Cause

There is no discernible cause for temper tantrums. They are seen as an inevitable consequence of a youngster’s struggle to assert autonomy and independence from his parents. The immediate precipitating cause for a tantrum is almost always frustration, either to the parent saying ‘no’ to a request so that the child is not allowed to have his way, or else the frustration that comes from the child not being able to perform some developmental task. Usually the tantrum is manipulative and directed towards the parents.

Clinical features

All parents will be only too aware of the characteristics of a temper tantrum. While the precipitating factors, intensity, duration and action during a tantrum will vary from child to child, there are certain features which are universal. In response to frustration — usually the parent saying ‘no’ — the child may scream, throw himself on the floor, vigorously flail arms and legs, often kicking toys, furniture, the floor, or the parents. Sometimes toys and other objects are thrown across the room. The episode is usually terminated by the parent, who distracts the child or gives in to the original demand, or else picks the child up.

Left to his own devices, however, the child usually loses interest in the tantrum as soon as he is deprived of an audience. Parents will observe that the child stops the tantrum momentarily at regular intervals to make sure that the parent is still in the room. In other words, the parent is clearly the target of the demonstration, and this provides the most important clue for management of temper tantrums.

Toddlers seem expert at picking the times when parents are the most vulnerable to the effects of a full-blown temper tantrum, such as when they are out shopping (‘the supermarket syndrome’), or else visiting friends. This of course makes it even more likely that the tantrum will have the desired effect, and in turn will strengthen the child’s resolve to turn it on again the next time — ‘same time, same place’.

Sometimes the child seems to lose control during a tantrum, so he becomes really worked up and genuinely distressed. What started off as a manipulative ploy then becomes a rather frightening event for the child.

*180\90\8*

Coronary artery disease may develop in people in the early thirties but heart attacks become more common in the late forties and early fifties.

Women seem relatively immune from heart attack until after the menopause, when the incidence rises dramatically and may exceed that for men.

Gradual narrowing of the coronary arteries may lead to the condition of angina.

When the heart has to work harder with more exertion, the heart muscle requires more blood to supply its own needs. With narrowing of the arteries, not enough blood may be able to get through.

The diagnosis of angina is usually easy to make as the story is so typical, although examination may not reveal any abnormalities and even the electrocardiograph may be normal.

*407/71/1*

The treatment is D and C.

It is worth remembering that miscarriage is an all-or-nothing business.

Should the threatened miscarriage settle down and the pregnancy proceed to term, then the baby is normal.

Some women fear that when the threat to pregnancy has been averted, an abnormal baby may be preserved. Therefore, they worry considerably and unnecessarily for the remainder of the pregnancy.

Even when a woman is unhappy with the pregnancy, miscarriage may still produce an emotional reaction. Depression is common and of course is due to a normal grief reaction.

We grieve for something lost.

At this time husbands need to be particularly understanding.

And often associated with the depression is a sense of guilt.

A woman may worry that either she did something she should have avoided, or neglected some precaution she should have taken.

*153/71/1*

Soon afterwards I visited young Jimmy. Certainly, he rarely complained and was usually a bright happy lad. But today he was pale and obviously unwell. He had been off his food for about 24 hours, and his temperature had suddenly shot up, leaving him feeling very miserable. He was sweating profusely, and just before I arrived he had been vomiting slightly—also unusual for Jimmy. Passing his urine was definitely painful, and this immediately suggested an infection in the bladder or kidney region. When I gently prodded below his navel, in the so-called supra-pubic region, he winced. ‘Hurts,’ was all he would say, then he quietly shed a few tears. Similarly, pressure in the lower part of his back, just over his kidneys, was also quite uncomfortable.

‘We shall have a specime of urine checked out,’ I said to Jane. ‘This will tell us exactly the nature of the germ causing the trouble. It will also indicate the best treatment to give. Antibiotics are usually very satisfactory, but a sensitivity test will give us the exact result and indicate the most suitable treatment.’

