Tetanus-diphtheria (TD) booster.

High-risk groups. Hepatitis B vaccine for homosexually active men, intravenous drug users, recipients of some blood products, or people in health-related jobs who are frequently exposed to blood or blood products.

Pneumococcal vaccine for persons who have medical conditions that increase the risk of pneumococcal infection (e.g., chronic cardiac or pulmonary disease, sickle-cell disease, nephrotic syndrome, Hodgkin’s disease, asplenia, diabetes mellitus, alcoholism, cirrhosis, multiple myeloma, renal disease, conditions associated with immunosuppression).

Influenza vaccine for residents of chronic care facilities and persons suffering from chronic cardiopulmonary disorders, metabolic diseases (including diabetes mellitus), hemoglobinopathies, immunosuppression, or renal dysfunction.

This list of preventive measures is not exhaustive. It reflects only those topics reviewed by the U.S. Preventive Services Task Force. Your doctor may wish to add other preventive measures on a routine basis, after considering your medical history and other individual circumstances. Examples of conditions not specifically examined by the Task Force include:

Chronic obstructive pulmonary disease.

Hepatobility disease.

Bladder cancer.

Endometrial disease.

Travel-related illness.

Prescription drug abuse.

Occupational illness and injuries.

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Back to the ovary. Here there is a sudden gap left when the ovum escapes. There are about 100-200,000 other primitive eggs still left behind, and one by one a certain number of these will be released. But for the moment, egg production ceases. The hole left by the escapee is filled with blood. In a short time special cells grow into the space, to produce an organ called the corpus luteum. This rapidly starts to manufacture chemicals or hormones, which have a dramatic effect on the inner part of the tube and the endometrium, the lining of the womb.

Each month the lining is prepared to receive a fertilized ovum. If this takes place, then other changes quickly occur. But if pregnancy does not ensue, this is gradually shed in the form of a normal, regular menstrual bleed or “period.”

In the lifetime of any one woman, the number of times pregnancy will take place is extremely small. But fortunately the ovary and womb are not aware of this, for they would otherwise soon despair! But they tenaciously carry out their appointed duties with unfailing regularity, month in and month out. However, if the ovum is fertilized, then there must be great rejoicing. But the chances are not high. Unless fertilized within about thirty-six hours of its release, the egg disintegrates and dies. A sperm can live for only about forty-eight hours outside the male. Therefore, there is a period of about thirty-six to forty-eight hours in any given menstrual month when pregnancy can possibly occur.

Considering the number of allegedly unwanted babies in this hard, cold world, it is amazing how frequently intercourse must take place at the crucial moment. But nature is really artful, as has already been pointed out.

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In recent years great changes have taken place in the attitude towards therapeutic abortion. This means that abortion is carried out by a doctor as a method of treating his patient, and for her welfare.

Prior to this, abortion was considered a criminal offence, both for the person carrying out the operation as well as for the participant-patient. Only under very unusual circumstances was the action legally condoned.

However, world-wide attitudes are changing. As the population explosion becomes an increasing problem in many countries, the laws have been reshaped or indeed changed completely. Now, in many Scandinavian countries, Eastern lands and Japan, abortion is freely available and indeed actively encouraged for social and economic reasons.

In quite a few places it is readily available completely free of charge, and carried out in government hospitals under their care and at their expense. Certain safeguards are present, but many consider it an attempt by such countries to survive the pressing urgency of population problems.

The Western world has been a little slower and more cautious. However, Britain has led the way, and in April 1968, the “Abortion Act of 1967″ came into force. Basically, this removed many of the previous barriers to the legal termination of pregnancy for therapeutic reasons. Abortion became legally permissible, provided a set of clear-cut regulations were followed. However, the actual interpretation of some of these requirements seemed open to wide variation. The result has been an enormous increase in the rate of legal terminations being carried out.

From the low point in 1968 the figures rapidly climbed to a peak of well over 160,000 in 1974. After this they started to decline slightly, probably because abortion reform became available in certain other European countries, and women who travelled to the U.K. for treatment now found this was no longer necessary.

However, these figures pale into insignificance when compared with figures for Japan where, as far back as 1955, an estimated 1.7 million terminations were carried out. This has now settled down to a fairly constant figure of around 750,000 a year – still a vast number, nevertheless.

In America various states have undertaken “reform,” and termination of pregnancy is now more readily available.

The Australian scene has taken a major change in recent years. South Australia introduced variation to its state laws early in the 1970s, making it more readily available under a closely scrutinized set of rules. New South Wales left the law intact, but judicial decisions later opened the way with the existing legislation for a much wider interpretation to be given.

