Scabies may be acquired by any skin contact between individuals and is not always spread by sexual contact. It is due to infestation by a small mite which burrows into the skin and lays its eggs.

The pubic louse is usually, but not exclusively, spread by sexual contact. These lice inhabit the hair in the pubic area, but in hairy men may extend to the hair on the abdomen or thighs. Occasionally, these lice are seen in the eyebrows.

The hepatitis  virus has been shown to be spread by sexual contact. Hepatitis A or infectious hepatitis is usually spread by contamination by faeces as the virus is shed through the bowel. The  virus has a longer incubation and may also be spread by contamination with blood. This can occur in hospital workers and by drug addicts using the same needle.

Recently it has been shown that infectious mononucleosis or glandular fever can be spread by sexual contact.

While it is possible for any of the sexually transmitted diseases to be acquired by contact other than sexual, this is unusual. Certainly the old belief of infection from toilet seats is no longer believed.

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In myopia, or short-sightedness, the person cannot see well at a distance, but his near-vision is usually good.

Simple myopia does not give rise to headaches.

Presbyopia results from the weakening of the ability to focus the lens.

This starts in the earliest years, but usually doesn’t give rise to any symptoms until the forties.

Then it tends to get worse as the person continues to age.

In presbyopia, increasing the amount of light available may make it easier to see.

A person with presbyopia who requires different glasses for distance and near-vision can either have these prescriptions made up separately — in which case he will have to change his glasses each time he wants to read.

Or he can have bifocal glasses which have an upper part for distance and a lower part for near-vision.

In astigmatism the cornea has irregularities and does not form a smooth rounded part of a sphere.

It is common in mild degrees but usually does not give rise to trouble.

In more severe cases, it is likely to interfere with distant and near-vision.

Astigmatism is usually easily corrected by the wearing of glasses.

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I use the word ‘likely’ because, of course, no one can ever look into the future and tell you exactly what will happen to you as an individual. You have to use probabilities and not certainties when weighing up the balance of cost versus benefit. This balance must be considered for each possible treatment. Always remember to include treatment Of symptoms only (with no actual anti-cancer treatment) as one of the alternatives to assess. This alternative will not always be mentioned by your practitioner, so it is easy to forget. Where the recommended anti-cancer treatments are very heavy in cost and very light in likely benefit, the decision to have no anti-cancer treatment at all may well be the best and bravest decision you could make.

This concept of balancing cost against benefit is very important. Try to keep it in mind as you read on.

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I have explained that there is no simple reliable test for cancer. In the same way, I’m afraid there is also no single, simple, reliable treatment for cancer—no treatment which we can rely on to eradicate every cancer cell in every patient. In your heart of hearts I’m sure you know that’s true—otherwise why are so many different treatments promoted? The fact that there are such a bewildering number of treatments recommended simply means that no one of them is a wonderful, highly effective and reliable cure for every type of cancer. This is not to say that there are no effective cancer treatments. There are treatments which have a very good chance of curing or controlling particular types of cancer, but there is no single treatment which works against every type of cancer.

Why is this so? Firstly, as you now know, there are many different types of cancer. As well as differing in appearance, where in the body they start, when and how they usually spread and so on; they also differ in how? they react to treatment.

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It is said that Julius Caesar was not born in the conventional way, but that a cut was made through his mother’s abdomen into her womb and the child emerged that way.

The modern operation to deliver a child has been called caesarean section because of this.

Until recently, a caesarean childbirth was a rare last-ditch event.

In America the rate has increased three or four times over the past 10 years and now one baby in eight is born this way. At a large Australian hospital caring for mothers and babies, the rate is only half that.

Medical consumers — pregnant women and their husbands — are demanding a return to more “natural” methods of childbirth. Why then, are the suppliers of the service — the medical profession — making it more scientific and involved?

In obstetrics, there are two patients — the mother and the baby. In the past, the greater emphasis was placed on the mother’s welfare and the baby had to take second place. Now that modern medicine has reduced the risks to the mother, the concern is increasingly for the health and welfare of the child.

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The social context. The significance of other people to both yourself and your client is an important source of information for your ethical decision making. Everyone is motivated by the attitudes and opinions of others, especially those who are important in one’s life.

How do the opinions and attitudes of others affect this client’s goals? Obese clients often declare that they wish to lose fat because someone else wants them to, usually a partner but sometimes also another helper such as a physician. A careful examination of the relationship between the client and the other person will tell you something about the ethics of working with the client. For example, the extent to which the client wishes to lose fat for personal reasons, or feels forced into it, is likely to be relevant.

