Man is the only animal that likes to take medicine but he brings the average very high. Arguments about this fact are usually of the all or none type. Dr. Oliver Wendell Holmes is frequently credited with saying, “If the whole materia medica could be sunk to the bottom of the sea it would be all the better for mankind – and all the worse for the fishes.” Dr. Holmes liked to give out smart sayings, but he was a clear thinker and an able physician and actually he carefully modified his statement. Before sinking the drugs he excluded opium and anesthetics and specifics: such things as quinine for malaria and mercury for syphilis and iodine for lack of thyroid secretion. Then he was willing to drop overboard most of the other things which could be useful but more often were harmful. At the present time he would not so dispose of antibiotics, although there is more and more evidence that as they are now they cause much trouble. Unfortunately a large proportion of the populace are not like Dr. Samuel Johnson, who said that he could be abstemious, but resemble him closely in their inability to be temperate.

One cardinal rule in taking drugs is that any, active enough to help out the body, are powerful enough to injure it. A poison is usually a comparatively large dose of a substance which in proper doses is helpful. Few things in nature have been more of a blessing to man than opium. Yet you all know that the normal person can be killed by it or ruined if he habituates himself to taking it in large doses. In some states cyanide gas is used to execute criminals. In small amounts cyanides are pleasing and harmless flavorings; almond, for instance.

A drug may have varying effects on different people. De Quincey said that opium stimulated him and I have seen that he was right. Barbiturates, which are delightfully quieting for most people, may at times cause a delirium, especial in the elderly.   This change may develop fairly quickly in one who over a period of years has taken them infrequently but always with soothing effect. We get fairly well acquainted with the idiosyncrasies of the drugs which we have lived with for some time, but we never can be perfectly sure of the idiosyncrasies of the patients on whom they are used.  The allergic reactions are examples of this. With the present-day enthusiasm for treatment and the extravagant publicity which every new drug and treatment gets as soon as it is announced, it is more and more necessary to counsel caution.

Fortunately some useful drugs cause, with large or long continued doses, such unpleasant symptoms that they have to be discontinued before they do serious harm. Digitalis, so valuable in certain heart conditions, irritates the stomach at times, causing nausea and vomiting, so that the patient cannot continue taking it any longer. Ipecac’s value is dependent on the nausea and vomiting it produces and must have been used much in the days when puking and purging were standard procedures. Many of you have doubtless experienced an excessive flow of saliva when you were nauseated. This increase of fluid is what makes ipecac in small amounts valuable as a cough medicine. The fluid increase occurs in the lungs, diluting the sticky secretions there and making them easier to cough up. I have a physician friend who has long had the foolish habit of tasting medicines. He sat at his desk one day advising mothers and occasionally sampling a bottle of syrup of ipecac. Later as he drove across the city he noticed that he was taking deep yawns. At his first place of call he leaned over to listen to a baby’s chest and suddenly all went black. You see, ipecac causes not only nausea, salivation, bronchial secretions, but also anemia of the brain. As many medicines are made up of a combination of drugs it ought to be evident to you that there are possibilities of many unpleasant effects when you dose yourselves.

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GENERAL HEALTH

Dylan Abraham, 40, of Madison, Wisconsin, was diagnosed at age 18 as having schizophrenia. “My symptoms began when I was 16,” Mr. Abraham recalls. “They started with a sense of anxiety and unease. By 18, I was having hallucinations: I saw a gold rim of light around people. I heard voices. God and Satan were talking to me, telling me that I was godlike. I thought the CIA, the FBI, and the Communists were after me. I had totally lost it. I was arrested for disorderly conduct. My mother came to get me at the jail. She hospitalized me. That was in 1974.”

The voices he heard did not exist in reality, of course. But to Mr. Abraham, those voices were quite real.

“I was totally psychotic,” he says. “It was very frightening – the most frightening thing I had ever experienced.”

With all that going on inside his skull, Mr. Abraham could not work, study, make friends, or simply sit still. The disease crashed over him in waves.

“When I went to get Dylan from the police that time back in 1974,” recalled his mother, Nancy Abraham, “had I not known that it was Dylan, I would not have recognized him. He was so ill. I had lost the son I knew.”

Those terrible times are now part of the past for Mr. Abraham, and they probably will stay there, so long as he takes his medication. In 1990, he was given Clozaril, then a new drug.

“In the last 5 years,” he says, “Clozaril has wiped out the schizophrenia in me. I study tai chi, play volleyball, go to the gym. I’m dating.”

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GENERAL HEALTH

Cause

The commonest cause of a water blister is friction, for example new shoes rubbing against the back of the heel. Blisters also characteristically appear with chickenpox. Burns, including sunburn, can also cause blistering of the skin, as can insect bites. Impetigo can be a more serious cause of blisters.