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What should the pregnant mother eat?

Much has been written and spoken about this. A tremendous volume of ridiculous advice has been offered, and no doubt will continue to be offered. For some strange reason, the pregnant woman has always been the target of all kinds of well-meant advice given her by everyone who thinks that their information is “special.”

Of course, as so many mothers-to-be are young, and without yardsticks with which to compare, they are vulnerable to the verbal missiles of every so-called expert in the land.

Pregnant women are a fine target for commerce, too. Not only is their own health involved, but they are responsible for that of their developing offspring. For this reason, many feel a moral obligation to seek out the very best, and cost what it may, give this to baby-to-be. So the advertising experts aim their propaganda at the unfortunate expectant mother.

Give baby this; take that; eat something else; regularly imbibe this vitamin compound, or else you are depriving your poor little baby of the ‘ ‘best.” So the story goes on and on. Every day mothers across the land are bombarded with slick advertising and dubious promotion, essentially in the name of commerce, but dished up so that it appears to be in the name of better health, life and vitality for mother and baby.

As a general rule, pregnant women would be far better off completely ignoring this barrage of “advice.” It is far better to stick to simple, well-established principles as far as dietetic intake is concerned. Ignore the fad routine so often advised. Ignore the smart advertising and glossy folders from pharmaceutical houses.

Many of these firms certainly give advice, much of which is reasonable, but they are essentially out to separate you from your money.

The baby business is big business in every country in the Western world. So, read the mass of material that is thrown your way. But treat it all with a rather critical eye.

Your doctor will outline the general principles that matter. Use these as the basis for your food patterns. Don’t be duped into spending a fortune on fancy products. Neither you nor your baby will measurably benefit.

In general terms, a pregnant woman will eat much the same type of food she ate before she became pregnant. It will not change much. The old notion that she ”must eat for two” is an idea of a bygone era. There is quite sufficient in her normal daily food intake to take care of herself plus the needs of her growing infant, provided she is careful and sensible in her food selection.

A person’s normal food intake varies. It will depend on the country in which she lives, and the local cultural habits. It is related to her normal routine, and this in turn is related to her socio-economic standard.

When money is no object, families tend to consume more protein products, as they are usually more expensive, and perhaps more desirable. Poorer people tend to eat more carbohydrate (starchy) products.

Recently a well-known obstetrician succinctly summed it up this way: ”In affluent societies the advice should be, Buy all you can afford from the butcher, the greengrocer and the dairy, and spend only little at the confectioner’s, the grocer’s and the chemist’s.”

This is an excellent precise of what is best for the pregnant woman. It may be used as a constant guide throughout the full term of her prenatal months.

These days, there is an increasing emphasis on the value of a vegetarian dietetic routine, not only for pregnant women, but for the community in general. It is now well established that meat substitutes are perfectly safe, and quite adequate. So, women desiring to follow a vegetarian diet can certainly omit meat products. However, it is essential that this be replaced by adequate amounts of protein replacement items.

Many protein replacement foods are easy to make, and frequently involve the use of soy beans, soy products, gluten flour and the many items that are readily prepared from these, and many other bean products. These include Lima, broad, butter, navy and other bean varieties. Most nuts are high in protein values, and these include cashews, almonds, peanuts, etc.

Today, many of these items are available ready for use, and precooked in commercial form (tinned). As a flow-on from this, a wide range of “health food” products incorporating the use of most of these products is now widely available commercially. So, for those desiring this excellent form of protein intake, there is no shortage of products from which to choose.

For women not conversant with vegetarian eating and cooking, today there are plenty of recipe books which clearly set out methods of preparing nutritious and attractive meals, using these non-meat products.

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Many reports have been issued on the relationship between drug medication taken by patients under regular treatment for epilepsy, and congenital birth defects.

The treatment of epilepsy is a continual, ongoing process. But from studies carried out in many countries, including one at the Royal Women’s Hospital in Melbourne, it now seems there is a definite and fairly high risk in becoming pregnant while on this form of therapy.

This naturally raises a problem of some magnitude in the minds of younger women recently married who are desirous of having a family. Should they cease their medication, reproduce and run the risk of epileptic attacks? Or should they run another risk of producing abnormal offspring, and remain attack-free?

It is a question of major importance in their lives. At present there is no simple answer. With the passage of time, the question will become more difficult to answer. They must discuss the whole situation with their obstetrician before ceasing medication or embarking on a course that will result in pregnancy.

