Dear Ann Landers,
She wouldn't smoke rfiore than four cigarets a day. She would not inhale. She would pay for her own and not "borrow" mine. Unfortunately, I discovered that Maria broke two of the promises yes-terday. I found 10 cigaret butts in her wastebasket and one floating in the toi-let. I noticed too that she had taken three cigarets out of the pack in my purse. (I remembered I had just opened a fresh pack and smoked only one.) I smoke too much and know what a terrible habit it is. I've tried to quit many times but can't. How can I help my daughter avoid the trap that I am now in? Please advise me. I feel HELPLESS

DEAR MOTHER,
Your first mistake was giving Maria permission. Those conditions didn't mean a thing, as you well know. I've said repeatedly that smoking is a habit. The health authorities have made it abundantly clear that a strong connection exists between cisraret smoking and lung cancer and heart disease. Smoking among teenagers is at an be in big trouble eventually. As for all-time high. I don't know what else Maria, I suggest the firm, hard line, can be done to get the message through "No. You do not have my permission to these kids. The bodies they now to smoke. I am 100 percent against it." have must last them all their lives. If Of course, it would help a lot if you they don't take care of them, they may would quit with her. AN APPEAL FROM ANN: DEAR READERS: Please forgive this personal reference but I must share with you, my millions of friends, what is on my mind and in my heart. A few weeks ago, our family gath-ered in Omaha to bury one of the dearest, most gentle people I have ever known. He was David Brodkey, mar-ried for 43 years to our eldest sister, Helen. Dave was a delight. We adored him. He was meticulous about detail, the perfect choice to take charge of any family project. Dependable. Indus-trious. Thorough. "Integrity" was his middle name. Dave cherished Helen, and well he might. She was a devoted wife, the beauty of the family, a talented pian-ist, a superb cook, and a leader in com-munity affairs. But Dave, the Perfectionist, the man who did everything right, did ONE thing wrong. He smoked at least two packs of cigarets every day for 30 years. This senseless addiction de-prived him of the joy of seeing his grandchildren marry. And it will deny those who loved him of the pleasure of his beautiful presence. So often I have heard smokers say, "Well, you have to die from some-thing." True. But please, friends, if you can help it, die from something else and don't rush the event. Lung cancer is a horrible way to go. While non-smokers, too, die from lung can-cer, the evidence is irrefutable cigaret STOP SMOKING TODAY! smoking does cause lung cancer. The more we study it, the more certain we become. Smokers are the leading can-didates for this dreaded disease and heart trouble and emphysema as well. One out of every four Americans alive today will have some form of cancer during his lifetime. One out of six people who get cancer will die from it unless, of course, we learn more about how to prevent this scourge and how to cure it. The economic cost of cancer in our country is $20 billion a year, to say nothing of the agony and suffering. The life of every person who reads this column has been touched in some way by cancer. It is the second biggest killer in the United States. Almost the last words Dave uttered to his wife were these: "I should have listened to you years ago when you begged me to stop smoking." But like so many others, Dave believed cancer happens to other people. And now, all you wives who are nagging your husbands, and all you husbands who are pleading with your wives to throw away those filthy kill-ers, and aff you young people who are turning your healthy pink lungs into tar pits at 65 cents a pack, for God's sake, for the sake of those who love you, STOP SMOKING TODAY. Do it for yourself. Do it for the people who care about you. ANN LANDERS Circumcision at Birth Circumcision, or surgical removal of the male foreskin, has been practiced since biblical times. The covenant between God and Abraham recorded in Genesis 17:10 instructed Abraham to "circumcise among you every male." It is fair to say, however, that the procedure has never been as common in other cultures as it is in the United States today. In some hospitals of the United States, 90 percent or more of the male infants are circumcised at or near the time of birth. Practices vary around the world, in different cultures and in different areas of the United States. On the subcontinent of India, Hindus don't, but Moslems do. Jewish people do, most eastern Europeans don't. In the United States it is more common in urban areas than in rural and in the North than in the South and is the subject of much controversy today. Circumcision done at or near the time of birth is a relatively simple proce-dure and usually carried out with one of three instruments: a metal instru-ment with a slit in it, a metal bell clamp, or a plastic bell that falls off after eight or ten days. Serious complications are unusual. Small amounts of bleed-ing, an occasional infection, swelling or the removal of too much or too little foreskin are the more common complications. Why are infants circumcised? The reasons vary. The ritual circumcision among Jews (Bries) done on the eighth day of life is well known and an ex-ample of ritual circumcision accompanied by prayer, feast, a joyous occasion and an opportunity for the entire family to be together. For years, cleanliness has been used as a reason for this procedure. It is easier to keep the circumcised penis clean and odor free. Uncircumcised males occasionally have a painful swelling of the foreskin when it is retracted (phimosis) that necessitates emergency circumcision at any age. Smegma, the white material that accumulates under the foreskin, has been cited as a cause of cancer of the penis in the male and cancer of the cervix (neck of the womb) in females. Cancer of the penis is very rare in the cir-cumcised male, and the wives of males circumcised during infancy .have an extremely low incidence of cancer of the cervix. The usual question of whether sex is more pleasurable when the male is circumcised will probably never be answered. Some people feel that constant exposure of the end of the penis after circumcision to the irritation from clothes makes it less sensitive than the tip protected by the foreskin. The con-clusion drawn by these individuals is that the circumcised male gets a little less sexual satisfaction. Last we should consider the circumstances in which the boy is to grow up. It is not good to be the only circumcised boy in a locker room