Dear Ann Landers,
Of course it's possible. At this very moment I'm sure some-where in the world several wives are beating up their husbands. Many women are in much better physical condition than their mates. They can pack a mean wallop and are faster on their feet. That's all it takes, Mister. Bedwetting {Enuresis) Bedwetting (or enuresis) may be a symptom of a deeper problem. There is no single solution or treatment since there are a number of situations that might cause a child to wet his bed. The cause most parents hope for is some disease of the bladder which can easily be cured by their doctor. In fact, some parents talk about bedwetting as "a weak bladder." Inflammations of the bladder may indeed cause bedwet-ting, as well as daytime wetting, since the irritation produces a symptom called urgency, or a sense that the bladder must be emptied immediately. Since inflammation of the bladder is more common in girls than in boys, and bedwetting is more common in boys than in girls, this obviously cannot be considered a common cause. More important than the bladder is the muscular ring at the mouth of the bladder called the sphincter. At birth this muscular ring operates automat-ically, opening up when the bladder reaches full capacity. The infant is not constantly wet, but urinates at intervals without any voluntary control. Toward the end of the first year of life, as the nervous system develops, the sphincter gradually comes under the control of the child, along with some influence of the parent. At first, with the encouragement of the mother, urine is held back until the clothing can be removed, and the toilet is available. Slowly, as it becomes easier to contract the sphincter, and the bladder capacity increases, it be-comes possible for the child to remain dry through the night, although there may be some "accidents" after a stressful day. The ability to voluntarily relax the sphincter is a later development, so that the child cannot urinate unless the bladder is close to capacity. An infrequent cause of bedwetting is some neurological defect of the spinal cord interfering with sphincter function. This rarely results, however, in just bedwetting. There would more likely be a general problem in sphincter control, with both wetting and soiling during the day as well as during the night. A more common cause of bedwetting lies in the area of parental attitudes to toilet training. On the one extreme there are families where almost every-one wets. If this is expectable behavior, the child will follow the family pat-tern. No message has ever been given that it is both possible and desirable to have a dry bed. Many children learn this only when they want to stay over-night with friends, go to camp or even enter the army. I have also seen this "no training" attitude in "liberal" families who are afraid any training is harsh, and fostered by pediatricians who assure them that it is best to ignore the wet bed and "eventually it will go away by itself." Some children may be constitutionally slow in developing urinary control, and may spontaneously stop wetting at age six to seven, or else at puberty. Some attempt should be made to help them, however, because they do feel embarrassed. "Magical" cures may sometimes occur by simply informing the child that he is old enough to go through the night without urinating, or else he should get up and go to the toilet if he feels the urge. At the other extreme, which is not common at present, is the overly consci-entious mother who makes a big deal out of training and control. If control is attained at the earliest age when it is physically possible, it is easily broken down by illness or stress. It then becomes much harder to re-establish, be-cause both the child and mother feel like failures. Some years ago, a urologist pointed out that the child who is placed on the toilet very frequently may fail to develop the bladder capacity which makes it possible to stay dry through the night. Also, because of the delay in the abil-ity to relax the sphincter voluntarily, the child who is urged to urinate before bedtime or a trip, even though he had urinated a short time before, and can-not may be viewed as stubborn, and become involved in a power struggle with the parent. Urinary control then becomes a battlefield. This power struggle is certainly an important part of bedwetting. Some-times the act is conscious and deliberate, occurring when the child is awake, although usually the loss of sphincter control occurs on waking from the deepest stage of sleep. In the very young child who has just attained control, the most frequent stress is the birth of a brother or sister. Wetting may be seen as a plea to remain a baby, or an expression of anger at the parents and the new baby. The older child has trouble understanding why the baby is excused from the controls which are expected of him. In later childhood there may be more difficulty in determining the "mes-sage" of the symptom. Usually the child has been dry for some time, and the parent tends to concentrate on controlling the symptom and loses sight of the situation or the event that triggered it. The parent often tries punishment or various commercial devices, ignoring the symptom, calling the child a baby, etc., before seeking professional help. The parent needs help to get out of a power struggle which he cannot win without the co-operation of the child. There are a number of