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Some years ago an Australian eye surgeon named Norman Gregg noticed an apparent relationship between women who had suffered from the common and relatively innocuous viral infection called rubella (German measles) and certain eye abnormalities in their babies.

This prompted him to study the situation much more closely, and this was the beginning of one of the most important discoveries of recent times on the maternity scene. Gregg’s early studies have had world-wide repercussions of major magnitude since they were first enunciated.

Little did he realize when he published his original report in an Australian eye magazine that he was touching the tip of a giant iceberg. In fact, the results are still being felt, as the general principle is still being investigated in many allied fields.

Gregg’s basic discovery was this: The mother became infected with rubella, an innocuous disease in itself, producing a mild rash, a few swollen glands in the neck, and maybe symptoms of a mild cold. But, the mother’s system harboured the germs in profusion. Some of the viruses crossed over the “placental barrier” and gained access to the developing embryo in the maternal womb.

Occurring during the vital first weeks of development, they were able to interfere dramatically with the cell division and organ development of the embryo. As time passed, it became very evident that the eyes were not the only organs to be adversely affected. The ears and heart were also prime targets.

It did not take long before Gregg’s work received world-wide acknowledgment. In fact, major epidemics of rubella are now followed by an unfortunate wake of blind or deaf children or those with heart defects. Indeed, se serious has the situation become that a mother in the early stages of pregnancy who contracts rubella is considered to be a suitable candidate for a legal termination of her pregnancy. This is now a very widely held principle in many countries of the world.

Of course, many women still refuse to undergo this operation, and are often left with a deformed baby to rear. It is a sad event, but one which still occurs in large numbers of cases throughout the world.

It has been calculated from major epidemics in many parts of the world that a woman who is pregnant and becomes infected with rubella will produce a congenitally deformed infant, or will spontaneously abort in 40 per cent of cases. If the infection occurs in the first six weeks of pregnancy, there is a 50 per cent chance of a major congenital abnormality taking place.

The lens of the eye and the major parts of the ear develop in the embryo between the fourth and twelfth weeks. The chief chambers of the heart develop between the fifth and seventh weeks. Therefore, the importance of infections during these vital times may be appreciated.

In the light of these discoveries, it can now be stated with a fair amount of accuracy what abnormalities may be expected. For example, rubella occurring during the fifth and seventh weeks may produce cataracts in the eye. (This means the lens of the eye becomes opaque and the child is virtually unable to see.) Deafness will take place with rubella infection during the eighth to ninth weeks. Heart abnormalities occur with infections during the fifth and tenth weeks. It is now as clear-cut as this.

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Hobbies provide relaxation and help to maintain the zest for living that doctors have come to realize is immensely important to your health and general well-being.

Ideally, each of us should have an indoor and an outdoor hobby that gives us genuine, long-range satisfaction. Some energetic people change their hobbies every year or two. I prefer to be more casual, letting the hobby grow with time. I enjoy photography, which lends itself to both indoors and outdoors; piano playing, fishing, and swimming have also served well for me.

Hobbies need not be expensive. Some of them, like gardening and refinishing old furniture, or sewing and embroidering, can more than pay for themselves.

A hobby should be something you want to do. It should give you both satisfaction and relaxation. Your hobby should be worth doing. If it is a mere time filler with no built-in value, you will soon become bored. Being worthwhile, it will sooner or later be productive, not only in terms of inner satisfaction, but possibly even financially. Many women who started sewing or embroidering for fun and many men who turned to cabinet-making for relaxation later found their skills and services in demand at a profit. Finally, do not wait to begin until you are retired. How you develop your interests and activities as a young person, then in middle age, will largely determine how enjoyably you will spend your later years.

Adult education is becoming more and more popular. The motives range from completing degree requirements, to acquiring new knowledge or skill for its own sake, to developing a hobby.

Your local education department may offer adult courses at night.

*5\68\2*

Constipation can be organic—that is, due to actual physical change in some organ. It can be caused by a tumour or cancer that is obstructing the intestines, a stricture that narrows them, or some disorder such as a hypothyroid condition. It is important to consult a doctor if you have constipation, especially if it has come on fairly suddenly.

Movements that are too hard to pass easily require straining and can bring about rectal troubles such as haemorrhoids and fissures, or they can aggravate hernias or the tendency to a hernia. Constipation can cause a number of uncomfortable symptoms that include nausea, heartburn, headache, and distress in the rectum or intestines, continuing until the stool is passed.

