PREVENTABLE BLINDNESS

In senile macular degeneration (SMD), new blood vessels grow over the retina (the light-sensing layer in the back of the eye), distorting it so that it no longer functions properly. Although SMD accounts for nearly all new cases of blindness in people over 65, its cause remains unknown.

Nevertheless, physicians working at the National Eye Institute have made an exciting announcement. A brief session in the doctor’s office with about 10 minutes of laser beam treatment usually stops the blood vessel proliferation and restores normal vision in over 80 percent of cases. Most of the remainder benefit, too, but partially. Many people need this treatment repeatedly.

The researchers announcing this advance in Archives of Ophthalmology (100:911) make it clear that, to benefit, SMD patients must obtain laser treatment soon after the onset of symptoms. If they wait too long, irreversible damage will already have been done. To catch SMD recurrences early enough, the researchers urge, all victims should test their own vision daily with an Amsler grid (which they can get from an ophthalmologist), and report changes right away.

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WATER PILLS AND SUNLIGHT

Certain drugs have the ability to induce an allergic hypersensitivity to sunlight, a side effect known as phototoxicity. Perhaps the most common medicines to do this are the thiazide diuretics (“water pills”) that so many people rely upon for the control of high blood pressure or heart failure.

Phototoxic effects in the skin include itching and a red, bumpy rash (due to many small blisters) on parts of the body exposed to sunlight. When the drug is stopped right away, the rash may quickly disappear, even if it continues to be exposed to the sun. However, if the drug is ever given again, the rash quickly returns and will continue to cause discomfort for the rest of the person’s life whenever he or she is exposed to sunlight.

In such cases, it may be possible to shield the skin with PUVA (an artificial deep suntan). To do this, the Archives of Dermatology (121:522) reports, dermatologists give an artificial vitamin A-like drug by mouth that, after it is absorbed, darkens the skin in the presence of ultraviolet light (UV), while they administer graded doses of UV. Without such treatment, people who have chronic phototoxicity must permanently avoid the sun.

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MEDICAL CARE DURING PREGNANCY: CHOICE OF HOSPITAL

Many women have their hearts set on attending a certain hospital. This is usually because a close relative or friend attended that particular hospital for her confinement. Maybe you visited her there, found everything to your liking, and decided it was the place for you if and when your time came.

Moreover, your friend probably extolled the virtues of the place. She has told you how happy she was there, how efficient the services were, how kind and thoughtful and attentive the nursing staff were, and how delightful and well prepared and served the food was.

These are important factors, to be sure. If the efficiency of the institution extended also to the more practical medical side, if it is geared to meet all possible requirements, to cope with all emergencies and eventualities, then that hospital may indeed be the “ideal place for you.

But a few other factors are also worth bearing in mind. If the hospital, no matter how good it is, happens to be located many miles from where you live, and is almost inaccessible, then it may not be the most convenient place after all. Just think that you are actually to live there for about a week (more or less, depending on how you fare). No doubt you will look forward to frequent social visits from your family and friends. If you are situated miles away, the chances of very many visits will not be high. It is not important now, but later on it may be a factor that makes your hospital days happy or not-so-happy. At least, it is worth bearing in mind.

Also, you must physically ‘ ‘get to the hospital on time.” Of course, with confinement number one, there is usually plenty of warning time. But with subsequent confinements, there is not always a great deal of time between the initial warnings and the time baby puts in his appearance. So, long distances to travel (maybe in traffic snarls and peak-hour difficulties) could present a problem. You will have enough to cope with at the time without worrying about the mechanics of getting to hospital in safety.

Many a baby has been born in a taxi or an ambulance en route to the hospital. Such events often make the front pages of newspapers. But it is certainly a most undesirable situation, both for mother and baby. Indeed, it can lead to major problems, and is definitely not for you.

So, when you discuss doctors, the hospital situation must also be considered at the same time. The sooner this is attended to, the better. Usually the doctor arranges the hospital booking. Often it is necessary for you to back this up by a personal attendance at the hospital, fill out certain forms, pay a deposit, and attend to certain formalities. In these days of hospital overcrowding, it is essential that this all be attended to very early. Frequently, the doctor will do his part within minutes of your leaving his office after the initial attendance.

These days, economics often plays a part in medical care. So, some people will prefer to attend hospital clinics direct. Once more, it is a case of taking action promptly as soon as you feel you may be pregnant. Once there, the routine is very similar to the system you will follow if you attend a doctor in a private capacity. In short, you get aboard the merry-go-round, and you go wherever it takes you.