How do the opinions of others affect your goals? Everyone’s job meets a variety of personal needs, including social ones. For example, a client may have been referred to you by someone you respect or value as a source of referrals and do not want to disappoint. You may feel the need to get a good result in order to secure your relationship with the referrer. This need to impress the referrer may make it difficult for you to turn the client down even if there are good reasons to do so. Conversely, you may feel the need to prove your effectiveness as a fat loss agent and may therefore avoid offering help to clients who appear unlikely to achieve impressive fat losses even though they could benefit greatly from your help in other ways.

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The glycaemic index concept (the G.I. factor) was first developed in 1981 by Dr David Jenkins, a professor of nutrition at the University of Toronto, Canada, to help determine which foods were best for people with diabetes. At that time, the diet for people with diabetes was based on a system of carbohydrate exchanges or portions, which was complicated and not very logical. The carbohydrate exchange system assumed that all starchy foods produce the same effect on blood sugar levels even though some earlier studies had already proven this was not correct. Jenkins was one of the first researchers to question this assumption and investigate how real foods behave in the bodies of real people.

Jenkins approach attracted a great deal of attention because it was so logical and systematic. He and his colleagues had tested a large number of common foods. Some of their results were surprising. Ice cream, for example, despite its sugar content, had much less effect on blood sugar than ordinary bread. Over the next fifteen years medical researchers and scientists around the world, including the authors of this book, tested the effect of many foods on blood sugar levels and developed a new concept of classifying carbohydrates based on the glycaemic index (G.I. factor) of a food.

For some years the glycaemic index was a very controversial area. There were avid proponents and opponents of this new approach to classifying carbohydrate. The two sides almost came to blows at conferences aimed at reaching a consensus.

Initially, there was some criticism which was justified. In the early days, there was no evidence that G.I. factors for single foods could be applied to mixed meals or that the approach brought long-term benefits. There were no studies of its reproducibility or the consistency of G.L factors from one country to another. Many of the early studies used healthy volunteers and there was no evidence that the results could be applied to people with diabetes. But now the evidence is in and we know that it is a valid tool and a clinically proven tool in its applications to diabetes, appetite control and sport. To date, clinical studies in the United Kingdom, France, Italy, Sweden, Australia and Canada all have proven without doubt the value of the glycaemic index. Notably, the United States remains one of the last bastions of opposition. This may have more to do with academic politics than science!

The glycaemic index (or G.L factor) of foods is simply a ranking of foods based on their immediate effect on blood sugar levels. To make a fair comparison, all foods are compared with a reference food such as pure glucose and are tested in equivalent carbohydrate amounts.

Today we know the G.I. factors of hundreds of different food items that have been tested following the standardised method.

*22\33\4*

I do not intend to discuss each and every form of pain, but this system lends itself so well to the control of the pain of childbirth that we must have a few final words about it.

The young woman approaching childbirth is in fact subjected to an extraordinary number of

anxiety-producing influences. Other women seem bent on telling her stories of terrible pain and complications. The stories often end with a kind of negative suggestion, “But you will be all right, dear,” which of course conveys the idea that she just might not be all right. Many women tend to talk of their experience of childbirth in the way that others describe their adventures in sports or war. “Of course, I had to have six stitches.” All this has its effect on the young woman. The very fact of going to the hospital makes her feel that there is something wrong. She thus goes with a high level of anxiety to have her baby, and with the clear expectation of suffering considerable pain. Her anxiety not only lowers her threshold of pain, but may tend to make the contractions of the womb less smooth and co-ordinated. And worst of all, anxiety makes tense those parts which should relax, so that they are painfully forced by pressure instead of relaxing easily and naturally.

However, the young woman can guard against these unpleasant eventualities by being secure in her knowledge that childbirth is a natural process, and that older women often gain some strange satisfaction in telling exaggerated stories of their own experiences.

An unfortunate aspect of the problem is that the situation tends to become self-perpetuating. The woman in her first pregnancy is made anxious and expects pain. As a result, she experiences pain. Then with this experience behind her, she is increasingly nervous at her second pregnancy, and the painful experience is repeated, and so on. One of the reasons why this unhappy state of affairs is allowed to persist is that obstetricians are usually very busy people and often short of sleep. They simply do not spend the necessary time with the expectant mother to put these things right.

With these thoughts in mind, do a little preparation for the coming event. Practise the relaxing mental exercises, naturally and easily, so that you can let yourself go into the relaxed mental state when you wish it. This will also help you with the discomfort of the increased weight of the last few weeks. If you like, you can practise the exercises with pain, but this is not essential, because if you really learn the mental relaxation, pain will not be a problem.

When you feel the first contractions—this is what the older women call “the pains”

—remember what is happening. The muscles of your womb are contracting to push your baby down into the birth canal. As the contraction comes on, you let yourself go.—You let yourself go completely.—You let yourself go in body and mind as you feel the contraction.—You feel it good and strong.—It is good, pushing the baby down to be born.—It is strong.—You feel the strength, natural strength.—Natural, so that there is no hurt. —Between the contractions you lie back, easy and relaxed. —And all the time you have with you the calm and the relaxation of the mental exercises.