Treatment

Avoid bursting the blister as this can lead to infection. The liquid inside a blister is usually sterile, as long as the thin covering of skin is still intact. If the blister does burst, apply a small pad of foam with a hole cut in the centre, to prevent further pressure on the area, which can be quite painful. Dab with antiseptic solution twice a day, and keep the wound as clean as possible. It should dry up in a few days, and the skin will then peel. Make sure your child wears open shoes, or shoes which do not press on the blister.

When to see your doctor

• if the blister is filled with greenish fluid, or the surrounding skin is reddish as this may mean that the blister is infected;

• if your child has multiple blisters and a fever or is unwell.

Prevention

Make sure that your child wears well-fitting shoes, that are neither too tight nor too loose. If your child has new shoes, put sticking plaster such as Bandaids on the back of the heels for the first week until he ‘breaks in’ the shoes.

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Make sure that your baby’s furniture is chosen according to safety guidelines. Your local Child Safety Centre will be able to give you advice about what to look for and suggest brands. Consumer protection and advisory organisations and consumer publications may also be a good source of advice.

Car safety

The baby must be transported in a bassinet in a baby car restraint which conforms to Australian design and safety standards. A baby will be ready for a car seat when he weighs 9 kg and can hold his head up well.

Animals

Keep animals away from babies as much as possible. We do not wish to encourage you to give away your pets, rather, take greater care when they are around the baby. The change in composition of the household may upset some pets, and babies can easily annoy a pet with their actions.

Falls

Do not leave your baby alone on the change table; he can easily roll right off. Pad sharp edges of furniture, as babies fall frequently when learning to walk. Install barriers at the top and bottom of stairs.

Scalds

Be careful when bathing your baby. In the bath, always run the cold water first. Babies will readily pull the cord of an electric jug or kettle, or the edge of a tablecloth. Use place mats instead of a tablecloth, and use curly cords on electrical appliances. Never nurse your baby if you are smoking, or drinking a hot drink.

Burns

Keep your baby out of the sun — he has very sensitive skin and will burn easily, even on an overcast day. Fires and heaters pose a particular danger. Choose close fitting nightwear, and check the label to make sure it is fire resistant. Install smoke detectors in your house.

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You have taken several tests already. Review those tests as a couple. Remember that the scores are not the issue. The process of learning and discussion is the key point.

Six Sex Drawings

Add to your tests, tapes, medical examination results, and the seven super marital sex opportunities a couples’ drawing test. Doing and sharing the drawings was fun for the couples and led them to interesting insights. Each of you should buy a small pack of crayons. Draw, in color, yourself and your partner separately and then draw one picture of yourself and your partner together. Claims of lack of artistic ability are not accepted because this is not an art test. Anything you draw will give you some ideas about how you see yourselves, each other, and the relationship. Here are some questions to help you learn from your six drawings.

1. Look at the size of the figures. Who’s bigger, smaller, fatter, skinnier?

2. What details were focused upon in the drawings? (Head, genitals, breasts, legs, arms, stomach?) Who focused on what and why?

3. What colors were chosen for which drawings and why? What do they mean to you? (Red=hot? Blue=cool? There are no correct answers; just discuss what a color meant to you.)

4. What was each figure doing?

5. What was the couple doing in the couples drawings?

6. How do the figures seem to “feel” as they appear in each drawing?

7. Write down one sentence that each figure is saying, and don’t forget the two sentences for the couples drawings.

8. On the back of one of the drawings, complete each of the following sentences:

1. To me, sex is . . .

2. What I like best about our sex is . . .

3. The characteristic of my spouse that turns me on most is . . .

4. My favorite thing to do sexually is . . .

5. The characteristic about me that I think turns my partner on most is . . .

6. What I think my spouse likes most about our sex is . . .

If you can laugh and share as you go over these drawings and your answers to the questions, you have made considerable progress already. You are now ready to focus on any problems you may want to correct in your sexual interaction.

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I love my parents. But I’ll tell you one thing. I will never understand how they stayed together.

HUSBAND

We are seldom allowed a view into the intimacy of our parents’ marriage from which we can construct a model for relating in our own marriage. Few of us have the slightest idea about our parents’ sexual interaction beyond some secret late-night bed squeaks and unclear murmurs. Short of pornographic distortions, we almost never see anyone else making love, and our ideas about our parents’ marriages are probably badly distorted.

A basic question asked of all the thousand couples was, “How do you remember you parents’ marriage?” More than half of the men and women in my sample (57 percent) had negative memories of the way in which their parents interacted. Thirty-six percent reported physical or verbal abuse in their parents’ relationships. Often, couples commented that their parents tolerated one another, just ignored each other, or “survived.”