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FAMILY PLANNING: THE CONDOM

The condom, or sheath, is still used, although this too has been replaced with most by other forms. It consists of a rubber sheath that the male fits over the penis in the erect state prior to vaginal penetration. The spermatic ejaculate enters a small dilated nipple at the closed end of the device. It is often used in women who are on the Pill, but who prefer to be ‘ ‘off it” for a month or two rest spell.

It appears to be more widely used among unmarried couples or with those whose sexual encounters are of the casual kind. At least the condom has one added function which is most important these promiscuous days. It gives both parties excellent protection against the risk of contracting or spreading venereal infections, and for that reason it is to be hoped its availability will continue. There is no hope of stamping out promiscuous living, and this, at least, is one way of reducing the national V.D. toll, which has been escalating at an appalling rate.

Doctors are well aware of the protective value of the simple condom. In fact, the advent of the Pill and its ready availability has often been blamed for the increase in V.D. Women, of all social strata, now tend to use the Pill, whereas in former times there was a greater reliance on the condom, which mechanically prevented or greatly reduced the V.D. transmission factor.

World-wide, the condom is said to be very widely used, particularly in the Orient.

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MARRIAGE: SEXUAL ASPECT

The sexual aspect of marriage is vitally important. While it may be possible to have a happy marriage and yet not have a satisfactory sexual relationship, such a situation is the exception rather than the rule. Happiness in the marriage bond may not be entirely dependent upon the mutually satisfactory sexual arrangements and attitudes; however, in practice, to a large extent, marital contentment is usually closely bound up with this side of marriage.

There are many couples who have sexually drifted apart. Some of these may declare that they are quite content with things as they are, that they are in no need of such satisfactions as others may obtain from a sexual relationship with their partners. However, it is a matter of record that such relationships are fragile at best, for one or the other (or sometimes both) of the marriage partners will come to the place when they tire of this arrangement, and it is not long before a secret liaison is established with someone else. In other words, it is easy to fool ourselves that we have no physical and emotional needs which are normally satisfied with a sexual relationship within marriage; but literally millions of couples have proved that, by adopting this attitude they have done themselves—and their marriage—an irreparable disservice.

For those who have found a satisfying relationship with their marriage partners, the sexual side of marriage almost invariably demonstrates the fact that this very thing which is often abused, scoffed at and made light of, is fundamental to the smooth operation of the marriage and an integral part of the warmth of companionship that true marriage is founded upon.

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MARRIAGE: CLOSENESS WITH CHILDREN

Naturally, every parent will try to inculcate into their children what is right and what is wrong. Moral standards in every walk of life may be taught, but in a friendly, co-operative manner, not thrust down his throat like a set of textbook rules. This will never be accepted, and may only breed resentment.

Closeness with your children can mean that the communication gap will never open up, and thus a major hurdle is overcome. So many parents and children look on the generation gap—the time-distance between them both— with awe. It exists in many, many families, and prevents meaningful communication. Each believes he is in a different world, and in effect this is true. But if the drift can be prevented in the first place, their worlds can be identical.

Children should learn to respect the property of others, and this is easier when there are several children in the one family. In fact, learning to give and take and share physical property (as well as responsibilities) comes easier and more naturally the more there are in the family circle. Often, of sheer necessity, each must learn to share to make everything go around.

Let your children know that they must work for what they get in life. Many parents sensibly attribute monetary values for things, particularly as the children become older. Money doesn’t grow on trees, but many children believe it does, having enormous numbers of items thrust on them during childhood.

Very often, the more a person has, the less he appreciates it. If he has to work for it, to make some physical effort to gain what he wants, pride of ownership means so much more. For this reason, many parents will give the child so much “pocket money” as he gets older, on a regular weekly basis. But for this he may be expected to do a certain number of listed chores. In this manner he is getting to know the value of money, and this may help inestimably in his future life. He learns values, and the fact that nothing comes for free in this world. Some parents may disagree then with this, but in principle (probably with some sort of modification to suit the situation), I believe it to be sound.

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ALL ABOUT MARRIAGE: JUST MARRIED

So you are now married!

Congratulations!

This is one of the most satisfying periods in a person’s life. It is a major milestone, for it represents the start of a totally new way of living. Gone are the days when you were part of the family circle created by your own parents. Right now you are out in the big world about to begin the circle all over again.

