches and other painful symptoms. This can be helped by certain exercise routines. Relaxation is the key. Lie down flat on your back, without a pillow, listening to some soothing music. Close your eyes and concentrate on feeling your facial and scalp muscles. Try to let your neck and jaw go completely slack. The most common areas of tension are at the back of the neck, just where the spine ends; the jaw muscles below the ear; and the centre point between your eyes. If you use your eyes for close work or a great deal of reading, you may also locate tension in the tiny muscles around the eyes, notably at the outer edges. If this tension becomes severe, accompanied by frequent headaches, it may be advisable to consult your doctor or optician. Even people in good health suffer from strain in the facial region, es­pecially when under stress. And though you may not be aware of it, you probably have some small mannerism such as a constant frown or rapid eye movement vyhlchcan lead the muscles to be set into a rigid pattern which encourages wrinkli'Js. A.shortexercise routine performed eY~.ry.day for about ten minutes can be beneficial. Start with relaxation tech­niques, such as sitting comfortably but with your spine straight, and letting your head hang down from the nape of the neck. Slowly turn your head in a circle from right to left, then from left to right. Let your head hang down so that your chin reaches the chest, then lift it back so that your chin points upwards. Re­peat several times. To exercise your facial muscles, sit in front of a mirror. Begin by toning the eyebrow muscles. Lift your eyebrows upwards as far as they can go, then relax and repeat. Follow by knitting the brows together, then releasing them. At each point, it is very important to relax the muscles between tensing them. Your eye muscles can be exercised by first closing the eyes for a few seconds, concentrating on complete freedom from tension. Then screW up the eyes tightly, relax and repeat a few times. Follow by rolling the eyeballs first right and then left, then up and down and finally in a full circle, trying to keep your head still and looking ahead. Next, the mouth and jaw muscles: relaxing your neck, open your mouth as wide as possible, then slowly close it. Then, keeping lips together, stretch your mouth at the sides, relax, repeat. Purse your lips together as if making an '0' then relaxing them. Massage as exercise Massage is an important and simple way to tone the face and scalp. When applying cleanser or soap, massage by placing the cleansing substance on the fingertips and gently stroking it in, always using upwards or circular move­ments. Start from the chin, working up­wards towards the cheekbones; move from the nostrils to the bridge of the nose; stroke outwards from below the eyes towards the hairline above your ears; and move in two circles, one made with each hand, from the centre to the upper edge of the eyebrows. Massage your neck with upward movements starting at the nape and moving round to the area under the chin. Massage your. scalp whenever you wash your hair. Using. your fingertips, gently work from the top of the spine towards the crown of your head, moving in small circles. Work back downwards in the same way towards the ears, then follow this by massaging the front of the head. Finish by spraying lukewarm water on the scalp. Taken from The Marshall Cavendish A – Z GUIDE IN WEEKLY PARTS - DOCTOR’S ANSWERS – LIVE BETTER NATURALLY - PART 28, FACIAL AND SCALP EXERCISES, Page 776. (Sorry - Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out) , This painful muscle condition deserves its graphic name ­but it can be brought on by such mundane activities as carrying suitcases or wringing out the washing. Q If I had tennis elbow, how would I recognize it? A You would have a dull ache around the elbow area and upper side of the forearm, with a particular tender spot on, or near the bump that can be felt on the upper side of the elbow with the forearm placed across the chest Activities such as typing, using a squash or tennis racquet or even picking up heavy objects may be painful. Q How soon can one resume playing squash after suffering from tennis elbow? A That depends on how serious the injury was; you should seek your doctor's advice But it does vary considerably from person to person. In mild cases, you may only have to wait for a few days until the pain and stiffness subside, and then resume the sport gradually. More serious cases may necessitate a longer lay­off. But if you find that the tenderness returns whenever you play, then make sure you consult your doctor as soon as possible. Q I am presently taking part in a two-week tennis tournament, but have developed a painful tennis elbow on the first day. I don't want to withdraw from the tournament, so what should I do? A You should ask your doctor for a pain-killing injection, but he may not be willing to give it The danger is that you could seriously aggravate the injury without knowing it, thus delaying full healing for several weeks or even months. An alternative is to wear an elasticated sleeve or crepe bandage around the affected forearm. This will provide some relief from the pain and will reduce the chance of aggravating the injury. However, in the long-term, it really would be better if you rested the arm for a few days. Q Do you only get tennis elbow from playing tennis? A No. The injury is common in a wide variety of sports ­especially in racquet sports - and also occurs as a result of household chores and carpentry, in particular. Tennis elbow is a very common arm injury. Although it often develops during a hard game of tennis, it can also occur in a wide variety of other sports. and e,'en as a result of non-sporting acti,'ities. Tr.e injury is not really to the elbow itself. 8m to one or more of the forearm muscles "n their point of attachment to the elhJ\. These muscles are involved ir. r:~O't', ments of the wrist and fingers. \':-.ic:-, is why it is such a common injury 2r:'Cr.2" racquet players. of tennis elbow is due to small tears ,,'here the muscles join the lateral epicondyle. The cause of the Injury is un­accustomed vigorous or prolonged use of the forearm muscles, especially during sports like tennis, squash, cricket and athletic throwing events. It can also be caused during everyday events like wringing out the washing or using a tool like a screwdriver. Causes The elbow joint forms a pivot betv:t'e:-, ::',t' humerus bone in the upper arm. an:] ::"t' two bones in the forearm. At the lYe:e" i end of the humerus are two pro,iec:;('~"s­~ called epicondyles - to which a TI"clmct"": C forearm muscles are attached Tf-tt' :C2::~ Symptoms The pain of tennis elbow comes on gradually rather than suddenly, and is made worse by such activities as gripping something or picking up a heavy object, :~ke a full kettle. A very tender spot can 'clsually be felt at the site of the injury ·.':he,'e the forearm muscles are attached ::' the lateral epicondyle, but pain and stiffness may sometimes extend over the ·.•. bJle of the upper side of the forearm. Treatment ?est and a pain-relieving drug are ".lSlla':v sufficient to allow a return to full ,':':,t' ':1:' :he affected arm within a few days. :i:!'e pe,'sistent tennis elbow may be ::'i'~.:ec. \'ith a corticosteroid injection :'2"t':'-:e:' \'ith an anaesthetic which will '"i'~Jce :he pain and tenderness while the ::-l,'u:':: heals. \-here the injury is severe and per­:,t:'tent. heat treatment and physio­::-.erapy are used. Some tennis players :',a,'e found acupuncture helpful. Tennis elbow can be more than a temporary disability - it can actually hamper a successful tennis career, as in the case of the Australian star Tony Roche. Taken from The Marshall Cavendish A to Z GUIDE IN WEEKLY PARTS, DOCTOR’S ANSWERS: PART 85, TENNIS ELBOW, Page 2356. (Sorry. Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the script have been left out) , Is there a link between physical characteristics and temperament? A morose fat man? A jolly scarecrow? These combinations probably seem implausible because we tend to categorize people according to their physique. But is there really a link between physical characteristics and temperament? Q I have suffered from migraine all my life. My friend tells me that this is caused by my personality, that I worry too much and should try to be happier. My doctor tells me that the migraines may be caused by a distended blood vessel in my brain. Who do I believe, my friend or my doctor? A Physiologically, the distension of a blood vessel in the head is indeed one of the more frequent causes of migraine, and ergot, a drug which causes the blood vessels to constrict, is often used to treat it. Yet statistics reveal that people who suffer from migraine tend to have strong guilt feelings and also strong feelings of insecurity, So both your doctor and your friend may be right. However, each individual is different and treatments that work with one patient will often fail with another, Only systematic investigation of your complaint at a migraine clinic will reveal the appropriate treatment for you, This will take psychological factors into consideration and if necessary you will be given professional help to identify any tendencies in your personality that might contribute to your condition, Trying to be happier should do no harm, but do remember that you are applying a simplistic solution to a complex problem and that it is unlikely to solve your problem on its own, Q Is it true that twins exhibit the same personality traits? A Twins who have been brought up together, whether they are identical or fraternal, tend to develop different personality traits, most probably as a way of expressing and establishing their independence, One twin might become more studious, the other more sociable, What is interesting however is that pairs of monozygotic twins (identical twins, formed from a single ovum) exhibit almost identical personality traits if they are brought up separately, Many studies have been made recently on twins separated at, or shortly after, birth, The results are a strong argument for the idea that many personality traits are indeed inherited, A person's temperament, or na:'..;ra: disposition, is an aspect of his or her :Je", sonality. Temperament is closely li::-,,;.;:ecl to emotion and in fact determines ho\\~ a" individual will react to his ,'arious emotions and moods. It has been thought for a long time that temperament has a physical origin, Modern medical research is now begin, ning to unearth some of the facts behind this traditional belief Ancient beliefs We have a natural tendency to categorize other people into 'types', For example, many people still believe in a theory developed by the ancient Greeks, that an individual's fate and character are determined by the positions of the stars at the time of his or her birth. And most of us still speak of people as being jovial ~eaning merry and hearty, qualities thought to derive from the influence of .Jupiter. or Jove, at the time of their birth): saturnine (Saturn was credited ,\'ith endowing people born under its influence with cold, sluggish and gloomy temperaments); or mercurial (quick­witted and volatile, born under Mercury). This theory of temperament seems to have broadened, rather than diminished, with the growth of scientific knowledge. But however strong a hold astrology may have on the imagination, investigation has shown that there is little conclusive evidence about the correlation between personality characteristics and the position of the stars at the time of birth. In Classical Greek drama, the actors traditionally wore masks as their faces might have revealed their own temperament and detracted from the characters they were portraying. In this modern performance of the 'Oresteia' by Aeschylus, the convention has been revived - and to great dramatic effect (below). Another belief concerning the link between the mind and the body origin­ated in ancient India and claimed that the body was governed by certain sub­stances: air, which is cold and dry; bile, which is hot and fluid; and phlegm. which is cold and oily. When these three are in their correct proportions the body is healthy; ill-health is caused by an excess or a lack of fluid or humour. People's ideas about temperament were governed for centuries by the doctrine of the four humours. The sanguine person was dominated by air and was optimistic and courageous; the phlegmatic individual by water, making him cool and calm. The hot­tempered choleric was ruled by fire and the melancholic by black bile. This doctrine of humours became the basis for medical diagnosis and treatment for more than a thousand years. For example. a patient suffering from wind might be diagnosed as suffering from an excess of air. An oil mi2-t'_: then be prescribed to counteract the ~air. As the doctrine spread from India to other civilizations it became broadened and modified. Blood was added as a fo'.,E':::-. humour and the Greeks, who belie\'ed that the earth was composed of four elements - earth, water, fire and air ­linked the two ideas together, formula­ting a theory embracing body and mind. Theophrastus, a student of Aristotle, postulated that people in whose body phlegm was the predominant humour were governed by the element water, and tended to be cool and calm, or sluggish and apathetic. Those people in whom yellow bile predominated were governed by the element fire and were said to be TEMPERAMENT choleric or irascible in temperament. Sanguine people were governed by air and had a predominance of blood, which made them courageous and optimistic, but melancholic people were dominated by a black bile, linked to the earth. Far-fetched though this theory may seem to us now, it governed people's \'ie\\'s of temperament for salong, and in so \':ide an area of the world, that it has ?ained the respect of modern scientists, 'TIan\ ,):' \':hom feel it might have been an If.stirc:i·:e groping towards the truth. Recent theories One of:he ~'eat phvsiologists of the 19th century. Cla'...lQe Bernard. pointed out that altho!.;g!: ::::e heart' \\'hose task it is to pump blood a!'o!.;nd the bodyl is a mechanism entirelv separate from the nervous svsteIY:.. it is r:e\'ertheless subject to nervous control. A strong emotion. such as terror. pro\'oked bv a strong TEMPERAMENT Q Can certain temperaments make some people more susceptible to disease than people with different kinds of temperament? A There is no conclusive evidence on this, although there are some theories that attempt to explain the link between personality and disease. Recent investigations into the immune system, for example, have brought to light the fact that negative emotions - such as feelings of helplessness, lack of love, and despair - produce high levels of certain hormones in the body that have a dampening effect on the immune system, predisposing the individual's body to attacks by viruses. Q I seem to have more frequent changes of mood than most people, and my mother says that I inherited my moodiness from my father's side of the family. Could she be right? A Without knowing a great deal about the psychological history of a family it is impossible to say whether a character trait, or indeed a physical symptom or an illness, is inherited. However, there has been much biological research into psychiatry during the past 20 years and one fact that has emerged is that certain personality disorders are inherited. These findings, however, have been made on the basis of a study of severe mental abnormalities, such as schizophrenia and manic depression, and it is not possible to say with any certainty that foibles of temperament are also inherited. They may be the result of life experiences having had a profound effect on the personality, or of environmental conditioning. Q Why is it that alcohol can cause changes in mood? A Alcohol is an 'anti-stimulant' - it depresses the arousal level in the brain. As the level of cortical arousal differs from one person to another, so the effect of alcohol varies. Extroverts are thought to have an under-active cortex and may be more susceptible to this depressant than introverts, who have high arousal levels. stimulus, is enough to stop it completely. Bernard wrote: 'A milder stimulus will stop the heart more briefly, but the function will be resumed with an increase of tempo, fluttering, or palpitations, which will send more blood to the brain, and result in a blush.' Many physiologists, both before and since, have remarked on the tendency of certain individuals to be altogether 'redder' than others. ·Such people may have a ruddy complexion, or may simply tend to blush more easily and more often than others, and perhaps also have a fiery temper, or be more self-conscious than others. The ancients merely observed and recorded such phenomena. Today's physiologists have the more difficult task of understanding and explaining. Claude Bernard was the physiologist who first formulated the idea of homeo­stasis - the ability of the body to maintain its equilibrium in the face of external changes, particularly of temperature. This mechanism is governed by the body's autonomic nervous system, under the control of the cortex of the brain. Our knowledge of how the brain functions is still in its infancy, and anyone attempting to discover the origins of a particular aspect of behaviour will 'Elementary, my dear Watson'- the actors' faces reflect Sherlock Holmes's effortless superiority and the good doctor's credulity. Their strongly contrasting temperaments made for a winning team! usually find progress blocked at some stage by lack of knowledge. However it is known that whenever parts of the cortex are damaged or removed, dramatic changes in temperament follow. Damage to the temporal lobe (the front part) of the brain is followed by docile or compulsive behaviour or with abnormal­ly high sexual response in man and other mammals. Similarly, drugs that depress or stimulate the production of chemicals that playa part in transmitting electrical impulses from one part of the brain to the other result, respectively, in sedation or stimulation. Amphetamines, for example, are stimulants that act by releasing a trans­mitter substance called noradrenalin from nerve cells; they probably prevent other chemicals from being manufac­tured to inactivate adrenalin. It is believed that the tranquillizer reserpine inhibits the release of stimulating substances from the brain's nerve cells. Therefore, an habitually nervous person may have consistently high levels of stimulants in the brain. Conversely, a person with a tendency to lengthy bouts of depression may have abnormally high levels of chemicals which depress the release of stimulants. The link between mind and body Although our understanding of the brain may be incomplete, physiologists dis­covered the physical link between mind and body very early on. This is the hypothalamus, a gland that is located in the cortex of the brain. One of the hypothalamus's major functions is to relay impulses and stimuli between the brain and organs such as the heart and respiratory centres. It does this by receiving certain of the chemical transmitter substances released by the nerve cells of the brain and, in response to the trigger, releasing hormones. Hormones are formed in the glands by internal secretions and are carried to specific organs of the body which they stimulate into action. Hormones regulate the body's homeo­stasis as well as mood and behaviour. In man, hormones regulate the body clock ­the heartbeat, breathing and digestion. The hypothalamus is the body's master gland. The hormones it releases regulate body temperature and the volume of the blood plasma (the fluid in ,,'hich red and white blood cells float I. Some of these are transmitters which influence the secretion of other hormones from other glands. In addition, the hypothalamus helps the brain to decide whether a stimulus from outside is pleasant or painful and it also influences sexual behaviour. Other glands also affect temperament in different ways. For example, the thyroid gland, when over-active, results in over-anxiousness and rapid mood changes, while people with under-active thyroids tend to be slow and apathetic. These and other examples demonstrate how great a part glandular secretions play in regulating everyday moods, but it is also thought that they may have an even greater role - in the establishment of human character. Is it growing older that inhibits our willingness to stand out in a crowd? The singingof'The Red Flag' is traditional at the end of Labour Party conferences, but such public displays seem to suit some temperaments more than others (left). There is no aspect of behaviour which is not controlled in some way by hormones, Yet the idea that glands actually deter­mine temperament is now thought to be exaggerated. There are serious disorders of temperament in which hormones seem to play no part; manic depressive psychosis and schizophrenia, for instance. Moreover, although glandular activity does affect patterns of behaviour it is - equally true that there is no activity of a specific gland, or indeed of the entire autonomic nervous system, that cannot be upset by emotion. The example of blushing, in which the blood vessels suddenly dilate, is a good example. What is certain is that there is some interdependence between emotional states and hormonal activity. Temperament and physique Some 50 years ago the scientist E. Kretschmer noticed a striking difference in physique between people with different disturbances. He realized that while schizophrenic patients tend to be thin and ascetic in appearance, manic-depressive patients are broadly built and short. By means of observation and measurement he succeeded in demonstrating some affinity between illness and physique, and believed that the schizophrenic and the Bjorn Borg and John McEnroe ­both marvellous tennis players, but how different in temperament! Borg's steely calm seems to make him impervious to the tensions and dramas of the Centre Court and makes him a trul:y formidable opponent. The gifted McEnroe, on the other hand, is renowned for his explosive temper which frequently gets him into trouble with line judf{es and umpires. manic depressive were two extremes of two common personality types, with predispositions to different psychoses. Kretschmer's investigations have not withstood the test of time, but perhaps simply because people seem instinctively to classify people they meet in everyday life into types, researchers have con­tinued trying to discover a science of individual differences. In the 1940s, the American psychol­ogist W. H. Sheldon began a rigorous study not on abnormal human beings, but on people within the normal range of personality types. 'Tradition has it', he pointed out, 'that fat men are jolly and generous, that lean men are dour, that short men are aggressive and that strong men are silent and confident.' Sheldon began his investigations by photographing 4000 nude men, all of a similar age, in identical poses and in controlled conditions. From comparisons of measurements taken from five different regions of the body he produced his now familiar theory of physical types. Endomorphs, he stated, are people who are predominantly round and fat. Meso­morphs, in contrast, have a pre­dominance of bone, muscle and connec­th-e tissue in their body and, in ever. greater contrast, ectomorphs are predominantly fragile and elongated in physique. During his investigations he inter­\'ie\wd and closely observed each of the ,±GOO men on successive occasions. When he had produced his theory of physique he \,'em on to compare the data from these inten'ie\,'s to see if it was possible to distinguish any correlation between physique and personality. Endomorphs. he discovered, tend to exhibit a predominance of relaxed. friendly, pleasure-loving traits. They live, as it were, by and for the digestion- Studies linking body type to temperament maintain that athletic mesomorphs are vigorous, outgoing souls - full of life. loving food and often disliking exercise ­and needing companionship, even when troubled. He called this personality type viscerotonia. The mesomorph, in contrast, is the vigorous outdoor type of person, adventurous and dominating, and not only loving, but needing, daily physical activity. This type of person tends to be direct and outgoing, but not necessarily intellectual. He called this type somatotonia. The ascetic ectomorph tended to be intellectual and introverted, often shy and ill at ease, and often disliked exercise. This type was indifferent to company and food and the social ceremony that accompanies eating in most societies. Sheldon called this type of personality cerebrotonia. Since the characteristic of each type in Sheldon's scheme could differ from individual to individual - a need for solitude, for example, being characteris­tic of cerebrotonic types, but stronger in some than others - each individual was assessed numerically according to his individual trait. The pattern expressed in the resulting number became the indi­vidual's somatype. Sheldon's research makes absorbing reading, but it has been criticized as being over-simplified, since it merely considers personality traits and fails to discuss their organization in the per­sonality as a whole. However as psychology as a science advances, students of behaviour are Round and chubby endomorphs are supposedly not so keen on physical exercise - what they really relish is their food. tending more and more towards specialization in 3Uch matters as the investigation of a brain function, or a specific personality trait. In this context, Sheldon's attempt at a 5cientific explora­tion of temperament is an invaluable work which has gi\'en rise to many theories. Illness and temperament The idea that people's emotions pre­dispose them to certain types of illness is a belief older than the doctrine of humours, but its investigation is a new branch of science. Ancient Chinese medicine postulated that the body is an integral mechanism in which inconsistencies contradict each other. Contradictions of mental and emotional activity caused by the influences of society and the natural environment may cause disease, or hasten its development. Emotions as diverse as joy, excitement, happiness, anger, fright and sorrow under most conditions will not cause disease, but under some they can damage normal body functions and cause neurosis or functional disturbances. Also, body­build, bodily reactions and individual differences of age, sex and resistance can predispose people to disease. This way of thinking about the human body, which has persisted in China until today - though modified by new know- Ectomorphs have a fragile frame and in theory tend to be introverted, intellectual, tense and rather ill at ease in company. ledge and new theories - has begun to influence modern Western medicine. It has given rise to theories correlating personality and disease, and has led to new concepts of psychosomatic medicine. One theory, for example, suggests that people with certain personality traits may be susceptible to certain diseases; such people are classified into 'biotypes'. Thus, the heart attack biotype is an achiever and competitor. His or her body is constantly prepared for 'fight or flight' and he may, as a result, have higher levels of hormones such as adrenalin and noradrenalin in the bloodstream. These mobilize fats and cholesterol from body tissues into the bloodstream, raise the blood pressure and increase the ability of the blood to clot. Excess cholesterol in the arteries soon leads to a heart attack. Other biotypes include people sus­ceptible to angina, ulcers or rheumatism. This branch of medicine does offer one solution: gradually to change the personality and the unconscious tenden­cies by changing the patient's life-style. Psycho-physiologists (those who study the relationship between mind and body) investigate individual differences and attempt to bring the branches together. These medical scientists are, in effect, trying to establish a method of measuring individual responses to emotional situations, cyclic events, stress and drugs, in order to discover the truth behind the observations of individual differences and the causes of temperament.     Taken from The Marshall Cavendish A  to Z GUIDE IN WEEKLY PARTS,  DOCTOR’S ANSWERS: PART 85, TEMPERAMENT, Page 23240 to 2345.   (Sorry. Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out)   . But is there really a link between physical characteristics and temperament? Q I have suffered from migraine all my life. My friend tells me that this is caused by my personality, that I worry too much and should try to be happier. My doctor tells me that the migraines may be caused by a distended blood vessel in my brain. Who do I believe, my friend or my doctor? A Physiologically, the distension of a blood vessel in the head is indeed one of the more frequent causes of migraine, and ergot, a drug which causes the blood vessels to constrict, is often used to treat it. Yet statistics reveal that people who suffer from migraine tend to have strong guilt feelings and also strong feelings of insecurity, So both your doctor and your friend may be right. However, each individual is different and treatments that work with one patient will often fail with another, Only systematic investigation of your complaint at a migraine clinic will reveal the appropriate treatment for you, This will take psychological factors into consideration and if necessary you will be given professional help to identify any tendencies in your personality that might contribute to your condition, Trying to be happier should do no harm, but do remember that you are applying a simplistic solution to a complex problem and that it is unlikely to solve your problem on its own, Q Is it true that twins exhibit the same personality traits? A Twins who have been brought up together, whether they are identical or fraternal, tend to develop different personality traits, most probably as a way of expressing and establishing their independence, One twin might become more studious, the other more sociable, What is interesting however is that pairs of monozygotic twins (identical twins, formed from a single ovum) exhibit almost identical personality traits if they are brought up separately, Many studies have been made recently on twins separated at, or shortly after, birth, The results are a strong argument for the idea that many personality traits are indeed inherited, A person's temperament, or na:'..;ra: disposition, is an aspect of his or her :Je", sonality. Temperament is closely li::-,,;.;:ecl to emotion and in fact determines ho\\~ a" individual will react to his ,'arious emotions and moods. It has been thought for a long time that temperament has a physical origin, Modern medical research is now begin, ning to unearth some of the facts behind this traditional belief Ancient beliefs We have a natural tendency to categorize other people into 'types', For example, many people still believe in a theory developed by the ancient Greeks, that an individual's fate and character are determined by the positions of the stars at the time of his or her birth. And most of us still speak of people as being jovial ~eaning merry and hearty, qualities thought to derive from the influence of .Jupiter. or Jove, at the time of their birth): saturnine (Saturn was credited ,\'ith endowing people born under its influence with cold, sluggish and gloomy temperaments); or mercurial (quick­witted and volatile, born under Mercury). This theory of temperament seems to have broadened, rather than diminished, with the growth of scientific knowledge. But however strong a hold astrology may have on the imagination, investigation has shown that there is little conclusive evidence about the correlation between personality characteristics and the position of the stars at the time of birth. In Classical Greek drama, the actors traditionally wore masks as their faces might have revealed their own temperament and detracted from the characters they were portraying. In this modern performance of the 'Oresteia' by Aeschylus, the convention has been revived - and to great dramatic effect (below). Another belief concerning the link between the mind and the body origin­ated in ancient India and claimed that the body was governed by certain sub­stances: air, which is cold and dry; bile, which is hot and fluid; and phlegm. which is cold and oily. When these three are in their correct proportions the body is healthy; ill-health is caused by an excess or a lack of fluid or humour. People's ideas about temperament were governed for centuries by the doctrine of the four humours. The sanguine person was dominated by air and was optimistic and courageous; the phlegmatic individual by water, making him cool and calm. The hot­tempered choleric was ruled by fire and the melancholic by black bile. This doctrine of humours became the basis for medical diagnosis and treatment for more than a thousand years. For example. a patient suffering from wind might be diagnosed as suffering from an excess of air. An oil mi2-t'_: then be prescribed to counteract the ~air. As the doctrine spread from India to other civilizations it became broadened and modified. Blood was added as a fo'.,E':::-. humour and the Greeks, who belie\'ed that the earth was composed of four elements - earth, water, fire and air ­linked the two ideas together, formula­ting a theory embracing body and mind. Theophrastus, a student of Aristotle, postulated that people in whose body phlegm was the predominant humour were governed by the element water, and tended to be cool and calm, or sluggish and apathetic. Those people in whom yellow bile predominated were governed by the element fire and were said to be TEMPERAMENT choleric or irascible in temperament. Sanguine people were governed by air and had a predominance of blood, which made them courageous and optimistic, but melancholic people were dominated by a black bile, linked to the earth. Far-fetched though this theory may seem to us now, it governed people's \'ie\\'s of temperament for salong, and in so \':ide an area of the world, that it has ?ained the respect of modern scientists, 'TIan\ ,):' \':hom feel it might have been an If.stirc:i·:e groping towards the truth. Recent theories One of:he ~'eat phvsiologists of the 19th century. Cla'...lQe Bernard. pointed out that altho!.;g!: ::::e heart' \\'hose task it is to pump blood a!'o!.;nd the bodyl is a mechanism entirelv separate from the nervous svsteIY:.. it is r:e\'ertheless subject to nervous control. A strong emotion. such as terror. pro\'oked bv a strong TEMPERAMENT Q Can certain temperaments make some people more susceptible to disease than people with different kinds of temperament? A There is no conclusive evidence on this, although there are some theories that attempt to explain the link between personality and disease. Recent investigations into the immune system, for example, have brought to light the fact that negative emotions - such as feelings of helplessness, lack of love, and despair - produce high levels of certain hormones in the body that have a dampening effect on the immune system, predisposing the individual's body to attacks by viruses. Q I seem to have more frequent changes of mood than most people, and my mother says that I inherited my moodiness from my father's side of the family. Could she be right? A Without knowing a great deal about the psychological history of a family it is impossible to say whether a character trait, or indeed a physical symptom or an illness, is inherited. However, there has been much biological research into psychiatry during the past 20 years and one fact that has emerged is that certain personality disorders are inherited. These findings, however, have been made on the basis of a study of severe mental abnormalities, such as schizophrenia and manic depression, and it is not possible to say with any certainty that foibles of temperament are also inherited. They may be the result of life experiences having had a profound effect on the personality, or of environmental conditioning. Q Why is it that alcohol can cause changes in mood? A Alcohol is an 'anti-stimulant' - it depresses the arousal level in the brain. As the level of cortical arousal differs from one person to another, so the effect of alcohol varies. Extroverts are thought to have an under-active cortex and may be more susceptible to this depressant than introverts, who have high arousal levels. stimulus, is enough to stop it completely. Bernard wrote: 'A milder stimulus will stop the heart more briefly, but the function will be resumed with an increase of tempo, fluttering, or palpitations, which will send more blood to the brain, and result in a blush.' Many physiologists, both before and since, have remarked on the tendency of certain individuals to be altogether 'redder' than others. ·Such people may have a ruddy complexion, or may simply tend to blush more easily and more often than others, and perhaps also have a fiery temper, or be more self-conscious than others. The ancients merely observed and recorded such phenomena. Today's physiologists have the more difficult task of understanding and explaining. Claude Bernard was the physiologist who first formulated the idea of homeo­stasis - the ability of the body to maintain its equilibrium in the face of external changes, particularly of temperature. This mechanism is governed by the body's autonomic nervous system, under the control of the cortex of the brain. Our knowledge of how the brain functions is still in its infancy, and anyone attempting to discover the origins of a particular aspect of behaviour will 'Elementary, my dear Watson'- the actors' faces reflect Sherlock Holmes's effortless superiority and the good doctor's credulity. Their strongly contrasting temperaments made for a winning team! usually find progress blocked at some stage by lack of knowledge. However it is known that whenever parts of the cortex are damaged or removed, dramatic changes in temperament follow. Damage to the temporal lobe (the front part) of the brain is followed by docile or compulsive behaviour or with abnormal­ly high sexual response in man and other mammals. Similarly, drugs that depress or stimulate the production of chemicals that playa part in transmitting electrical impulses from one part of the brain to the other result, respectively, in sedation or stimulation. Amphetamines, for example, are stimulants that act by releasing a trans­mitter substance called noradrenalin from nerve cells; they probably prevent other chemicals from being manufac­tured to inactivate adrenalin. It is believed that the tranquillizer reserpine inhibits the release of stimulating substances from the brain's nerve cells. Therefore, an habitually nervous person may have consistently high levels of stimulants in the brain. Conversely, a person with a tendency to lengthy bouts of depression may have abnormally high levels of chemicals which depress the release of stimulants. The link between mind and body Although our understanding of the brain may be incomplete, physiologists dis­covered the physical link between mind and body very early on. This is the hypothalamus, a gland that is located in the cortex of the brain. One of the hypothalamus's major functions is to relay impulses and stimuli between the brain and organs such as the heart and respiratory centres. It does this by receiving certain of the chemical transmitter substances released by the nerve cells of the brain and, in response to the trigger, releasing hormones. Hormones are formed in the glands by internal secretions and are carried to specific organs of the body which they stimulate into action. Hormones regulate the body's homeo­stasis as well as mood and behaviour. In man, hormones regulate the body clock ­the heartbeat, breathing and digestion. The hypothalamus is the body's master gland. The hormones it releases regulate body temperature and the volume of the blood plasma (the fluid in ,,'hich red and white blood cells float I. Some of these are transmitters which influence the secretion of other hormones from other glands. In addition, the hypothalamus helps the brain to decide whether a stimulus from outside is pleasant or painful and it also influences sexual behaviour. Other glands also affect temperament in different ways. For example, the thyroid gland, when over-active, results in over-anxiousness and rapid mood changes, while people with under-active thyroids tend to be slow and apathetic. These and other examples demonstrate how great a part glandular secretions play in regulating everyday moods, but it is also thought that they may have an even greater role - in the establishment of human character. Is it growing older that inhibits our willingness to stand out in a crowd? The singingof'The Red Flag' is traditional at the end of Labour Party conferences, but such public displays seem to suit some temperaments more than others (left). There is no aspect of behaviour which is not controlled in some way by hormones, Yet the idea that glands actually deter­mine temperament is now thought to be exaggerated. There are serious disorders of temperament in which hormones seem to play no part; manic depressive psychosis and schizophrenia, for instance. Moreover, although glandular activity does affect patterns of behaviour it is - equally true that there is no activity of a specific gland, or indeed of the entire autonomic nervous system, that cannot be upset by emotion. The example of blushing, in which the blood vessels suddenly dilate, is a good example. What is certain is that there is some interdependence between emotional states and hormonal activity. Temperament and physique Some 50 years ago the scientist E. Kretschmer noticed a striking difference in physique between people with different disturbances. He realized that while schizophrenic patients tend to be thin and ascetic in appearance, manic-depressive patients are broadly built and short. By means of observation and measurement he succeeded in demonstrating some affinity between illness and physique, and believed that the schizophrenic and the Bjorn Borg and John McEnroe ­both marvellous tennis players, but how different in temperament! Borg's steely calm seems to make him impervious to the tensions and dramas of the Centre Court and makes him a trul:y formidable opponent. The gifted McEnroe, on the other hand, is renowned for his explosive temper which frequently gets him into trouble with line judf{es and umpires. manic depressive were two extremes of two common personality types, with predispositions to different psychoses. Kretschmer's investigations have not withstood the test of time, but perhaps simply because people seem instinctively to classify people they meet in everyday life into types, researchers have con­tinued trying to discover a science of individual differences. In the 1940s, the American psychol­ogist W. H. Sheldon began a rigorous study not on abnormal human beings, but on people within the normal range of personality types. 'Tradition has it', he pointed out, 'that fat men are jolly and generous, that lean men are dour, that short men are aggressive and that strong men are silent and confident.' Sheldon began his investigations by photographing 4000 nude men, all of a similar age, in identical poses and in controlled conditions. From comparisons of measurements taken from five different regions of the body he produced his now familiar theory of physical types. Endomorphs, he stated, are people who are predominantly round and fat. Meso­morphs, in contrast, have a pre­dominance of bone, muscle and connec­th-e tissue in their body and, in ever. greater contrast, ectomorphs are predominantly fragile and elongated in physique. During his investigations he inter­\'ie\wd and closely observed each of the ,±GOO men on successive occasions. When he had produced his theory of physique he \,'em on to compare the data from these inten'ie\,'s to see if it was possible to distinguish any correlation between physique and personality. Endomorphs. he discovered, tend to exhibit a predominance of relaxed. friendly, pleasure-loving traits. They live, as it were, by and for the digestion- Studies linking body type to temperament maintain that athletic mesomorphs are vigorous, outgoing souls - full of life. loving food and often disliking exercise ­and needing companionship, even when troubled. He called this personality type viscerotonia. The mesomorph, in contrast, is the vigorous outdoor type of person, adventurous and dominating, and not only loving, but needing, daily physical activity. This type of person tends to be direct and outgoing, but not necessarily intellectual. He called this type somatotonia. The ascetic ectomorph tended to be intellectual and introverted, often shy and ill at ease, and often disliked exercise. This type was indifferent to company and food and the social ceremony that accompanies eating in most societies. Sheldon called this type of personality cerebrotonia. Since the characteristic of each type in Sheldon's scheme could differ from individual to individual - a need for solitude, for example, being characteris­tic of cerebrotonic types, but stronger in some than others - each individual was assessed numerically according to his individual trait. The pattern expressed in the resulting number became the indi­vidual's somatype. Sheldon's research makes absorbing reading, but it has been criticized as being over-simplified, since it merely considers personality traits and fails to discuss their organization in the per­sonality as a whole. However as psychology as a science advances, students of behaviour are Round and chubby endomorphs are supposedly not so keen on physical exercise - what they really relish is their food. tending more and more towards specialization in 3Uch matters as the investigation of a brain function, or a specific personality trait. In this context, Sheldon's attempt at a 5cientific explora­tion of temperament is an invaluable work which has gi\'en rise to many theories. Illness and temperament The idea that people's emotions pre­dispose them to certain types of illness is a belief older than the doctrine of humours, but its investigation is a new branch of science. Ancient Chinese medicine postulated that the body is an integral mechanism in which inconsistencies contradict each other. Contradictions of mental and emotional activity caused by the influences of society and the natural environment may cause disease, or hasten its development. Emotions as diverse as joy, excitement, happiness, anger, fright and sorrow under most conditions will not cause disease, but under some they can damage normal body functions and cause neurosis or functional disturbances. Also, body­build, bodily reactions and individual differences of age, sex and resistance can predispose people to disease. This way of thinking about the human body, which has persisted in China until today - though modified by new know- Ectomorphs have a fragile frame and in theory tend to be introverted, intellectual, tense and rather ill at ease in company. ledge and new theories - has begun to influence modern Western medicine. It has given rise to theories correlating personality and disease, and has led to new concepts of psychosomatic medicine. One theory, for example, suggests that people with certain personality traits may be susceptible to certain diseases; such people are classified into 'biotypes'. Thus, the heart attack biotype is an achiever and competitor. His or her body is constantly prepared for 'fight or flight' and he may, as a result, have higher levels of hormones such as adrenalin and noradrenalin in the bloodstream. These mobilize fats and cholesterol from body tissues into the bloodstream, raise the blood pressure and increase the ability of the blood to clot. Excess cholesterol in the arteries soon leads to a heart attack. Other biotypes include people sus­ceptible to angina, ulcers or rheumatism. This branch of medicine does offer one solution: gradually to change the personality and the unconscious tenden­cies by changing the patient's life-style. Psycho-physiologists (those who study the relationship between mind and body) investigate individual differences and attempt to bring the branches together. These medical scientists are, in effect, trying to establish a method of measuring individual responses to emotional situations, cyclic events, stress and drugs, in order to discover the truth behind the observations of individual differences and the causes of temperament.     Taken from The Marshall Cavendish A  to Z GUIDE IN WEEKLY PARTS,  DOCTOR’S ANSWERS: PART 85, TEMPERAMENT, Page 23240 to 2345.   (Sorry. Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos in the  script have been left out)  , Although they are by far the most common of multiple births, twins still excite a great deal of wonder from parents and outsiders alike. What are the special problems of twinship and how should they be dealt with? Q What is the difference between identical and non­identical twins? A On a biological level, identical twins are the result of a single fertilized egg cell dividing into two identical cells which then separate and develop independently. Since both twins are derived from one sperm and one egg, they are genetically identical. Non-identical twins, on the other hand, are no more genetically similar than ordinary brothers and sisters. They develop from two different ova and have separate placentas. Q Is it true that Siamese twins are actually identical twins, and that they can be separated by surgery? A Yes, it is. In rare instances, identical twins can be born joined together, usually at the hip, chest or abdomen. Naturally they will be of the same sex, but may look radically different from each other. Sometimes they can be separated by surgery, but if they share a vital organ surgery will usually not be done. Q I've read that if one member of a pair of twins dies at birth his or her twin feels incomplete for the rest of his life. Is this true? A Yes. There have been reported cases where the dead twin had a lasting influence on the live twin, who lived with a dramatic sense of loss. In some instances this feeling of loss was diverted into a fantasy life which involved the dead twin, and this often influenced the pattern of the live twin's future relationships. Q Is it possible for identical twins to look so alike that you can't tell them apart? A Yes. A celebrated case was that of the 'Toni Twins' - identical twins who appeared in a series of advertisements in the 1950s. They underwent a series of tests twenty years later, and it was found that not only did they still look identical, but their fingerprints were the same, blood pressure readings were the same-even the cholesterol levels in their bodies were identical! Fraternal twins In a normal pregnancy only one ovum or egg is fertilized. However, if two ova are fertilized at the same time, fraternal or non-identical twins will be born. These twins may be of the same or different sexes, and can be as dissimilar to each other as any pair of siblings. This is because they grow from two separate egg cells fertilized at the same time. The tendency to give birth to fraternal twins is inherited, especially through the mother's side. They tend to miss every other generation so that children of dizygotic twins are more likely to bear twins than to be born twins themselves. These twins also appear more frequently after the second pregnancy and if the mother becomes pregnant later in life. Research has shown that mothers aged 35-40 are three times likelier to have fraternal twins than mothers under 20. Identical twins In rare cases, if one ovum is fertilized, as in a normal pregnancy, but the resulting embryo divides at a very early stage and produces two embryos, monozygotic or identical twins will be born. Since these twins would originally have formed from the same ovum and sperm, identical twins will have the same genetic make­up; they will be of the same sex and have the same blood group, same build and the same physical characteristics. Occasionally some pairs of twins have the same characteristics in reverse: for example, the hair of one twin may part on the right, while the other's hair part naturally on the left. These twins come from a common egg cell that did not divide until it had developed left- and right-sided characteristics. Psychology of twins The psychological development of twins is a fruitful area of scientific research - in fact, studying pairs of identical twins has led to valuable insights into distin­guishing constitutional characteristics from those that are acquired. More often than not, twins are quite different psychologically. Even monozygotic or identical twins raised in the same environment may have very different personalities. However, if one twin has schizophrenia, the other twin - especially if he is an identical one - runs a higher risk of developing the same condition.  Very often, however, the bond between a pair of twins transcends any physical similarities. There are hundreds of 5tories, for example, of one twin feeling great pain when his or her twin has been hurt - even when they were miles apart. There are also accounts of one member of a pair of identical twins going through all the symptoms of childbirth when her sister was in labour. In fact, on a more basic level identical twin babies can show disconcerting psychological similarities. Often when one twin is reprimanded the other will act as if he or she is guilty as well. They will be happy at the same time, sad at the same time, bored in the same situations. In fact it is this constant process of identification with each other on the basis of their similarity of emotional experience which keeps identical twins 'identical' in spite of differences acquired in later life. Twins and individuality Some parents emphasize the twinship of their children by treating them as if they had no individuality: dressing them alike, giving them the same presents, or treating them as if they were one unit rather than two possibly very different individuals. This isn't very surprising ­the whole world is fascinated by twins, makes a fuss of them and likes them to look and dress alike. In some respects this could be dangerous: by throwing twins on to each other exclusively, the tendency of one twin to copy the other or become dependent on him or her increases. This may overstress the twins' normal identification with each other and thus produce a team relationship which may estrange them from their surroundings. Emotional disturbances may develop, especially if for some reason the twins have to be separated. Even so, parents should not be afraid to dress their twins alike or to enjoy the attention the twins get because of their similarity - provided that it's kept in perspective. Twins. in fact, can develop great strength of personality from being twins, a capacity for playing together independently of their parents. Feeding twins can be a problem. The majority of parents have found that it is essential to try to get the twins on to a schedule as soon as possible, and to feed both babies at once or one right after the other, or else they will be feeding all day and all night. Breast feeding is entirely feasible: as soon as the babies can nurse they can be put to breast together, either lying across their mother's arms or in her lap, one on top of the other, with heads at opposite sides. Problems with twins The mortality rate of twins in the womb is higher than that of single foetuses. This is because life in the uterus for the twins tends to be more difficult and twin preg­nancies are often associated with complications. Twins are also more prone to growth retardation and there is a higher rate of mental subnormality and congenital problems. Identical twins may run a higher risk of such diseases as leukaemia.                           The odds against twins reaching 100 years of age are a staggering 700 million to one, but these American twins - pictured together at the turn of the century and celebrating their centennial birthday - have defied those odds! Twinship taken to a happy extreme: these two pairs of twins met at a party, were married at a double wedding and lead virtually identical lives. Non-identical (fracternal) twins result from two separate eggs that are fertilized at the same time by two separate sperm. Each twin develops its own placenta. Identical twins result when a single egg is fertilized and later divides. These twins usually share the same placenta unless the cells separate at an early stage of development.     Taken from The Marshall Cavendish A  to Z GUIDE IN WEEKLY PARTS,  DOCTOR’S ANSWERS: PART 90, TWINS, Page 2481 to 2483.   (All photos in the  script have been left out)., , , We have joined a growing community of therapists around the world who are collaborating with children and families in ways that allow all of us (therapists, children, and parents alike) to be lighthearted, humorous, and creative--and yet surprisingly effective in resolving many of the problems that we face today. In our view, the developments collectively known as narrative therapy offer some unique and helpful perspectives to the field of child and family therapy. The term narrative implies listening to and telling or retelling stories about people and the problems in their lives. In the face of serious and sometimes potentially deadly problems, the idea of hearing or telling stories may seem a trivial pursuit. It is hard to believe that conversations can shape new realities. But they do. The bridges of meaning we build with children help healing developments flourish instead of wither and be forgotten. Language can shape events into narratives of hope. We humans have evolved as a species to use mental narratives to organize, predict, and understand the complexities of our lived experiences. Our choices are shaped largely by the meanings we attribute to events and to the options we are considering. A problem may have personal, psychological, sociocultural, or biological roots--or, more likely, a complex mix of the above. Moreover, young persons and their families may not have control over whether a certain problem is in their life. But even then, how they live with it is still within their choice. As Aldous Huxley once said, "Experience is not what happens to you. It is what you do with what happens to you." A PLAYFUL APPROACH It has continued to astonish us how resourceful, responsible, and effective children can be in facing problems! Externalizing language separates children from their problems and allows a lighthearted approach to what is usually considered serious business. Playfulness enters into a family therapy when we narrate the relationship between a child and a problem. When adults and children collaborate actively play is a mutual friend. It inspires children to bring their resources to bear on problems and make their own unique contributions to family therapy. Playful approaches in narrative therapy direct the focus away from the child as a problem and onto the child-problem relationship in a way that is meaningful for adults as well as intriguing, not heavy-handed or boring, for children. EXTERNALIZATION "The problem is the problem, the person is not the problem" is an oft quoted maxim of narrative therapy. The linguistic practice of externalization, (White, 1988/9; White & Epston, 1990a) which separates persons from problems, is a playful way to motivate children to face and diminish difficulties. In a family, blame and shame about a problem tend to have a silencing and immobilizing effect. Moreover, when persons think of a problem as an integral part of their character or the nature of their relationships, it is difficult for them to change, as it seems so "close to home." Separating the problem from the person in an externalizing conversation relieves the pressure of blame and defensiveness. No longer defined as inherently being the problem, a young person can have a relationship with the externalized problem. This practice lets a person or group of persons enter into a more reflective and critical position vis-à-vis the problem. With some distance established between self and problem, family members can consider the effects of the problem on their lives and bring their own resources to bear in revising their relationship with it. In the space between person and problem, responsibility, choice, and personal agency tend to expand. This practice also tends to create a lighter atmosphere wherein children are invited to be inventive in dealing with their problem, instead of being so immobilized by blame, guilt, or shame that their parents are required to carry the full burden of problem-solving. As White (1988/9, p.6) has commented, externalizing conversation "frees persons to take a lighter, more effective and less stressed approach to 'deadly serious' problems." Soiling was one of the first problems to be externalized by Michael White (1984; 1989). In a straightforward externalization encopresis was renamed "Sneaky Poo." Encopresis is a medical diagnostic term; in itself there is nothing wrong with it. However, the grammar that we use in speaking with and about young people has certain effects. To say that "Tom is encopretic" is to imply something about his identity. To say that "Tom's problem is that he soils his pants" is accurate, but it may be adding shame to an already humiliating situation. To say that "Sneaky Poo has been stinking up Tom's life by sneaking out in his pants" is a more gamesome way to describe Tom's relationship with the problem of soiling. It is more likely to invite Tom's participation in the discussion of his problem. It can also evoke a more sportive stance for Tom vis-à-vis the problem, as we can now talk about how "Tom can outsneak Sneaky Poo and stop it from sneaking out on him." Tom no longer has to be a different kind of person from the one he understands himself to be. In fact, revising his relation with such a problem as "Sneaky Poo" may very well confirm him as being just the right kind of person for the job at hand--"outsneaking Sneaky Poo." Standing as an alternative to the diagnosis and treatment of pathology, the focus in an externalizing conversation is on expanding choice and possibility in the relationship between persons and problems. Roth and Epston (1996, p. 5) write: In contrast to the common cultural and professional practice of identifying the person as the problem or the problem as within the person, this work depicts the problem as external to the person. It does so not in the conviction that the problem is objectively separate, but as a linguistic counter-practice that makes more freeing constructions available. When they enter therapy overwhelmed by a problem, members of the family may expect that the clinician will discover further underlying conflicts in their minds or relationships. Therapists take an active role in shaping the attributions that are used to describe young persons and families and to explain their problematic situations, and when a therapist listens to, accepts, and then furthers the investigation of a pathological description of a child, the child's identity may suffer. When a problem is externalized, the attitude of young people in therapy usually shifts. When they realize that the problem, instead of them, is going to be put on the spot or under scrutiny they enthusiastically join in the conversation. Relief shows on their faces. Their eyes light up, as if to say, "Yeah, that's it, that's how I look at it. It's not my fault." They are then in a position to acknowledge that the "problem" happens to be making them and others miserable and to discuss matters with, at times, remarkable candor. Although in one sense it is a serious pursuit, we find this practice to be inherently playful and appealing to children. Maria sent Jenny a valentine card one year, with the caption "Poo Poo to Fear and Temper" and little drawings of each on the front. On the back was written "I like talking with you and I like calling fear and temper names. From Maria." Jenna, a nine-year-old once wrote in relation to a mask she had made of "The Trickster Fear": 'You're no longer nothing . . . being nothing made it hard to know you. Once you're named, you can be known and conquered!" EXTERNALIZATION AND CHILDREN'S IDENTITY FORMATION Aside from their understandable opposition to being blamed or shamed, perhaps children are showing common sense in resisting being defined by descriptions that imply that their identities are limited or fixed. Even adults do not find rigid negative descriptions of themselves particularly motivating toward change. Why shouldn't children resist a fixed adult-imposed definition or a normative characterization? After all, identity remains exploratory and relatively fluid well into adolescence. Viewing the child as facing rather than being a problem is a helpful start to preserving the fluidity of identity formation. Externalization seems a natural fit for many children. It is compatible with the way they typically approach difficulties in the dynamic learning environment of play. In play, along with hats, costumes, and accents, multiple perspectives and roles are tried on during "dressup" and other games. This fluidity allows the child to explore variations of attitude, identity and behavior--to try out the emotional flavor of the moment or day. In fact, when a child's play is repetitive, ritualistic, or confined in its range of roles and behaviors, we may wonder about abuse or other severe interruptions to developing identity. For the child, externalization is like playing a game of "pretend." Implicitly, or sometimes even explicitly, we are saying to the child, "Let's pretend the problem is outside yourself and we'll play with it from there." As Paley (1990, p. 7) writes, "'Pretend' often confuses the adult but it is the child's real and serious world, the stage upon which any identity is possible and secret thoughts can be safely revealed." As therapists, we have been especially trained in the use of words. But practicing the language of externalizing conversations is for us, as for many others, not so much about learning a technique as about developing a particular way of seeing things. As Roth and Epston (1996a, p. 149) write: We do not see externalizing as a technical operation or as a method. It is a language practice that shows, invites, and evokes generative and respectful ways of thinking about and being with people struggling to develop the kinds of relationships they would prefer to have with the problems that discomfort them. We have noticed some benefits for us personally. Focusing our attention on values, hopes, and preferences, rather than on pathology, we find ourselves less fatigued by the weight of the difficulties we encounter. Since we can now put the problem in the spotlight, we can be more forthright in our questions and comments. As well as allowing us to connect with children "where they live," this practice stimulates our creativity as well. This approach is distinct from most open, unstructured play therapy, in that we collaborate closely with children in play that is actively focused on facing a problem. Children's sense of effectiveness as agents of change clearly increases when they experiment with possibilities in relationship to an externalized problem. In therapy with families the play is mainly with words, using humor wherever possible! But an externalizing conversation is easily enhanced with other forms of expression favored by children, such as play and expressive arts therapy. SELECTED READINGS (Emphasis on children) Epston, D. (1986). Nightwatching: An approach to night fears. Dulwich Centre Review, 28-39. Epston, D. (1989). Collected papers. Adelaide, Australia: Dulwich Centre Publications. Epston, D. (Autumn, 1989a) Temper tantrum parties: Saving face, losing face, or going off your face! Dulwich Centre Newsletter, 12-26. Epston, D. (1993). Internalising discourses versus externalizing discourses. In S. Gilligan & R. Price (Eds.), Therapeutic Conversations (pp. 161-177). New York: Norton. Epston, D. (1994). Extending the conversation. Family Therapy Networker, 18(6), 31-37, 62-63. Epston, D., & Betterton, E. (1993). Imaginary Friends: Who are they? Who needs them? Dulwich Centre Newsletter, 2, 38-39. Epston, D., & Brock, P. (1989). Strategic approach to a feeding problem. In Epston, D. Collected Papers. Adelaide: Dulwich Centre Publications. Epston, D., Morris, F., & Maisel, R. (1995). A narrative approach to so-called anorexia/bulimia. In Weingarten, K. (Ed.),Cultural Resistance: Challenging beliefs about men, women, and therapy . (pp. 69-96). New York: Haworth. Epston, D. & White, M. (1992). Experience, contradiction, narrative, and imagination: Selected papers of David Epston & Michael White, 1989-1991. Adelaide, Australia: Dulwich Centre Publications. Epston, D., & White, M., & "Ben" (1995). Consulting your consultants: A means to the co-construction of alternative knowledges. In S. Friedman, (Ed.), The reflecting team in action: Collaborative practice in family therapy. (pp. 277-313). New York: Guilford. Epston, D., Lobovits,D., & Freeman, J. (1997). Annals of the "new Dave". Gecko, v.3 Freedman, J., & Combs G. (1996). Narrative therapy: The social construction of preferred realities. New York: Norton. Freeman, J., Epston, D. & Lobovits, D. (1997). Playful approaches to serious problems: Narrative therapy with children and their families. New York: Norton. Freeman, J. C., & Lobovits, D. H. (1993). The turtle with wings. In S. Friedman (Ed.), The new language of change: Constructive collaboration in psychotherapy. (pp. 188-225). New York: Guilford. Lobovits, D. H., Maisel, R., & Freeman, J. C. (1995). Public practices: An ethic of circulation. In S. Friedman (Ed.), The reflecting team in action: Collaborative practice in family therapy. (pp. 223-256). New York: Guilford. Lobovits, D., & Prowell, J. (1995). Unexpected journey: Invitations to diversity. Paper from workshop presented at"Narrative Ideas and Therapeutic Practice," Fourth International Conference, Vancouver, BC. Lobovits, D. & Freeman, J. (1997) Destination Grump Station, Getting Off the Grump Bus. In D. Nylund and C. Smith (Eds.)Narrative Therapy with Children and Adolescents. New York: Guilford Press. Roth, S. & Epston, D. (1996). Developing externalizing conversations: An exercise. Journal of Systemic Therapies, 15(1), 5-12. Roth, S. & Epston, D. (1996a). Consulting the problem about the problematic relationship: An exercise for experiencing a relationship with an externalized problem. In M. Hoyt (Ed.) Constructive therapies: Volume 2., (148-162). New York: Guilford. Seymour, F. W. & Epston, D. (1992). An approach to childhood stealing with evaluation of 45 cases. In M. White & D. Epston (Eds.) Experience, contradiction, narrative, and imagination: Selected papers of David Epston & Michael White, 1989-1991. (pp. 189-206). Adelaide, Australia: Dulwich Centre Publications. White, M. (1985). Fear busting and monster taming: An approach to the fears of young children. Dulwich Centre Review. White, M. (1986). Negative explanation, restraint and double description: A template for family therapy. Family Process, 25(2), 169-184. White, M., (Winter,1988). The process of questioning: A therapy of literary merit? Dulwich Centre Newsletter, 8-14. White, M. ,(Spring, 1988a). Saying hullo again: The incorporation of the lost relationship and the resolution of grief. Dulwich Centre Newsletter, 7-11. White, M. (1988/9). The externalizing of the problem and the re-authoring of lives and relationships. In M. White (Ed.),Selected Papers . (pp. 5-28). Adelaide, Australia: Dulwich Centre Publications. White, M. (1989). Pseudo-encopresis: From avalanche to victory, from vicious to virtuous cycles. In Selected Papers.Adelaide Australia: Dulwich Centre Publications. (pp. 115-124). Original work published in 1984, Family Systems Medicine, 2(2). White, M. (1991). Deconstruction and therapy. Dulwich Centre Newsletter, 3, 21-40. White, M. (1993). Commentary: The histories of the present. In S, Gilligan & R. Price (Eds.), Therapeutic Conversations (pp. 121-135). New York: Norton. White, M. (1995). Re-authoring lives: Interviews and essays. Adelaide, Australia: Dulwich Centre Publications. White, M., & Epston, D. (1990). Consulting your consultants: The documentation of alternative knowledges. Dulwich Centre Newsletter. 4, 25-35. White, M., & Epston, D. (1990a). Narrative means to therapeutic ends. New York: Norton. http://www.narrativeapproaches.com/narrative%20papers%20folder/arts_process.htm Narrative Therapy with Children and their Families May 2000 Expressive Arts Workshop Materials © Jennifer Freeman M. F. C. C. , R. E. A. T.  http://www.narrativeapproaches.com/narrative%20papers%20folder/narrative_therapy.htm MULTI-MODAL NARRATIVE/EXPRESSIVE PLAY   Meditate: Guided relaxation. Be centered, contact inner wisdom/resourcefulness. Find a still/empty space. Allow an externalized problem to present itself. NB: It is OK if during the process, the problem changes or mutates. Best to just trust the process and find out what you can learn from this.It is optional to share with a partner at points throughout. Journal: Option I Consider these questions and take a few brief notes:How does this problem oppress you and limit your experience of yourself; relationships; actions and choices? How did the problem, like a weed, take hold in your life? What is the soil it grew in? (E.g. social /cultural--gender, class, race, socio-economic--messages and practices). How would you prefer things to be? Option 2: Have the problem write/tell a brief description of you, or tell your story from its point of view. E.g.: This is the way I (the problem) see Jack/Jackie. This is what I get him to be and do. This is what I keep her from doing. Here's what I need from him/her to keep me going. My main underpinnings are (social ideas /ideologies and practices; other habits, problems or ways of thinking e.g. perfectionism supported by insecurity). Let me tell you if there are times I am friend to him/her and when I am foe. Draw: the influence or effects of the problem on your life. Suggestions: #Your own inspiration. #A symbolic drawing. #A map of the problem's influence. #A cartoon series showing different areas of effect. # An intuitive drawing using your non-dominant hand and showing the influence of the problem in shapes and colors. Movement: Relax and play. Walk around in an everyday way. Now let the problem influence your walking. What happens when the problem is in charge? Notice your posture and breathing. Develop into a movement. What sounds emerge? Develop a transitional movement that loosens the grip of the problem. Explore pathways out of the problem into a preferred state. Expand into a movement of liberation. Draw: Your preferred relationship with the problem-- relatively free or empowered. Journal: 1. Jot down some notes Think of a time when you were able to have a better relationship with the problem, when you felt empowered or were free of it. Does the movement remind you of this? What relationship do you prefer to have with the problem that you have experienced before, or would like to experience more of? What becomes possible when you hold this image of yourself? 2. Now describe yourself as a loving friend might from the "alternative knowledge" or empowered point of view (rather than the problem's point of view). Try to incorporate past, present and future into your story. Relax & visualize: how do you imagine your life as you continue to embrace this direction in a week, or in a few years. What possibilities open up for you? Receive an eidetic image or symbol of this preferred relationship and healing and thank your inner guidance. Share with your partner or reflect in journal: What was meaningful to you in this exercise? What possibilities do you sense for yourself in your work?, Three essential strokes One minute each, fifty repetitions Mixed percussion Fast friction Walking the back The Coffee Break Vs. the Massage Break If your partner has been depending on stimulants for a pickup during the day, mas­sage will open up a new world of possibilities. The following strokes are ideal for hard­working people who want a quick energy boost -without a crash afterward. In the kitchen, living room, or office, a variety of percus­sion and friction movements, none of which require oiling or special preparations, can be used to alter your partner's mood. In fact, major changes start happening inside the body even before you finish massaging. In minutes, as oxygen levels throughout the massaged area climb, fatigue is diminished and a wonder­fully energetic feeling takes its place. Stiffness in the mus­cles and joints yields to the sort of fluid ease one usually experiences after a strenuous physical workout. Finally, as acids are flushed out of the tissues to be replaced by oxy­gen-enriched blood, irritabil­ity gives way to an optimistic can-do attitude. The effects are particularly impressive in situations where people must sit and concen­trate for long hours at a tele­phone, typewriter, or com­puter. As fatigue departs, endurance levels are dramati­cally improved. Apple Com­puter, Pacific Telesis, and Raychem, to name just a few. Do Schedule the massage when your partner is not likely to be inter­rupted. Be punctual. Get feedback on stroke and pressure preferences. Appear confident and organized. Bring with you everything you will need. Take whatever simple steps are possible to quiet the environment. Take all of your partner's requests seriously. Leave quietly as soon as the massage is finished. Don't Massage while your partner does something else. Don't get flustered if interruptions do occur. Encourage conversation. Comment on how tense your partner seems to be. Randomly explore your partner's body - people dislike being probed. Impose a complex routine of strokes to impress your partner. Introduce complicated rules or exotic theories. Needlessly take up your partner's time. Team Massage The most common problem one encounters when massag­ing busy executives is the overbooked itinerary. If your partner is too busy to sit still for a massage, try ganging up on her. Two pairs of hands can deliver twice as much sensation as one. The feeling of four hands thundering up and down the back during a pounding movement is so overwhelming that even the most self-absorbed type will stop talking and surrender to massage. They always thank you afterward. The Office Pillow If you can't locate a lounge in which to sprawl out, the mas­sage pillow becomes very important. With it, percus­sion and friction strokes for the upper back, the staple of on-the-job massage, become much more effective. Every worker needs a pillow large enough to support the full weight of the upper body when placed across the sur­face of a desk. Subdued col­ors are most inviting. The pillow should give good sup­port during any of the com­mon percussion movements, but remain firm enough to retain its shape. A removable cover makes occasional oiling possible, although a large towel can serve as well. Some offices have nothing at all that can be used as a mas­sage pillow, so it's wise to inquire ahead of time and provide one, if necessary, whenever you do massage at work. Mixed Percussion Percussion strokes are prob­ably the easiest to prepare for in massage. Don't bother hav­ing your partner lie down or remove any clothing; just grab a pillow and you're ready to go. In fact, if no pillow is handy, the head can be sup­ported on the hands without seriously compromising the stroke. For offices without lounges, or for a quick burst of energy around the house, nothing satisfies like a few minutes of intense percussion. Move up and down the back on both sides of the spine, but stay off the spine itself. Save your greatest pressures for the thickest muscles at the top of the back and across the shoulders. Generally, these movements are more effective over the rib cage, where bones provide a kind of natural cushioning effect. If you move to the lower back, follow the elevated ridge of muscles that runs parallel to the spine. Be care­ful not to pound on your part­ner's kidneys. Choose a per­cussion speed that you can comfortably maintain for a while. Rhythmic consistency is more important than raw speed. Start with pounding, the most intense percussion movement, and let it give way to a more gentle full hand cupping stroke Your partner may want to direct the percussion to a specific part of the back, listen for feedback. If nothing is actually said, remember that pleasurable moaning means that what you're doing feels good - keep it up for a while. Percussion strokes set up a vibration that carries right through the body. Work on the back for two or three minutes, and the feeling goes on after you stop. Fast Friction Immediately after percus­sion, while your partner is still relaxing on a pillow, try some fast friction. It's the per­fect stroke for that stiff neck or nagging pain at the top of the back. This energetic, immensely versatile friction variation can be used on almost every part of the body. It penetrates easily through clothing and works in nearly any setting, making it ideal for on-the-job massage. Fast friction is one of the rare mas­sage strokes that takes some real effort to sustain. How­ever, the extra exertion is always appreciated; no other stroke in massage produces a more intense feeling. It's shown here on the top of the back, the area most fre­quently requested by office workers, but the stroke is equally effective on any fleshy part of the body. The key to successful fast fric­tion is good anchoring, with­out which the mOvement becomes sloppy and random. To cover the whole upper back, push down between the shoulder blades with the flat surface of one hand, then work up to the lower neck. Anchor near the shoulder, pushing flesh toward your friction hand. You'll need to reposition your anchor hand frequently dur­ing fast friction. Rotate the friction hand while pressing down moderately hard. Re­member: friction strokes turn on the interior tissues, not the surface of the skin. You will feel the muscular interior of the upper back as you turn. Press in constantly with your anchor hand to confine the movement to the area under your friction hand - you don't want to shake the entire body. Your partner should feel an intense vibration that is confined to a single spot. Once you get the feel of the stroke, try increasing the speed. Fast friction can move almost as fast as you're able to go, but never push it to the limit - you'll have trouble sustaining the speed and con­trolling the stroke. Check with your partner to find out just how much speed he likes. Raking the Back Generally, most massage strokes stay off the spine itself, focusing instead on nearby muscle groups. When­ever they get tight, the long muscles that run parallel to the spine pull directly on spinal nerves. Repeated fre­quently enough, this stroke will go a long way toward relieving direct muscle pres­sure to the spine that keeps the nerves irritated. Have your partner lean for­ward and support the weight of his head either on his arms or a desktop pillow. Forming a rigid arch with both hands, begin stroking down both sides of the spine with your fingertips. Keep your fingers flexed and rigid throughout this stroke. That way you can glide across the surface of clothing while penetrating deep within. Start at the neck and pull straight down in a series of alternating, foot-long strokes. The stroke moves slowly down the back, cover­ing every portion five or six times. When you reach the bottom of the spine, start again from the top. Rake the whole back at least three times. Walking the Back Traditional back walking works only if you're consider­ably smaller and lighter than your partner. With a bit more effort much the same effect can be created using the fists. In fact, you can feel tensions with the hands that would go unnoticed beneath the feet. As your hands travel up and down the back, pressures can be directed with great preci­sion - you can actually feel tensed muscles begin to relax. This movement follows the same path you took during the raking stroke. You can stand directly behind your partner and do both sides of the spine at once. Make a fist and press the flat part of the knuckle into the long muscles that run parallel to the spine. As your fist sinks into the muscle, roll it for­ward slightly, pressing down hard as you roll. Start at the base of the neck with one fist, then repeat the movement immediately below with the other. Move all the way down the spine, pressing down first with one fist, then the other. Do each side of the spine twice; more if your partner asks for it. They usually do. Quick Friction for the Arms and Hands Although the hands and arms are used constantly at work, we tend to ignore their aches and pains, focusing instead on the shoulders or lower back. Given just five minutes to work, most masseurs will settle for the lower back and shoulders. Before you do, look closely at your partner's job. Are typing, computer work, or extended telephone conversations required? After massage, the feeling of new­found energy will be just as invigorating in the hands and arms as in the high stress areas of the back. This stroke also provides an excellent introduction to on­ the job massage. Even the most harried executive can be persuaded to rest an arm on the desk for a few minutes, or better yet, collapse on a couch in the company lounge. To massage the shoulders, circle your partner's wrist and pull it straight out until the whole arm is extended. Then rotate the same flat part of your knuckle on the muscular shoulder top. Remember: you need only a few minutes to get the fluid release effect started. With your partner lying on her back, anchor her extended arm at the wrist and press down on the fore­arm with the flat surface of your knuckle. Rotate slowly, moving up and down the arm from the wrist to the shoulder. Ease up over the exposed blood vessels at the wrist and inside the elbow, reserving your real pressures for the muscular forearm. Rotating the Bones of the Arm and Hand When was the last time your partner had her bones rotated? The hand is operated by remote control via long ten­dons and bones that begin at the elbow. As the hand and arm turn, the two descending bones, the radius and ulna, demonstrate one of the more extraordinary aspects of human anatomy by actually crossing at the center of the forearm. During massage, however, the bones of the forearm can be made to cross while simply rotating the complex joint at the wrist. Just as an effective foot mas­sage starts up at the knee, massage for the hand must consider parts of the body between the wrist and elbow. Grasp your partner's hand around her loosely clenched fingers (as shown on p. 138) and rotate the wrist once just to test the limits of the turn­ing arc. Pay close attention to the real limits of the arc, which will change several times in a single rotation. As you turn the wrist, the bones of the forearm will cross and uncross themselves. Rotate the hand three times in each direction. Then grasp your partner's hand tightly between both of your hands, keeping your thumbs on top and rotate your hands slowly. The bones inside her hand will move with your hands. Massaging on a couch, you can rotate the bones of her other hand by simply reaching across her body. There's no need for your partner to move at any time during this stroke. You do all the work for her. Throwing the Arm Here is the perfect movement to break the monotony of desk work. While an arm flies through the air, your partner does nothing at all. The large ball joint at the shoulder is vigorously exercised as circu­lation throughout the limb is stimulated. Lift your partner's arm first above the elbow, then at the wrist, until it's straight up in the air. Con­tinuing to hold steady at the wrist, bring the arm up over her head until you feel resis­tance. Then move the wrist and arm all the way down to a point near her waist. Move the arm back and forth sev­eral times until you are com­pletely familiar with the limits of the arc. Only then are you ready to begin the throwing part of the move­ment, starting with a small arc and enlarging it gradually. With your partner's arm fully extended, toss the wrist from one hand to the other. As you increase your throwing arc to the previously established limits, increase the speed. Let your arm give way a bit each time you catch your part­ner's wrist. Reach across your partner's body to throw the other arm. This is the fastest passive exercise. Arm throwing-a thriller. Real and Imaginary Massage Our Puritan heritage has assigned all physical contact between adults to two rather narrow categories: sexual or commercial. You're either making a sexual advance or you're making money when you touch other adults. Those engaged in commercial touch­ing are careful to remain as impersonal as possible lest they be accused of making a sexual advance. This unfortu­nate stereotyping has created serious confusion in the mas­sage profession. We have mas­sage as a familiar euphemism for prostitution vs. massage therapy in which the body is manipulated as impersonally as a collection of auto parts. Real massage, the kind that has been practiced every­where on earth since biblical times, is a sensual art: it works because it feels good. Sensuality is part of the wide spectrum of human feeling between sex and therapy. We live in a society that tries to deny its existence. In massage, this denial has created some bizarre imita­tions. A prostitute posing as masseuse fiddles around with a leg or an arm for a minute or two before getting down to business. The customer really didn't expect massage and none was offered. But the massage therapist posing as doctor has even less use for real massage. Any gadget that will confer authority on the practitioner and distance him from the sensual is embraced wholeheartedly. High-speed electrical