full of uncir-cumcised males or vice versa. In communities where circumcision is not regu-larly carried out the circumcised male is viewed as something of a freak and can be the object of ridicule. "Now what do I suggest for my patients?" I tell them everything that I've presented in this article. I strongly recommend that if they are con-sidering circumcision that it be done before the infant leaves the hospital. I also tell them that circumcision in infancy presents fewer complications and is a much simpler procedure than if done in adulthood. credit: Donald M. Sherline, M.D., Professor and Director, Perinatal Biology, Department of Obstetrics and Gynecology, Rush-Presbyterian-St. Luke's Hospital, Chicago. Circumcision of Adults Adult circumcision has been practiced for many generations. It is probably becoming progressively less frequent since circumcision at birth, at least in this country, has been rapidly increasing over the past thirty to forty years. However, there still are many men who have never been circumcised and who in later life desire or are advised by their doctors to undergo circum-cision. Some men elect to have the foreskin removed for cosmetic reasons. They think the penis looks better without the foreskin which cloaks and hides the head of the penis. The most common reason for circumcision in the adult male is to improve hygiene. The foreskin permits the accumulation of smegma and moisture which produces an undesirable odor and also may cause irritation and inflammation of the penile head and the undersurface of the foreskin. This is painful and discourages sexual intercourse. Similar infection is more frequently seen among patients with diabetes. Sugar in the urine trapped under the foreskin promotes bacterial growth. In some cases the foreskin may be tom-usually during sexual intercourse- and these tears usually occur on a fold of skin on the underside of the penile head. This area is stretched when the penis is erect and the foreskin re-tracted. The resultant bowstring effect can then be more easily torn. Fre-quently this may recur and each time the scar tissue thus formed makes the bowstring more taut and the scarred tissue is also more easily torn. Under-standably this phenomenon is most unhappy for the bearer since intercourse and even erection may cause much pain until the tear is healed. Circumcision also includes cutting out the fold and replacement with penile skin that is more easily stretched and much less subject to tearing. In some individuals the foreskin cannot be retracted or can only be done with great difficulty because the opening is too small or contracted to slip back over the head of the penis. This situation is undesirable for several reasons. It discourages or makes it impossible to clean under the foreskin. With erection and/or sexual intercourse the skin at the opening is more sub-ject to tearing, and sexual intercourse is less pleasurable due to the presence of the foreskin over the sexually sensitive head of the penis. Finally, and most important, individuals who don't or can't retract their foreskin may harbor cancer of the penis. Hidden from sight and painless, this malignant growth may go undiscovered too long with tragic consequences. Partial or total amputation of the penis may be required for cure. If un-successful, it will ultimately lead to death because of the spread of this dis-ease. Circumcision in the adult may not prevent penile cancer but the disease is more quickly recognized and hence treated earlier. Circumcision is a minor operation. It may be performed in the doctor's office under local anesthesia or in the hospital under general anesthesia. It is not a difficult operation but best results are probably obtained by someone who does this operatioft frequently. There is definite tenderness at the line of cutting and suturing. In addition, the previously unexposed head of the penis is much more sensitive for a time to touch of clothing. This problem can be overcome or minimized by covering the sensitive area with a gauze bandage for as long as the doctor and the patient desire. If there is no wound infection and normal healing occurs, sexual inter-course is usually comfortable and without risk of injury in six to eight weeks. Even then liberal use of lubrication is advised. I have no idea as to the number of adult circumcisions performed annually. I would guess that the majority are performed by urologists. These specialists may well average fifteen to twenty cases per year. credit: Jack N. Taylor, M.D., Associate Professor of Surgery (Urology), Ohio State University College of Medicine, Columbus, Ohio. Class Class never runs scared. It is surefooted and confident that it can handle whatever comes along. Class has a sense of humor. It knows that a good laugh is the best lubricant for oiling the machinery of human relations. Class never makes excuses. It takes its lumps and learns from past mis-takes. Class knows good manners are nothing more than a series of petty sacrifices. Class bespeaks an aristocracy unrelated to ancestors or money. A blue- blood can be totally without class while the son of a Welsh miner may ooze class from every pore. Class can "walk with kings and keep its virtue and talk with crowds and keep the common touch." Everyone is comfortable with the person who has class because he is comfortable with himself. Cleft Lip and Palate Clefts of the lip and palate are congenital separations in the muscle and skin of the lip, and of the structure of the palate (upper gum and roof of mouth). These problems are the result of an "accident" in development and occur in approximately one of every six or seven hundred live births. The appearance of the cleft in the lip and palate is, of course, of great con-cern to the families of these infants. The deformity often evokes feelings of rejection, guilt, recrimination and anger. The family's stability is severely tested as blame and responsibility are divided. Whereas heredity does play a part, other causes of this deformity can of this date only be characterized as accidental. Extensive research suggests possible causes such as vitamin deficiency, drug usage, viral infections, nutritional disorders, mechanical fac-tors and oxygen deficiency affecting the embryo during the critical fifth to tenth week following conception. None of these factors, however, has been proved as a cause of the cleft deformity. Heredity does play a role in the occurrence of cleft lip and palate. The chances of a cleft lip occurring in a child of parents, one of whom has a cleft, is about 2 percent. This increases to 14 percent if there is already a sibling with a cleft lip. If two normal