Treatment

To begin with, doctors often prescribe one, of the ‘broad spectrum’ antibiotics, even before the results of investigation are received. This may start the patient quickly on the path to recovery. Many excellent varieties are now available and the urinary system is very receptive to them.

Also, keeping the patient in bed for a few days, until he feels and looks better and his temperature has come back to normal, is a good idea.

Plenty of fluids are advisable, for this flushes out the dead germs and general toxins, not only from the system but from the urinary tract in particular. It also replaces the fluids lost from perspiring and sweating.

Powders and granules given in fluid to ‘alkalinize’ the urine are often used, and this is claimed to help. Paracetamol will often reduce fevers and make the patient feel more comfortable and it reduces aches and pains which commonly accompany urinary infections. However, if there is vomiting, the more that is introduced into the stomach the worse the patient feels, so the less the better. Sucking chipped ice or cold drinks are often acceptable, and frequently retained.

Most infections in children affect the bladder region, but they are usually brought under control rapidly. Sometimes, especially if there are recurrences, it may indicate that the kidneys and upper parts of the urinary system (the ureters) may also be infected. It may be necessary to have further and more complete investigations carried out after the child has settled down and the acute bouts are brought under control.

Tests on thousands of children, especially those of school age, shows that many individuals carry around small numbers of germs in their bladders, even though symptoms are not present. Sometimes these can suddenly get out of control and an acute attack supervene. Some doctors believe that all urinary infections, however mild, should be treated.

It is a very important system, and disorders here can lead to more serious ones in later life. It is worth keeping a close check for symptoms and reporting any abnormality promptly to the doctor, for treatment or further investigation.

*82\87\2*

The symptoms include hyperactivity (excessive movements), a short attention span, being impulsive and being easily distracted. Sometimes learning difficulties and other nervous system signs are also present. From the point of view of the teacher or parent, hyperactivity is most likely to be the main symptom which leads to a visit to the doctor.

However, increasing evidence is accumulating which suggests that, from the child’s point of view, it is the disorder of attention which is the most important. The two do not necessarily go hand in hand, for the level of physical activity often bears little relationship to the child’s difficulty in learning or with his nervous system disabilities.

The frequency with which the disorder occurs is variable. In school-aged children in primary school, estimates have varied from 4-10 per cent. However, behavioural patterns of children which caused parents and teachers to seek medical help are far more frequently encountered. In one survey reported in the Medical Journal of Australia, restlessness occurred in 50 per cent of boys and 28 per cent of girls.

These sorts of figures are causing considerable concern in countries like the United States, where medication of supposedly hyperactive children is getting out of hand.

It is well-established that boys are affected more commonly than girls, and the ratio of nine to one is frequently reported.

Many other terms are used to describe these children, for the complexity of the disorder is being realized by doctors and psychologists. The terms ‘learning disability’ and ‘minimal brain dysfunction’ (MBD) and ‘hyperactivity’ are now commonly used. Doctors tend to use the term ‘MBD’ in the medical literature (particularly in American medical literature, although ‘hyperactivity’ seems more common in Australia). ‘Learning disability’ and ‘hyperactivity’ are used widely by educators and psychologists.

Symptoms

A great deal of controversy exists over what constitutes a hyperactive child. The dividing line between normal and abnormal is difficult to establish, as the range of figures of complaints indicates.

Although physical hyperactivity may be a symptom of certain disorders which can be clearly distinguished, it may be a symptom of some other disorder. Because of the implications of treatment, correct diagnosis is necessary, although it may be difficult. It may require special investigation and psychometric tests. For instance, there may be mental retardation (anywhere from borderline to severe); perceptual disorders (relating to the ability to hear and see); psychological disorders (anxiety states, psychoses); neurological disorders (such as lead poisoning or the use of certain drugs); and acute medical disorders (for example, chorea or thyroid excesses). Finally, there may be cultural differences: what is socially acceptable in one society may be attributed to some pathological disorder in another.