devices, magnets, bits of stone, and vials of un­certain chemicals are solemnly pressed against the body. Hands are waved back and forth in the air in order to "balance" mysterious forces. When flesh finally does meet flesh, it's always to demon­strate an exotic theory, never simply to please. Bursts of nasty finger-poking alternate with violent manipulation of the joints because "blocked energy" must be liberated. Strokes wander aimlessly across the body, departing from the map of the circula­tory system, from nerve paths, and, finally, from all known systems. As the confu­sion mounts, charts covered with exotic oriental characters are rolled out, indicating that dozens of independent lines converge on the bottom of the spine, the side of an ear, or the back of one toe. And of course the magnets and bits of stone converge on those spots with full liturgical ceremony. Through it all the practi­tioner advances relentlessly on his helpless "patient;' self­righteously poking, jabbing, and pulling at the body in the name of "healing:' In man­ner, if not in practice, the therapist seeks to emulate the high priests of the medical profession (usually his sworn enemies). Ask a question and the authoritative bullying begins: your therapist knows things you don't know about: "meridians;' "auras;' "energy imbalances;' and "pressure points:' It's all very mysteri­ous and complex, and if it hurts, well ... it's good for you. Quackery, not prostitution, is the biggest problem facing massage today. We're in the process of rediscovering an ancient health principle that can enrich our lives, but for many people the quack and his spooky bag of tricks will be the first and last contact with massage. The human body, perhaps the most com­plex arrangement of matter in nature, remains a mystery to the quack. He usually has little understanding of anat­omy and no appreciation for the simple, sensual beauty of massage. Those who love massage understand that something primal pervades the experience - this is one of the most ancient human activities. Unfortunately, so is quackery. Thousands of years ago, when people massaged by the light of open fires, bead strokers and body pokers con­centrated on purging the body of evil spirits. Proving? That, in quackery, little has changed over the past few millenniums; self-promotion remains far more important than healing. The quack has always sought power by trans­forming the body into a supernatural freak show that only he can understand. But there is a gray zone, too, between quackery and real massage. Many earnest prac­titioners, concerned that their efforts will be confused with prostitution, go to great lengths to "dignify" massage. The airs and exotic terminol­ogy are usually abandoned the moment a partner begins to sink into that profound state of relaxation that only real massage can bring. How to Find a Good Professional Masseur Thinking of hiring a profes­sional masseur for yourself or your company? The rewards are great, but it pays to shop carefully. The right masseur, or team of masseurs, can change the whole working environment for a small or large company. Employees are happier, more relaxed; the workplace becomes a pleasant environ­ment where one feels good. Absenteeism declines, and productivity, that elusive goal, goes up. Do something this nice for your employees, and they're going to return the favor. How much is stress costing you? Are your employees attempting to tack ambitious exercise programs onto the workload - failing - then turning to drugs to relax? Professional massage is less expensive and time-consum­ing than any of the standard medical services. You'll see dramatic results after just five minutes of massage two or three times a week; each ses­sion takes less time than the average coffee break. If stress is a serious problem at your company, massage can be­come a kind of preventive medicine, permitting the doc­tor to do other things. Which would you rather pay: the masseur or the workman's compensation claims? The number of good profes­sional masseurs is growing every year, but with no stan­dardized licensing proce­dures, you have no way of knowing what to expect until the massage begins. Never­theless, setting up a corporate massage program is one of the most pleasant tasks in business, simply because the interviewer will be massaged by so many of the job appli­cants. But there's more to the interviewing job than collaps­ing on a couch in your office while your neck and shoul­ders are kneaded. Use the following guidelines to pick the right professional for your company. First, find out if any com­panies in your area have already set up massage pro­grams - their recommenda­tions are a good place to begin. Larger companies require a team of masseurs with a common philosophy­ program. Choose a program that's flexible enough to fit into your business day. If there's no separate lounge area in your company that can be used for massage, a team should be able to adapt to conditions in the office itself without causing any problems. If necessary, mas­sage can be going on at one desk while work proceeds at the next. Again, the best way to audition a masseur, once references have been checked and preliminary interviews completed, is on your own body. Each masseur should be able to continue any stroke for at least five minutes with­out breaking rhythm. Ideally, he (or she) should be as effi­cient and invisible as a good waiter. And as silent. If you're planning an extended massage program for a larger company, hire masseurs who keep simple records concerning the condi­tion and special needs of each employee. Finally, look closely at your masseur's gen­eral presentation. A calm, confident manner will help put your employees at ease, while an officious, overly busy approach will ruin the experience. A masseur should be clean, with carefully trimmed fingernails, and a pleasant personality. How do you separate the quacks from the serious masseurs? Beware of any prac­titioner who attempts to justify painful treatments in the name of massage. The quack shows up with an incomprehensible program that invariably in­cludes plenty of nasty poking and twisting "because it's good for you." At best the quack is annoying and a waste of time, worst actu­ally dangerous. Turn one loose in your office, and your employees become a testing ground for excruciating "body therapies;' thereby creating more, not less, work for the company doctor. The responsible practitioner, on the other hand, will respect your rights throughout a mas­sage (see "The Massage Bill of Rights"). It is, after all, your body, not a pet theory, that matters most. Above all a masseur must be flexible enough to meet your personal needs. This means that you should get exactly what you desire (even if it means skip­ping the masseur's forty­seven-point program). If you want your shoulders kneaded for five minutes straight, ask, and if you get an argument, move on to another masseur. Much the same criteria can be used to hire a personal masseur. Naturally, it becomes even more impor­tant to be sure the masseur will be sensitive to your own specialized needs. People come in various body types, and a good masseur will rec­ognize yours, immediately seeking out the trouble spots and lingering on the most pleasure-sensitive areas. Nevertheless, your request, if you feel like making any, should come first. And after­ward you should feel more relaxed than before.   Taken from SUPER MASSAGE, Simple Techniques for instant relaxation by GORDON INKELES (Author of the ART OF SENSUAL MASSAGE) Copyright 1988 Gordon Inkeles, first published in Great Britain in 1989 by Judy Piatkus (Publishers)Ltd of 5Windmill Street, London W1, Printed and bound in Great Britain by Butler & Tanner Ltd, Frome and London, Designed and produced by Jon Goodchild/Triad, Photographed by Gordon Inkeles, Illustrations by Sigga Bjornsson, Reprinted in 1989 and twice in 1990. Pages 132 to 143., , , , The acupuncturist corrects an imbalance in the body's energy flow, or Chi, by inserting needles at specific points. This woman is being treated for hay fever. A traditional Chinese acupuncture chart shows meridians, or channels of the body's energy flow, and pressure points. The bust below shows the meridians on the head and shoulders and the poi nts where the needles should be inserted. An ancient Chinese technique, acupuncture works by releasing the body's vital energy, known as Chi. Once this life force is flowing freely, a number of physical problems can be relieved, from headache to asthma. In China, Japan and many other parts of the Far East, it is one of the most common forms of treatment. It is particularly effective in dealing with pain and with specific physical problems, such as arthritis, asthma, headache and eczema. A VITAL FORCE Chinese medicine regards 'Chi' as the body's vital energy and it flows through channels called meridians. The meridians are separate from the circulatory or nervous systems. They are an independent network and have acupuncture points dotted along them. Chi comprises the two elements known as 'yin' and 'yang'. These are complex entities but yin can be regarded as the male principle. Its opposite, yang, is the female principle. In health, yin and yang are in a delicately fluctuating balance with each other. However, if they are thrown out of balance, the Chi can no longer flow freely through the body and the result of this is illness. The acupuncturist will study your eyes, skin and tongue to gain an impression of your general state of health. A pale tongue, for instance, may be a sign of a poor diet or anaemia. Acupuncture facts In 1979, the World Health Organisation recognized acupuncture as a successful treatment for 40 diseases, including ulcers, migraines and painful menstruation. Acupuncture has remarkable pain-killing powers and has even been used during surgery. This may be because, when a needle is inserted into an acupuncture point, the body releases its own natural painkillers called endorphins. The origins of this ancient technique are shrouded in mystery. The founder is thought to have been Shen Nung, also known as the Yellow Emperor, who lived around 2700BC. Acupuncture can be successful with patients suffering from emotional or psychological problems - such as anxiety and depression - as well as physical conditions.                           CAUSES OF ILL HEALTH The imbalance between yin and yang can spring from a variety of causes, such as poor diet, lack of exercise, bad posture, emotional strain and lack of sleep. If the flow of Chi is disrupted, it won't reach certain areas of the body and often a painful condition will develop there, such as sciatica. If the Chi is blocked, a build-up can cause inflammatory conditions such as arthritis or a migraine. A lack of Chi can lead to a lack of energy. The acupuncturist aims to set the Chi flowing freely. He looks at specific ailments as well as your breathing and your voice and then take 12 different pulses, six at each wrist, each of which relates to different functions of the body. Finally, he may ask you about your lifestyle and if your symptoms change at different times of the day. PRECISE POINTS Having made a diagnosis, the acupuncturist decides where the Chi has been disrupted and inserts sterile needles at the relevant acupuncture points. He may insert the needles around the problem area or in a different part of the body. For instance, he may treat a migraine by inserting needles in the hand, knee, foot or ear lobe. PAINLESS TECHNIQUE The actual treatment - inserting the needles - should not cause any pain. The acupuncturist may insert them just below the surface of the skin, or several centimetres deep. He may leave them in place, or he may rotate them in position. The needles may also be heated with a dried herb, moxa, on the tips - a process known as moxibustion. Treatments can last up to an hour and you will usually need a course, depending on the condition. Many people use acupuncture as a successful means of giving up smoking. It can also be used to treat other addictions - to alcohol, sleeping pills or other drugs.     Taken from THE HEALTH FILE  A Complete Medical Encyclopedia, A MARSHALL CAVENDISH REFERENCE COLLECTION by DR JOHN CORMACK, WEEKLY Australia, New Zealand, Malaysia Singapore Malta RSA Other Countries Namibia. DR JOHN CORMACK, BDS MB BS MRCS LRCP, is the medical consultant to The Health File. The senior partner in an Essex­ based practice, he is also a member of the General Medical Council and has written for numerous magazines and news­papers as well as for the medical press. He is a regular broadcaster on television and radio and has scripted a number of award-winning educational videos.   Copyright Marshall Cavendish 1995, Printed in Great Britain, Published by Marshall Cavendish Partworks Ltd, 119 Wardour Street, London WIV 3TD (Due to the urgency of education on this site, spelling will be corrected at a later stage….All photos and charts in the  script have been left out)., Keep a crystal near to hand and, it is claimed, you'll enhance your general well-being. Crystal healers may use up to 50 different types of crystals to treat different conditions. Your own personal crystal is thought to help  keep  your natural energy forces in balance, thus  maintaining good health. Crystals placed on the energy points or 'chakras' of the body are thought to amplify the body's own healing process. The idea of curing pain with a lump of rock may sound far-fetched, but precious stones have been used for healing since ancient times and many people believe they are just as effective today. Why would someone take ci;)ian amethyst to bed with .. them, unless they had forgotten to take off their jewellery? The reason is simple, if unusual: putting a lump of amethyst under your pillow is the prescription for insomnia recommended by healers who work with crystals. In the same way that alternative therapies such as acupuncture and aromatherapy were once labelled cranky but are now widely practised, healing with crystals looks set to gain the same level of acceptance. It should also be regarded as complementary to orthodox medicine, rather than as a replacement for it. CRYSTAL POWER Crystal healers concentrate on the seven' chakras', or energy points of the body. Each chakra is thought to govern a separate area of bodily or mental functions. Techniques vary, but typically, a healer will place one or a group of crystals on a chakra, or perform a type of , crystal massage', rotating a crystal in small circles over a chakra. As with acupuncture, the idea is to clear any blockages in the life force flowing through the body and correct any imbalances. The seven chakras are: the crown chakra on the top of head, which governs the glandular system; the third eye chakra, between the eyes, which governs fear and spiritual insight; the throat chakra at the centre of the throat, which governs the metabolism; the heart chakra at the centre of the chest, which controls the immune system; the solar plexus chakra at the navel, which is for the pancreas; the spleen chakra below the navel, controlling adrenalin production, and finally the base chakra above the groin, which governs sexuality. How can a piece of inanimate rock possibly heal the human body? Crystal healers believe that your body acts like the battery of a quartz watch, stimulating a crystal's natural vibrations. These vibrations in turn influence and energize the body's own healing powers. It is also thought that using a personal crystal can promote and maintain good health. CHOOSING YOUR CRYSTAL You'll find crystals for sale at gift shops and fairs. You need one which is large enough to provide a focus during the healing process. A crystal the size of a small apple, which can be grasped firmly in the palm of one hand, is ideal for most healing techniques. Crystal healers emphasize that you should rely on your instincts and pick the crystal to which you feel strongly attracted. This will be the one most closely in tune with your body's unique aura. Crystals are thought to be affected by the emotional discharges of everyone who handles them, so it's suggested that you purify your crystal by soaking it in seawater or warm water with sea salt dissolved in it. Leave the crystal for at least 36 hours, but for no longer than 70.   WHICH CRYSTAL? Specific healing powers for different conditions are attributed to different types of crystal: AGATE: Relieves tension and anxiety. Use a couple of small ones as worry beads, jiggling them around in the palm of your hand. AMETHYST: Place one under your pillow to help you sleep. The Romans believed they prevented hangovers and used to drink out of goblets studded with them. BLOODSTONE: Said to be a very calming stone when held in the hand and to help regulate an erratic menstrual cycle. JADE: The stone of friendship, this is claimed to help overcome shyness. Drinking water in which jade has been soaked is believed to boost the immune system. QUARTZ: Good for headaches. Lie down and place three of these crystals on your forehead - one pointing up to the crown and two pointing towards it from the left and right sides. ROSE QUARTZ: Also for headaches and for relieving the symptoms of depression. Hold it in your right hand and think about your problem. Then press the crystal lightly against your forehead. Next, breathe into the crystal, letting it absorb your negative thoughts. TOURMALINE: Effective for emotional upset. If you've been rejected by someone you love, keep this stone near you and clasp it as often as possible.   SELF-HEALING One of the simplest ways to benefit from crystal power is to keep one by you day and night. Its influence will interact with your body's electrical impulses, restoring any imbalances. For a quick pick-up, hold a crystal in your left hand, pointing towards your wrist, and one in your right hand, pointing away from it. Hold for five to ten minutes, resting your hands on a table if you need to. To clear up minor skin blemishes and improve the texture of your skin, soak a crystal of your choice in your bathwater for 10 minutes before you get in. Red coral and aventurine are thought to be especially effective. Drink crystal water to help flush toxins out of your body. Prepare the drink by leaving a crystal in a glass of water overnight. Then drink the 'charged' water first thing in the morning.   Taken from THE HEALTH FILE  A Complete Medical Encyclopedia, A MARSHALL CAVENDISH REFERENCE COLLECTION, NATURE’S CLINIC by DR JOHN CORMACK, WEEKLY Australia, New Zealand, Malaysia Singapore Malta RSA Other Countries Namibia. DR JOHN CORMACK, BDS MB BS MRCS LRCP, is the medical consultant to The Health File. The senior partner in an Essex­ based practice, he is also a member of the General Medical Council and has written for numerous magazines and news­papers as well as for the medical press. He is a regular broadcaster on television and radio and has scripted a number of award-winning educational videos.   Note: Where gender is unspecified, individuals are referred to as 'he', This usage is for convenience only and not intended to imply that all doctors and patients are male. Medicheck charts are only a rough guide to diagnosis, Always seek medical advice if you have worrying symptoms. Copyright Marshall Cavendish 1995, Printed in Great Britain, Published by Marshall Cavendish Partworks Ltd, 119 Wardour Street, London WIV 3TD , We all feel fed up and miserable from time to time. But depression is more than just a feeling of unhappiness. It's a major health disorder that causes untold suffering to millions of people. We expect to feel sad if someone close to us is ill or dies, we lose our job, or a relationship flounders. Any event that involves loss or disap­pointment will make us unhappy. But sometimes the misery just doesn't go away, or a sense of hopelessness Just comes out of the blue for no obvious reason at all. Whether there's a cause for it or not, depression drains us of energy and our ability to enjoy life. It can make us feel worthless, leaving us unable to achieve anything at all. TYPES OF DEPRESSION Depression can range from a normal mood to a severe clinical disorder. Clinical depression is usually classed as major or minor. Major depression is defined as a low mood and the inability to be interested or take pleasure in one's surroundings for at least two weeks. This is usually accompanied by a characteristically negative way of thinking, including guilt, pessimism, feelings of personal worthlessness and ideas about suicide and being better off dead. DIAGNOSIS Clinical depression is a serious medical condition that can last for years if untreated. Change in sleep patterns Restlessness or lethargy Lack of energy or fatigue Loss of concentration Thoughts of death and suicide Loss of confidence Appetite or weight change To be diagnosed as major, depres­sion must include at least four of the following classic seven symptoms: low self-esteem or guilt; loss of con­centration; thoughts of suicide; loss of en­ergy and extreme tiredness; loss or in­crease of appetite and weight; insomnia or excessive sleeping; and either a slowing down or a constant sense of agitation. MORE THAN LOW MOODS Special brain scans can show up differences in the metabolic activity in the tissues of a normal person and one who is severely depressed. Minor depression is defined as having a low mood and also showing fewer than four of the symptoms that characterize major depression. People who have a low mood but show few of the classic seven symptoms have subclinical depression. If left untreated, an episode of depression lasts between six and nine months, on average, However, another class of depression has recently been recognized. Called recurrent brief depression, these bouts of severe depression last one to 14 days and then vanish, but can occur up to 20 times a year. WHY IT OCCURS Depression is thought to be caused by a reduction of certain chemicals in the brain called neurotransmit­ters, These chemicals affect our mood by stimulating brain cells. But no one really knows why depression develops, Sometimes it seems to come out of the blue, and sometimes it's an obvious response to life. A range of internal and external factors can trigger changes in our mood. EXTREMELY COMMON Depression can affect anyone at any age, but some of us are more vulnerable to it than others.  At any one time, around five per cent of us are suffering clinical depression. The most severe forms are more common in middle and old age, and perhaps up to a third of us will experience a milder form of depression. Recurrent brief depres­sion is thought to affect up to one in 10 of us - men and women are affected equally, But it is not yet certain how many of us will suffer from depression at some point in our lifetimes. MEN AND WOMEN Women are twice as likely as men to be depressed. This is partly because of hormonal factors, and also partly because women with young children may be vulnerable to social stress, Women are also more likely to go to the doctor and admit that they feel depressed. Can children get depressed? Yes they can, but the symptoms are often different than with adults. The most common symptom of depression in children is withdrawal from family and friends. Other signs include poor school achievement, truanting or aggressive behaviour. Tearfulness is unusual in children. Depression in teenagers may often be misinterpreted as moodiness, but up to one in 10 ado­lescents report episodes of depression. There may also be link between depression and genetic makeup. Recent medical evidence suggests it may run in families. People whose mothers were absent during their childhood, either because their mother died or was herself too depressed to adequately care for her family, are at higher risk of depression. GETTING EMOTIONAL Your psychological profile is also significant Psychoanalysts believe that people who repress their emotions, particu­larly anger, are vulnerable to depression, People who have been bereaved and who don't weep or talk about their sadness - the classic stiff upper lip ­often get stuck in a long period of depression. EXTERNAL CAUSES Severe illness often triggers depression. A strong support network of family and friends can make all the difference in your ability to cope. There are also a number of external causes that are traditionally known to be a cause of depression, For exam­ple, illness or injury and any number of stressful life events, such as bereavement, job loss or the breakup of a relationship, are likely to cause an unhappy mood, Lack of family and friends as a network of support is a contributing factor. SEASONAL CHANGES Depression can follow a viral infection, and it may be set off by low levels of sunlight in winter (a condition called Seasonal Affective Disorder). Lack of sleep due to waking up at dawn is a common symptom of depression. It may make the person feel worse and the depression harder to resolve. Antidepressants are extremely effective at relieving disabling symptoms, thus enabling the sufferer to cope with day to day living, But finding the right one is vital to successful treatment.   HORMONAL CHANGES Hormonal factors play a large part. Depression is very common among women just before their periods (PMS or premenstrual syndrome), immediately after giving birth (post-natal depression) and around menopause. These are all times of hormonal change and many doctors believe that it is the reduction in the levels of oestrogen which is responsible for so much female unhappiness, However, other doctors believe that these types of depression may have nothing to do with hormones and everything to do with social at­titudes towards women. The 'baby blues' affects up to half of all new mothers, but this short­lived mood of tearfulness that occurs a few days after giving birth is not true post-natal depression. PND is a distinct condition which affects up to 15 per cent of women in the six months to a year after having their baby. Symptoms include a low mood, anxiety, irritability, tearfulness and tiredness. Some doctors believe PND is caused by social factors such as lack of support and social isolation after having a baby. They say that counselling is the best form of treatment. Others believe that PND is caused by a hormonal imbalance and often prescribe oestrogen (though some prescribe progesterone). Antidepressants are often prescribed, but women caring for a baby should not be given medication with a strong sedative effect. Breastfeeding women may pass some drugs into the baby's system via the breast milk. GETTING HELP Only about half of all people with major depression are identified as such by their family doctor, This is because anyone who is depressed may find it hard to talk about how terrible they feel. They often consult their doctor with one of the physical symptoms of depression, such as constipation, sleep problems or weight loss, but are reluctant to specify that they feel unhappy or depressed. A number of people don't want treatment and simply accept their low mood. But effective treatments for depression do exist. ANTI-DEPRESSANT DRUGS Many people are reluctant to take drugs for depression because they think that medication will stop them sorting out their problems. But relieving the symptoms of depression means the sufferer can get on with life, instead of getting trapped in the classic downward spiral of decreasing energy and self-confidence. TYPES OF ANTIDEPRESSANT There are several classes of anti­depressant drugs, all of which act in different ways on the levels of neurotransmitters in the brain. The most common are tricyclics, of which there are various types. Some improve sleep, while others are given to people who feel lethar­gic. Side-effects include drying of the mouth and blurred vision, but these usually soon wear off. Monoamine oxidase inhibitors may be prescribed when people don't respond to the tricyclics. These can have major side-effects and interact with other drugs. Serotonin re-uptake inhibitors have fewer side-effects but may cause nausea. Prozac comes from a new class of antidepressants known as specific serotonin re-uptake inhibitors. HOW EFFECTIVE ARE THEY? Antidepressants are beneficial for treating major depressions, but less effective for milder depression. Around three-quarters of people with depression respond to them. They are not addictive, but they have to be taken for as long as six to nine months after the depression has lifted to be successful. Though antidepressants are effective, evidence suggests that a combination of anti-depressant drugs plus psychotherapy is the best treatment of all. BENEFITS OF THERAPY When we become depressed, we can get stuck in negative thought processes. If we lose our job, we start thinking that we'll never work again. If a relationship breaks up, we imagine that we're unlovable. Cognitive psychotherapy, in which the therapist teaches you to identify gloomy ways of looking at life and replace them with more positive attitudes, can help. But almost any form of talking therapy is useful. It can draw the depressed person out of their bleak world, and help them to understand their feelings and what steps they can take to help themselves. Regular aerobic exercise has been shown to have an uplifting effect on depressed people as well as improving mood generally. The theory is that aerobic exercise triggers the release of certain chemicals in the brain called endorphins. These are the body's natural opiates that make us feel good. Depressed people seem to have lower levels of endorphins. Studies have shown the medical benefits of laughter. It reduces stress and increases the output of hormones which can help overcome depression. OTHER TREATMENTS  Hormonal depression in women can sometimes be relieved by taking oestrogen or progesterone. As a very last resort, people with major depression who have not re­sponded to other treatments may be admitted to hospital for ECT (electro-convulsive therapy). It's not known exactly how ECT works. The theory is that the elec­tric shock causes a fit, which seems to lift depression. However, it can cause confusion and short-term memory loss, and both therapy and medication should be tried first. • Regular aerobic exercise oxy­genates the brain and raises levels of endorphins, the body's natural painkillers • Smile at people - even if you don't feel happy, your brain doesn't know and starts to imagine that you're feel­ing well • Laughter is good for you. Watch comedy shows on TV, hire funny films, or get a group of friends togeth­er for a good laugh • Set yourself easy achievable daily tasks, like writing a letter or doing the laundry • Try speaking to yourself positively, tell yourself how well you're coping during this difficult time   Taken from THE HEALTH FILE  A Complete Medical Encyclopedia, A MARSHALL CAVENDISH REFERENCE COLLECTION, NATURE’S CLINIC by DR JOHN CORMACK, WEEKLY Australia, New Zealand, Malaysia Singapore Malta RSA Other Countries Namibia. DR JOHN CORMACK, BDS MB BS MRCS LRCP, is the medical consultant to The Health File. The senior partner in an Essex­ based practice, he is also a member of the General Medical Council and has written for numerous magazines and news­papers as well as for the medical press. He is a regular broadcaster on television and radio and has scripted a number of award-winning educational videos.   