parents have a child with a cleft, there is said to be a 5 percent chance that subsequent children will have the deformity. Clefts of the lip alone are more common in males and clefts of the palate alone are more common in females. Both of these deformities can, however, occur in either sex separately or combined. The cleft deformity can also affect either one or both sides of the lip and palate. The clefts may be partial or complete, involving various portions of the lip, gum and palate. The full deformity involves a total separation of the lip, gum and palate with flaring out of the affected nostril, protrusion of the middle of the face and distortion of the involved side. Few would suspect from a casual glance that in actuality nothing is missing. The deformity consists of a lack of fusion in the developing parts and herein lies the methods involved in repair and the hope for a good result in appearance and function. By sur-gical means the parts are rotated and repositioned to a more normal rela-tionship and surgically repaired. The major responsibility for surgical correction rests with the plastic and reconstructive surgeon, but the over-all treatment of the problem involves a "team of experts," each with his important part to play. The team consists of the pediatrician, orthodontist, otolaryngologist (specialist in diseases of the ear, nose and throat), speech therapist, social worker, psychologist and others. Only with the advice of all these can the proper sequence and timing of treatment for the individual patient be outlined and planned. Basically, lip repair is carried out from the time of birth to three months of age, and repair of the palate from six months to eighteen months of age. The timing of these repairs and methods used is open to wide differences of opinion and must be individualized with each patient. More than one operation may be required for the original defect and others later for revision, resulting in refinements of appearance and function. Several areas of function and development are involved in the over-all scheme of rehabilitation. These areas include cosmetic appearance, speech function, dental development and hearing function. Cosmetic considerations in the patient with clefts of the lip and palate pri-marily involve the form and shape of the lip and nose area. A great deal can be accomplished in achieving good cosmetic appearance at the time of the in-itial closure of the lip cleft. Secondary revisions of the scar and later nasal plastic surgical procedures may be necessary to give the ultimate benefit in final appearance. Speech function is in all likelihood the most important area of concern in the patient with the cleft palate. Efforts are directed at prevention of the characteristic "nasal speech" pattern so frequently associated with cleft palate patients. Many studies have shown that early closure (by twelve to eighteen months of age) of at least the soft palate cleft greatly contributes to the pro-duction of good speech. Generally, it can be said that about two out of three cleft palate patients will have a very satisfactory speech result. Persistent nasal speech may occur and require extensive speech therapy and in some cases a secondary surgical procedure. In these operations, a pharyngeal flap (tissue from the back of the throat) can be rotated into place at the back of the palate to diminish the nasal air loss and thus decrease the nasal quality of the patient's speech. Dental development is often distorted by the presence of the cleft through the gum area, abnormal development of the maxilla (upper jaw), and at times by scar tissue present as a result of the surgical closure of the cleft. Treatment should consist of a co-ordinated effort involving both the pedi-atric dentist for general dental care and an orthodontist for bite readjustment and the recording of key measurements of facial bone growth. It has been said that careful examination of cleft palate patients will reveal that 90 to 100 percent of them have abnormal fluid behind the eardrum even during infancy. This is felt to be due to a malfunction of the Eustachian tube leading from the middle ear into the throat area. More often than not, tiny plastic drainage tubes must be inserted through a small incision in the ear-drum and left indwelling to allow for the evacuation of this fluid. Forty to 50 percent of the children with cleft palates had significant hearing loss because of recurrent ear infections prior to the utilization of these drainage tubes. This has eliminated the problem of hearing loss, but ear infections must still be carefully watched for and promptly treated. In summary, clefts of the lip and palate occur as accidents of development. Some hereditary factors do come into play and parent counseling is thus beneficial. Most patients following treatment obtain gratifying results in ap-pearance and function, allowing them to lead normal and productive lives. credit: Robert M. Swartz, M.D. (Reconstructive Plastic Surgery), Arlington Heights, Illinois. Clubfoot Just a few decades ago, if a mother had been informed that her child was born with a clubfoot, she would have been terrified and would have envi-sioned her child with a deformity, limping and handicapped through life. The last thirty years has changed all that. Clubfoot is now no longer con-sidered a tragedy. Medical science has learned what to do about it. Tech-niques and management have been greatly improved. The cause of clubfoot (an extreme twisting of the foot is probably a com-bination of events. We are not really sure. Other coexisting limb and muscle deformities may be subtle and are not always immediately apparent. There-fore a careful and thorough examination should always be made. The pressure of the feet against the womb is a definite factor, but there may also be an inherent weakness, an inability of muscles to withstand such pressures. Thus heredity has a part in clubfoot, especially if it occurs in others in the family. The good news, of course, is that almost all cases of clubfoot can be cured without so much as a snip of surgery. If therapy is begun early, sometimes in the hospital nursery, complete re-covery often occurs. Verifying diagnosis is the important first step. The treatment is two-pronged: to correct the deformity and to build up muscle strength to main-tain that correction. As the child gets older the good corrective therapy- casts, braces, etc.