Many of these causes may be totally unrecognised by parents or teachers. For example, a child with borderline retardation may react with restlessness and lack of co-operation when his parents indicate excessive expectations of him.

Cause

There are many theories on the cause of the syndrome. Some claim it is a genetically determined developmental abnormality resulting from a low nervous system arousal. It tends to run in families. Parents producing hyperactive children can describe similar problems in their own childhood.

Others believe the condition is ‘psychogenic’. There may have been a poor social relationship between mother and child early in life. This may have resulted from early separations, or more commonly from emotional distancing resulting from maternal disturbances. This can commonly occur in the time immediately following birth, and is manifest as a depression, which may persist undiagnosed. The child reacts to this with an increasing aggression and a diminished capacity to develop internal controls on aggression and impulsiveness.

Another group claims hyperactivity is due to ‘minimal brain damage’. Damage is slight for general intelligence to be noticeably impaired or for there to be gross nervous system signs of impairment. This damage might occur prenatally or in the postnatal period. Giving weight to this are abnormal brain tracings (EEGs) that are found in up to 50 per cent of these children.

Treatment

Diagnosis of hyperactivity is no simple matter. If a parent or teacher suspects that a child may be suffering from the syndrome and can identify some of the suspect symptoms (some are quite obvious, others are not), then take the child to the doctor. In turn, your family doctor may refer the child to a doctor who specialised in this particular field. Further tests are necessary to clearly establish the correct diagnosis, as has been explained.

If the child is diagnosed as hyperactive, then specialised therapy may be indicated. As an ongoing process, this must be under the general supervision and guidance of persons with the necessary knowledge and expertise in the field, usually child psychiatrists.

The Feingold Diet: A theory which has gained wide credence and support is the one put forth by Dr. Ben Feingold, an allergist who claims certain ‘small sized molecules’ occurring in some natural foods and in some artificial colours and flavours have an adverse effect on brain cells of children afflicted with the syndrome.

He has put forth proposals that limitation of these foods (simply by dietetic restriction) yields positive benefits to the children.

The Feingold method has attracted considerable criticism, but its following is enormous. Doctors themselves are in disagreement, and medical journals regularly print fiery articles either supporting or denouncing the system.

It seems relevant that many parents with hyperactive children frequently follow the system on their own account, and often report favourable results. Probably they all cannot be right; neither can they all be wrong. The truth of the matter is still unknown. More clinical trials under strict, closely supervised conditions are necessary before the final word is given.

‘From my private practice, of 72 families I have instructed and supervised to date, 62 found sufficient change to continue adherence to the diet to date, from 4 to 20 months. A difficult diet is less difficult to manage than a difficult child, and it is surely preferable that a child be “set apart” because of his diet than because of his behaviour,’ is typical of the reports appearing in medical magazines in support of the routine. This excerpt came from the Medical Journal of Australia from a doctor in Queensland.

But others are just as convincing in the opposite direction. ‘The diet costs averages $120 per week per family,’ an MJA editorial states. ‘The results suggest that on objective tests, no changes of any kind were observed—physical, behavioural or cognitive—and in school children neither were there any parental or teacher reports of behavioural change.’

‘The diet was not designed for use in normal households,’ another correspondent says. ‘To place this treatment in perspective, the Feingold diet is no more difficult than many other dietary regimes commonly used in medical therapy, for example, diabetic, or gluten free diets.’

The book by Dr. B.F. Feingold which started the controversy on the diet is entitled Why Your Child is Hyperactive, (Random House, New York, 1975). No doubt many parents are already trying out his suggestions on their own.

In 1980 another detailed book which examined the Feingold system in detail came off the press. It is entitled Food Additives and Hyperactive Children by Dr. C.K. Connors (Plenum Press, New York, 1980).