Note: Where gender is unspecified, individuals are referred to as 'he', This usage is for convenience only and not intended to imply that all doctors and patients are male. Medicheck charts are only a rough guide to diagnosis, Always seek medical advice if you have worrying symptoms. Copyright Marshall Cavendish 1995, Printed in Great Britain, Published by Marshall Cavendish Partworks Ltd, 119 Wardour Street, London WIV 3TD     , , DIFFICULTY SLEEPING - There are many reasons why you might have trouble sleeping. Some may be minor, while others may require medical treatment. Use this chart if you often lie awake at night, wake at odd hours or if you feel tired in the morning Do you find it difficult to get to sleep?                    Are you often tense and irritable during the day? Do you find that you keep waking up very early in the morning and that it's then difficult to get back to sleep again? If you are female, is there a chance that you might be pregnant? You could be suffering from anxiety. Try to cut back on the stress in your life. Make time to learn and practise a relaxation therapy such as yoga or some form of meditation. When you lie awake, are you preoccupied with problems? Do you feel a failure or that your life has no purpose? When you wake. do you find that you often feel breathless? It's quite common to have trouble sleeping during pregnancy. Often there is a need to urinate during the night. If this is your problem, cut back the amount you drink in the evening. If you are constantly tired, consult your doctor. Difficulty sleeping is often a sign of depression. Discuss this with your doctor. Attacks of breathlessness could signify a heart condition. If you are under 40, however, the problem is more likely to be asthma. Discuss this with your doctor. Have you been drinking a lot of tea, coffee or cola drinks during the day? Do you often go to bed feeling overfull or after having drunk a lot of alcohol? Have you recently given up sleeping pills or tranquillizers? Are you generally an inactive person who takes very little exercise? Are you aged 60 or over? Too much caffeine overstimulates the central nervous system and can interfere with your sleep. Some people are particularly sensitive to caffeine while others can consume little or none without suffering adverse effects. Eating and drinking too much late at night can cause sleeplessness. Though alcohol initially helps you get to sleep, too much can cause you to wake during the night or too early in the morning. Drugs like these can upset normal sleeping patterns and it may take several weeks before your body learns to readjust. The withdrawal symptoms should eventually pass. Your body may not be tired enough to allow you to fall asleep easily. Try to get some exercise during the day. Do not exercise too close to bedtime, as this could make the situation worse. The amount of sleep we need and the way in which we take it often changes as we get older. Elderly people often fall into a pattern of waking early and then taking an afternoon nap. As long 'as you don't feel sleepy or unwell, there's nothing to worry about. Cut down on your caffeine intake. Switch to decaffeinated drinks or herbal teas or try cutting out caffeine altogether. If you're at all concerned about the length of time this is taking, discuss it with your doctor. Try to adjust to your new sleeping pattern by finding more to do in your waking hours.  Taken from THE HEALTH FILE  A Complete Medical Encyclopedia, A MARSHALL CAVENDISH REFERENCE COLLECTION,MEDICHECK  by DR JOHN CORMACK, WEEKLY Australia, New Zealand, Malaysia Singapore Malta RSA Other Countries Namibia. DR JOHN CORMACK, BDS MB BS MRCS LRCP, is the medical consultant to The Health File. The senior partner in an Essex­ based practice, he is also a member of the General Medical Council and has written for numerous magazines and news­papers as well as for the medical press. He is a regular broadcaster on television and radio and has scripted a number of award-winning educational videos.  Note: Where gender is unspecified, individuals are referred to as 'he', This usage is for convenience only and not intended to imply that all doctors and patients are male. Medicheck charts are only a rough guide to diagnosis, Always seek medical advice if you have worrying symptoms. Copyright Marshall Cavendish 1995, Printed in Great Britain, Published by Marshall Cavendish Partworks Ltd, 119 Wardour Street, London WIV 3TD , , , , , , Naturopathy, or Naturopathic Medicine, is a natural approach to health and healing that is both a way of life and a concept of healing. It has as its primary goal the establishment and maintenance of optimum health, which is achieved by teaching and promoting the principles of wellness, and treating with natural substances, as opposed to relying on pharmaceutical substances, in order to restore dynamic balance to the body and mind. It is a distinct, integrated system of primary health care, based on the vitalistic principles of naturopathic philosophy and holism, which is able to treat a wide range of disorders and imbalances. Vitalism treats disease through the support and stimulation of the body's own inherent healing capacity i.e. the vital force promotes self-cleansing and self-repair and subsequently self-healing. Naturopathy incorporates several fundamental components of health, including biochemistry, biomechanics, and emotional temperament i.e. it takes into account the multifactorial nature of illness, in order to restore healing and balance to the body and mind. Fundamental to the practice of naturopathy is recognition of the integrity of the whole person, which takes into account physical, mental, spiritual, emotional, genetic, social and environmental factors; respect for the healing processes of Nature; and empowerment of the individual to take responsibility for his or her own health process - in partnership with treatments and education provided by the practitioner.   Food is the best medicine Naturopathic treatments originated as a system of using food, herbs, air, sun, and water for medicine and as healing agents for the restoration of health. The same principles still apply in modern day practice, with some innovations, but primarily it still consists of the diagnosis, treatment, and prevention of human disorders by the therapeutic use of diverse natural methods and materials, such as: Clinical nutrition, which incorporates micronutrient supplementation, diet, and fasting Botanical, aromatic and homeopathic medicine, which include herbals, homeopathics, essential oils, flower essences and other energetic medicaments Iridology and other technical devices Physical medicine, which includes diathermy, ultrasound, exercise, hydrotherapy, detoxifications, massage, manipulations, electromagnetics, acupressure, acupuncture/dry needling, reflexology and aromatherapy Counselling, which incorporates diet, lifestyle and stress management, biofeedback, hypnotherapy and stress management. Naturopathic medicine is based on the following fundamental principles:   First do no harm - Primum no nocere The healing power of Nature - Vis medicatrix naturae Identify and treat the cause - Tolle causum Treat the whole person - Tolle totum The physician as teacher - Docere Prevention is the best cure - Preoccupo est optimus remedium Establish health and wellbeing. Fundo valetudo quod salus The naturopathic mode of healing ensures that each individual is treated according to his or her own unique set of symptoms and reactions. Since these indicators govern the naturopathic doctor's approach towards therapy, each person receives an individualized treatment protocol.   REGULATION OF NATUROPATHIC MEDICINE IN SOUTH AFRICA The Allied Health Professions Council of South Africa [AHPCSA] is the statutory council that regulates naturopathy in South Africa, in accordance with Act 63 of 1982. The AHPCSA controls all matters relating to students and practitioners including disciplinary matters, educational standards, scopes of practice, and professional fees. www.ahpcsa.co.za Information provided by Dr S Nye www.greenhousehealth.com http://www.integrativemedicine.co.za/naturopathy.html , , CHANGING YOUR PERSONAL APPEARANCE - There comes a point in anyone's life where she needs to change She wants to undergo metamorphosis. This is not easy to do when you do not know where to start. So in case you are one of those people who want to undergo an abrupt change in life, seek the advice of a fashion stylist. An image consultant is not just an expert in dressing up. A fashion stylist is also an image consultant. Fashion stylists help people in shaping or reshaping their characters. So, when you really want change, you can change the way you look with guidance from an image consultant. Being a wall flower usually happens with a person who doesn't have any confidence. So how do you let the confidence in a very timid person spark? If you are a timid person and was born a wall flower, you can do something about that. You can hire a fashion stylist. An image consultant would help you build up your confidence that would let you shine. From being a wall flower, you would eventually be the life of the party. Perhaps, you are always called the ugly-duckling. Maybe your appearance is somewhat different from your brothers and sisters. But it doesn't necessarily mean that you are ugly. What you need to do is to discover your inner beauty and let it come out. If you do not think that you are gorgeous, how would different people believe that? Always think that you are beautiful and others would see that. One tip is to look in the mirror every morning and smile to yourself and say to yourself that you are good-looking. If you want to know more ideas, talk to a fashion stylist. She knows better. If you've always been in the crowd, perhaps it is now the time for you to stand out. Do not be contented with being in and being just like any others. People are born to be distinctive and not a copycat. So as to do this, you need to uncover your personal uniqueness. You need to create a unique persona. Instead of being just a follower, why not be the standard? Having some individuals to look up to you is a really nice feeling. Blending in the crowd is just like throwing a needle in the haystack. No one would see you and you would soon be irrelevant. Ask the help of an image consultant and you would certainly find your way out of the crowd. Maybe a new haircut or a brand new wardrobe may spice up your life. Whatever that thing is, a fashion stylist would surely find that out for you. A fashion stylist is more than just an outfit consultant and a personal shopper. They create images through clothes and accessories. They build images by bringing out self-confidence. A fashion stylist is a professional in creating one's image. Remember that even celebrities hire fashion stylists. So if you want to get out of the box, ask help from them. From being boring, you can be stunning and exciting. http://8gigusb.com/articles/?change-your-personal-appearance-with-assistance-coming-from-a-fashion-stylist-407  , ,  Theories of Why We Sleep: Scientists have explored the question of why we sleep from many different angles. They have examined, for example, what happens when humans or other animals are deprived of sleep. In other studies, they have looked at sleep patterns in a variety of organisms to see if similarities or differences among species might reveal something about sleep's functions. Yet, despite decades of research and many discoveries about other aspects of sleep, the question of why we sleep has been difficult to answer. The lack of a clear answers to this challenging question does not mean that this research has been in vain. In fact, we now know much more about the function of sleep, and scientists have developed several promising theories to explain why we sleep. In light of the evidence they have gathered, it seems likely that no single theory will ever be proven correct. Instead, we may find that sleep is explained by two or more of these explanations. The hope is that by better understanding why we sleep, we will learn to respect sleep's functions more and enjoy the health benefits it affords. Inactivity Theory One of the earliest theories of sleep, is the adaptive or evolutionary theory, inactivity at night - adaptation - serves as survival function - keeps organisms out of harm's way at times when they would be particularly vulnerable. Animals that are able to stay still during these periods of vulnerability have an advantage over other animals that remain active. These animals do not have accidents during activities in the dark - are not killed by predators. Through natural selection, this behavioral strategy became what we now recognize as sleep. A counter-argument to this theory - it is always safer to remain conscious to be able to react to an emergency (even if lying still in the dark at night). So there does not seem to be any advantage of being unconscious and asleep if it comes to  safety. Energy Conservation Theory One of strongest factors in natural selection - competition for and effective utilization of energy resources. Less apparent to people living in societies in which food sources are plentiful. Primary function of sleep - reduce individual's energy demand and xpenditure during part of day or night, (especially at times when it is least efficient to search for food). Research shows reduction in energy metabolism during sleep (10 percent in humans, more in other species). E.g, both body temperature and caloric demand decrease during sleep, compared to wakefulness. Such evidence supports proposition that one of primary functions of sleep - to help organisms conserve their energy resources. Many scientists consider this theory to be related to, and part of, the inactivity theory. Restorative Theories Another explanation for why we sleep is based on the long-held belief that sleep in some way serves to "restore" what is lost in the body while we are awake. Sleep provides the opportunity for the body to repair and rejuvenate itself. In recent years, these ideas have gained support from empirical evidence collected in human and animal studies. Most striking of these - animals deprived entirely of sleep lose all immune function and die in a matter of weeks - further supported by findings that many of the major restorative functions in the body like muscle growth, tissue repair, protein synthesis, and growth hormone release occur mostly, or in some cases only, during sleep. Other rejuvenating aspects of sleep are specific to brain and cognitive function. E.g, while awake, the neurons in the brain produce adenosine, a by-product of the cells' activities. Build-up of adenosine in the brain - thought to be one factor that leads to perception of being tired. (Incidentally, this feeling counteracted by use of caffeine, which blocks actions of adenosine in brain - keeps us alert.) Scientists think that this build-up of adenosine during wakefulness may promote "drive to sleep." As long as we are awake, adenosine accumulates and remains high. During sleep, the  body has a chance to clear adenosine from the system - more alert when awake. Brain Plasticity Theory Most recent and compelling explanation - based on findings that sleep is related to changes in structure and organization of brain. This phenomenon, known as brain plasticity - not entirely understood - but connection to sleep has several implications. E.g it becomes clear that sleep plays a role in brain development in infants and young children. Infants spend about 13 to 14 hours per day sleeping. About half of that time is spent in REM sleep - the stage in which most dreams occur. The link between sleep and brain plasticity becomes clear in adults as well. This is seen in the effect that sleep and sleep deprivation have on people's ability to learn and perform a variety of tasks. Although these theories remain unproven, science has made a tremendous stride to discover what happens during sleep, what mechanisms in the body control cycles of sleep and wakefulness. While this research does not directly answer the question, "Why do we sleep?" it sets the stage to put the question in a new context and generate new knowledge about this essential part of life., Braille music - Braille music is a Braille code that allows music to be notated using Braille cells so that music can be read by visually impaired musicians. The Braille music system was originally developed by Louis Braille Braille music uses the same six-position Braille cell as literary braille. However braille music assigns an entirely separate meaning to each braille symbol or group of symbols, different from literary braille, and has its own syntax and abbreviations. Almost anything that can be written in standard print music notation can be written in braille music notation as well. However, braille music notation is a completely independent and well-developed notation system with its own conventions and syntax. The world's largest collection of braille music is located at the National Library for the Blind, in Stockport, UK. Learning Braille music Braille music, although different from print music, is in general neither easier nor more difficult to learn. Visually impaired musicians gain the same benefits by becoming musically literate learning to read braille music as do sighted musicians who learn to read print music. Visually impaired musicians who become highly proficient performers without ever learning to read music have the same difficulties and disadvantages as sighted musicians in the same situation. In either case, the illiterate musician is completely dependent upon others for learning new music or new parts. And it is very difficult for the advanced musician to have the patience to spend months or years re-visiting the rudiments of music in order to learn to read and write what can already be performed with ease. Visually impaired musicians can begin learning to read braille music about the time they have reasonable competence reading Grade 2 literary braille. Teaching Braille music Braille music for beginners, like print music for beginners, is quite simple. Sighted or visually impaired music teachers with no previous knowledge of braille music can easily learn the rudiments of braille music notation and keep a step or two ahead of the beginning student who is learning braille music. Some common print method books are available in music braille, so that the sighted teacher can use a print version and the visually impaired student the brailled version (or the other way around). Information about courses and materials for learning braille music can be found in the Braille Music FAQ. Transcribing music into Braille Much commonly-used music has been transcribed into braille. In the U.S. this is available from the National Library Service (NLS) of the Library of Congress (free for qualified individuals) and through other sources. Most countries have a national library similar to the NLS. See the Braille Music FAQ for details. However, many visually impaired musicians require a good deal of music that has never before been transcribed to braille music. In the United States, Canada, United Kingdom, and many other countries, there is a network of braille music transcribers who can transcribe such music. Another option is to use a computer-music system. Such systems typically allow a sighted or visually impaired user to enter music into a computerized music notation program. The software then automatically converts the print notation that has been entered into braille music notation. Such software programs are Dancing Dots. Toccata. FreeDots (open source licensed under the GNU General Public License) BrailleMUSE (free web application software) The Braille Music KIT works in both directions: musicians can create a braille music score that can then be converted to print music, or a sighted musician can use Finale to create a print score which is then be converted to braille musi Pitch and rhythm In practice beginners first learn the most common rhythmic value (8th, quarter, half, and whole notes) and ignore the other possibility. For advanced students there is never rhythmic ambiguity between the two values because the musical context, including meter signature and bar lines, makes the intended rhythmic value clear. For instance, in a measure of 4/4 time that includes only the symbol with dots 1,3,4 (whole or 16th rest), musical context says that the symbol must indicate a whole rest. Octave marks An Octave Mark is included before a note symbol to specify the octave of the note. For instance, the 4th Octave is the octave starting with middle C and going up to the B above middle C. Octave symbols are only specified when needed. For instance, a melody proceeding upward from the first octave can, if moving by step, proceed to the second, third, and fourth octaves without requiring additional octave signs. The rule is that, in the absence of an octave mark specifying otherwise, notes always move by a unison, 2nd, or 3rd rather than a 6th, 7th, or octave. For instance, the following moves upward continuously, ending in octave 5:  Octave 2 C C D E F G A B C D E F G A B C D E F G A B B C C The rule for 4ths and 5ths is different, however: in the absence of an octave sign specifying otherwise, a melodic leap of a 4th or a 5th will always stay within the same octave as the previous note. For instance, the following always stays within Octave 2:  Octave 2 C G D A E B F C G D A E Because of the use of octave marks, clef symbols are technically not required in braille music. On occasion when transcribing print music into braille, clef symbols (bass clef, treble clef, or other) will be indicated simply so that the visually impaired musician will be aware of every detail of the original print score. Musical markings Musical indications like "dim", "cresc", or "rit" are inserted inline with the note and rhythm notation and, to differentiate them from note, octave, and other musical signs, are always preceded by the "word sign" (dots 3,4,5). Slurs may be indicated by a slur sign between two notes or a bracket slur surrounding a group of notes to be slurred. Musical signs such as staccato or tenuto are generally placed before the note or chord they affect. The musical signs shown on the chart are shown modifying a quarter note C (dots 1,4,5,6). "Music hyphen" is used to indicate that a measure of music will be continued on the following line (this happens somewhat more often in braille music than in print music). A "word apostrophe" indicates that the word will be continued on the following line. Repetition symbols Like literary braille, braille music tends to be rather bulky. Because of this, a system of repetition symbols--much more extensive than that used in print music--is employed to reduce page turns, size of scores, and expense of printing. The repetition symbol (dots 2,3,5,6) is used similarly to the musical repetition symbol to indicate that a beat, a half measure, or a full measure is to be repeated. In addition, braille music often includes instructions such as "repeat measure 2 here" or "repeat measures 5-7 here". Such indications are in addition to the commonly used repeat marks and first and second endings employed in print music, which are also used in braille music. Contrapuntal lines and chords within a staff Unlike print music notation, braille music is an entirely linear format. Therefore certain conventions must be used to indicate contrapuntal lines and chords, situations where more than one note is played simultaneously within a single staff. In-accords Independent contrapuntal lines within a single staff are indicated via whole-measure or part-measure "in-accords". First one of the contrapuntal lines is given, then the second contrapuntal line, enclosed by the in-accord symbols. The in-accord symbols indicate that the two lines are to be played simultaneously. Interval notation Homophonic chordal sections are written using interval notation. For instance, the notation "quarter-note-C, 3rd, 5th" would indicate playing a C along with the notes a 3rd and 5th higher than C, altogether making a chord C-E-G a quarter note in length. There is also a limited ability within the interval notation to allow, for instance, an inner voice to move briefly with rhythmic independence from the other voices. Such movement is common in four-part chorale style and it is convenient to be able to handle this situation without resorting to in-accords. Reading the interval notation is somewhat complicated by the fact that some staves use bottom up notation (the bottom note of each chord is specified and intervals are read upwards from the given note) and some staves use top down notation (the top note of each chord is specified and intervals are read downwards from the given note). The modern convention regarding the choice between bottom-up or top-down interval notation is to specify the main note (either the bass line or the melody line) and let the intervals go up or down from there, as appropriate. For instance, in most piano music the left hand specifies the bottom note and intervals go bottom-up while the right hand specifies the top note and intervals go top-down. Many older scores use a different method, however, with all staves reading bottom up or all staves reading top down. Most scores have a note indicating the direction of the intervalic notation. However in some older scores the direction of the interval notation must be established from the musical context. By convention, in-accords are given in the same direction as the direction used by the interval notation. For instance, if interval notation is bottom-up then the in-accords for that staff will be given with the lowest contrapuntal line first, then the next higher contrapuntal line second, and so on. Thus, examining the in-accords is one way to establish whether the interval notation on a particular staff is bottom-up or top-down. Dealing with different staves Much print music is written on several different staves. For instance, piano music is typically written on two different staves combined into the grand staff: one for treble clef and one for bass clef, while choral music often has four different staves (one each for soprano, alto, tenor, and bass). In print music, the notes in different staves that play simultaneously are aligned vertically. Because of the nature of braille music, and the fact that the braille musician can typically read only one staff at a time, multiple staves are handled in several different ways depending on the complexity of the music and other considerations. Bar over bar format is most similar to print music. Simple piano music in bar over bar format is quite similar to print music, with right hand notation on the top line and left hand notation on the bottom line. Some degree of vertical alignment between the right hand and the left hand is maintained. Other ways of dealing with multiple staff music are line over line format, section by section format, paragraph style, and bar by bar format. As a rule these formats take up less space on the page but require more of the musician in working out how to fit the staves together. For instance, in a piano score notated in section by section format, the right hand part may be written out for the first 8 measures, followed by the left-hand part for the same 8 measures. No attempt is made by the transcriber to align or synchronize the right hand and left hand parts for these measures. The same procedure is followed for measures 9-16 (first music for the right hand, then for left hand), and so on, section by section, throughout the score. On a practical level, the musician learning a score notated in section by section format learns and memorizes one section right hand alone, then the same section left hand alone, then works out the two hands together by memory and by referencing various spots in the braille music score to work out mentally how the sections fit together. A note from the transcriber in the score often clarifies the format used. However, with many older and more complex scores the format must be determined by examination of the music and context. Variations in Braille music Over the years and in the many different countries of the world, a variety of minor differences in braille music practice have arisen. Some countries have preferred a different standard for interval or staff notation, or have used different codes for various less common musical notations.   