-becomes even more effective. Surgery, however, may be needed if the muscles do not respond adequately to conservative therapy. Each child should be evaluated individually because there are varying de-grees of severity of clubfoot, and in the more severe cases surgery may be required. credit: Jay M. Arena, M.D.; Department of Pediatrics; Duke University Medi-cal Center, Durham, North Carolina; author of Child Safety Is No Accident, with Miriam Bachar, M.A., Durham, North Carolina: Duke University Press. John M. Harrelson, M.D., Assistant Professor of Orthopedics, Duke University Medical School, Durham, North Carolina. (The Common Cold) The famous physician Sir William Osier once said, "There is just one way to treat a cold and that's with contempt." Few Americans heed this advice. In-stead. they spend over half a billion dollars a year for non-prescription decon-gestants, antihistamines, and other cough and cold remedies. At this very mo-ment, thirty million Americans are suffering with a cold. If you are not among them, chances are three out of four that you will have a cold at some time during the year. The common cold is caused by a virus, which is picked up from someone who has it. There is no sure way to avoid catching cold. Some people seem to catch colds frequently. Others seem rarely or never to have one. The best protection is to get enough rest, eat properly and stay at arm's length from anyone who is sneezing, blowing or coughing. It is important to be aware that a variety of viruses may cause what feels and looks like a common cold but exposure to allergens and irritating sub-stances may produce the same symptoms. There is no evidence that going without a hat, getting your feet wet, sitting bare-armed in an air-conditioned room, or exposure to cold winds will bring on a cold. Excellent studies by W. E. C. Andrews in England point out that patients who are not carrying one of the viruses that cause the common cold can be exposed naked and soaking wet to icy gales and not get a cold. However, they may experience some stuffiness of the nose when they return to a warm room. This is not a cold but is due to changes in the degree of nasal congestion as they shift from cold to a warm environment. A recent Food and Drug Administration report noted that cold medica-tions relieve certain symptoms but do not prevent, cure or shorten the dura-tion of the "common cold." It lasts seven to fourteen days no matter what you do. Still, most of us must "do something" even though we have been told re-peatedly it won't make much difference. For this reason, many physicians recommend cold remedies, even though they are rarely dramatically effective. Certain medications, however, can make you feel better if they are used properly. For example, locally applied decongestants in the form of nose drops or sprays can unplug a stuffed nose whether caused by a cold or an allergy. These preparations shrink the dilated blood vessels and temporarily reduce swelling in the mucous membranes that line the nasal passageway. This makes breathing easier. But there is a hazard. Often as the effect wears off, the membranes swell again, sometimes worse than before. After about three days, this condition, known in medical jargon as the rebound phenomenon or, more elegantly, as rhinitis medicamentosa, may develop. To break this vicious cycle, some physicians advise discontinuing the nose drops or sprays on one side for several days, and then on the other. This allows breathing on one side while the other recovers from the rebound effects of the decongestant. Avoid the rebound phenomenon by using topical decongestants no more than three days at a time at recommended intervals. Oral decongestants do not cause the rebound phenomenon but still should not be used longer than a week. These medications are not recommended for people with high blood pressure, heart disease, diabetes or thyroid problems. Antihistamines help relieve runny nose, sneezing, and itchy eyes and nose caused by allergies, but they do not relieve the cold itself. A precaution: Antihistamines may actually increase and thicken the mucus in your lungs and set the stage for bronchial complications. People with high blood pressure, diabetes, glaucoma or prostate disease should check with a physician before taking any cold remedy. Another warning: Antihistamines may cause drowsiness which might make it dangerous to operate automobiles or machinery. Cough suppressants (antitussives) temporarily relieve the urge to cough, but sometimes the cough reflex is essential for clearing secretions from the lungs and should not be suppressed. Anybody with a persistent cough should consult a physician. A fever of over 100Â� F. is not part of an ordinary cold in an adult and should be reported to a doctor. Various cold remedies may cause minor side effects such as drowsiness, excessively dry nose and mouth, nervousness and sleeplessness if taken be-fore bedtime. One of the worst things that has happened to the common cold since the pharmaceutical industry has come up with "packaged relief" is that people tend to ignore the old-fashioned home remedies which are much less expen-sive and equally as effective. I refer to bed rest, hot tea with a teaspoon of honey, hot milk with egg yolk, sugar and a little vanilla (in Yiddish it's called a "gawgell-mauggel"-which is delicious), warm baths and the old stand-by, chicken soup. Aspirin is still good for relieving minor aches and fever. In 1975 Linus Pauling, the distinguished scientist (twice winner of the Nobel Prize), came out with the theory that massive doses of Vitamin C would prevent (and cure) the common cold. Needless to say, the manufac-turers of vitamins profited handsomely from the statement, but after a few months many True Believers were sniffling and blowing in spite of the mas-sive doses and some had come down with something worse than a cold- kidney damage. So much for that "magic formula," although many people in-sist that Vitamin C has alleviated the discomfort to a noticeable degree. The best way to keep from getting a cold is (a) get sufficient rest, (b) eat a balanced diet, (c) don't get chummy with someone who has one. credit: Louis Weinstein, M.D., Peter Bent Brigham Hospital, Boston, and Visit- ing Professor of Medicine, Harvard, Cambridge, Massachusetts. Colitis Colitis by definition means "inflammation of the colon." The colon is the part of the gut extending from the upper end of the large bowel down to the rec-tum, which is the lower end of the large bowel. Only acute inflammatory conditions of the colon should be termed colitis. The inflammation can begin suddenly and appear a few hours to a day or so after eating contaminated foods, water, etc. It is called "acute colitis" or "acute enterocolitis" if the small bowel is also inflamed. It is generally due to a virus, bacteria, or parasites (or the by-products of these). If a specific causal