methods, in-cluding electric conditioning devices, which may succeed in stopping the wet-ting symptoms. In children who are constitutionally slow, these may have some value, and they feel better in being able to visit away from home. How-ever, if the wetting has been a symptom of a power struggle, or a neurosis, then professional help for the total situation will be necessary. The professional investigation starts with a careful history, to determine if there might be some physical problem that requires medical treatment. It should also include a history of the toilet training experience, and significant events relating to the beginning of the bedwetting. Somewhat more difficult to determine are the attitude and behavior of fam-ily members toward the child. Sometimes there has been actual physical abuse, and wetting is the child's revenge. There may be sexual stimulation not suitable to the child's age, with a reaction in that organ of the body which has a sexual as well as urinary function. There may be loss of a parent, or a more subtle loss of support from a parent, with greater demands for mature behavior than the child can comfortably deliver. Bedwetting is very common in children's institutions, where the loss of parents for various reasons has required children to depend on themselves and strangers. I do not wish to imply that every case of bedwetting needs psychiatric treatment. For the well-meaning parent, the first task is to prevent the wet bed from becoming a battleground. It is necessary to hold to the idea that each child will one day be able to have a dry bed. This can be done in a positive manner by sensing when the child can respond to the desire to be more mature, usually toward the end of the second year of life. Girls are often ready sooner than boys. It may take a year to establish a reliable habit. Praise for success is usually more effective than shame or punishment for failure. If bedwetting develops after dryness has been attained, some atten-tion should be paid to the stress which may have triggered the backward step. In a case of the birth of a sibling, the loss of a parent or an illness in the child, it is best to be patient, allowing time for the child to express his feel-ings, then gradually encourage an effort to have a dry bed. Sometimes reducing expectations in the area of school achievement or household chores temporarily will allow for progress to resume. If it does not, after a period of a month or two, the symptoms may be addressed more directly by offering rewards for dry nights until the pattern is established. If this is not successful, professional help should be sought. A consultation may be sufficient to suggest to parents a more effective approach. However, if the child has complex problems relating to immaturity, sexuality or hostility which no longer respond to good parental handling, treatment of the child may need to be long-term and intensive. credit: Helen R. Beiser, M.D., Chicago Institute for Psychoanalysis. Bicycle Safety The bicycle, like a car, is not inherently dangerous unless, of course, it is me-chanically deficient. It's bicyclists who cause accidents. In fact, bicyclists ap-pear to be at fault in nearly 80 percent of all collisions with motor vehicles, according to the Insurance Institute for Highway Safety. Bicycle safety must be learned and practiced by the bicyclist. In one re-spect, the bicyclist faces a greater challenge than the motorist: He must not only know all motor vehicle safety regulations, but also those which apply to bicycling. Over half of all bicycle/car accidents occur at intersections, reports the Na-tional Safety Council. Why? Because either the driver or the bicyclist failed to yield the right of way. WHAT ARE THE OTHER CAUSES? Riding too close to the center of the road, ignoring traffic signals and signs and moving against the flow of traffic follow in that order. The U. S. Consumer Product Safety Commission lists the following causes: Loss of control (caused by difficulty in braking, riding too large a bike, riding double, stunting and striking a bump or obstacle). Mechanical and structural problems (such as brake failure, wheel and/or steering mechanism faults, chain slippage and pedal and spoke breakage). Entanglement (of feet, hands or clothing). Foot slipping from the pedal. DO BICYCLISTS EVER HAVE THE RIGHT OF WAY? By law, they have the same right to the road as motorists-as well as the same responsibilities. But don't dispute the law or the right of way with the motorist. Besides having the advantage of their vehicle's weight and size, most motorists are unaccustomed to seeing anything on the highway smaller than a motorcycle. Face it, the bicyclist is vulnerable. WHAT LAWS MUST THE BICYCLIST OBEY? The bicyclist shall be granted all the rights and shall be subject to all the duties applicable to the driver of an automobile. This means the bicyclist must: Obey all traffic signs and signals. Ride on the right side of the road, single-file. Never hitch a ride by attaching the bicycle to a motor vehicle. Never carry more riders than the bicycle is designed to hold. The bicycle must: Be equipped with white front and red rear lamps (if ridden at night) capa-ble of being seen from a distance of 500 feet (a red reflector may also be mounted on the rear). Have sufficient braking power to make the tires skid on dry pavement. Have a warning device that can be heard 100 feet