Sexual intercourse between men and women is constructive only within marriage. Courtship should include talking, kissing, cuddling, holding, sex play, mutual masturbation, and intense physical interaction, but not sexual intercourse. We should tell them so. Young adults would have to learn to energize the courtship sequence with feelings, thoughts, and touch rather than coitus. They would then select better partners for better sex that allows a total sexual system commitment.

It is pure myth to assume that practice with many different partners makes for good sex with a given partner. Sex is not like tennis. Practice does not make perfect in sex, it only leads to more practice. If we see sexual intercourse as the ultimate form of intimacy, it belongs in the ultimate committed relationship. If we see intercourse as some type of casual recreational activity, it belongs only in casual relationships and has little to do with bonding. I believe, and the thousand couples believed, that intercourse means much more than recreation, that it belongs in committed relationships. Open, more vulnerable courtship free of the “it” factor, the intercourse factor, will help us to find better partners for lasting super marriage and change courtship from a training ground for divorce to an opportunity for the learning of intimacy.

It is interesting to note that Masters and Johnson and other sex therapists almost always tell their couples in treatment to stop having intercourse, to become re-acquainted on deeper and broader personal levels before moving on to the intimacy of sexual intercourse. I suggest that we use this recommendation for our courtship patterns as well. A little preventive sex therapy couldn’t hurt.

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A baby may spend 20 hours of each day sleeping. This gradually lessens and most adults make do with about six to eight hours per day.

Insomnia is a common problem, for many this is a result of their emotional distress.

Depression usually leads to sleep disturbance and this is commonly frequent waking during the night or early morning awakening.

Most babies in the first few weeks of life cry before dropping off to sleep and some parents do not allow them to “wind down” but become anxious and pick them up. This may lead to future sleep disorder.

About one in every 40 people walks in his or her sleep.

Sleepwalking and night terrors tend to run in families and are prominent in males.

Sleep terrors tend to occur more in children and they are different to nightmares.

The child will suddenly sit or jump up, crying out, appear distressed and can’t be consoled.

This lasts several minutes and then the child drops back to sleep and has no memory of the episode.

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Diets which stress no carbohydrates or high protein or fat can be dangerous unless followed under strict medical and dietetic control.

Drugs are often used to help people lose weight. They are of little use, except in special cases. Most of the appetite suppressant drugs are derived from amphetamine. They may reduce the appetite at the start, but tend to lose this effect after a month or so.

Unfortunately, because of their stimulant effect, some people become addicted to them.

There are some anorexiants or appetite suppressing drugs which appear to be free of these side effects, but in my experience are of little value.

Diuretics are often used, but these rid the body of water, not fat. After taking them you can see that your weight has dropped a kilo or two. But it will all come back again once your body re-establishes its water balance.

Thyroid tablets are sometimes used. All that happens is that normal production of this hormone by the thyroid gland is shut down. If bigger doses are given this can put a strain on the heart.

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CDT, or combined tetanus and diphtheria vaccine, is given from 18 months instead of triple antigen.

There are increasing numbers of adults who show no immunity to diphtheria. Possibly they could contract the disease or act as carriers to their children or grandchildren.

But there is an adult form of CDT vaccine and the possibility of using it when updating tetanus immunisation should be considered by the doctor treating adults.

Poliomyelitis, or infantile paralysis, once so common, is a rarity. But it is still a common disease in countries to our immediate north.

Once we become complacent and believe immunisation is no longer necessary for our children, we may have to suffer the heartbreak of having them develop what should be a preventable illness and suffer death or a serious complication.

There are side effects from the vaccines, as there are side effects with many forms of medical treatment. But these are rare and should not deter parents from subjecting their children to immunisation.

The risks of getting the disease far outweigh the minor risk of suffering a reaction.

Has your child been immunised? If so, is the schedule up to date?

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X-rays are one means of looking indirectly at internal organs. Just what are X-rays? They are a form of electromagnetic radiation. Other electromagnetic rays include ordinary light, infra red, ultraviolet, radio and TV waves. These are all forms of energy which can travel through space in straight lines but differ in wavelength and frequency.