Just as your parents established their home several years ago, and subsequently made you part of it, so you are embarking on a similar course.

You are about to set up your own family circle. In due course, it is to be hoped, the two of you will produce and establish a family. You are hoping this will be a happy, healthy family that will bring an enormous amount of pleasure to many people, first to yourselves, and secondly to those who will ultimately form your very own family – your children.

From the start, let’s point out how important children are to fulfilling happiness and contentment within marriage.

Despite what modern society might say, reproducing and bringing children into the world, and subsequently raising them is one of the greatest delights available. Fashions and fads come and they go. But this one stays for ever. The Pill may have altered the concept of family planning, but the basic idea of procreation continues.

Some couples foolishly believe that they will go through life caring and thinking of themselves only. They have no wish to live for anyone else but themselves. This of course is a selfish as well as a foolish concept.

I can assure you, that concept will not last. Humans are built to love, make love, and reproduce. It is one of the most forceful inbuilt intuitions we possess. Although during the first few weeks and months of your new-found euphoric world you might think that your passions will never fade, that you are meant for each other, that you do not want anything or anyone else to become part of it, this will gradually alter. It may take months, or even years. But sooner or later, the desire to reproduce will come strongly upon you both.

Over the years, I have seen this picture unfold on countless occasions. Efforts are often made to “take the Pill” regularly every night, or use some other fool-proof system of birth control. But it doesn’t matter how rigidly the system is adhered to, sooner or later a change takes place. One partner or the other decides to opt out. Often it is the girl who begins to think wistfully about a family. Suddenly she realizes that life is becoming empty. She sees her friends pushing prams and strollers. She sees tiny feet following her other married friends. The feeling becomes overwhelming. She too has the desire to do the same thing. After all, what is life all about?

So, whatever the preconceived plans and ideas, the overwhelming desire takes hold. She is not happy until she becomes pregnant and gives birth to a new life.

Or it may be the husband who “becomes clucky.” Suddenly he realizes that his peers and current friends are continually talking about what “Little Jimmy” did. How well he is sleeping at night . . . taking his feeds . . . how he looks just like dad . . . mum . . . how he has said “Dad-Dad” for the first time . . . and the husband has witnessed the glow of happiness, satisfaction and pride that has accompanied such talk.

What’s the marriage game all about? he suddenly asks himself. Say, why should we be left out of this business? Let’s get started!

A quick talk often solves the problem. Why bother trying to get the house paid off before deciding to start a family? Why try to pay for the car, the refrigerator, the television set? It looks as though it could take an age. If we don’t start until then, we will be geriatrics and probably incapable of having children!

These thoughts tend to race through fertile young minds. If one agrees and the other doesn’t, the end-point is often one that is not very important. The wife can easily stop taking the Pill, or cease using whatever contraceptive measures she might be on. In the early stages of marriage, this side is usually left up to the wife.

But for whatever reason, if pregnancy ensues, one thing is absolutely certain. Both partners are invariably agreed that it is a good idea, and usually are delighted. This might take a bit of time to adjust to. In fact, it might take several months.

I have frequently seen one partner, or sometimes both, absolutely furious when told pregnancy has taken place.

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THE DISABLING DISEASES: BRUCELLOSIS (UNDULANT FEVER)

There are several forms of undulant fever, an infectious disease that is known by various names. The word ‘undulant’ indicates that the fever comes in waves, or undulations, instead of being constant. Recently, all forms of the disease have been given the name ‘brucellosis,’ because they are all due to infections with some member of the germ family called Brucellaceae, which was named for Dr. David Bruce (1855-1931), the English bacteriologist, who discovered it.

Symptoms

The symptoms of brucellosis usually come on slowly and are rather indefinite, consisting of irregular fever, chills, sweating, and aches and pains in the joints and muscles. The death rate is not very high. However, it is rare for a person to recover after only one attack of the illness. As a rule, another attack follows the first after an interval, and this may be repeated almost indefinitely.

Transmission and prevention

Brucellosis is very rarely carried from one person to another. It is, however, constantly carried from animal to animal, and from animal to person. The animals that harbour the germ are chiefly domesticated goats, cattle, and hogs. Each species of animal has a particular kind of Brucella germ that is characteristic.

It is also possible to acquire brucellosis from contact with diseased animals or their carcasses. Farmers, veterinarians, slaughterhouse employees, and butchers are exposed to the infection, as well as housewives who handle infected meat in the kitchen.