The baby is pushed down the birth canal slowly and easily and naturally. His head comes to the muscles at the end of the canal. You feel this because there are more nerves in these muscles. Now you relax deeper, deeper than ever, knowing that it is good that he has reached the end of the canal, and in a few moments he will be born.

There is just one other point that I would mention. Some people feel that they do not get themselves deep enough, as it were, in their relaxing mental exercises. They feel,

“This would not be sufficient if I were in real pain.” The fact is that when we are actually faced with potentially painful stimuli, as in childbirth, we can let ourselves go very much more completely. This may seem strange to you, but it is true. The reason is that in practising our exercises we lack real psychological motivation; we only have an intellectual logical motivation, which is not the same thing. So in the actual situation we surprise ourselves by doing much better than we expected.

Just one last comment. Take your obstetrician into your confidence about what you are doing. Remember that obstetricians have different views about this kind of approach, and that some still adhere to a rather mechanistic, drug-oriented way of doing things. Do not let any conflict

develop between you and your doctor on account of this, as such would only cause tension. It is best to find out the obstetrician’s views early in pregnancy, so that if necessary you can find another who will go along with you in these matters. If it is too late for this, go along with him. If he wants you to have drugs or injections, do not fight about it. In any case, you will need very much less than if you had not had the experience of the mental exercises.

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The pupil as such is entirely dependent upon the function of the iris. Therefore, all reactions and conditions of the pupil are to be considered basically as no more than changes affecting the inner margin of the iris. For the irisdiagnostician, however, only those abnormal conditions are significant which by paralysis or irritation of the nerves controlling the muscles of the iris, produce changes in the function or state of the pupil. (M. sphincter pupillae = pupil contraction and M. dilatator pupillae = pupil dilation.) Consequently, all those disturbances which are caused by local injuries or other conditions of the eyeball are to be ignored.

The normal shape of the pupil is circular. It should lie in the centre of the iris (perhaps somewhat disposed towards the nasal side), and appear neither too large nor too small under ordinary conditions of lighting. The normal diameter is 3-4 mm. On the whole, relatively larger pupils are found in small children, while in adults the size of the pupil progressively diminishes as old age advances.

The pupil should not show any undue variation in width, and the movements of contraction and dilation should affect both pupils symmetrically.

*39\78\2*

They are trying another kind of treatment at both these places too. When they first started to investigate the hormone level in patients suffering from premenstrual tension, they discovered that women who had a low level of progesterone in their blood often had a correspondingly high level of another hormone called prolactin. They felt that the correct balance might be restored if they gave these patients drugs which would cut back the amount of prolactin they were producing. Prolactin is another one of those powerful hormones that have a profound effect on the way our bodies function and the way we feel and behave, as you can see if you look at the particular times in our lives when we naturally produce greater quantities of it. They’re the great private moments. And the first of them is when we have made love and enjoyed it. Now as prolactin is one of the hormones that dampen down our response to stress and make us feel less anxious, this could be one of the reasons why we feel so good after really pleasurable love making. Although only one, of course! We also release large quantities of prolactin when we are giving birth. And when we suckle our new babies, their sucking makes us produce more prolactin and the prolactin in its turn makes us produce more milk. Which is a nice neat way of ensuring that the supply will meet the demand.

But it doesn’t stop there. As the baby sucks and our bodies respond by producing more prolactin two other very important things happen as a result. For a start, the prolactin cuts down the amount of adrenalin we’re producing, and this keeps us calm while we’re feeding our infants and gives us that lovely purring sense of well-being that so many happily breast-feeding mothers enjoy. And on top of that, it makes us produce another of those subtle but very influential body scents or pheromones. This one is specially for the baby who will smell it and respond to it at once. This is how even a very new baby can recognize its own mother and respond to her. It’s a powerful, natural way of ensuring that these two very important human beings bond to each other. And it works on the same principle and in the same sort of way as the sexy pheromones we produce half-way through the month — the ones that turn on our husbands and boyfriends.

I can’t help feeling that we shouldn’t tamper with such a powerful hormone, especially when we know what far-reaching effects it has on the way we function as wives and mothers. Even the doctors at St Thomas’ who are the most ardent advocates of using drugs to cut down the amount of prolactin their patients produce, are honest enough to admit that they don’t know yet exactly what the effects of suppressing it may be. One of them, Dr Brush, a biochemist who works at St Thomas’ says: ‘The exact mechanism of action of pyridoxine in premenstrual tension treatment is not yet fully understood but it is likely to be at more than one level’.

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