An international effort to standardize the braille music code has continued to make progress, culminating in the updates summarized in Braille Music Code 1997 and detailed in the New International Manual of Braille Music Notation (1997). However, braille music users should be aware that they will continue to encounter divergent usages when ordering scores from printing houses and libraries, because these scores are often older and come from various countries. http://en.wikipedia.org/wiki/Braille_music , , , , , Aromatherapy and Aromachology - Aromachology and Aromatherapy both promote the positive effects of fragrance on mood and emotion but that may be where the similarity ends References in commercial writing often blur their distinctions leaving many readers confused. Aromachology is the scientific study of the effects of fragrance on human psychology and behavior. This term was coined in 1989 by what is now the Sense of Smell Institute, a division of The Fragrance Foundation, which in turn is the non-profit, educational arm of the international fragrance industry. Aromachology emphasizes controlled scientific study, deals only with the psychological effects of fragrance and considers both natural and synthetic odorants. Aromachology is driven by corporate sponsorship and ultimately endeavors to identify fragrance applications that have commercial opportunity. Aromatherapy is the therapeutic use of plant essential oils to improve physical health as well as psychological health. The term was first used in 1928 by French chemist Rene Maurice Gattefosse to describe the healing action of aromatic plant essences but the use of herbs and plant oils dates back to antiquity. The practice of Aromatherapy remains an integral part of folk medicine. The pharmacology of essential oils is seldom studied scientifically as there is no commercial incentive to do so. Aromatherapy uses only pure, natural essential oils, each with specific attributes for healing, and how they smell is secondary to their therapeutic action.  How are they different? The two disciplines appear to overlap where aromatherapy uses inhalation of diffused oils to treat conditions related to mood and emotion, such as anxiety, depression, lethargy, or irritability. But even in this circumstance, there is an important distinction. Aromatherapy does not endorse the use of artificial fragrances which have no therapeutic value and can not affect mood beyond the psychological effects of "odor memory". On the other hand, researchers in Aromachology will point out that the special virtues of essential oils are not supported by a substantial body of clinical evidence. But is there really a conflict? The effect of fragrance on emotion The fact that our emotions are affected by fragrance is widely accepted. Memory and emotion are often strongly associated with odor. We have all experienced it. A whiff of a particular odor and our minds are suddenly flooded with a memory and the emotions associated with that memory. There is an anatomical basis for this phenomenon. Within the human brain the primary olfactory cortex, which processes information about odors, is directly connected to the amygdala, which controls the expression and experience of emotion, and the hippocampus, which controls the consolidation of memories. These are primitive functions that have been around since the time in early evolution when we needed to use our sense of smell for survival. Controlled studies would suggest that our appreciation of an odor and our emotional response to it, are determined by the emotional context in which the odor was first encountered, even if the association is subtle and we are not consciously aware of it. This is why our appreciation of odors is such a personal matter and why there are significant differences in odor preference from one culture to the next.  Both natural and synthetic odorants can trigger a psychological response which is at the heart of Aromachology but only the appropriate essential oil will cause a specific physiological response which is the healing goal of Aromatherapy. Are the claims of Aromatherapy unproven?  It is true that there is little scientific research into the pharmacology of essential oils. Lack of funding is the primary reason. Essential oils are not patentable and so with a few exceptions there is no commercial incentive for conducting research. On the other hand, thanks to Aromachology controlled studies have validated some of the historical claims for essential oils. For example, it has been proven that Rosemary enhances cognitive performance, Peppermint is invigorating and Lavender is relaxing. The practice of Aromatherapy has withstood the test of time. Within western cultures its popularity as a complementary medicine continues to grow.  In reality there is no conflict between Aromachology and Aromatherapy because they have different agendas and neither invalidates the other. In the end, Aromachology may prove to be of great benefit to Aromatherapy by adding the weight of modern research to the large body of common knowledge that has supported it for hundreds of years. Marilyn Flook manages the Forever Fragrant website which promotes aromatherapy and natural products. Learn more about essential oils and their practical uses. Tips on Buying Aromatherapy Products Aromatherapy Benefits Aromatherapy Gift Baskets Aromatherapy Stress - How Aromatherapy can combat its Effects Aromatherapy Accessory: Products to Aid Aromatherapy Evolution of Aromatherapy Tension-type Headache? Find Relief with Aromatherapy What is Amrita Aromatherapy and What Makes it Special? The Benefits Of Aromatherapy And Essential Oils Aromatherapy Oil: Pamper Your Skin and Your Senses Will Thank You Aromatherapy of Rome - A perfect way to Relax Jewelry Used for Aromatherapy History of Aromatherapy Setting up the Environment for Aromatherapy Massage Modern Aromatherapy - A New Age for Natural Medicine Aromatherapy for Health Uplifting Aromatherapy Aromatherapy Candles Types of Aromatherapy Facials Aromatherapy Recipes for Depression Aromatherapy Recipes for Acne Aromatherapy Recipes for Hair Aromatherapy Recipes for Stress Aromatherapy Candle Making Aromatherapy Candles Benefits How does Aromatherapy Work Aromatic Bath Salts Aromatherapy and Facials Aroma Therapy: Titillating the Senses  http://www.buzzle.com/articles/aromachology-and-aromatherapy-do-you-know-the-difference.html , , , Vibratese - A method of communication through touch. It was developed by F. A. Geldard, 1957. It is a tactile system based on both practical considerations and on results from a set of controlled psychophysical experiments Vibratese was composed of 45 basic elements, the tactile equivalent of numerals and letters. The entire English alphabet and numerals 0 to 9 could be communicated this way. Geldard reported that with proper training, rates of more than 35 words per minute were  possible for reading. These rates are three times that of an expert with Morse code. Vibratese is no longer in use, with little literature available on the subject. http://www.servinghistory.com/topics/Vibratese , , Senses - There is no firm agreement among neurologists as to the number of senses because of differing definitions of what constitutes a sense The physiological capacities within organisms that provide inputs for perception. The senses and their operation, classification, and theory are overlapping topics studied by a variety of fields, most notably neuroscience, cognitive psychology (or cognitive science), and philosophy of perception. The nervous system has a specific sensory system or organ, dedicated to each sense. Definition - There is no firm agreement among neurologists as to the number of senses because of differing definitions of what constitutes a sense. One definition states that an exteroceptive sense is a faculty by which outside stimuli are perceived.The traditional five senses are sight, hearing, touch, smell and taste, a classification attributed to Aristotle. Humans are considered to have at least five additional senses that include: nociception (pain); equilibrioception (balance); proprioception and kinaesthesia (joint motion and acceleration); sense of time; thermoception (temperature differences); and possibly an additional weak magnetoception (direction), and six more if interoceptive senses (see other internal senses below) are also considered. One commonly recognized categorisation for human senses is as follows: chemoreception; photoreception; mechanoreception; and thermoception. This categorisation has been criticized as too restrictive, however, as it does not include categories for accepted senses such as the sense of time and sense of pain. Non-human animals may possess senses that are absent in humans, such as electroreception and detection of polarized light. A broadly acceptable definition of a sense would be "A system that consists of a group of sensory cell types that responds to a specific physical phenomenon, and that corresponds to a particular group of regions within the brain where the signals are received and interpreted." Disputes about the number of senses typically arise around the classification of the various cell types and their mapping to regions of the brain. Senses Sight Sight or vision is the ability of the brain and eye to detect electromagnetic waves within the visible range of (light) and, in some cases, determine between varying colors, hues, and brightness. There is some disagreement as to whether this constitutes one, two or three senses. Neuroanatomists generally regard it as two senses, given that different receptors are responsible for the perception of colour (the frequency of photons of light) and brightness (amplitude/intensity - number of photons of light). Some argue that stereopsis, the perception of depth, also constitutes a sense, but it is generally regarded as a cognitive (that is, post-sensory) function of brain to interpret sensory input and to derive new information. The inability to see is called blindness. Hearing Hearing or audition is the sense of sound perception. Since sound is vibrations propagating through a medium such as air, the detection of these vibrations, that is the sense of the hearing, is a mechanical sense because these vibrations are mechanically conducted from the eardrum through a series of tiny bones to hair-like fibers in the inner ear which detect mechanical motion of the fibers within a range of about 20 to 20,000 hertz, with substantial variation between individuals. Hearing at high frequencies declines with age. Sound can also be detected as vibrations conducted through the body by tactition. Lower frequencies than that can be heard are detected this way. The inability to hear is called deafness. Taste Taste or gustation is one of the two main "chemical" senses. There are at least four types of tastes that "buds" (receptors) on the tongue detect, and hence there are anatomists who argue that these constitute five or more different senses, given that each receptor conveys information to a slightly different region of the brain. The inability to taste is called ageusia. The four well-known receptors detect sweet, salty, sour, and bitter, although the receptors for sweet and bitter have not been conclusively identified. A fifth receptor, for a sensation called umami, was first theorised in 1908 and its existence confirmed in 2000. The umami receptor detects the amino acid glutamate, a flavour commonly found in meat and in artificial flavourings such as monosodium glutamate. Note: that taste is not the same as flavour; flavour includes the smell of a food as well as its taste. Smell Smell or olfaction is the other "chemical" sense. Unlike taste, there are hundreds of olfactory receptors, each binding to a particular molecular feature. Odor molecules possess a variety of features and thus excite specific receptors more or less strongly. This combination of excitatory signals from different receptors makes up what we perceive as the molecule's smell. In the brain, olfaction is processed by the olfactory system. Olfactory receptor neurons in the nose differ from most other neurons in that they die and regenerate on a regular basis. The inability to smell is called anosmia. Some neurons in the nose are specialized to detect pheromones. Touch Touch, also called tactition or mechanoreception, is a perception resulting from activation of neural receptors, generally in the skin including hair follicles, but also in the tongue, throat, and mucosa. A variety of pressure receptors respond to variations in pressure (firm, brushing, sustained, etc.). The touch sense of itching caused by insect bites or allergies involves special itch-specific neurons in the skin and spinal cord. The loss or impairment of the ability to feel anything touched is called tactile anesthesia. Paresthesia is a sensation of tingling, pricking, or numbness of the skin that may result from nerve damage and may be permanent or temporary. Balance and acceleration Balance, equilibrioception, or vestibular sense is the sense which allows an organism to sense body movement, direction, and acceleration, and to attain and maintain postural equilibrium and balance. The organ of equilibrioception is the vestibular labyrinthine system found in both of the inner ears. Technically this organ is responsible for two senses of angular momentum and linear acceleration (which also senses gravity), but they are known together as equilibrioception. The vestibular nerve conducts information from sensory receptors in three ampulla that sense motion of fluid in three semicircular canals caused by three-dimensional rotation of the head. The vestibular nerve also conducts information from the utricle and the saccule which contain hair-like sensory receptors that bend under the weight of otoliths (which are small crystals of calcium carbonate) that provide the inertia needed to detect head rotation, linear acceleration, and the direction of gravitational force. Temperature Thermoception is the sense of heat and the absence of heat (cold) by the skin and including internal skin passages, or rather, theheat flux (the rate of heat flow) in these areas. There are specialized receptors for cold (declining temperature) and to heat. The cold receptors play an important part in the dogs sense of smell, telling wind direction, the heat receptors are sensitive to infrared radiation and can occur in specialized organs for instance in pit vipers. The thermoceptors in the skin are quite different from the homeostatic thermoceptors in the brain (hypothalamus) which provide feedback on internal body temperature. Kinesthetic sense Proprioception, the kinesthetic sense, provides the parietal cortex of the brain with information on the relative positions of the parts of the body. Neurologists test this sense by telling patients to close their eyes and touch the tip of a finger to their nose. Assuming proper proprioceptive function, at no time will the person lose awareness of where the hand actually is, even though it is not being detected by any of the other senses. Proprioception and touch are related in subtle ways, and their impairment results in surprising and deep deficits in perception and action. Pain Nociception (physiological pain) signals near-damage or damage to tissue. The three types of pain receptors are cutaneous (skin), somatic (joints and bones) and visceral (body organs). It was previously believed that pain was simply the overloading of pressure receptors, but research in the first half of the 20th century indicated that pain is a distinct phenomenon that intertwines with all of the other senses, including touch. Pain was once considered an entirely subjective experience, but recent studies show that pain is registered in the anterior cingulate gyrus of the brain. Direction Magnetoception (or magnetoreception) is the ability to detect the direction one is facing based on the Earth's magnetic field. Directional awareness is most commonly observed in birds, though it is also present to a limited extent in humans. It has also been observed in insects such as bees. Although there is no dispute that this sense exists in many avians (it is essential to the navigational abilities of migratory birds), it is not a well-understood phenomenon. One study has found that cattle make use of magnetoception, as they tend to align themselves in a north-south direction. Magnetotactic bacteria build miniature magnets inside themselves and use them to determine their orientation relative to the Earth's magnetic field. Other internal senses An internal sense or interoception is "any sense that is normally stimulated from within the body". These involve numerous sensory receptors in internal organs, such as stretch receptors that are neurologically linked to the brain. Pulmonary stretch receptors are found in the lungs and control the respiratory rate. The chemoreceptor trigger zone is an area of the medulla in the brain that receives inputs from blood-borne drugs or hormones, and communicates with the vomiting center. Cutaneous receptors in the skin not only respond to touch, pressure, and temperature, but also respond to vasodilation in the skin such as blushing. Stretch receptors in the gastrointestinal tract sense gas distension that may result in colic pain. Stimulation of sensory receptors in the esophagus result in sensations felt in the throat when swallowing, vomiting, or during acid reflux. Sensory receptors in pharynx mucosa, similar to touch receptors in the skin, sense foreign objects such as food that may result in a gag reflex and corresponding gagging sensation. Stimulation of sensory receptors in the urinary bladder and rectum may result in sensations of fullness. Stimulation of stretch sensors that sense dilation of various blood vessels may result in pain, for example headache caused by vasodilation of brain arteries. Non-human senses Analogous to human senses Other living organisms have receptors to sense the world around them, including many of the senses listed above for humans. However, the mechanisms and capabilities vary widely. Echolocation Certain animals, including bats and cetaceans, have the ability to determine orientation to other objects through interpretation of reflected sound (like sonar). They most often use this to navigate through poor lighting conditions or to identify and track prey. There is currently an uncertainty whether this is simply an extremely developed post-sensory interpretation of auditory perceptions or it actually constitutes a separate sense. Resolution of the issue will require brain scans of animals while they actually perform echolocation, a task that has proven difficult in practice. Blind people report they are able to navigate by interpreting reflected sounds (esp. their own footsteps), a phenomenon which is known as human echolocation. Smell Most non-human mammals have a much keener sense of smell than humans, although the mechanism is similar. Sharks combine their keen sense of smell with timing to determine the direction of a smell. They follow the nostril that first detected the smell. Insects have olfactory receptors on their antennae. Vomeronasal organ Many animals (salamanders, reptiles, mammals) have a vomeronasal organ that is connected with the mouth cavity. In mammals it is mainly used to detect pheromones to mark their territory, trails, and sexual state. Reptiles like snakes and monitor lizards make extensive use of it as a smelling organ, transferring scent molecules to the vomeronasal organ with the tips of the forked tongue. In mammals it is often associated with a special behavior called flehmen characterized by uplifting of the lips. The organ is vestigial in humans, because associated neurons have not been found that give any sensory input in humans. Vision Cats have the ability to see in low light due to muscles surrounding their irises to contract and expand pupils as well as the tapetum lucidum, a reflective membrane that optimizes the image. Pitvipers, pythons and some boas have organs that allow them to detect infrared light, such that these snakes are able to sense the body heat of their prey. The common vampire bat may also have an infrared sensor on its nose. It has been found that birds and some other animals are tetrachromats and have the ability to see in the ultraviolet down to 300 nanometers. Bees and dragonflies are also able to see in the ultraviolet. Balance Ctenophora have a balance receptor (a statocyst) that works very differently from the mammalian's semi-circular canals. Not analogous to human senses In addition, some animals have senses that humans do not, including the following: Electroreception (or electroception) is the ability to detect electric fields. Several species of fish, sharks and rays have the capacity to sense changes in electric fields in their immediate vicinity. Some fish passively sense changing nearby electric fields; some generate their own weak electric fields, and sense the pattern of field potentials over their body surface; and some use these electric field generating and sensing capacities for social communication. The mechanisms by which electroceptive fish construct a spatial representation from very small differences in field potentials involve comparisons of spike latencies from different parts of the fish's body. The only order of mammals that is known to demonstrate electroception is the monotreme order. Among these mammals, the platypus has the most acute sense of electroception. Body modification enthusiasts have experimented with magnetic implants to attempt to replicate this sense, however in general humans (and probably other mammals) can detect electric fields only indirectly by detecting the effect they have on hairs. An electrically charged balloon, for instance, will exert a force on human arm hairs, which can be felt through tactition and identified as coming from a static charge (and not from wind or the like). This is however not electroception as it is a post-sensory cognitive action. Magnetoreception (magnetoception) is the ability to detect a magnetic field to perceive direction, altitude or location. This sense plays a role in the navigational abilities of several animal species and has been postulated as a method for animals to develop regional maps. Pressure detection uses the organ of Weber, a system consisting of three appendages of vertebrae transferring changes in shape of the gas bladder to the middle ear. It can be used to regulate the buoyancy of the fish. Fish like the weather fish and other loaches are also known to respond to low pressure areas but they lack a swim bladder. Current detection The lateral line in fish and aquatic forms of amphibians is a detection system of water currents, mostly consisting of vortices. The lateral line is also sensitive to low frequency vibrations. The mechanoreceptors are hair cells, the same mechanoreceptors for vestibular sense and hearing. It is used primarily for navigation, hunting, and schooling. The receptors of the electrical sense are modified hair cells of the lateral line system. Polarized light direction/detection is used by bees to orient themselves, especially on cloudy days. Cuttlefish can also perceive the polarization of light. Most sighted humans can in fact learn to roughly detect large areas of polarization by an effect called Haidinger's brush, however this is considered an entoptic phenomenon rather than a separate sense. Slit sensillae of spiders detect mechanical strain in the exoskeleton, providing information on force and vibrations. Plant senses Some plants have sensory organs, for example the Venus fly trap, that respond to vibration, light, water, scents, or other specific chemicals. Some plants sense the location of other plants and attack and eat part of them. Culture The five senses are enumerated as the "five material faculties" (pañcannaṃ indriyānaṃ avakanti) in Buddhist literature. They appear in allegorical representation as early as in the Katha Upanishad (roughly 6th century BC), as five horses drawing the "chariot" of the body, guided by the mind as "chariot driver". Depictions of the five senses as allegory became a popular subject for seventeenth-century artists, especially among Dutch and Flemish Baroque painters. A typical example is Gérard de Lairesse's Allegory of the Five Senses (1668), in which each of the figures in the main group allude to a sense: sight is the reclining boy with a convex mirror, hearing is the cupid-like boy with a triangle, smell is represented by the girl with flowers, taste by the woman with the fruit and touch by the woman holding the bird. http://en.wikipedia.org/wiki/Sense , First steps to understanding the needs of a deaf person - Before anyone with normal hearing can start to support a deaf person, they need to understand precisely what problems the deaf person is having The trouble is, though, that our everyday language is woefully inadequate for the purpose. For example, people tend just to think that a deaf person doesn't 'hear' what is going on on the assumption that the remedy is merely to find a way of making it louder. However, 'hear' is not really a particularly helpful word anyway because it is so ambiguous. A sound may not loud enough for a deaf person, but other questions need to be asked, particularly for 'hearing' speech. Can the deaf person, for example, register (hear) that someone is speaking, but not be able to distinguish the words clearly enough to follow what is being said? If so - as is commonly the case - is there more of a problem with some voices than with others, like with the high pitched ones of children? Is there more of a problem in a noisy environment where voices seem to merge into the background noise? Are some sounds, which appear to be acceptably loud to people with normal hearing, too painful to endure. The list of questions could grow longer. So whether or not a deaf person can 'hear' a sound is nowhere near as helpful as whether they can listen to it comfortably, 'understand' it or 'interpret' it. So it is important to understand something about hearing problems in order to be able to express and understand the needs of a deaf person - see the links in the box above right. Other problems with the ears such as 'tinnitus' and 'vertigo' are not considered here because they have blessedly never affected me severely and so I have not had to try to understand them at all deeply or to develop coping strategies for them http://www.deaftalk.co.uk/needs.htm , , , , , Homeopathy is a system of alternative medicine originated in 1796 by Samuel Hahnemann, based on his doctrine of similia similibus curentur ("like cures like"), according to which a substance that causes the symptoms of a disease in healthy people will cure similar symptoms in sick people. Scientific research has found homeopathic remedies ineffective and their postulated mechanisms of action implausible. The scientific community regards homeopathy as a sham; the American Medical Association considers homeopathy to be quackery, and homeopathic remedies have been criticized as unethical. Hahnemann believed that the underlying cause of disease were phenomena that he termed miasms, and that homeopathic remedies addressed these. The remedies are prepared by repeatedly diluting a chosen substance in alcohol or distilled water, followed by forceful striking on an elastic body, called succussion. Each dilution followed by succussion is said to increase the remedy's potency. Dilution sometimes continues well past the point where none of the original substance remains. Homeopaths select remedies by consulting reference books known as repertories, considering the totality of the patient's symptoms as well as the patient's personal traits, physical and psychological state, and life history. The low concentration of homeopathic remedies, which often lack even a single molecule of the diluted substance, has been the basis of questions about the effects of the remedies since the 19th century. Modern advocates of homeopathy have suggested that "water has a memory" – that during mixing and succussion, the substance leaves an enduring effect on the water, perhaps a "vibration", and this produces an effect on the patient. This notion has no scientific support. Pharmacological research has found instead that stronger effects of an active ingredient come from higher, not lower doses. Homeopathic remedies have been the subject of numerous clinical trials. Taken together, these trials showed at best no effect beyond placebo, at worst that homeopathy could be actively harmful. Although some trials produced positive results, systematic reviews revealed that this was because of chance, flawed research methods, and reporting bias. The proposed mechanisms for homeopathy are precluded by the laws of physics from having any effect. Patients who choose to use homeopathy rather than evidence based medicine risk missing timely diagnosis and effective treatment of serious conditions. The regulation and prevalence of homeopathy vary greatly from country to country. History 1857 painting by Alexander Beydeman showing historical figures and personifications of homeopathy observing the brutality of medicine of the 19th century Historical context Hippocrates, in about 400 BC, perhaps originated homeopathy when he prescribed a small dose of mandrake root – which in larger doses produced mania – to treat mania itself; in the 16th century the pioneer of pharmacology Paracelsus declared that small doses of "what makes a man ill also cures him." Samuel Hahnemann (1755–1843) gave homeopathy its name and expanded its principles in the late 18th century. At that time, mainstream medicine used methods like bloodletting and purging, and administered complex mixtures, such as Venice treacle, which was made from 64 substances including opium, myrrh, and viper's flesh. These treatments often worsened symptoms and sometimes proved fatal. Hahnemann rejected these practices – which had been extolled for centuries – as irrational and inadvisable; instead, he advocated the use of single drugs at lower doses and promoted an immaterial, vitalistic view of how living organisms function, believing that diseases have spiritual, as well as physical causes. Hahnemann's concept The term "homeopathy" was coined by Hahnemann and first appeared in print in 1807. Hahnemann conceived of homeopathy while translating a medical treatise by the Scottish physician and chemist William Cullen into German. Being skeptical of Cullen's theory concerning cinchona's use for curing malaria, Hahnemann ingested some of the bark specifically to investigate what would happen. He experienced fever, shivering and joint pain: symptoms similar to those of malaria itself. From this, Hahnemann came to believe that all effective drugs produce symptoms in healthy individuals similar to those of the diseases that they treat, in accord with the "law of similars" that had been proposed by ancient physicians. An account of the effects of eating cinchona bark noted by Oliver Wendell Holmes, and published in 1861, failed to reproduce the symptoms Hahnemann reported. Hahnemann's law of similars is an ipse dixit axiom, in other words an unproven assertion made by Hahnemann, and not a true law of nature. Proving Hahnemann began to test what effects substances produced in humans, a procedure that would later become known as "homeopathic proving". These tests required subjects to test the effects of ingesting substances by clearly recording all of their symptoms as well as the ancillary conditions under which they appeared. A collection of provings was published in 1805, and a second collection of 65 remedies appeared in his book, Materia Medica Pura, in 1810. Since Hahnemann believed that large doses of drugs that caused similar symptoms would only aggravate illness, he advocated extreme dilutions of the substances; he devised a technique for making dilutions that he believed would preserve a substance's therapeutic properties while removing its harmful effects. Hahnemann believed that this process aroused and enhanced "the spirit-like medicinal powers of the crude substances".He gathered and published a complete overview of his new medical system in his 1810 book, The Organon of the Healing Art, whose 6th edition, published in 1921, is still used by homeopaths today. A homeopathic remedy prepared from marsh tea: the "15C" dilution shown here exceeds the Avogadro constant, so contains no trace of the original herb. Miasms and disease In The Organon of the Healing Art, Hahnemann introduced the concept of "miasms" as "infectious principles" underlying chronic disease.  