The best way to prevent brucellosis is to eradicate the disease in animals. The danger of brucellosis is a powerful argument for universal pasteurization of public milk supplies. Infection by contact with diseased animals or their carcasses is less easy to prevent and is essentially a matter of industrial hygiene. Persons who are exposed to brucellosis in their jobs should be fully informed of the dangers and” should take precautions against unnecessary exposure.

Several of the antibiotics alone or in combination with sulpnonamides are extremely helpful in treatment. They are more effective in the early, acute stages than in the chronic form of the disease.

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CARING FOR A SICK PERSON AT HOME

Good home nursing requires knowing how to make the bed, take the pulse, and give medicines, and a willingness to work hard. Sympathetic understanding and intelligent planning are also essential.

If there is a choice between home nursing and hospitalization, here are some of the points that should be taken into consideration.

1. Remember that once the decision has been made, it may be difficult or even impossible to change it. Do not decide impulsively. Always talk it over thoroughly with your doctor first.
   
2. In certain illnesses, a hospital is essential because of the treatment required or the special equipment that may be needed.
   
3. In general, a sick child is better off at home than in a hospital. However, certain diseases, such as rheumatic fever and poliomyelitis, are handled much more effectively in a hospital.
   
4. Very old people, like children, find it difficult to adjust to a new .environment. They, too, are usually better off if cared for at home.
   

UNDERSTANDING CHILDREN’S BEHAVIOUR: THE ‘AVERAGE CHILD’ VERSUS YOUR CHILD

I want to make it very clear that the child I described above is the average child as described by statistics. Your child is an individual. It would be quite remarkable if he happened to be average in every detail. He is far more apt to be above the average in some respects, below it in others, and to alternate at various periods.

Growth

As far as growth is concerned, I think it is a good idea to record your child’s weight and height and the arrival of his teeth so that your doctor will know whether the rate is within normal limits. Leave that up to him and do not worry about it yourself. Your child must not be made to feel uncomfortable about his physical development, and comments by relatives on his size should be discouraged.

Sleep

Give your child the opportunity to obtain the average amount of sleep. It will not hurt to keep him up once in a while on special occasions, but do not make a habit of depriving children of the sleep they need just to suit your own convenience. Try to provide a reasonably comfortable place where he will be relatively free from being disturbed by household noise. Even more important, you should provide a proper attitude as far as sleep is concerned.

Sleep should not be a major problem. If there is any trouble, do not decide your child is being bad; try to find and eliminate the cause of the difficulty. For example, your child may at some time be afraid of the dark. A dim light or the door left open just a little will often help. A cuddly doll or teddy bear may be comforting company.

Children usually go to sleep more readily if the evening meal is a simple one, and they are not too stimulated at bedtime. A tapering-off period of quiet relaxation, perhaps a soothing story, are helpful.

Do not put a child to bed as a punishment. Be fair and considerate; make going to bed as pleasant as possible, but also be firm about it.

Eating

Similarly, eating habits often become an issue in the household. Self-regulation, usually gets a baby off to a good start, but at some time or other most children fail to eat as well as their mothers would wish. I advise mothers to place the food before their children and remove it without any comment if they do not eat it. They are usually ready for it by the next meal.

If a child is a poor feeder, either regularly or at certain stages of his development, the mother should calmly go about discovering the circumstances under which he eats best. Often being alone where he will not be distracted helps. Sometimes he does well with very small portions, or food that is easily chewed, or food that is easy to manipulate. Sometimes he prefers to be fed, even though he is old enough by the timetable of ‘averages’ to feed himself. Sometimes, especially if he is restless, teething, or overtired, it helps if you read one of his favourite stories to him while he is eating.

In regard to eating (and sleeping), remember:

1. Do not worry. Children do not starve themselves. Some carefully controlled investigations have shown that even very small children who are allowed to choose their foods select a reasonably well-balanced diet. They do not eat ice cream and sweets only.
   
2. Feeding problems are often problems that involve something other than, or in addition to, eating. It is best to discover what they are and solve them, but if you cannot, a general atmosphere of love and relaxation will help.
   
3. Your child is not the ‘average child.’ He may eat less or more because that is what he needs.
   
4. Your child grows and changes. At one time he may eat or sleep well; at another time, he may not. Most children eat less in hot weather, in teething periods, and during the second year of life.
   

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