away. WHAT ARE THE "UNWRITTEN" RULES OF BICYCLE SAFETY? Ride Defensively-As in driving an automobile, remember to be on the defensive-not on the offensive. Ride a Straight Course-Stay as close to the side of the road as possible and ride in a straight line. Stay out of the flow of traffic, but far enough from the curb to avoid sewer drains or car doors that open. Read the Road-Learn to simultaneously scan the road immediately in front of the bicycle for unexpected hazards-potholes and bumps, glass, pedestrians, car doors opening and others-and the road ahead for distant traffic situations. Pretend You Are Invisible-By assuming you cannot be seen, you are more likely to anticipate the motorist's driving behavior and moves. Know Yourself and Your Bicycle-Compensate for lack of speed and visi-bility by forethought and strategic planning. Test yourself to find out how fast you can pedal should you have to flee an approaching vehicle or swerve around a car leaving the curb. Apply your brakes evenly when stopping, and apply the brakes repeatedly to dissipate heat whep riding downhill. (If you have hand brakes, the front brake usually makes contact with the wheel before the rear brake.) "See" with Your Ears-Consciously listen for approaching traffic-try to visualize what's happening behind you. Plan Your Rides-Select roads to ride on that are relatively free from traffic (particularly trucks). By avoiding congested arteries you usually can make better time and arrive less harried. WHAT HAZARDS CONFRONT THE BICYCLIST? Car Doors Opening-Your first reaction to a car door opening in your path is to swerve to the left-a deadly response, especially if a car is approaching from behind. A safer move is to stop. If you have to, turn to-ward the curb. Broken Glass and Gravel-It is safer to run over objects than to swerve out of their way into traffic. Bicycle tires and gravel don't mix. If you must ride on gravel, approach it head on, avoid changing course and go slowly. Wet Roads-Not only will your tires slide on slick pavement, but water on the rims reduces and wipes out braking power. Also, your vision may be impaired when raindrops land in your eyes. (Be careful that your raincoat doesn't get caught in the spokes or chain.) Dogs-If attacked, stop and get off the bicycle-this will usually end the assault. If it doesn't, use the bike as a barrier between you and the dog. Never try to outdistance the animal-you will only make him more deter-mined. Bugs-It isn't unusual to have a fly, gnat or bee hit you in the face, causing you to lose control. Avoid taking your hands off the handlebar to rub a sting. Instead, steer to the roadside and attend to the problem. Pedestrians-Pedestrians, especially at intersections, must be allowed the right of way. Bicycle/pedestrian accidents don't occur very often, but when they do it's usually because neither saw the other approaching. SHOULD YOU USE HAND SIGNALS? State law says you should. Before you turn left or right, or stop, you should give the same signals which are required for motorists who do not have turn signals. However, bicyclists with drop-style handlebars will need extra practice with this difficult maneuver. In fact, using a hand signal at the wrong time may cause the rider to lose balance in a turn, or not allow the use of both hands should sudden braking be required. The point is, signal with your hands but do so well in advance of your turn -do not take your hands off the handlebar while you are turning or braking. WRONG-WAY BICYCLING IS DANGEROUS Drivers tend to look left first at intersections, then right, before they pull out. If you are coming toward the driver from his extreme right, he will prob-ably hit you before he sees you. Riding on the left exposes you to possible head-on collisions with oncoming vehicles, the impact of which may be sev-eral times that of being struck from the rear. (A head-on collision between a bicycle and a car, where the two vehicles are traveling at 20 mph, would result in an impact speed of 40 mph.) RIDING TWO ABREAST IS UNSAFE When bicycling two abreast, the rider on the traffic side is vulnerable to passing cars. It's safer to ride single-file. When following other bicyclists, stay at least two bicycle lengths behind and in an offset position (slightly to one side of the rider in front). Use an "early warning" system whereby the first and last riders signal the others of approaching vehicles. FLAGS AND REFLECTORS MAY NOT MAKE YOU SAFE Bicycling is safer when the rider equips his bike with a pole-mounted flag and reflectors. But don't be lulled into thinking that these are all that is needed to be safe. Flags and reflectors have not reduced bicycling accidents -but awareness of safety rules on the part of bicyclists and motorists will. ARE YOU PEDALING PROPERLY? It isn't uncommon to see a bicyclist with his feet planted flat on each pedal, the pedals nestled under each instep. This position is tiring and reduces the power of each leg stroke. By pedaling with the balls of the feet one can ex-tend each leg farther and allow the thigh and calf muscles to push harder. (If your bicycle has toe clips, practice loosening them several times before you ride in order to be prepared for emergency dismounts.) WHAT SHOULD YOU WEAR? BRIGHT CLOTHING: BE CONSPICUOUS! If you are a beginner or haven't ridden in a long time, wear long, thick pants (an old pair) to protect your legs from bruises or