Hahnemann associated each miasm with specific diseases, and thought that initial exposure to miasms causes local symptoms, such as skin or venereal diseases; if however these symptoms were suppressed by medication, the cause went deeper and began to manifest itself as diseases of the internal organs. Homeopathy maintains that treating diseases by directly opposing their symptoms, as is sometimes done in conventional medicine, is ineffective because all "disease can generally be traced to some latent, deep-seated, underlying chronic, or inherited tendency".  The underlying imputed miasm still remains, and deep-seated ailments can be corrected only by removing the deeper disturbance of the vital force. Hahnemann originally presented only three miasms, of which the most important was psora (Greek for "itch"), described as being related to any itching diseases of the skin, supposed to be derived from suppressed scabies, and claimed to be the foundation of many further disease conditions. Hahnemann believed psora to be the cause of such diseases as epilepsy, cancer, jaundice, deafness, and cataracts. Since Hahnemann's time, other miasms have been proposed, some replacing one or more of psora's proposed functions, including tuberculosis and cancer miasms. The law of susceptibility implies that a negative state of mind can attract hypothetical disease entities called "miasms" to invade the body and produce symptoms of diseases. Hahnemann rejected the notion of a disease as a separate thing or invading entity, and insisted it was always part of the "living whole".Hahnemann coined the expression "allopathic medicine", which was used to pejoratively refer to traditional Western medicine. Hahnemann's miasm theory remains disputed and controversial within homeopathy even in modern times. In 1978, Anthony Campbell, then a consultant physician at the Royal London Homeopathic Hospital, criticised statements by George Vithoulkas claiming that syphilis, when treated with antibiotics, would develop into secondary and tertiary syphilis with involvement of the central nervous system. This conflicts with scientific studies, which indicated penicillin treatment produces a complete cure of syphilis in more than 90% of cases. Campbell described this as "a thoroughly irresponsible statement that could mislead an unfortunate layman into refusing orthodox treatment". The theory of miasms has been criticized as an explanation developed by Hahnemann to preserve the system of homeopathy in the face of treatment failures, and for being inadequate to cover the many hundreds of sorts of diseases, as well as for failing to explain disease predispositions, as well as genetics, environmental factors, and the unique disease history of each patient. 19th century: rise to popularity and early criticism Homeopathy achieved its greatest popularity in the 19th century. Dr. John Franklin Gray (1804–1882) was the first practitioner of homeopathy in the United States, beginning in 1828 in New York City. The first homeopathic schools opened in 1830, and throughout the 19th century dozens of homeopathic institutions appeared in Europe and the United States. By 1900, there were 22 homeopathic colleges and 15,000 practitioners in the United States. Because medical practice of the time relied on ineffective and often dangerous treatments, patients of homeopaths often had better outcomes than those of the doctors of the time. Homeopathic remedies, even if ineffective, would almost surely cause no harm, making the users of homeopathic remedies less likely to be killed by the treatment that was supposed to be helping them.The relative success of homeopathy in the 19th century may have led to the abandonment of the ineffective and harmful treatments of bloodletting and purging and to have begun the move towards more effective, science-based medicine. One reason for the growing popularity of homeopathy was its apparent success in treating people suffering from infectious disease epidemics. During 19th century epidemics of diseases such as cholera, death rates in homeopathic hospitals were often lower than in conventional hospitals, where the treatments used at the time were often harmful and did little or nothing to combat the diseases. From its inception, however, homeopathy was criticized by mainstream science. Sir John Forbes, physician to Queen Victoria, said in 1843 that the extremely small doses of homeopathy were regularly derided as useless, "an outrage to human reason".James Young Simpson said in 1853 of the highly diluted drugs: "No poison, however strong or powerful, the billionth or decillionth of which would in the least degree affect a man or harm a fly." 19th century American physician and author Oliver Wendell Holmes, Sr. was also a vocal critic of homeopathy and published an essay in 1842 entitled Homœopathy, and its kindred delusions. The members of the French Homeopathic Society observed in 1867 that some of the leading homeopathists of Europe not only were abandoning the practice of administering infinitesimal doses but were also no longer defending it. The last school in the U.S. exclusively teaching homeopathy closed in 1920. Revival in the late 20th century In the United States the Food, Drug, and Cosmetic Act of 1938 (sponsored by Royal Copeland, a Senator from New York and homeopathic physician) recognized homeopathic remedies as drugs. In the 1950s, there were only 75 pure homeopaths practicing in the U.S. However, by the mid to late 1970s, homeopathy made a significant comeback and sales of some homeopathic companies increased tenfold. Greek homeopath George Vithoulkas performed a "great deal of research to update the scenarios and refine the theories and practice of homeopathy" beginning in the 1970s, and it was revived worldwide; in Brazil during the 1970s and in Germany during the 1980s.[64] The medical profession started to integrate such ideas in the 1990s and mainstream pharmacy chains recognized the business potential of selling homeopathic remedies. Remedies and treatment Homeopathic remedy Rhus toxicodendron, derived from poison ivy. Homeopathic practitioners rely on two types of reference when prescribing remedies: materia medica and repertories. A homeopathic materia medica is a collection of "drug pictures", organised alphabetically by "remedy," that describes the symptom patterns associated with individual remedies. A homeopathic repertory is an index of disease symptoms that lists remedies associated with specific symptoms. Homeopathy uses many animal, plant, mineral, and synthetic substances in its remedies. Examples include arsenicum album (arsenic oxide), natrum muriaticum (sodium chloride or table salt), Lachesis muta (the venom of the bushmaster snake), opium, and thyroidinum (thyroid hormone). Homeopaths also use treatments called "nosodes" (from the Greek nosos, disease) made from diseased or pathological products such as fecal, urinary, and respiratory discharges, blood, and tissue. Homeopathic remedies prepared from healthy specimens are called "sarcodes". Some modern homeopaths have considered more esoteric bases for remedies, known as "imponderables" because they do not originate from a substance, but from electromagnetic energy presumed to have been "captured" by alcohol or lactose. Examples include X-rays and sunlight. Today, about 3,000 different remedies are commonly used in homeopathy.[citation needed] Some homeopaths also use techniques that are regarded by other practitioners as controversial. These include "paper remedies", where the substance and dilution are written on pieces of paper and either pinned to the patients' clothing, put in their pockets, or placed under glasses of water that are then given to the patients, as well as the use of radionics to prepare remedies. Such practices have been strongly criticised by classical homeopaths as unfounded, speculative, and verging upon magic and superstition. Preparation Mortar and pestle used for grinding insoluble solids, including quartz and oyster shells, into homeopathic remedies In producing remedies for diseases, homeopaths use a process called "dynamisation" or "potentisation", whereby a substance is diluted with alcohol or distilled water and then vigorously shaken by 10 hard strikes against an elastic body in a process homeopaths call "succussion". Hahnemann advocated using substances that produce symptoms like those of the disease being treated, but found that undiluted doses intensified the symptoms and exacerbated the condition, sometimes causing dangerous toxic reactions. He therefore specified that the substances be diluted, due to his belief that succussion activated the "vital energy" of the diluted substance and made it stronger. To facilitate succussion, Hahnemann had a saddle-maker construct a special wooden striking board covered in leather on one side and stuffed with horsehair. Insoluble solids, such as quartz and oyster shell, are diluted by grinding them with lactose ("trituration"). Dilutions Three logarithmic potency scales are in regular use in homeopathy. Hahnemann created the "centesimal" or "C scale", diluting a substance by a factor of 100 at each stage. The centesimal scale was favored by Hahnemann for most of his life. A 2C dilution requires a substance to be diluted to one part in 100, and then some of that diluted solution diluted by a further factor of 100. This works out to one part of the original substance in 10,000 parts of the solution. A 6C dilution repeats this process six times, ending up with the original substance diluted by a factor of 100−6=10−12 (one part in one trillion or 1/1,000,000,000,000). Higher dilutions follow the same pattern. In homeopathy, a solution that is more dilute is described as having a higher potency, and more dilute substances are considered by homeopaths to be stronger and deeper-acting remedies. The end product is often so diluted as to be indistinguishable from the dilutant (pure water, sugar or alcohol). Hahnemann advocated 30C dilutions for most purposes (that is, dilution by a factor of 1060). In Hahnemann's time, it was reasonable to assume the remedies could be diluted indefinitely, as the concept of the atom or molecule as the smallest possible unit of a chemical substance was just beginning to be recognized. The greatest dilution reasonably likely to contain even one molecule of the original substance is 12C. This bottle contains arnica montana (wolf's bane) D6, i.e. the nominal dilution is one part in a million (10-6). Critics and advocates of homeopathy alike commonly attempt to illustrate the dilutions involved in homeopathy with analogies. Hahnemann is reported to have joked that a suitable procedure to deal with an epidemic would be to empty a bottle of poison into Lake Geneva, if it could be succussed 60 times. Another example given by a critic of homeopathy states that a 12C solution is equivalent to a "pinch of salt in both the North and South Atlantic Oceans",which is approximately correct. One-third of a drop of some original substance diluted into all the water on earth would produce a remedy with a concentration of about 13C. A popular homeopathic treatment for the flu is a 200C dilution of duck liver, marketed under the name oscillococcinum. As there are only about 1080 atoms in the entire observable universe, a dilution of one molecule in the observable universe would be about 40C. Oscillococcinum would thus require 10320 more universes to simply have one molecule in the final substance. The high dilutions characteristically used are often considered to be the most controversial and implausible aspect of homeopathy. Dilution debate Not all homeopaths advocate extremely high dilutions. In fact, most homeopathy products sold in EU (and produced even by companies such as Bayer), use dilutions of 8D or 6D, which contain picogram to nanogram amounts of diluted substances.[citation needed] Many of the early homeopaths were originally doctors and generally used lower dilutions such as "3X" or "6X", rarely going beyond "12X". The split between lower and higher dilutions followed ideological lines. Those favoring low dilutions stressed pathology and a strong link to conventional medicine, while those favoring high dilutions emphasised vital force, miasms and a spiritual interpretation of disease. Some products with such relatively lower dilutions continue to be sold, but like their counterparts, they have not been conclusively demonstrated to have any effect beyond that of a placebo. Provings A homeopathic proving is the method by which the profile of a homeopathic remedy is determined. At first Hahnemann used undiluted doses for provings, but he later advocated provings with remedies at a 30C dilution, and most modern provings are carried out using ultradilute remedies in which it is highly unlikely that any of the original molecules remain.[94] During the proving process, Hahnemann administered remedies to healthy volunteers, and the resulting symptoms were compiled by observers into a "drug picture". The volunteers were observed for months at a time and made to keep extensive journals detailing all of their symptoms at specific times throughout the day. They were forbidden from consuming coffee, tea, spices, or wine for the duration of the experiment; playing chess was also prohibited because Hahnemann considered it to be "too exciting", though they were allowed to drink beer and encouraged to exercise in moderation. After the experiments were over, Hahnemann made the volunteers take an oath swearing that what they reported in their journals was the truth, at which time he would interrogate them extensively concerning their symptoms. Provings have been described as important in the development of the clinical trial, due to their early use of simple control groups, systematic and quantitative procedures, and some of the first application of statistics in medicine. The lengthy records of self-experimentation by homeopaths have occasionally proven useful in the development of modern drugs: For example, evidence that nitroglycerin might be useful as a treatment for angina was discovered by looking through homeopathic provings, though homeopaths themselves never used it for that purpose at that time. The first recorded provings were published by Hahnemann in his 1796 Essay on a New Principle. His Fragmenta de Viribus (1805) contained the results of 27 provings, and his 1810 Materia Medica Pura contained 65. For James Tyler Kent's 1905 Lectures on Homoeopathic Materia Medica, 217 remedies underwent provings and newer substances are continually added to contemporary versions. Though the proving process has superficial similarities with clinical trials, it is fundamentally different in that the process is subjective, not blinded, and modern provings are unlikely to use pharmacologically active levels of the substance under proving. As early as 1842, Holmes noted the provings were impossibly vague, and the purported effect was not repeatable among different subjects.[35] Physical, mental, and emotional state examination; repertories Homeopaths generally begin with detailed examinations of their patients' histories, including questions regarding their physical, mental and emotional states, their life circumstances and any physical or emotional illnesses. The homeopath then attempts to translate this information into a complex formula of mental and physical symptoms, including likes, dislikes, innate predispositions and even body type. From these symptoms, the homeopath chooses how to treat the patient. A compilation of reports of many homeopathic provings, supplemented with clinical data, is known as a "homeopathic materia medica". But because a practitioner first needs to explore the remedies for a particular symptom rather than looking up the symptoms for a particular remedy, the "homeopathic repertory", which is an index of symptoms, lists after each symptom those remedies that are associated with it. Repertories are often very extensive and may include data extracted from multiple sources of materia medica. There is often lively debate among compilers of repertories and practitioners over the veracity of a particular inclusion. The first symptomatic index of the homeopathic materia medica was arranged by Hahnemann. Soon after, one of his students, Clemens von Bönninghausen, created the Therapeutic Pocket Book, another homeopathic repertory.] The first such homeopathic repertory was Georg Jahr's Symptomenkodex, published in German (1835), which was then first translated to English (1838) by Constantine Hering as the Repertory to the more Characteristic Symptoms of Materia Medica. This version was less focused on disease categories and would be the forerunner to Kent's later works. It consisted of three large volumes. Such repertories increased in size and detail as time progressed. Some diversity in approaches to treatments exists among homeopaths. "Classical homeopathy" generally involves detailed examinations of a patient's history and infrequent doses of a single remedy as the patient is monitored for improvements in symptoms, while "clinical homeopathy" involves combinations of remedies to address the various symptoms of an illness. Homeopathic pills Homeopathic pills are made from an inert substance (often sugars, typically lactose), upon which a drop of liquid homeopathic preparation is placed. "Active" ingredients The list of ingredients seen on remedies may confuse consumers into believing the product actually contains those ingredients. According to normal homeopathic practice, remedies are prepared starting with active ingredients that are often serially diluted to the point where the finished product no longer contains any biologically "active ingredients" as that term is normally defined. James Randi and the 10:23 campaign groups have demonstrated the lack of active ingredients in homeopathic products by taking large overdoses. None of the hundreds of demonstrators in the UK, Australia, New Zealand, Canada and the US were injured and "no one was cured of anything, either". While the lack of active compounds is noted in most homeopathic products, there are some exceptions such as Zicam Cold Remedy, which is marketed as an "unapproved homeopathic" product. It contains a number of highly diluted ingredients that are listed as "inactive ingredients" on the label. Some of the homeopathic ingredients used in the preparation of Zicam are galphimia glauca, histamine dihydrochloride (homeopathic name, histaminum hydrochloricum), luffa operculata, and sulfur. Although the product is marked "homeopathic", it does contain two ingredients that are only "slightly" diluted: zinc acetate (2X = 1/100 dilution) and zinc gluconate (1X = 1/10 dilution), which means both are present in a concentration that contains biologically active ingredients. In fact, they are strong enough to have caused some people to lose their sense of smell, a condition termed anosmia. This illustrates why taking a product marked "homeopathic", especially an overdose, can still be dangerous because it may contain biologically active ingredients, though as discussed previously, most homeopathic preparations contain no active ingredients. Because the manufacturers of Zicam label it as a homeopathic product (despite the relatively high concentrations of active ingredients), it is exempted from FDA regulation by the Dietary Supplement Health and Education Act of 1994 (DSHEA). Related treatments and practices Isopathy Isopathy is a therapy derived from homeopathy invented by Johann Joseph Wilhelm Lux in the 1830s. Isopathy differs from homeopathy in general in that the remedies, known as "nosodes", are made up either from things that cause the disease or from products of the disease, such as pus. Many so-called "homeopathic vaccines" are a form of isopathy. Flower remedies Flower remedies can be produced by placing flowers in water and exposing them to sunlight. The most famous of these are the Bach flower remedies, which were developed by the physician and homeopath Edward Bach. Although the proponents of these remedies share homeopathy's vitalist world-view and the remedies are claimed to act through the same hypothetical "vital force" as homeopathy, the method of preparation is different. Bach flower remedies are prepared in "gentler" ways such as placing flowers in bowls of sunlit water, and the remedies are not succussed. There is no convincing scientific or clinical evidence for flower remedies being effective. Veterinary use The idea of using homeopathy as a treatment for other animals, termed "veterinary homeopathy", dates back to the inception of homeopathy; Hahnemann himself wrote and spoke of the use of homeopathy in animals other than humans. The FDA has not approved homeopathic products as veterinary medicine in the U.S. In the UK, veterinary surgeons that use homeopathy belong to the Faculty of Homeopathy and/or to the British Association of Homeopathic Veterinary Surgeons. Animals may be treated only by qualified veterinary surgeons in the UK and some other countries. Internationally, the body that supports and represents homeopathic veterinarians is the International Association for Veterinary Homeopathy. The use of homeopathy in veterinary medicine is controversial; the little existing research on the subject is not of a high enough scientific standards to provide reliable data on efficacy. Other studies have also found that giving animals placebos can play active roles in influencing pet owners to believe in the effectiveness of the treatment when none exists. Electrohomeopathy Electrohomeopathy was a 19th century practice combining homeopathy with electric treatment. Evidence Homeopathy Claims    Proponents claim that illnesses can be treated with specially prepared extreme dilutions of a substance that produces symptoms similar to the illness. Homeopathic remedies rarely contain any atom or molecule of the substance in the remedy. Related scientific disciplines    Chemistry, Medicine Year proposed    1807 Original proponents    Samuel Hahnemann Subsequent proponents    Organizations: Boiron, Heel, Miralus Healthcare, Nelsons, Zicam Individuals: Deepak Chopra, Paul Herscu, Robin Murphy, Rajan Sankaran, Luc De Schepper, Jan Scholten, Jeremy Sherr, Dana Ullman, George Vithoulkas Pseudoscientific concepts The medicinal claims of homeopathy are unsupported by the collective weight of modern scientific research – outside of the CAM community, scientists have long regarded homeopathy as a sham. There is an overall absence of sound statistical evidence of therapeutic efficacy, which is consistent with the lack of any biologically plausible pharmacological agent or mechanism. Abstract concepts within theoretical physics have been invoked to suggest explanations of how or why remedies might work, including quantum entanglement, the theory of relativity and chaos theory. However, the explanations are offered by nonspecialists within the field, and often include speculations that are incorrect in their application of the concepts and not supported by actual experiments. Several of the key concepts of homeopathy conflict with fundamental concepts of physics and chemistry. For instance, quantum entanglement is not possible as humans and other animals are far too large to be affected by quantum effects, and entanglement is a delicate state which rarely lasts longer than a fraction of a second. In addition, while entanglement may result in certain aspects of individual subatomic particles acquiring each other's quantum states, this does not mean the particles will mirror or duplicate each other, or cause health-improving transformations. Plausibility The extreme dilutions used in homeopathic preparations often leave none of the original substance in the final product. The modern mechanism proposed by homeopaths, water memory, is considered implausible in that short-range order in water only persists for about 1 picosecond. Existence of a pharmacological effect in the absence of any true active ingredient is inconsistent with the observed dose-response relationships characteristic of therapeutic drugs (whereas placebo effects are non-specific and unrelated to pharmacological activity). The proposed rationale for these extreme dilutions – that the water contains the "memory" or "vibration" from the diluted ingredient – is counter to the laws of chemistry and physics, such as the law of mass action. Analysis shows proposed mechanisms for homeopathy are precluded from having any effect by the laws of physics and physical chemistry. High dilutions The extremely high dilutions in homeopathy preclude a biologically plausible mechanism of action. Homeopathic remedies are often diluted to the point where there are no molecules from the original solution left in a dose of the final remedy. Homeopaths contend that the methodical dilution of a substance, beginning with a 10% or lower solution and working downwards, with shaking after each dilution, produces a therapeutically active remedy, in contrast to therapeutically inert water. Since even the longest-lived noncovalent structures in liquid water at room temperature are stable for only a few picoseconds, critics have concluded that any effect that might have been present from the original substance can no longer exist. No evidence of stable clusters of water molecules was found when homeopathic remedies were studied using nuclear magnetic resonance. Furthermore, since water will have been in contact with millions of different substances throughout its history, critics point out that water is therefore an extreme dilution of almost any conceivable substance. By drinking water one would, according to this interpretation, receive treatment for every imaginable condition. For comparison, ISO 3696: 1987 defines a standard for water used in laboratory analysis; this allows for a contaminant level of ten parts per billion, 4C in homeopathic notation. This water may not be kept in glass as contaminants will leach out into the water. Practitioners of homeopathy contend that higher dilutions produce stronger medicinal effects. This idea is inconsistent with the observed dose-response relationships of conventional drugs, where the effects are dependent on the concentration of the active ingredient in the body. This dose-response relationship has been confirmed in myriad experiments on organisms as diverse as nematodes, rats, and humans. Physicist Robert L. Park, former executive director of the American Physical Society, is quoted as saying, "since the least amount of a substance in a solution is one molecule, a 30C solution would have to have at least one molecule of the original substance dissolved in a minimum of 1,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000,000 [or 1060] molecules of water. This would require a container more than 30,000,000,000 times the size of the Earth." Park is also quoted as saying that, "to expect to get even one molecule of the 'medicinal' substance allegedly present in 30X pills, it would be necessary to take some two billion of them, which would total about a thousand tons of lactose plus whatever impurities the lactose contained". The laws of chemistry state that there is a limit to the dilution that can be made without losing the original substance altogether. This limit, which is related to Avogadro's number, is roughly equal to homeopathic potencies of 12C or 24X (1 part in 1024). Scientific tests run by both the BBC's Horizon and ABC's 20/20 programs were unable to differentiate homeopathic dilutions from water, even when using tests suggested by homeopaths themselves. Efficacy The effectiveness of homeopathy has been in dispute since its inception. One of the earliest double blind studies concerning homeopathy was sponsored by the British government during World War II in which volunteers