agent is known, it is usually included in the description of the acute colitis, for example, "amoebic colitis." The specific "acute colitis" may sub-side in a few days without treatment, for example, "Tourista," "Montezuma's Revenge," etc. In some instances, however, the inflammation may be rampant and the bowel movements torrential, containing blood and pus. These stools should be examined in a laboratory, the specific causal organism isolated, and its sensitivity to various medicines tested. Patients with this type of acute colitis may require hospitalization and treatment with intravenous fluids and antibiotics. A colon X ray and a rectosigmoidoscopic examination may help to establish a specific cause. "Acute colitis" is seldom a serious, life-threatening problem, but it may carry some risk in the very young and the elderly. It is primarily a problem in the United States in patients who have recently traveled to foreign countries. Treatment consists of avoiding solid foods and taking fluids to combat dehy-dration. If fever of 101 degrees is present or if there is blood in the bowel movement, the advice of a physician should be promptly sought. Often a "nervous bowel" or "irritable bowel" is erroneously called colitis, for example, "spastic colitis," "mucous colitis," etc. Patients with these prob-lems who may well have loose, urgent and watery stools do not have "coli-tis," for there is no inflammation of the colon. It is a mistake to label these patients under the category of colitis. This problem can be worrisome and frightening and require extensive and expensive medical investigation to ex-clude true colitis. It is a derangement of the bowel motor function and is not due to disease. It is not a precursor to a diseased bowel nor is it a symptom of cancer. Chronic ulcerative colitis is a serious disease of the large bowel. It is a chronic, non-specific inflammatory and ulcerative disease of the colon. Its cause is not known, but much research is being done and hopefully we may have an answer in the not too distant future. It is not infectious nor does it seem to be inherited. The patient usually has frequent bowel movements- small in amount-often urgent, and the stools frequently contain red blood and pus. The patient is ill, has a poor appetite with weight loss, often to the point of emaciation. Fever of a low-grade character is often present and ab-dominal cramping is common. It may begin abruptly and persist for months, but often it starts insidiously and may come and go only to gradually worsen and become persistent. This illness seems more likely to begin in youngsters of either sex, but may start in middle or even old age. Severe attacks may be associated with leg ul-cers or joint problems, especially a low back pain, or eye symptoms. It can be a life-threatening disease. The weight loss and general deterioration cause the patient to feel ill and the disease may progress to marked enlargement of the bowel and even rup-ture. Some patients do well, but many experience recurrent flare-ups. Patients seldom develop cancer during the first ten years of the disease, regardless of the severity of the inflammation. However, any patient who has had ulcera-tive colitis for ten years or longer regardless of the severity has a definite in-creased risk of developing cancer. Cancer risk is especially great if the patient developed the illness as a child and has had it for ten or more years. Diagnosis is made by proctosigmoidoscopy and colon X ray. A relatively new procedure using a flexible colonoscope allows for visual inspection of the entire colon and this may on occasions be needed. Treatment consists of a high protein, low residue diet. Sulfasalazine is often helpful and can be used over long periods with benefit. Cortisone preparations are frequently used, but these have many side effects and should be used with caution. If the disease is not responding to medical treatment, surgical removal of the entire colon and rectum is the treatment of choice and the results are very satisfactory. Unfortunately, even if the patient has done well after a period of ten years, the risk of cancer looms great and removal of the colon must be given serious consideration. Removal of the colon and rectum means there must be an opening of the small bowel to the abdominal wall. The contents of the small bowel then empty either into a sack or into an intestinal internal pouch (Brooke ileostomy). The surgery is quite successful and many patients live their normal life expectancy and do not find their lifestyle greatly re-stricted. Surgery, of course, precludes the risk of cancer of the colon, which is a major threat if the patient retains the large bowel. This is a serious disease and chronic ulcerative colitis should be treated only by a thoroughly compe-tent physician, preferably a gastroenterologist. Crohn's disease (inflammatory bowel disease, regional enteritis, segmental colitis) is often classified as colitis. It is frequently confused with chronic ul-cerative colitis. If it involves the terminal part of the small bowel, it may be called terminal or regional ileitis ("President Eisenhower disease"). It may or may not be limited to the small bowel, but can involve the small and the large bowel or just the large bowel. The distal large bowel (rectum) is often spared in Crohn's disease whereas this is nearly always involved, very early, in ulcerative colitis. The patient usually has abdominal cramps and symptoms much like those of chronic ulcerative colitis except that bowel movements usually occur less frequently, perhaps only two to five a day, and may have no red blood. The disease is often discovered when an operation is per-formed for supposed appendicitis. These patients heal poorly and may de-velop fistulas (openings from the bowel to the abdominal wall), etc. Often the patient with Crohn's disease may have abscesses and fistulas about the rectum and this may be the first hint as to the diagnosis. A proctosigmoido- scopic examination may be negative. A colon and small bowel X ray are often needed for diagnosis. A colonoscopic examination may be helpful. In general, the same treatment advice is often given as that described above for ulcerative colitis. However, there seems a little more rationale for not removing the whole colon and rectum in Crohn's disease and the threat of cancer that is such a major problem in ulcerative colitis is very minimal in Crohn's disease and perhaps can be ignored. Unfortunately, Crohn's disease does have a tendency to recur after surgery, whereas this seldom is the case in ulcerative colitis. Crohn's disease is not a condition that should be treated by a lay person