Light is the one that is most familiar to us, simply because light is the only one that the human eye can detect. To help you understand how an X-ray picture is produced, we can use an example involving a form of electromagnetic radiation that we all understand—light. Imagine a light shining through a stained glass window onto a white wall. On that wall you can see a ‘picture’ of the window. The picture is formed because light gets through some parts of the window more easily than others. No light gets through the frame or the lead separating the pieces of coloured glass. Some light gets through the glass but the amount depends on the strength of the light and the thickness and colour of the glass. The detail we get in our indirect ‘picture’ depends on these factors. Exactly the same sort of process is involved in getting an X-ray picture. The X-ray machine sends out X-rays like a source of light. The X-rays get through some parts of our body more easily than others. Because we can’t see X-rays with our eyes, instead of a white wall on the other side we need an X-ray plate. The X-rays react with the special coating on the X-ray plate to form a ‘picture’ which we can see. X-rays travel most easily through air and least easily through very solid things like metal and bone. Just as we can use a stronger light to get more detail, so we can adjust the machine to send out ‘stronger’ X-rays if we need more detail.

*64/40/1*

Women in parts of India who are kept in purdah welcome the arrival of the menopause as an era of new freedom; now they can cast off their veils, mix with men and travel freely. In China, the sixtieth birthday is a momentous event, celebrating the status and wisdom of the old person. After the menopause, Bantu women may take part in activities previously forbidden to them, and women in Bali can join in ceremonies from which they were barred during their childbearing years. From India to Africa, from China to South America, the end of menstruation brings new freedom to women. Middle-aged and elderly women are an active part of the extended family, they help on the land, they feel useful, needed and valued. Ageing is a gain in wisdom, not just the loss of youth; in the same way that many cultures celebrate the start of a girl’s menstruation, so its ending is a positive event, too. And in countries where older people have enhanced privilege and status, menopausal symptoms are almost unknown.

How different things are in our ‘advanced’ societies of the West. Ours is a society that gives status and emphasis to physical prowess, to attractiveness and to youth. Men and women (but especially men) lose status when they are no longer defined by the job they do. Children grow up and move away, and the busy mother/chauffeur/cook/nanny/ supporter of the PTA/and helper at Brownies suddenly finds her role has disappeared. In these societies, where getting older is seen as a definite minus, 80 per cent of women suffer from menopausal symptoms.

You probably remember the days when ‘black’ was a term of abuse towards people of African and Caribbean origin. Most black people living in white cultures at that time felt themselves to be inferior to whites, accepting their status as second-class citizens. Then black people themselves coined the phrase ‘Black is Beautiful’, and suddenly their image changed. They felt proud of their black heritage and culture, and of the colour of their skin.

Why shouldn’t older people, too, change how they see themselves, and how society sees them? The Gray Panther movement in the United States is a powerful lobby for the rights of retired people, and they certainly don’t see themselves as has-beens.

*77\42\4*

Will I age prematurely if my ovaries are removed?

The answer to this depends on whether you go on hormone therapy, your body size, whether you had your ovaries removed before or after your menopause, and your genetic make-up. Before menopause the ovaries are the body’s main source of hormones such as oestrogen, which has wide-ranging influences on a woman’s body. Some of the areas it affects are:

• the thickness and tone of the vaginal lining and the vagina’s production of secretions

• the fullness, tone and secretions of the vulva, cervix and urethra

• bone structure and growth

• temperament and sexual interest

• the appearance and perhaps function of many other body tissues such as the skin, hair, heart, blood vessels, breasts, liver and joints.

After menopause, most women continue to make measurable and useful amounts of oestrogen in fat and muscle tissue and in the ovaries and adrenal glands (two small organs near the kidneys). How much body fat you have, and your genetic make-up, are among the most important influences on oestrogen levels after menopause.

If you have a slight build and your ovaries are removed before your menopause you are likely to experience more severe, acute menopausal symptoms (such as hot flushes, vaginal dryness, and bladder problems) than if you are well-built and you lose your ovaries after menopause. If you are in the former group, you may also find that your hair seems drier and your skin has less tone and you will also be at increased risk of heart disease and bone thinning (osteoporosis) in later life. For all these reasons you should consider oestrogen replacement therapy (a form of hormone therapy).

Women who are well-built and whose ovaries are removed before menopause tend to experience an intermediate level of symptoms and a slight to moderate increase in their long-term risk of heart disease and osteoporosis. Although such women may find oestrogen supplements useful, they may not be vitally important to their well-being.