tested the efficacy of homeopathic remedies against diluted mustard gas burns. No individual preparation has been unambiguously shown by research to be different from placebo. The methodological quality of the primary research was generally low, with such problems as weaknesses in study design and reporting, small sample size, and selection bias. Since better quality trials have become available, the evidence for efficacy of homeopathy preparations has diminished; the highest-quality trials indicate that the remedies themselves exert no intrinsic effect. A review conducted in 2010 of all the pertinent studies of "best evidence" produced by the Cochrane Collaboration concluded that "the most reliable evidence – that produced by Cochrane reviews – fails to demonstrate that homeopathic medicines have effects beyond placebo." Publication bias and other methodological issues The fact that individual randomized controlled trials have given positive results is not in contradiction with an overall lack of statistical evidence of efficacy. A small proportion of randomized controlled trials inevitably provide false-positive outcomes due to the play of chance: a "statistically significant" positive outcome is commonly adjudicated when the probability of it being due to chance rather than a real effect is no more than 5%—a level at which about 1 in 20 tests can be expected to show a positive result in the absence of any therapeutic effect. Furthermore, trials of low methodological quality (i.e. ones which have been inappropriately designed, conducted or reported) are prone to give misleading results. In a systematic review of the methodological quality of randomized trials in three branches of alternative medicine, Linde et al. highlighted major weaknesses in the homeopathy sector, including poor randomization. A related issue is publication bias: researchers are more likely to submit trials that report a positive finding for publication, and journals prefer to publish positive results. Publication bias has been particularly marked in complementary and alternative medicine journals, where few of the published articles (just 5% during the year 2000) tend to report null results. Regarding the way in which homeopathy is represented in the medical literature, a systematic review found signs of bias in the publications of clinical trials (towards negative representation in mainstream medical journals, and vice-versa in complementary and alternative medicine journals), but not in reviews. Systematic reviews and meta-analyses of efficacy Both meta-analyses, which statistically combine the results of several randomized controlled trials, and other systematic reviews of the literature are essential tools to summarize evidence of therapeutic efficacy. Early systematic reviews and meta-analyses of trials evaluating the efficacy of homeopathic remedies in comparison with placebo more often tended to generate positive results, but appeared unconvincing overall. In particular, reports of three large meta-analyses warned readers that firm conclusions could not be reached, largely due to methodological flaws in the primary studies and the difficulty in controlling for publication bias. The positive finding of one of the most prominent of the early meta-analyses, published in The Lancet in 1997 by Linde et al., was later reframed by the same research team, who wrote: The evidence of bias [in the primary studies] weakens the findings of our original meta-analysis. Since we completed our literature search in 1995, a considerable number of new homeopathy trials have been published. The fact that a number of the new high-quality trials ... have negative results, and a recent update of our review for the most "original" subtype of homeopathy (classical or individualized homeopathy), seem to confirm the finding that more rigorous trials have less-promising results. It seems, therefore, likely that our meta-analysis at least overestimated the effects of homeopathic treatments. In 2002, a systematic review of the available systematic reviews confirmed that higher-quality trials tended to have less positive results, and found no convincing evidence that any homeopathic remedy exerts clinical effects different from placebo. In 2005, The Lancet medical journal published a meta-analysis of 110 placebo-controlled homeopathy trials and 110 matched medical trials based upon the Swiss government's Program for Evaluating Complementary Medicine, or PEK. The study concluded that its findings were compatible with the notion that the clinical effects of homeopathy are nothing more than placebo effects. A 2006 meta-analysis of six trials evaluating homeopathic treatments to reduce cancer therapy side-effects following radiotherapy and chemotherapy found that there was "insufficient evidence to support clinical efficacy of homeopathic therapy in cancer care". A 2007 systematic review of homeopathy for children and adolescents found that the evidence for attention-deficit hyperactivity disorder and childhood diarrhea was mixed. No difference from placebo was found for adenoid vegetation, asthma, or upper respiratory tract infection. Evidence was not sufficient to recommend any therapeutic or preventative intervention, and the delay in medical treatment may be harmful to the patient. In 2012, a systematic review evaluating evidence of homeopathy's possible adverse effects concluded that "homeopathy has the potential to harm patients and consumers in both direct and indirect ways".One of the reviewers, Edzard Ernst, supplemented the article on his blog, writing: "I have said it often and I say it again: if used as an alternative to an effective cure, even the most 'harmless' treatment can become life-threatening." The Cochrane Library found insufficient clinical evidence to evaluate the efficacy of homeopathic treatments for asthma dementia, or for the use of homeopathy in induction of labor. Other researchers found no evidence that homeopathy is beneficial for osteoarthritis, migraines or delayed-onset muscle soreness. Health organisations such as the UK's National Health Service, the American Medical Association, and the FASEB have issued statements of their conclusion that there is no convincing scientific evidence to support the use of homeopathic treatments in medicine. Clinical studies of the medical efficacy of homeopathy have been criticised by some homeopaths as being irrelevant because they do not test "classical homeopathy". There have, however, been a number of clinical trials that have tested individualized homeopathy. A 1998 review found 32 trials that met their inclusion criteria, 19 of which were placebo-controlled and provided enough data for meta-analysis. These 19 studies showed a pooled odds ratio of 1.17 to 2.23 in favor of individualized homeopathy over the placebo, but no difference was seen when the analysis was restricted to the methodologically best trials. The authors concluded "that the results of the available randomized trials suggest that individualized homeopathy has an effect over placebo. The evidence, however, is not convincing because of methodological shortcomings and inconsistencies." Jay Shelton, author of a book on homeopathy, has stated that the claim assumes without evidence that classical, individualized homeopathy works better than nonclassical variations. In a 2012 article published in the Skeptical Inquirer, Edzard Ernst reviewed the publications of the research group that has published most of the clinical studies of homeopathic treatment from 2005 to 2010. A total of eleven articles, published in both conventional and alternative medical journals, describe three randomized clinical trials (one article), prospective cohort studies without controls (seven articles) and comparative cohort studies with controls (three articles). The diseases include a wide range of conditions from knee surgery, eczema, migraine, insomnia to ‘any condition of elderly patients". Ernst's evaluation found numerous flaws in the design, conduct and reporting of the clinical studies. Examples include: little detail of the actual homeopathic treatment administered, misleading presentation of controls (comparison of homeopathic plus conventional treatment and conventional treatment, but presented as homeopathic versus conventional treatment); and published similar data in multiple articles. He concluded that the over- and misinterpreted weak data made the homeopathy appears to have clinical effects which can be attributed to bias or confounding, and that 'casual reader can be seriously misled'. Explanations of perceived effects Science offers a variety of explanations for how homeopathy may appear to cure diseases or alleviate symptoms even though the remedies themselves are inert: The placebo effect — the intensive consultation process and expectations for the homeopathic preparations may cause the effect Therapeutic effect of the consultation — the care, concern, and reassurance a patient experiences when opening up to a compassionate caregiver can have a positive effect on the patient's well-being Unassisted natural healing — time and the body's ability to heal without assistance can eliminate many diseases of their own accord Unrecognized treatments — an unrelated food, exercise, environmental agent, or treatment for a different ailment, may have occurred Regression toward the mean — since many diseases or conditions are cyclical, symptoms vary over time and patients tend to seek care when discomfort is greatest; they may feel better anyway but because the timing of the visit to the homeopath they attribute improvement to the remedy taken Non-homeopathic treatment — patients may also receive standard medical care at the same time as homeopathic treatment, and the former is responsible for improvement Cessation of unpleasant treatment — often homeopaths recommend patients stop getting medical treatment such as surgery or drugs, which can cause unpleasant side-effects; improvements are attributed to homeopathy when the actual cause is the cessation of the treatment causing side-effects in the first place, but the underlying disease remains untreated and still dangerous to the patient Lifestyle changes — homeopaths often recommend diet and exercise, as well as limitations in alcohol or coffee consumption and stress reduction, all of which can increase health and decrease symptoms[citation needed] Effects in other biological systems While some articles have suggested that homeopathic solutions of high dilution can have statistically significant effects on organic processes including the growth of grain, histamine release by leukocytes, and enzyme reactions, such evidence is disputed since attempts to replicate them have failed. In 1987, French immunologist Jacques Benveniste submitted a paper to the journal Nature while working at INSERM. The paper purported to have discovered that basophils, a type of white blood cell, released histamine when exposed to a homeopathic dilution of anti-immunoglobulin E antibody. The journal editors, sceptical of the results, requested that the study be replicated in a separate laboratory. Upon replication in four separate laboratories the study was published. Still sceptical of the findings, Nature assembled an independent investigative team to determine the accuracy of the research, consisting of Nature editor and physicist Sir John Maddox, American scientific fraud investigator and chemist Walter Stewart, and sceptic James Randi. After investigating the findings and methodology of the experiment, the team found that the experiments were "statistically ill-controlled", "interpretation has been clouded by the exclusion of measurements in conflict with the claim", and concluded, "We believe that experimental data have been uncritically assessed and their imperfections inadequately reported." James Randi stated that he doubted that there had been any conscious fraud, but that the researchers had allowed "wishful thinking" to influence their interpretation of the data. Ethics and safety The provision of homeopathic remedies has been described as unethical. As homeopathic remedies often contain only water and/or alcohol, they are however thought to be generally safe – only in rare cases are the original ingredients present at detectable levels. This may be due to improper preparation or intentional low dilution. Instances of arsenic poisoning have occurred after use of arsenic-containing homeopathic preparations. Zicam Cold remedy Nasal Gel, which contains 2X (1:100) zinc gluconate, reportedly caused a small percentage of users to lose their sense of smell; 340 cases were settled out of court in 2006 for 12 million U.S. dollars. In 2009, the FDA advised consumers to stop using three discontinued cold remedy products manufactured by Zicam because it could cause permanent damage to users' sense of smell. Zicam was launched without a New Drug Application (NDA) under a provision in the FDA's Compliance Policy Guide called "Conditions Under Which Homeopathic Drugs May be Marketed" (CPG 7132.15), but the FDA warned Zicam via a Warning Letter that this policy does not apply when there is a health risk to consumers. The lack of convincing scientific evidence supporting its efficacy and its use of remedies without active ingredients have led to characterizations as pseudoscience and quackery, or, in the words of a 1998 medical review, "placebo therapy at best and quackery at worst." The Chief Medical Officer for England, Dame Sally Davies, has stated that homeopathic remedies are "rubbish" and do not serve as anything more than placebos. Jack Killen, acting deputy director of the National Center for Complementary and Alternative Medicine, says homeopathy "goes beyond current understanding of chemistry and physics." He adds: "There is, to my knowledge, no condition for which homeopathy has been proven to be an effective treatment." Ben Goldacre says that homeopaths who misrepresent scientific evidence to a scientifically illiterate public, have "...walled themselves off from academic medicine, and critique has been all too often met with avoidance rather than argument." Homeopaths often prefer to ignore meta-analyses in favour of cherry picked positive results, such as by promoting a particular observational study (one which Goldacre describes as "little more than a customer-satisfaction survey") as if it were more informative than a series of randomized controlled trials. Referring specifically to homeopathy, the British House of Commons Science and Technology Committee has stated: In the Committee's view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice - which the Government claims is very important - as it means patients do not have all the information needed to make choice meaningful. Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS. The National Center for Complementary and Alternative Medicine of the United States' National Institutes of Health states: Homeopathy is a controversial topic in complementary medicine research. A number of the key concepts of homeopathy are not consistent with fundamental concepts of chemistry and physics. For example, it is not possible to explain in scientific terms how a remedy containing little or no active ingredient can have any effect. This, in turn, creates major challenges to rigorous clinical investigation of homeopathic remedies. For example, one cannot confirm that an extremely dilute remedy contains what is listed on the label, or develop objective measures that show effects of extremely dilute remedies in the human body. On clinical grounds, patients who choose to use homeopathy in preference to normal medicine risk missing timely diagnosis and effective treatment, thereby worsening the outcomes of serious conditions. Critics of homeopathy have cited individual cases of patients of homeopathy failing to receive proper treatment for diseases that could have been easily diagnosed and managed with conventional medicine and who have died as a result and the "marketing practice" of criticizing and downplaying the effectiveness of mainstream medicine. Homeopaths claim that use of conventional medicines will "push the disease deeper" and cause more serious conditions, a process referred to as "suppression". Some homeopaths (particularly those who are non-physicians) advise their patients against immunisation. Some homeopaths suggest that vaccines be replaced with homeopathic "nosodes", created from biological materials such as pus, diseased tissue, bacilli from sputum or (in the case of "bowel nosodes") feces. While Hahnemann was opposed to such preparations, modern homeopaths often use them although there is no evidence to indicate they have any beneficial effects. Cases of homeopaths advising against the use of anti-malarial drugs have been identified. This puts visitors to the tropics who take this advice in severe danger, since homeopathic remedies are completely ineffective against the malaria parasite. Also, in one case in 2004, a homeopath instructed one of her patients to stop taking conventional medication for a heart condition, advising her on 22 June 2004 to "Stop ALL medications including homeopathic", advising her on or around 20 August that she no longer needed to take her heart medication, and adding on 23 August, "She just cannot take ANY drugs – I have suggested some homeopathic remedies ... I feel confident that if she follows the advice she will regain her health." The patient was admitted to hospital the next day, and died eight days later, the final diagnosis being "acute heart failure due to treatment discontinuation". In 1978, Anthony Campbell, then a consultant physician at The Royal London Homeopathic Hospital, criticised statements made by George Vithoulkas to promote his homeopathic treatments. Vithoulkas stated that syphilis, when treated with antibiotics, would develop into secondary and tertiary syphilis with involvement of the central nervous system. Campbell described this as a thoroughly irresponsible statement that could mislead an unfortunate layperson into refusing conventional medical treatment. This claim echoes the idea that treating a disease with external medication used to treat the symptoms would only drive it deeper into the body and conflicts with scientific studies, which indicate that penicillin treatment produces a complete cure of syphilis in more than 90% of cases. A 2006 review by W. Steven Pray of the College of Pharmacy at Southwestern Oklahoma State University recommends that pharmacy colleges include a required course in unproven medications and therapies, that ethical dilemmas inherent in recommending products lacking proven safety and efficacy data be discussed, and that students should be taught where unproven systems such as homeopathy depart from evidence-based medicine. Edzard Ernst, the first Professor of Complementary Medicine in the United Kingdom and a former homeopathic practitioner, has expressed his concerns about pharmacists who violate their ethical code by failing to provide customers with "necessary and relevant information" about the true nature of the homeopathic products they advertise and sell: "My plea is simply for honesty. Let people buy what they want, but tell them the truth about what they are buying. These treatments are biologically implausible and the clinical tests have shown they don't do anything at all in human beings. The argument that this information is not relevant or important for customers is quite simply ridiculous." Michael Baum, Professor Emeritus of Surgery and visiting Professor of Medical Humanities at University College London (UCL), has described homoeopathy as a "cruel deception". In an article entitled "Should We Maintain an Open Mind about Homeopathy?" published in the American Journal of Medicine, Michael Baum and Edzard Ernst – writing to other physicians – wrote that "Homeopathy is among the worst examples of faith-based medicine... These axioms [of homeopathy] are not only out of line with scientific facts but also directly opposed to them. If homeopathy is correct, much of physics, chemistry, and pharmacology must be incorrect...". Regulation and prevalence Homeopathy is fairly common in some countries while being uncommon in others; is highly regulated in some countries and mostly unregulated in others. It is practised worldwide and professional qualifications and licences are needed in most countries. Regulations vary in Europe depending on the country. In some countries, there are no specific legal regulations concerning the use of homeopathy, while in others, licences or degrees in conventional medicine from accredited universities are required. In Germany, to become a homeopathic physician, one must attend a three-year training program, while France, Austria and Denmark mandate licences to diagnose any illness or dispense of any product whose purpose is to treat any illness. Some homeopathic treatment is covered by the public health service of several European countries, including France, the United Kingdom, Denmark, and Luxembourg. In other countries, such as Belgium, homeopathy is not covered. In Austria, the public health service requires scientific proof of effectiveness in order to reimburse medical treatments and homeopathy is listed as not reimbursable but exceptions can be made; private health insurance policies sometimes include homeopathic treatment. The Swiss government, after a 5-year trial, withdrew homeopathy and four other complementary treatments in 2005, stating that they did not meet efficacy and cost-effectiveness criteria, but following a referendum in 2009 the five therapies are to be reinstated for a further 6-year trial period from 2012. A December 2012 letter to the Swiss Medical Weekly by Felix Gurtner of the Federal Office of Public Health (FOPH) reiterates these points, noting that the FOPH has concluded that homeopathy is not supported by good evidence and the current temporary reimbursement is on political, not medical, grounds. The Indian government recognises homeopathy as one of its national systems of medicine, it has established AYUSH or the Department of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy under the Ministry of Health & Family Welfare. The Central Council of Homoeopathy was established in 1973 to monitor higher education in Homeopathy, and National Institute of Homoeopathy in 1975. A minimum of a recognised diploma in homeopathy and registration on a state register or the Central Register of Homoeopathy is required to practice homeopathy in India. In the United Kingdom, MPs inquired into homeopathy to assess the Government's policy on the issue, including funding of homeopathy under the National Health Service and government policy for licensing homeopathic products. The decision by the House of Commons Science and Technology Committee follows a written explanation from the Government in which it told the select committee that the licensing regime was not formulated on the basis of scientific evidence. "The three elements of the licensing regime (for homeopathic products) probably lie outside the scope of the ... select committee inquiry, because government consideration of scientific evidence was not the basis for their establishment," the Committee said. The inquiry sought written evidence and submissions from concerned parties. In February 2010 the House of Commons Science and Technology Committee concluded that: ... the NHS should cease funding homeopathy. It also concludes that the Medicines and Healthcare products Regulatory Agency (MHRA) should not allow homeopathic product labels to make medical claims without evidence of efficacy. As they are not medicines, homeopathic products should no longer be licensed by the MHRA. The Committee concurred with the Government that the evidence base shows that homeopathy is not efficacious (that is, it does not work beyond the placebo effect) and that explanations for why homeopathy would work are scientifically implausible. The Committee concluded – given that the existing scientific literature showed no good evidence of efficacy – that further clinical trials of homeopathy could not be justified. In the Committee's view, homeopathy is a placebo treatment and the Government should have a policy on prescribing placebos. The Government is reluctant to address the appropriateness and ethics of prescribing placebos to patients, which usually relies on some degree of patient deception. Prescribing of placebos is not consistent with informed patient choice – which the Government claims is very important – as it means patients do not have all the information needed to make choice meaningful. Beyond ethical issues and the integrity of the doctor-patient relationship, prescribing pure placebos is bad medicine. Their effect is unreliable and unpredictable and cannot form the sole basis of any treatment on the NHS. The Committee also stated: We conclude that placebos should not be routinely prescribed on the NHS. The funding of homeopathic hospitals – hospitals that specialise in the administration of placebos – should not continue, and NHS doctors should not refer patients to homeopaths. In July 2010 the newly appointed UK Secretary of State for Health deferred to local NHS on funding homeopathy. A nineteen page document details the Government´s response, and it states that "our continued position on the use of homeopathy within the NHS is that the local NHS and clinicians, rather than Whitehall, are best placed to make decisions on what treatment is appropriate for their patients - including complementary or alternative treatments such as homeopathy - and provide accordingly for those treatments." The response also stated that "the overriding reason for NHS provision is that homeopathy is available to provide patient choice".by February 2011 only one third of PCTs still funded homeopathy. In 2012 in the United Kingdom, Derby University dropped its homeopathy program, and the University of Westminster ceased enrolling new homeopathy students. Salford University had dropped its homeopathy program the previous year. Public opposition Overdosing on homeopathic preparations by single individuals or in "mass suicides" have become more popular since James Randi began taking entire bottles of homeopathic sleeping pills before lectures. In 2010 The Merseyside Skeptics Society from the United Kingdom launched the 10:23 campaign encouraging groups to publicly overdose as groups. In 2011 the 10:23 campaign expanded and saw sixty-nine groups participate, fifty-four submitted videos. In April 2012, at the Berkeley SkeptiCal conference, over 100 people participated in a mass overdose, taking caffea cruda which is supposed to treat sleeplessness. The non-profit, educational organizations Center for Inquiry (CFI) and the associated Committee for Skeptical Inquiry (CSI) have petitioned the U.S. Food and Drug Administration (FDA), criticizing Boiron for misleading labeling and advertising of Oscillococcinum. CFI in Canada is calling for persons that feel they were harmed by homeopathic products to contact them. In August 2011, a class action lawsuit was filed against Boiron on behalf of "all California residents who purchased Oscillo at any time within the past four years." The lawsuit charges that it "is nothing more than a sugar pill," "despite falsely advertising that it contains an active ingredient known to treat flu symptoms." CBC News reporter Erica Johnson for Marketplace conducted an investigation on the homeopathy industry in Canada, her findings were that it is "based on flawed science and some loopy thinking". Center for Inquiry (CFI) Vancouver skeptics participated in a mass overdose outside an emergency room in Vancouver, B.C., taking entire bottles of "medications" that should have made them sleepy, nauseous or dead, after 45 minutes of observation no ill effects were felt. Johnson asked homeopaths and company representatives about cures for cancer and vaccine claims, all reported positive results. None could offer any science backing up their statements, only that "it works". Johnson was unable to find any evidence that homeopathic preparations contain any active ingredient. University of Toronto's chemistry department found that the active ingredient is so small "it is equivalent to 5 billion times less than the amount of aspirin... in a single pellet". Belladonna and ipeca "would be indistinguishable from each other in a blind test." http://en.wikipedia.org/wiki/Homeopathy , , "The true foundation of health care lies not in the eradication of disease, but in the promotion of health." The Ancient Road to Radiant Health Thousands of years ago, the people of China established an herbal system that today is considered the world over as one of the most sophisticated forms of natural health care. What makes this system so unique is it’s fundamental perception that lies in the promotion of health, not in the eradication of disease. Tonic Herbs Promote Physical and Mental Well Being Through centuries of personal experimentation, Chinese herbalists observed that taking certain herbs assisted in moving toward a state of balance. The result of this harmony of body and mind is the emergence of our inner nature or true self.  Someone who experiences this emergence of true self is awakened and attuned to their ultimate path in life – with the vitality and energy to pursue their dreams. “When the body balances, the mind will become clear.” - This is the true state of “Radiant Health”. Health Beyond Danger Radiant health starts with the ability to resist the onset of disease and recuperative powers that amaze.  Yet it is far more than the ultimate preventative health program. At the center of this system lies your body’s ability to adapt to all the internal and external stressors of life.  The adaptive energy of the superior herbs help us flow with the constant change of life.  With enhanced capacity to overcome stress we grow as human beings and expand our experience of life. http://www.askrogerdrummer.com/healingherbs/chinese-herbology ,



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