or druggist. The patient with this condition should seek a highly competent physician, preferably a gas-troenterologist. credit: James C. Cain, M.D., Gastroenterology and Internal Medicine, Mayo Clinic, Rochester, Minnesota. Conduct (How to Get Along with Others) Keep skid chains on your tongue. Say less than you think. Cultivate a pleasant voice. How you say it is often more important than what you say. Make few promises and keep them faithfully, no matter what the cost. Never let an opportunity pass to give a well-deserved compliment. If criticism is needed, do it tactfully. Don't use a sledgehammer when a fly swatter will do the job. Be interested in others-their work, their homes and families. Let ev-eryone you meet feel that you regard him as a person of importance. Don't burden or depress those around you by dwelling on your minor aches and pains and small disappointments. Everyone has something in his life that is not exactly as he would like it to be. Discuss, don't argue. It is a mark of a superior mind to be able to disa-gree without being disagreeable. Let your virtues, if you have any, speak for themselves. Be con-structive. Don't indulge in gossip. It is a waste of time and can be destructive. People who throw mudballs always manage to end up getting a little on themselves. Be respectful of the feelings of others. Wit and humor at the expense of a friend is rarely worth the small laugh, and it may hurt more than you know. Pay no attention to derogatory remarks about you. The person who carried the message may not be the world's most accurate reporter. Simply live so that nobody will believe him. Insecurity (or a stomach-ache, a tooth-ache, or a headache) is often at the root of most backbiting. Do your best to forget about the "rewards." If you deserve credit someone will "remember." Success is much sweeter that way. Keep in mind that the true measure of an individual is how he treats a person who can do him absolutely no good. credit: Ann Landers. Once upon a time a young lady consulted an eminent specialist for head-aches. The great man gave her a laxative. "But, doctor," she said, "I move my bowels every day." "I know," he replied, "but you are always twenty- four hours late." This story epitomizes the problem of defining a "normal" frequency of passing feces. For babies and natives of the tropics, three to four stools daily are common. Many healthy Westerners defecate once every two or three days. In general, bowel habits ranging between one movement every three days and three movements per day are compatible with health. The idea that a daily stool is necessary to avoid "intestinal toxemia," with headaches, tiredness, apathy and old age, is a myth. TYPES OF CONSTIPATION Three major varieties of constipation exist. The first (and most serious) is caused by gradual narrowing and obstruction of the colonic tube, where the feces become more solid. Cancer may be responsible. In others, colonic nar-rowing is caused by a chronic inflammation, usually diverticulitis. This disor-der may develop in numerous little colonic pouches known as diverticulums which commonly form as people grow older. The narrowing, whether cancer-ous or inflammatory, causes increased blockage of the bowel. Its main fea-ture, therefore, is a change in bowel habits over weeks to months and usually affects those past middle age. Symptoms are: increasingly infrequent stools, straining, lack of that good feeling after bowel movement, and cramps. Pro-gressive constipation of this type means you should seek medical advice right away. Furthermore, if any such symptoms occur, examine your bowel move-ments carefully to see if there are any flecks of blood. Blood in the stools should also get you to the physician's office immediately. The cause may he no more than hemorrhoids that bleed when a hard stool is passed, but you should check regardless. The second type of constipation is known as spastic constipation. The mus-cular walls of the colon, especially the sigmoid, instead of providing a relaxed reservoir between peristaltic waves, stay in a contracted state, or a "spasm." This holds up the passage of feces and they dry out and form little hard pellets (like rabbit dung). Difficult and incomplete evacuation of the rectum is common, and the spastic sigmoid is often sore and tender to touch. Strain-ing to produce a few mucus-covered pellets is typical. The causes of spastic constipation are not absolutely known, but irregular bowel habits (not heed-ing an urge to pass feces), no breakfast to stimulate a bowel movement, nerv-ous tension, laxative abuse and a variety of dietary habits are often the cause. The third common type is atonic constipation. The rectum fills with feces but there is no urge to move the bowels. As might be expected, it is a disor-der principally of old age, but persistent failure to respond to "nature's call" as well as dietary practices may play a role. In a few cases, a severe psychi-atric disorder may be responsible. Essentially, the muscles of the colon grad-ually give up their normal function. TREATMENT Symptoms of the first type of constipation, with bowel habits changing over weeks to months, means you should see a doctor right away. Regular Bowel Habits. Spastic and atonic constipation benefit from at-tempts to move the bowels regularly, preferably at the same time daily. Peo-ple with conventional working hours should get up in time to have some breakfast and then, shortly after, go to the toilet and try to have a bowel movement. Straining is inadvisable, but intermittent and voluntary "bearing down" may be attempted. Obviously, regular bowel habits cannot be es-tablished by half-hearted and brief attempts. A month or two may pass be-fore there is even partial success. Diet. A few years ago a "low roughage diet" was recommended for spastic constipation, but current medical thought favors a high fiber (in the past called "high residue" or "roughage") intake for both spastic and atonic con-stipation. The idea is that food residues in the colon should be bulky: The colon likes to stay in trim by having something to work on. The eating of high-fiber content food like bran, unrefined flour products, leafy vegetables, or fruits-all of which contain substances our small intestine cannot digest or absorb-means that the huge bacterial population of the large bowel has the food needed to produce gas bubbles that prevent feces from compacting, and to release products that have a slight laxative action. Fruit juices, especially prune juice, may also be helpful. It is also a good idea to drink at least five or six glasses of water every day. Laxatives. Laxatives as a rule should be avoided