scrapes. (Roll up your right pant leg or wear an elastic band to keep the fabric from catching in the chain.) Tennis sneakers or shoes with light soles are best. Always wear shoes with shoestrings-the slip-on type of shoe is too loose and may come off while pedaling. Shirts with several pockets allow you to carry such items as tool and patch kits, snacks, maps, etc. Often you will start your ride wearing a jacket or sweater, only to take it off after a few miles of riding. Put the jacket in a sad-dlebag rather than tying it around your waist-loose items of clothing some-how always get caught in the spokes. In cold weather you may want to wear thermal underwear in addition to heavy outerwear. Also, wear gloves, a scarf, a tight-fitting hat and wool socks. The wind can make it a lot colder than it really is. Experienced bicyclists wear riding helmets to protect their heads during falls. The head is the most vulnerable-and most important-part of the anatomy. Protect it at all costs! WHAT SHOULD YOU DO ABOUT BICYCLE REPAIRS? Ask the dealer for the information/repair manual that comes with your bike. It should cover everything from fixing a flat tire to tuning the gear mechanism. Take time to learn how to repair a flat tire. The dealer will show you how, as well as sell you a spare tube and patch kit. If you bicycle long distances, carry these items with you. Also, bring along a set of small wrenches, a screwdriver and a pair of pliers. To avoid tire failure, keep the tires inflated to the pressure suggested by the manufacturer (look on the sidewall of the tire) and examine them for cuts after each ride. Exert great caution when using a gasoline station air pump. They can fill your tire too quickly, causing the tube to explode and the tire to blow off the rim. Fill by holding the hose on the valve for short periods-bet-ter yet, use a bicycle hand pump. Leave the intricate repair jobs to the dealer. Bring the bike back to the dealer for routine maintenance at the specified intervals. HAVE WE FORGOTTEN ANYTHING? In summer bicycling, do not ride in direct sunlight for extended periods. Dizziness and fatigue are signs of heat stroke. It's best to cool off and relax when you feel hot or tired. Always carry adequate identification, as well as extra money for emergen-cies. Carry a small first-aid kit and a plastic bottle filled with water (frame- mounted). Avoid busy county and state roads. Many freeways prohibit bicycles-be sure to check which ones. Bikeways are safer than public roads, but don't let your guard down. Be prepared for careless bicyclists and pedestrians, as well as poorly marked or prepared paths. Use extreme caution when carrying children-even when using a specially designed seat. The weight of the child may cause you to lose balance, or the child may distract you. When carrying packages, distribute the load evenly in baskets mounted on both sides of the rear wheel. (Avoid front loading-it affects steering.) Make sure your wheel reflectors are mounted opposite the valve stem-this will provide better balance of the wheels at certain high speeds. Be cautious when riding on wide, well-paved shoulders. Shoulders often narrow down and force you onto the main part of the road anyway. Be-sides, it's illegal to ride on the shoulder. (Shoulders are for emergency use only.) Alcohol and medicine affect your judgment while driving. Just imagine what it does to you while riding a bicycle. If you must ride at night, stay on well-illuminated but less-traveled roads. credit: Written by James Hill Van Orden for the New Jersey Office of Highway Safety. Biofeedback If you want to demonstrate how biofeedback works, -Tape a thermometer to your mid-dle finger; the bulb to the fat pad. Make good skin contact but do not constrict circulation. -Sit still for five minutes with your eyes closed. Note the temperature of the finger. -Then while still sitting quietly, with eyes closed, repeat a few au-tosuggestion phrases to yourself slowly. Such as "I feel relaxed and warm. My hands feel heavy." Repeat the phrases slowly, allowing the suggestion to take effect. Every 5 or 10 minutes take a temperature reading. Most persons will show a rise in finger temperature after 10 to 20 min-utes, some increasing their finger tem-perature 3, 5 or even 10 degrees, some only a degree. By so doing, you will have demon-strated to yourself all the basic ele-ments of biofeedback. If you stand on a bathroom scale and look at your weight in the little round window, that is one kind of biofeedback. The machine tells you something about your biological condition, it feeds back to you information about your-self. If you want to lose weight you can use this information every day to guide your diet. If you want to learn to warm your hands or feet at will, you can tape the bulb of a tiny thermometer loosely to a fingertip or to a toe (the inexpensive room-temperature kind of thermometer that is sold at supermarkets) and practice warming. The thermometer, a biofeedback device, feeds back infor-mation about success or failure, and from this information you learn how to control the temperature, which means controlling the flow of blood through that part of the body. One way to learn to warm your hands is to imagine you are lying on a sunny beach with your hands buried in warm sand. Try to get the feeling of warmth. The trick in biofeedback is to imagine the feeling of what you want the body to do-and then totally