When asked if they would like their marriage to be like their parents’, the response (58 percent) was more typically no than yes. Even those who could find something to copy stated that they may be “seeing what I wanted to see” or “what I thought might be going on but never really knew.”

How about you? What is you marital learning history? Where and how did you learn to be married?

The media marriages leave us little to go by. They are either delightfully benign “Ozzie and Harriet” or “Leave It to Beaver” styles of relating, desexualized “marrinoids” acting out life, or hot, conflicted, distressed relationships of the Archie and Edith, Ralph and Alice type, drawn together by some secret attraction that not even they understand.

You will learn in following chapters that our relating style depends to a great extent on what researcher John Money calls “love maps,” early tracings of the results of our sex rehearsal during childhood. These rehearsals too often are corrupted, censored, and distorted by a society that insists on desexualizing children, preventing them from learning to unite emotion and sex. We have learned much more about what marriage is not and should not be than what it can be.

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Once thought to be mainly due to a congenital defect of a blind track or sinus in the skin, it is now mostly accepted that the condition is acquired and results from hairs pushing their way into the skin in this area. The hairs may come from the head, the back or the buttocks.

It is commoner in men and particularly dark, hairy men.

A small infection develops like a boil just above the buttocks. Antibiotics may control the infection but it usually recurs and pockets of pus may persist.

Small abscesses may be incised and drained during the acute infection.

Most cases eventually require operation, usually laying open the tracks and pockets and clearing them of pus and retained hairs. If the area is large, a skin graft may be necessary.

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This irritant group is the most commonly abused. These act by stimulating the nerves in the bowel wall causing overactivity of the muscles.

Prolonged use may cause degeneration of the nerves so that they are permanently damaged, impairing the bowel function so that chronic constipation persists.

These irritant purgatives include cascara, senna, phenolphthalein and bisacodyl.

The least harmful of substances which are taken for constipation are those which produce bulk. Natural food which contains indigestable fibre is best and can hardly be regarded as medicine.

Bran is probably now the most often discussed additive to add bulk. However, there are many preparations of cellulose material prepared from a variety of natural plants which swell when mixed with water.

These substances should be taken with several glasses of water so they will swell and add bulk to the diet.

If a patient complains of constipation, the doctor must assure himself that indeed that is the correct symptom. Some people have a normal bowel action, but, because of misinformation, may believe something is wrong. As with any other symptom, a full history will often reveal the diagnosis.

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Countless doctors are asked this question each year. Often the answer is determined by the doctor’s state of anatomical completeness rather than by scientific fact.

Circumcision is a widespread religious practice which somehow has, in some communities, become a social habit.

Most American Anglo-Saxons are circumcised, and this is also the custom in Australia and to a lesser extent in the United Kingdom.

It is uncommon in Europe and therefore, uncommon in the sons of European migrants in this country.

Is it ever really necessary? Most doctors now accept that it is rarely required medically, but many continue to carry out this operation on the newborn for a variety of reasons, which include the parents’ wish to make him the same as his father, his brothers or the other children at school; it’s easier to do then rather than later in life, or because the doctor genuinely believes it to be a necessary procedure.

The prepuce or foreskin covers the glans or bulb on the end of the penis. In the new-born this cannot be retracted.

By the age of one, it can be retracted in 50 per cent of boys, in 80 per cent at two years, and 90 per cent at three. Mothers should therefore resist the temptation to retract the foreskin to clean beneath it. This is unnecessary until the prepuce has separated from the glans.

It is not possible to examine a young infant and suggest that circumcision is indicated because the foreskin can’t be pulled back.

*22/71/1*

A wound that is deeper than it is long or wide

Home care

Wash the wound carefully and apply a nonirritating antiseptic.

If no foreign body remains in the wound, cover the area with a sterile bandage and inspect it regularly for signs of infection.

If a foreign body remains in the wound, take the child to the doctor.

Precautions

-    Redness, swelling, or stiffness of the joint at the site of a puncture wound is a medical emergency. Take the child to the doctor.

-    A puncture wound in the abdomen, in the chest, or in a joint requires immediate medical attention.

-    Never try to remove a foreign body (for example, needle and knife blade) from a puncture wound yourself.

-    A puncture wound that is still tender after a day or two should be seen by a doctor.

-    Make sure your child’s tetanus immunization is always current.

Wounds that pierce the skin are classified as abrasions (scrapes), lacerations (cuts), and punctures. A puncture is a wound that is deeper than it is long or wide. Most puncture wounds in children are made by nails, needles, pins, knives, or splinters.

Because of their small opening and then-depth, punctures present four particular dangers: the tetanus germ thrives in the absence of air, so a puncture is an ideal site for developing tetanus; a puncture wound is hard to clean and therefore susceptible to infection; punctures can penetrate deep into the body; and a puncture wound may harbor foreign bodies that are difficult to detect.

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