by those who have spastic constipation. If a laxative habit has already been established, it should be broken. Laxatives in general are of four types: Stool softeners containing mineral oil. The trouble with mineral oil is that in large amounts it may interfere with absorption of some vitamins. After prolonged use, the oil may fail to mix with the stools. Leaking may occur and cause embarrassment. Non-irritant bulk producers and stool softeners. Some of these sub-stances, which absorb and hold water, swell up in the bowel to produce, it is hoped, a soft bulky mass. Salts that are poorly absorbed and retain water in the colon. The most common are magnesium salts such as magnesium sulfate, carbonate, or hydroxide (milk of magnesia). Irritants. These contain substances that stimulate the intestinal mus-cles and nerves. Phenolphthalein and cascara are common ingredients in many widely advertised preparations. Use of this type is in general inadvis-able, because it tends to make the bowel dependent on an artificial stimulant to get into action. Castor oil, of course, is a famous old-time irritant laxative but not intended for prolonged use. Types A and B are to be preferred if any laxatives are used. The irritant type (D) should be particularly avoided by those with spastic constipation, for these medicines may produce muscular colonic spasms which are at the root of the trouble. In spastic constipation, attempts to establish regular bowel habits may have to be encouraged by initial use of laxative types A or B. The ultimate objective, however, is to wean the patient off all laxatives. In atonic constipation, all types of laxatives may have to be used, espe-cially by the elderly sedentary person. In fact, one may hold that in such per-sons continued use of laxatives, including types C and D, is necessary and not really harmful. Enemas. Like laxatives, enemas can act as bulk producers, irritants, or both. The mildest enema is one teaspoon of salt added to a pint of warm water. One quart of this solution, can be run in slowly, held five minutes, and then passed. Plain water is less desirable. Soap enemas are irritating. (Note: If you are on a salt-free diet, do not add salt to the water if you take an enema!) Enemas of all types have no place in the prolonged treatment of consti-pation. They can be used as semi-emergency procedures if the patient is very uncomfortable and after three days finds it is still impossible to defecate. Constipation existing for years is in itself no cause for concern. It causes no symptoms except abdominal discomfort and difficult evacuation of the rectum. A regular daily bowel movement is nice but not necessary. The treat-ment of constipation depends on establishing regular bowel habits and heed-ing, not postponing, going to the toilet if an urge to move the bowels is felt. Good dietary habits, including breakfast which consists of high fiber foods, are important. The laxatives or occasionally enemas should be used only as crutches if other measures fail. Don't forget, however, that constipation com-ing on over a few weeks or months, blood in the stools, or both, may mean more serious trouble and requires medical attention. Laxatives and enemas should not be used when constipation accompanies abdominal pains that are sudden, unusually severe or complicated by nausea, vomiting or fever. See a doctor and make sure the discomfort is not a symp-tom of a more complicated problem. credit: Franz J. Ingelfinger, M.D., Editor, New England Journal of Medicine, Cambridge, Massachusetts. Contraceptives No method of contraception is perfect for every woman all the time. This doesn't mean that the available methods don't work-they do. But a method which works perfectly for one woman may not be suitable for another. How, then, can you find out which method is right for you? There are several considerations: Safety: The ideal method of preventing pregnancy must be safe to use. All of the methods mentioned here have a high degree of safety. Effectiveness: Will the method do what it's supposed to? Will it work? While any method is better than none, not all are equally effective. Further-more, effectiveness depends in large part on whether or not any method is used properly and regularly. Medical Desirability: Some methods are not suitable for women who have had certain ailments, or whose present health is not good. Other women may find one method causes discomfort while others do not. Convenience: The less the method interferes with your normal life, the better it is. Cost: None of the methods discussed here can really be called expensive, though some cost more than others. Women who cannot afford a private doc-tor can usually pay the lower fees at clinics or obtain the services free if they are public aid recipients or visit public health departments. Personal Feelings: This is important too. Any method which you find un-pleasant, uncomfortable, or embarrassing may not be right for you. Don't hesitate to discuss your feelings with your doctor. He or she will help you se-lect the best method for you. Note: Two methods of birth control not covered here are voluntary sterili-zation and abortion. Sterilization of both men and women should be regarded as a permanent form of birth control. Vasectomy and tubal ligations are re-versible in only a small percentage of cases. Abortion is considered a "back-up" method when regular contraceptives fail. EFFECTIVENESS How effective a method of birth control is depends on how well the method itself works, and how correctly and regularly it is used. For example, the condom or rubber sheath is a relatively effective method if used properly. If, however, it is put on at the wrong time, it may not be effective at all. Because a birth control method is only effective if it is used properly, the method that makes the couple feel the most natural and comfortable is often the "best method." THE PILL The pill works by imitating some of the normal body reactions that take place during pregnancy. When a woman becomes pregnant, her body stops producing eggs until after the baby is bom. When a woman takes birth con-trol pills, much the same thing happens even though she isn't pregnant. That is, the hormones contained in the pill "signal" the body not to produce an egg (or ovum), just as naturally produced hormones act during pregnancy. With no egg present for the male sperm to meet and fertilize, a woman can-not become pregnant. The medical practitioner decides which kind of pill is best for each woman, as there are different kinds of pills. Pills vary in chemical composition, so side effects can sometimes be removed by changing to another type of pill. If