relax and let the body do it. If you "try harder" it is less likely to happen, like trying to force your-self to go to sleep. After several fifteen-minute practice sessions with temperature feedback, the average person will observe that the temperature is beginning to respond to mental commands. At first such an unusual exercise is likely to make the temperature of the hands drop a couple of degrees, but with practice most people can learn to raise the temperature from the seventies or eighties to around 95 degrees F. Even easier is learning how to make your mouth water -by imagining you are biting a big juicy pickle. A biofeedback instrument is not needed in this case to tell you that the visualization was successful. If you want to do something more difficult, such as making your right knee get warm, usually it is necessary to become physically and emotionally quiet first, with relaxation exercises, and then feel warmth flowing into the right knee. Make no attempt to force it. Just imagine it happening, and then let the body do it. Since 1960 several hundred research and clinical projects have demon-strated that through the use of different forms of biofeedback the average person can voluntarily regulate a number of body processes that were previously thought to be involuntary, such as heart behavior, blood pressure and skin voltage, as well as blood flow in specific parts of the body. This ca-pability may not be of much importance to a healthy person, but to someone who suffers from erratic heart behavior or high blood pressure, or some other blood flow problem, it can be of great importance. The "discovery" of this human capability (the knowledge of which apparently is as old as Yoga, per-haps 3,500 years) was new to Western science in 1960 mainly because few persons previous to 1960 attempted to determine with scientific instruments whether or not the heart and other body organs could be self-regulated. Biofeedback training is expected to be of considerable importance to medi-cine in the next decade. Physicians generally agree that 50 percent to 80 per-cent of adult illnesses result from improperly handled stress. These ills are not diseases as much as they are undesirable physiological reactions to emo-tional stress that we have allowed to get "under our skins." For instance, mi-graine headache is often triggered by stress. Fortunately, it is possible for most migraine patients to learn to change their normally unconscious reac-tion to stress and handle the pressures of life without headache. Some of the medical problems that can be handled fully or in part with biofeedback training include anxiety tension, migraine and tension headache, hypertension, cardiac arrhythmias, Raynaud's disease, gastrointestinal difficulties such as stomach ulcers and colitis, and neuromuscular disorders such as functional paralysis, torticollis and stroke paralysis. Technical infor-mation on biofeedback and the names of professional therapists in various parts of the country can be obtained from the Executive Secretary, Biofeed-back Society of America, Department of Psychiatry, University of Colorado Medical Center, 4200 East Ninth Avenue, Denver, Colorado 80262. credit: Elmer Green, M.D., the Menninger Foundation, Topeka. Kansas, au- thor with J. D. Sargent and E. D. Walters of "Psychosomatic Self-Regulation of Migraine Headaches," Seminars in Psychiatry, Vol. 5, No. 4, 1973. Birth Defects A BIRTHMARK THEORY DEAR ANN: Our son was born with a purple birthmark on his neck. The mark is the size of a dime. My mother's aunt, who came here from another country, insists that the birthmark is a punishment because my wife stole some plums from a market when she was a child. We know this is nuts, but please comment. R. AND L.

DEAR R. AND L.,
You've already said it's nuts, and I can't improve on your evaluation. See a dermatologist about new tech-niques for removing "port-wine stains." This sounds like it might be one. More than 200,000 babies are bom in the United States every year crippled, mentally retarded, blind, deaf, seriously anemic, diabetic, or defective in hun-dreds of other ways. That's about one baby in every fourteen. Many of these children die in infancy, particularly those who are bom weighing less than five and a half pounds. The others, with medical help and rehabilitation, may overcome their defects and lead useful, though often lim-ited lives. There are now fifteen million Americans whose daily lives are in some way affected by birth defects. Some birth defects can be prevented or corrected by present medical knowledge. Most can't. By funding clinics and medical research projects around the country, an effort is being made to: (1) dis- cover the basic causes of various birth defects, (2) apply those discoveries to prevent the disorders, (3) improve present methods of treatment, (4) make treatment more widely available, (5) provide families with genetic informa-tion and counseling, (6) find cures for defects which up to now have been in-curable, (7) find ways to prevent birth defects from happening in the first place. What is a birth defect? A birth defect can mean either brain damage or an abnormality of body structure or function. Either can be caused by heredity or the result of environmental influence on the unborn baby, or both. One might say that everybody has a birth defect of some kind-crooked teeth, a birthmark, or nearsightedness. But here we are