Sometimes, the bowel movements are not difficult to pass and cause no unpleasant symptoms, but simply do not occur as often as the individual thinks they should. The average person has a movement every day, usually right after breakfast. But countless people are perfectly normal even though they have more than one movement a day, or a movement every other day—or every third, fourth, fifth, or even eighth day! Self-induced constipation is caused by one or more of the following, which I discuss in detail under the heading ‘How to prevent or cure functional constipation’ below:

Improper diet: eating the wrong things or eating too little.

The use (that is, abuse) of laxatives, cathartics, and so on.

Irregularity in habits of elimination.

Functional constipation can also be caused by sluggishness. After food has been digested in the stomach and intestines, the residue is passed along in the form of watery material. The water is absorbed in the colon; that is why the faeces become hard and difficult to pass if they remain there too long before being eliminated. The stools are pushed along by a series of wavelike, peristaltic movements. These waves are irregular; usually they are strongest in the morning, which is why it is easiest to have a bowel movement before or just after breakfast. In some people, peristalsis is weak. This is apt to happen with increased age; elderly people may have to use some method to help elimination.

How to prevent or cure functional constipation

If you actually have constipation, there are certain things you can safely do to cure it. These same methods will also prevent you from becoming constipated:

Cultivate regular habits of elimination. Choose a regular time shortly before or after breakfast every morning for going to the toilet, and attempt to defecate, whether or not you have the urge. Allow ten minutes. Relax and be comfortable. If you go before breakfast, it will help to drink a glass or two of fluid upon getting out of bed; it can be warm or cool water, fruit juice, tea, or coffee. Teaching your bowels to move regularly can be done with patience, and once acquired, the habit persists.

Diet. The residue of the foods you eat is easier to eliminate if it contains some roughage in the form of fibres; lubricants in the form of fats or oils; and fluid. These should be included in the diet of healthy people. I stress this word because people suffering from certain diseases will not be able to tolerate roughage, for example. In Chapter 2 are tables giving normal food requirements. To cure or prevent constipation, make sure that your diet also includes—

For breakfast: One half to one glassful of juice—tomato, grapefruit,

prune, or orange. Also, one item from each of the following:

Mixed dried fruits: prunes, apricots, or stewed figs

Cooked, whole-grain cereals with milk: barley, brown rice, oats,

or wheat Butter or margarine Whole-grain bread Beverage

For lunch, dinner, or supper, some of the following: Green leafy vegetables—lettuce, spinach, cress, endive Baked potatoes (eat skins) Butter or margarine; salad oils

Dried or stewed fruits, especially for dessert at the evening meal

Drink two glasses of fluid between meals, and at least eight glasses during the day. Take an extra amount of water in summer, because part of it is lost in perspiration.

Exercise. Strong abdominal muscles are helpful in aiding the bowels to eliminate wind and stools. If you do not have a firm, well-toned abdominal wall, be sure to start the exercises described in Chapter 1. If your job requires much sitting, you should indulge in regular sports or other forms of exercise.

Live sensibly. Try to avoid the strains and stresses of modern living. Get some relaxation. Do not worry about your constipation. If your doctor gives you a clean bill of health on your periodic checkups and you follow my suggestions for home check-ups between visits (see Chapter 9), your constipation is not going to harm your health. But if failure to move the bowels causes real discomfort, you may carry out the suggestions in paragraphs 5 and 6.

Take an enema. It should consist of a pint of warm water containing a level teaspoonful of table salt. If an enema does not help, your doctor can show you how to insert olive oil into the rectum at night through a catheter; this will soften the stool and make it easier to pass in the morning.

If you cannot take an enema, take a mild laxative, such as petrolatum and agar, aromatic cascara sagrada, or milk of magnesia.

Do not do this until you have given your bowels a chance to work by themselves. The first step in curing constipation is to stop taking all laxatives and cathartics. Laxatives are frequently the cause of your constipation, and seldom necessary in its cure. Suppositories can be irritating and cause rectal fissures, or increase their severity. Bulky substances such as bran can produce irritation of the colon. Mineral oil may interfere with the body’s absorption of essential vitamins.

WARNING

Do not give a laxative to a child, and do not take any cathartic or laxative yourself, if there is any fever, nausea, pain, or general feeling of illness associated with the constipation. It can result in fatal consequences if the condition is caused by appendicitis.

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Fats

Use skim milk or powdered milk; or take the cream off whole milk and use the fat-free milk in your beverages—hot skim milk is good in breakfast coffee—and in soups, mashed potatoes, gravies, and so on. Powdered milk is excellent for gravies. Use cottage cheese instead of butter or margarine. Try it with chives or celery salt on thin, dry toast.