Parents who would like more information are coming together to pool their knowledge and ideas. The National Association of Hyperactivity’s address is P.O. Box 100, Narrabeen, Sydney, NSW, 2101. But whatever routine is considered, medical supervision by a medical practitioner specially versed in this difficult field is recommended.

*33\87\2*

A cough and shortness of breath are the first symptoms of pneumonia, accompanied by fever and sweating. Acute lobar pneumonia, which affects only one lobe of one lung, causes a dry cough. The sufferer may cough up blood. In the case of bronchopneumonia, usually affecting both lungs, there are sudden chest pains and the sufferer coughs up yellow, green, or brown sputum, sometimes containing blood.

Pneumonia can be a serious condition and a doctor should be consulted if it is suspected. However, some complementary therapies prescribed by qualified practitioners can be helpful. Herbal expectorants can be used to loosen the phlegm, including mullein and thyme. Echinacea, garlic and large doses of Vitamin C and Vitamin A may be recommended to boost the immune system against infection. Fruit or vegetable juice fasts may be recommended, followed by diets which exclude foods which increase mucus production such as dairy products and sweet foods.

*32\69\2*

The germs that cause dysentery are salmonella and shigella bacteria. (Typhoid bacteria are a type of salmonella.) Dysentery may also be caused by amoebas (amoebic dysentery). Some doctors consider cholera to be a form of dysentery.

Dysentery is the result of eating or drinking food, milk, or water that is contaminated with these specific bacteria or amoebas. It also may be contracted from someone who has the disease or is a carrier of dysentery. (A carrier is a person who has the germ in the body but is healthy.) Complications that may develop from dysentery include arthritis, meningitis, and perforation (ulcers) in the intestines.

Signs and symptoms

The major symptom of dysentery is diarrhea. The diarrhea is often severe and is commonly bloody. The child may have a prolonged high fever (39.4°Ñ to 40.6°C). The child may also be extremely weak and exhausted. Any persistent diarrhea should be suspected of being dysentery, especially if it is severe or bloody.

Home care

Do not attempt to treat dysentery on your own. Whenever diarrhea is severe and bloody, see your doctor. Dysentery must be diagnosed by a doctor and often requires treatment with specific medications.

While waiting to see the doctor, give the child plenty of clear liquids. Liquids are needed to replace those being lost from the diarrhea. Extra liquids will help prevent dehydration (a serious loss of body fluids). Clear liquids that are the most helpful include tea, water, flavored gelatin water, and commercial mineral and electrolyte mixtures.

Limit or eliminate solid foods from the child’s diet. Especially avoid foods with roughage, fruits (except bananas and apples), vegetables, butter, fatty meats, and peanut butter. Do not give the child milk, since milk may further aggravate diarrhea.

Precautions

• Always report severe or bloody diarrhea to your doctor.

• If any diarrhea lasts more than two or three days, call your doctor.

• The younger the child, the more easily dehydration can occur with diarrhea. Infants can become dehydrated rapidly (within 12 to 24 hours after diarrhea begins).

• Do not give anti-diarrheal medications to children, since side effects are common and can be dangerous.

• When traveling, carefully choose sources of food and water. Avoid sources where sanitation may be poor.

• If you suspect dysentery, isolate the child and dispose of stools carefully.

• Practice good hygiene in your own home. Wash hands after treating an ill member of the family. Wash hands carefully before cooking and eating.

Medical treatment

A culture of the stools (with microscopic examination for amoebas and other parasites) confirms the diagnosis. Cultures of the blood and urine are sometimes performed, as well as tests for specific antibodies in the blood.

If dysentery is diagnosed, your doctor may hospitalize your child for treatment and isolation. Specific antibiotics for treating dysentery are available, although they are not always necessary. Diagnosed cases of dysentery must be reported to health authorities.