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The myth of sleeping pills needs to be destroyed here. Sleeping pills are useful for two weeks only; after that the body develops a tolerance to the pills and they become less and less effective in inducing sleep. The reason why most people continue to take them beyond two weeks is to avoid rebound insomnia. Rebound insomnia is a withdrawal symptom experienced after sleeping pills are stopped. Rebound insomnia should be distinguished from true insomnia. When the sleeping pills are stopped, rebound insomnia follows immediately, and one must be prepared for not sleeping well for the next few nights. Natural sleep should commence after the rebound insomnia passes. Hence it is most important to stop taking the sleeping pills gradually. The tragedy is that most people stop taking the sleeping pills suddenly, and consequently they cannot sleep because they experience rebound insomnia. They then believe they have lost the innate ability to sleep, and they immediately start taking the sleeping pills again.

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The word “pain” comes from the Latin word poena which also means punishment. So there is nothing new in the association of these two ideas. The child is educated to a complicated system of values and behaviour which allows him to take his place in society. This is achieved primarily by the process of reward and punishment. Love and physical rewards are given for being good; and hostility and physical punishment for being bad. This is the learning process in its simplest form, and as a means of leading the child to acceptable behaviour it is very effective. However, the constant association of pain with punishment conditions us to lose sight of the biological

purpose of pain as a simple and helpful warning against injury. The child is constantly reminded of this association so that it persists into adult life. If in fact corporal punishment is not inflicted, the threat of it is usually still there, and even if it is not actually threatened it is referred to obliquely, “If you had been properly punished when you were younger, this would not have happened.” This is the child’s ordinary experience, so the two ideas, pain and punishment, become fused together in his mind.

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Q. What about side effects? We seem to read about adverse conditions occurring from time to time. Are these serious?

A. I suppose every known drug has an adverse side effect on somebody somewhere. It is a fact of life. Why, even most foods can be found to disagree with somebody. Considering that by 1984 around 30 million patients are said to have been treated with cimetidine, the number of adverse side effects is surprisingly small. Certainly researchers will dig up a wide range of symptoms which are claimed to have been produced by cimetidine, but in the total picture, these are very small and probably of little consequence.

The same doctors will also point out that simple, old fashioned aspirin, which has been around for nearly 100 years, may cause allergy reactions, asthma, bleeding from the stomach and bowel, nausea and vomiting, diarrhoea, and many other symptoms. But this does not preclude it from being one of the most valuable and widely prescribed drugs of all time.

If adverse side effects occur, then appropriate steps can be taken at once. On the other hand, if they are minimal, then the benefits of treatment will often outweigh any problems.

Q. Are other drugs in this family available, or is cimetidine the only one?

A. In 1982, another drug called ranitidine became available in Australia. Like cimetidine, it is a product of original research in Britain. It is marginally different, works in a similar manner, is claimed to have certain benefits, as all new drugs claim. Time, however, will show if this is really the case. Some major British trials have indicated that it may be of special benefit in the few cases in which cimetidine therapy fails to work. No drug will be effective 100% of times and a related drug may prove effective, this appears to be the case with ranitidine. Another preparation is a drug called oxmetidine, which is also similar in activity. Yet another named omeprazole has also been developed. How these will compare to the others, time will tell. It has all been succinctly put by a Sydney gastro-enterologist who recently wrote in an Australian medical magazine: “It is difficult to envisage that these drugs will be any safer or more effective than cimetidine in equipotent dosage.”

Q. Can the patient still take other medication with cimetidine if necessary?

A. The most likely medication will be antacids, and this is often taken in the early days along with cimetidine. It does little more than reduce pain. As pain disappears, most will cease using antacids, but they may be taken if desired. Often the decision is left with the patient.

It is pointed out that the doctor will be careful in prescribing other non-ulcer type drugs in the event of high dosage levels being required. Sometimes, in severely ill patients, cimetidine is given by injection, either directly into the blood stream (intravenous) or the muscle (intramuscular injection). This helps it work more rapidly.

In ageing patients, when the liver and kidney are not working as efficiently as in younger days, the drug may further reduce their working efficiency, and drugs such as warfarin, phenytoin, theophylline, which go to the liver also, must be taken with care. Nevertheless, this is the doctor’s concern. He is well aware of these special circumstances in certain patients and will offer the appropriate advice.

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