Cook finely chopped spinach and other greens in very little water to which a bouillon cube has been added, and you will not miss the butter. Avoid fried foods, especially those that are french fried. Boil or poach eggs; you probably will not mind unbuttered toast if you serve your egg on it. Try cooking eggs on the type of pan that does not require greasing. Cook stews ahead of time, let them cool, and remove the hardened fat, at least from your portion. Trim the fat from your meat. Omit the rich gravy.

Sweets

Sponge cakes are not very high in calories if you remove your portion before adding the icing for the family, or before adding jam or filling. Take very small portions of any dessert. Avoid sugar-rich soft drinks.

Starches

Eat leafy green vegetables to provide the bulk you are accustomed to getting from starches. Do not munch on bread and butter, especially in restaurants. In America, salads are served first. This is a good idea because salads take the edge off your hunger before you get to the higher calorie foods. Take wine vinegar with herbs or lemon juice on salads instead of oily dressings.

Other suggestions

Do not taste while cooking. It has been jokingly estimated that half the overweight housewives in this country have ‘tasted themselves fat.’

Nibbling and snacks

A cup of tea or coffee without cream and with one teaspoonful of sugar is only 16 calories. It may satisfy your hunger and provide the quick energy you need. In contrast, a chocolate sundae contains between 300 and 400 calories, while half a brick of plain ice cream is 200. Nibbling between meals helps some people to diet by decreasing their appetite at mealtime. If you try this, keep careful count of calories so you will know whether or not it is really helping you.

‘Helping’ children by sampling their dinners or finishing their portions is a common form of nibbling that helps neither them nor you.

Eating binges

Some dieters are able to go off their diets occasionally without ill effect. But remember, your appestat is easily conditioned, so be careful.

Breakfast

For reasons explained previously, a hearty, high-protein meal in the morning usually keeps people from being hungry in mid-morning and from eating too much at noon.

Alcoholic beverages

These are high in calories, and they seldom satisfy your hunger. Usually they make you forget you are on a diet. For example, three glasses of beer at 115 calories per 10 ounce glass will supply as many calories as a fairly substantial breakfast. Several mixed drinks at a party or before dinner will give you almost as many calories as a full day’s reducing diet. Even more serious is the fact that alcohol supplies empty calories, or energy without any of the other necessary food values such as proteins, vitamins, or minerals.

Moderation

This should be your key word. Remember, it took a long time for you to put on the fat you want to lose, so be moderate about reducing, too. Fat lost at the rate of one half pound to a pound a week stays off much better than that lost in a hurry—and a pound a week adds up to 52 pounds a year! When you lose weight slowly, your skin adjusts itself, and you do not look like a deflated balloon.

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These are food substances that are essential for growth, health, and life itself. You need them only in tiny quantities, but you cannot get along without them. Vitamins help to change the food we eat into bones, skin, muscles, nerves, and other parts of our bodies. A basic, balanced diet, such as those I describe in this chapter, provides all the vitamins and minerals you need. Thousands of dollars are spent on vitamins every year in this country. Much of that money is spent by perfectly healthy people who have been convinced by high-powered advertisements that they need extra vitamins. Your doctor will certainly tell you if you need a supplement to the vitamins present in your normal diet. Consult the entry on vitamins in the encyclopaedia section for information about the various vitamins and the deficiency diseases that result if certain vitamins are lacking in the diet.

Salt and other minerals

The body requires salt (sodium chloride). This is obtained in sufficient quantity from the average diet except when a person sweats profusely. Salt is lost in the perspiration, and during hot summer days, everyone, especially workers, athletes, and lively children, should have more than the usual amount of salt. They can salt their food liberally, eat a few salted nuts or biscuits, or add salt to tomato juice. If salt tablets are taken, they should be specially coated ones that do not irritate the stomach or the digestive system.

In addition to vitamins, the body needs small amounts of other valuable materials. Only a small fraction of an ounce of iron is required, but without this, the body develops a form of anaemia. The blood’s rich redness is produced by haemoglobin containing iron and protein. Foods rich in iron include kidney beans; liver and other meats; turnip tops, beetroot, and spinach; whole-wheat bread; and molasses. A trace of iodine is necessary to prevent goitre; this can be obtained easily by the regular use of iodized table salt. The body also requires small quantities of magnesium, manganese, copper, and other substances. Nature provides these for us in balanced diets.

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