concerned with the more serious kinds of defects, the ones that can either kill or substantially in-terfere with the normal life of an individual. Many defects are recognizable at birth; many are not. Diabetes, for in-stance, may not appear until a child is eight to ten years old, or until age fifty. Huntington's disease is another example in which the symptoms of nervous system degeneration do not show up until early middle age. A growing national concern is the problem of low weight at birth. Under-weight newborns generally have a lower survival rate. (This is commonly due to circulatory and respiratory problems.) These babies are also more likely to develop brain damage. Some 85,000 babies are bom each year weighing less than four and a half pounds. They are in grave risk of early death or long-term physical or mental impairment. It is useful to categorize birth defects by the general ways in which they affect the individual. An infant may have more than one defect. When several defects occur they are called a "syndrome." Down's syndrome (mongolism) is an example. Those affected are mentally retarded and have physical char-acteristics different from those of a normal child. Some infants with birth defects have parts of their bodies missing, mis-shapen, or duplicated. Examples are open spine (spina bifida), water on the brain (hydrocephalus), clubfoot, cleft lip or palate, extra fingers or toes, and dwarfism. What causes birth defects? More often than not, the answer is unclear or unknown. But we do know that some defects, about 20 percent, are inherited. Another 2 percent are thought to be caused by environmental influences on the fetus. The rest may result from heredity and environment acting together. Some traits, for instance, are strongly associated with others. Color blindness and hemophilia symptoms usually show up only in males. Other traits may be linked to racial or ethnic characteristics of the parents, such as sickle cell disease, most commonly found among blacks; Tay-Sachs disease, most prevalent among Jews of Eastern European ancestry; and thalassemia, whose victims are mostly Italians or others of Mediterranean origin. Other examples of inheritable birth defects include Huntington's disease, diabetes, and cystic fibrosis. The Forming of the fetus. Especially crucial is the first month and a half, when the embryo grows from a microscopic single cell to an odd-looking creature the size of a nickel. During these forty-five days, major body parts and systems are taking shape: arms, legs, hands, and feet; muscles and a soft skeleton; liver, pancreas, digestive tract, and kidneys; eyes, ears, and facial features; brain and beating heart. For the next seven and a half months, more specialized parts appear and the fetus grows in over-all size. It's an incredibly complicated and fast-paced period of development. The wonder is that it comes out so well most of the time. One might compare it to building a city from scratch, using millions of inexperienced workers guided only by blueprints telling them where to go and what to do. At any time, interference from outside-such as the mother's smoking cig-arettes and the use of hard drugs-can affect the normal development of the fetus. Generally, the effect is greater earlier in pregnancy. The most sensitive period is the first six weeks, when the basic fetal frame-work is being built. A serious blow, a fall, or an accident can cause gross deformities which may result in fetal death and subsequent miscarriage or stillbirth. Or, the baby may survive pregnancy and be bom with de-fects. Maternal age. Stillbirths are more frequent among young teenage mothers than in women past twenty-one years of age. Miscarriages and Mongoloid babies occur more commonly among women thirty-five years and older. In the first case, it is thought that the girl's reproductive system may not have fully matured; in the latter, the system may have begun to break down. The ideal ages for bearing children are from twenty-one to thirty-five. Number and spacing of prior pregnancies. Having several children in close succession can affect the mother's health, which in turn can affect the fetus. Ideally, children should be two years apart. ENVIRONMENTAL CAUSES ACTING ON THE MOTHER DURING PREGNANCY These are influences brought to bear upon the unborn child as a result of the mother's getting sick, eating poorly, or taking harmful drugs. They in-clude: Viral disease and infections. German measles (rubella) is perhaps the best- known. Depending on when during pregnancy the infection occurs, the vims can cause deafness, heart defects, cataracts, glaucoma, and central nervous system damage in babies. Venereal diseases can cause birth defects, too. In the case of syphilis, the child may be born with bone malformations and infection of many body or-gans. Gonorrhea can cause eye infection, which may lead to blindness if the baby is not promptly treated at birth. Drug use. Practically any kind of drug can potentially affect the develop-ment of the fetus. Thalidomide caused numerous limb deformities in new-borns during the 1960s. Evidence is accumulating against such everyday drugs as alcohol and nicotine. They too may affect the outcome of preg-nancy. The mother's use of narcotics can definitely affect a baby's health. If she is addicted, the baby may be addicted also. Researchers don't yet know for sure whether hallucinogens like LSD can cause birth