*56/84/5*

Keep in mind, though, that “healthy” is one thing, “medicinal” is another. True, intercourse does have its direct health benefits. It is, after all, exercise (though it comes in well below golf and sawing wood on the calorie-burning charts). It has an analgesic effect, reducing pain for several hours after the fact, most encouragingly for sufferers of arthritis. And there’s evidence that ejaculations on a steady, regular basis make for a healthier prostate.

But sex, as far as anybody knows, doesn’t cure cancer. It won’t prevent heart disease. We’d love to report that sex will fend off diabetes forever. But that, as a certain jowly ex-president once said, would be wrong.

Still, it’s wrong only in its overstatement, not in spirit. Sexual fulfillment is a player in the disease-fighting game, not because it cures anything directly but because it’s a morale-booster.

Sex is a motivator and a powerful one, according to Aaron Vinik, M.D., Ph.D., director of research at the Diabetes Institute in Norfolk, Virginia. “The contact that sex provides keeps you functioning and involved,” Dr. Vinik says. “Sexually inactive people become what I call slothful – apathetic and inactive.”

Apathy and inactivity are invitations to disease; they’re the antithesis of the disease-free lifestyle. To defy disease, you need to exchange those two losers for a couple of winners: inspiration and action. A lusty sex life is part of that motivational mix.

“A lot of the depression and withdrawal you see in people with illnesses is because of a loss of sexuality,” Dr. Vinik says. “Sex is important to feel whole, to have a healthy outlook, to maintain vibrancy.”

*64/36/5*

Today, hypertension has become a very common disease in East Africa and a review of deaths in hospitals there found that hypertension was responsible for ‘something like 40 t 60 per cent of the heart disease hospital diagnoses’. By 1978 it was the second commonest cause of death among the urbanized Bantu. Research has implicated many factor in this dramatic story but apart from the stresses of urbanization (which are difficult for quantify and are arguably not much greater than the stresses of tribal life), the amount of sail a population eats seems to be crucial. An analysis of the Kikuyu diet in 1930 found that salt was never added to food. The vast majority of the diet was unrefined starch in the form of carbohydrate (72 per cent of calorie: consumed); the rest was made up of fat (9 per cent) and protein (19 per cent). Salt intake started to rise in the 1920s and 1930s, first in urban areas. In places where diets were supervised by Europeans salt use was common.

Western man consumes 6-18 g of sodium (as common salt) daily. Primitive hunter-gatherer man consumes about 0.6 g daily. A recent study of such peoples found that their blood pressure does not rise with age.

Ethnic groups who do not add common salt “to their food have lifelong low blood pressure and no exceptions have been found to this rule. A part of this might be explained by different sensitivity to dietary salt. Genetically controlled salt sensitivity varies considerably both in animals and in man. It is now suggested that most people can tolerate a daily intake of up to about 4 g of salt but that above this level an increasing proportion of salt-sensitive subjects develop blood pressure with age. Above 6-8 g almost all salt-sensitive people will develop blood pressure with age. It is interesting that although fat people so often have hypertension in the West, obesity itself is not the cause-it is the high salt intake that so often goes with the obesity.

This knowledge has led to many trials of low-salt diets to alleviate hypertension. One major study found that reducing salt intake to 3 g daily was as effective in lowering blood pressure as drugs prescribed to another group for the same purpose. Many centers now claim to achieve normal blood pressure in their patients within a few weeks of putting them on a low-salt diet (4 g a day or less) and many people can then stop taking drugs entirely.

*57/72/5*

The researchers studied almost 6,000 people who had suffered heart attacks and found that among working people Mondays were especially dangerous, accounting for about 18 percent of all heart attacks.

Compared with the rest of the week, Mondays had a 40 percent higher risk of heart attacks. Thursday was the second riskiest day, followed by Saturday, Tuesday, Wednesday, and Friday. Sunday was the safest day, accounting for 12 percent of all heart attacks.

The researchers also noted in their report, which was presented at the annual scientific meeting of the American Heart Association, that for retirees and others who were not employed, there seemed to be no significant difference when heart attacks happened.

*4\27\8*