defects. It is wise to avoid any unnecessary drugs during pregnancy. A woman's doctor is the best judge of which drugs and medicines she may safely take, since he knows her case history. Smoking. Stillbirths, early infant mortality, and low birth weight occur more frequently among the babies of women who smoke during pregnancy. The degree of the effect appears to depend on how much the mother smokes. A recent study indicates that the risk may be lessened if smoking is stopped by the fifth month of pregnancy. Diet. Maintaining a balanced diet plays a vital role in having a healthy baby. Stillborn, premature, and underweight babies are associated with poor nutrition of the mother. Because of inadequate brain development and growth, the child may be mentally deficient. Effects of the larger environment. These include elements in the mother's general environment to which she may or may not know she has been ex-posed. One common example is: Radiation: X rays and other kinds of radiation have been linked with deformities to varying degrees. HEREDITY AND ENVIRONMENT Less than half of all birth defects can be attributed to a single environ-mental or hereditary cause. The majority are thought to result from an in-terplay between the two. Rh disease is one example. It occurs when a mother without the Rh factor in her blood conceives a child who does have the factor, inherited from its fa-ther. No damage is usually done to the child bom of the first such pregnancy. Following delivery, however, the mother develops antibodies in her blood which will attack the red blood cells of subsequent Rh-positive fetuses. The result of the next pregnancy could be an anemic or jaundiced baby which may die shortly after birth unless given a massive blood transfusion. DETECTION AND DIAGNOSIS A great many defects are readily apparent at birth, such as clubfoot, cleft lip, or Down's syndrome. Others, affecting internal body structure or chemis-try, may be less immediately obvious. Some defects can be diagnosed while the baby is still in the uterus, using several techniques. One of the most useful of these is called amniocentesis. It involves taking a sample of the amniotic fluid surrounding the fetus, using a hypodermic needle passed through the mother's abdominal wall and into the uterus. The fluid contains castoff fetal cells, which when grown in culture can be used to detect a number of defects. The fluid itself can also be tested. Other methods include ultrasound, a kind of harmless radar; fetal blood sampling; and late in pregnancy, when it is least dangerous, X ray. Other defects only show up much later and, unfortunately, cannot be de-tected until the individual develops the symptoms. By then it may be too late for treatment, even if it were available; doctors often can only alleviate the symptoms, or keep the condition from getting worse. Birth defects in this cat-egory today include Huntington's disease, diabetes, and gout, but tomorrow the story may be different. Detection is only a first step in combating birth defects. There remains the problem of how to treat them so as to minimize their effects. TREATMENT Only a few disorders, mostly structural malformations, can be cured today. We simply have no way of eliminating the basic abnormality of most birth defects. The majority of cases can only be treated to reduce harmful effects, or to keep them from getting worse. For many individuals, this enables them to lead fairly normal lives. Among the types of therapy available for children bom with birth defects: Corrective surgery. Particularly effective for structural defects, such as cleft lip, clubfoot, and some heart malformations. Also includes tissue grafts and organ transplants. Rehabilitative training. Can aid the blind, deaf, crippled, mentally re-tarded, or others with physical handicaps. Includes the use of mechanical or cosmetic prostheses, such as artificial limbs, braces, hearing aids, and glass eyes. PREVENTION To this point, I have described the things that can go wrong with a baby and what can be done about them. It adds up to a bleak picture, but there are bright spots. Only 10 percent of all babies bom in the United States suffer birth defects. Nine out of ten are bom perfectly healthy. Cure or effective treatment does exist for some of the more common defects. Finally, many defects can be prevented if prospective parents seek timely counseling and if pregnant women get good prenatal care. Prenatal care is many things: a balanced diet, exercise in the right amounts, good personal hygiene, avoidance of stress, and above all, regular visits to the doctor. "What can a doctor tell me?" a pregnant woman may ask. "With or with-out him, I'm going to have a baby." When a woman seeks medical care as soon as she thinks she is pregnant, the doctor can tailor a regimen for her which will guide her through those crucial early months with a minimum of risk. As the pregnancy continues, he can regularly check her health, personal habits, and the development of the baby to make sure that things are going normally. If at some point he finds that they're not, he can take steps to deal with them. During the pregnancy, the doctor is compiling information which will later aid in the delivery of the baby. Important factors are the baby's growth rate, its position in the uterus, the location of the placenta, and any maternal illnesses which might affect the delivery. Knowledge of these factors enables special arrangements, if necessary, to be made-as in the case of twins, pre-mature babies, Rh babies, or deliveries requiring Caesarean section. Prenatal care is the mainstay of prevention. But other newly developed techniques and services play a part, too. Within the last five years vaccines have been developed to combat German measles and Rh disease. The rubella vaccine is given to children under twelve years of age. This prevents the spread of rubella in two ways-it immunizes young girls who may someday be mothers, and it keeps children from getting the disease and passing it on to non-immunized women. It is never knowingly given to pregnant women, and generally not to women of childbearing age, because even the weakened vaccine virus could adversely affect the develop-ing unborn child. In the few years it has been available, the rubella vaccine is thought to have cut the number of reported congenital rubella cases substantially. The Rh vaccine, if given to Rh-negative mothers within three days after a birth, abortion, or miscarriage, prevents the buildup of antibodies in her blood which threaten the health of subsequent children. The vaccine is con-sidered almost 100 percent effective. Genetic counseling is available for couples who suspect that their future children may have a chance of inheriting a disorder. One or both parents may know of birth defects in their family history. They may belong to a ra-cial or ethnic group at relatively high risk for a specific defect, or they may have already had a defective child. In any of these cases, a genetic counselor will analyze the medical histories of the parents and their families. Blood samples may be taken for chemical and chromosomal studies. If the counselor finds there is some risk of a birth defect occurring, an at-tempt is made to define the odds as precisely as possible. A genetic counselor doesn't tell the couple what they should do. She (or he) provides facts. It is then up to the parents to decide what they will do about having children. This information was provided by the National Foundation-March of Dimes, founded in 1938 by President Franklin D. Roosevelt. Its original aim: to find a cure for polio. That goal was realized in 1955 with the licens-ing of the Salk vaccine. The Foundation then turned its energies and resources toward an even greater task: the prevention and cure of birth defects. March of Dimes chapters also sponsor medical service programs relating to birth defects at more than 150 medical and health centers throughout the country. In some, a defective child and his family can get expert diagnosis and treatment by specialist teams. Other programs support newborn inten- sive-care nurseries, and treatment during pregnancy and at delivery of women of high risk. Many supply genetic counseling and other genetics serv-ices. The National Foundation-March of Dimes helped build and continues to support the Salk Institute at San Diego, where a multidisciplinary group of scientists pursues the answers to basic questions of human biology. A number of Salk scientists are Foundation grantees. The Foundation also helps spread the latest information on birth defects, their treatment and prevention, to the health professions and to the public. The Foundation educates doctors and other health professionals through printed materials, audiovisual aids, and scientific conferences. Public awareness is raised through articles in newspapers and magazines, and on radio and television. In addition, the Foundation distributes pamphlets, audiovisual and other educational materials to the public through local chap-ters, health organizations, and community service groups. For those wishing specific help or more detailed information, write to the National Foundation-March of Dimes, Box 2000, Whites Plains, New York 10602. Animal Bites Over 600,000 humans in the United States are bitten and treated for animal bites each year. Probably two or three times that number are never reported. Dog bites are, of course, the most common, but there are many other ani-mals that bite, among them cats, bats, skunks, raccoons, squirrels, monkeys, rabbits, foxes, rats and mice. First and most important: Remember that all bites should be reported to a doctor at once. Even if you feel there is no chance of rabies, the animal may be carrying tetanus germs and a tetanus booster may be needed. If you are able, try to catch the animal. If that isn't possible, try to have an accurate de-scription for the police. Do not kill the animal. It must be kept under obser-vation for ten days for the possibility of rabies. Dogs in the United States carry less rabies than rats and foxes. The wound should be washed gently with soap and water. The victim should then go to a physician or a medical facility for evaluation. Since the human is the most intelligent of all animals, something should be said here about human bites. The mouth of every human contains a great number of bacteria capable of producing serious infection. If you are bitten by a human, the wound should be washed thoroughly with soap under running water. Tight bandages should not be used. A sterile, loose dressing can be applied. See a doctor. A tetanus booster may be needed. credit: Jay Arena, M.D., Chief of Pediatrics, Duke University, Durham, North Carolina, author of Safety Is No Accident; A Parents' Handbook, Durham, North Carolina: Duke University Press.