the pills are started on the correct day they are effective immediately. ADVANTAGES When used properly, this is the most effective method next to sterili-zation. No special preparations necessary before intercourse. Provides protection against pregnancy at all times. No special training required to learn to use the method. Pills are taken just like aspirin or any other tablet. Since pills are taken daily whether intercourse takes place or not, there is less temptation to take a chance on going without protection "just this once"-a very real danger with some methods. No need to insert anything into the vagina either before or after inter-course, or even to touch the female organs. Allows a woman to regulate and plan her monthly cycle. Usually causes a lighter menstrual flow. Often clears complexion. It's a good method for the woman whose partner does not want to accept responsibility for contraception, or may not want her to use another method. DISADVANTAGES Pills must be taken regularly whether intercourse takes place or not. Women who have intercourse infrequently may prefer another method, feel-ing pills an unnecessary precaution or the expense not worthwhile. Possible trouble remembering to take a pill at the same time each day. Some women have a fear of swallowing pills or any other medica-tions, feeling all drugs are "unnatural." A medical examination and a prescription are necessary. Pills should not be taken while breast-feeding. Side effects are a possibility. Some-though not all-women, during the first month or two of pill-taking, experience minor discomforts similar to complaints women have in early stages of pregnancy (nausea or morning sickness, spotting or bleeding between periods, gain or loss in weight, ten-derness or enlargement of breasts). These side effects almost always disap-pear during the first few months. It has been estimated that about one woman in two thousand on the pill is hospitalized for a blood-clotting disorder. For this reason, women who have had blood clots should not use this method. Women who have had migraine, fibroids of the womb, heart or kid-ney disease, asthma, high blood pressure, mental depression, diabetes, sickle cell anemia or epilepsy should be sure to tell the doctor. As these conditions may be aggravated by the pill, some other method of birth control will usu-ally be recommended. More serious complications, encountered by a small percentage of women taking the pill, include eye trouble, stroke, liver tumors, decreased sex drive or high blood pressure. IUD (INTRAUTERINE DEVICE) The IUD, also known as the "coil" or "loop," differs considerably from the other methods discussed here because the woman using it bears almost no re-sponsibility for its effectiveness. In fact, she need hardly be concerned with it at all, once it is inserted. The IUD is a small, white, soft plastic device that is inserted into the uterus (womb) by a physician and left in place for as long as the woman desires to prevent pregnancy. No other contraceptive is necessary once the IUD is in position, and the woman wearing it should be totally unaware of its presence. The woman should, however, examine herself after each menstrual period, at the least, to make sure the device is still in place. This is done by inserting the index finger well into the vagina to feel for the short nylon threads pro-truding from the cervix. There is some uncertainty as to exactly how the IUD works, but there is no doubt about its effectiveness. While some women using IUDs have become pregnant, the actual number is quite small. A small amount of copper wound around certain IUDs seems to increase their effectiveness. ADVANTAGES Once inserted, little or no thought need be given to contraception by either the woman or the man. Can be left in place for years without apparent harm. The copper IUD must be replaced every two years because the copper gradually loses its effectiveness. Apart from the initial cost of the IUD itself and the medical fee for insertion, there are no additional expenses. (A medical checkup once a year is advisable but this should be standard procedure for a woman whether she is using an IUD or not.) DISADVANTAGES It is common for women to have a heavier menstrual flow with the IUD, especially during the first and second periods after the insertion. Some women are unable to retain the device and it is expelled by con-tractions of the uterus. This is more apt to happen to women who have had no children. Cramps and backaches may occur during the first few days, particu-larly in women who have not had children. They usually disappear within a week, but if they do not, the woman will usually prefer to have the device re-moved. Temporary spotting or bleeding may occur between periods during the first few months-an inconvenience but no cause for alarm. There is a slight risk of infection; rejection of the device by the body; perforation of the uterine wall; septic abortion; or an undiscovered allergy to copper. Insertion of the IUD must be done by a medical practitioner and is a delicate and initially uncomfortable procedure. The fee varies, so it is wise to discuss this with your practitioner in advance, if cost is important. For greater effectiveness-close to 100 percent-foam may be used as a reinforcing method of contraception during the most fertile days of the monthly cycle (mid-cycle). DIAPHRAGM The diaphragm method is highly effective and has been used successfully for more than eighty years. It involves the use of a contraceptive cream or jelly in combination with a device called a vaginal diaphragm, which is made of soft rubber, shaped like a shallow bowl, with a flexible spring rim. When properly placed, the diaphragm fits securely and comfortably be-tween the rear wall of the vagina and the upper edge of the pubic bone. In that position, it completely covers the cervix and holds the contraceptive cream or jelly tighty cupped over the entrance to the womb. This provides a chemical barrier that acts to kill the male sperm. After the diaphragm is removed, it should be washed with a mild soap and water, dried and powdered with cornstarch and returned to the case. Occa-sionally it should be held up to the light or filled with water to see if there are any cracks or leaks. ADVANTAGES Women using the diaphragm need only concern themselves with being protected at those times when they expect to have intercourse. Diaphragm and jelly need not be inserted just before intercourse. A woman may insert them as much as two hours beforehand and still be pro-tected. When it is properly positioned, the woman should not feel the device, no matter how active she may be. (If she does, it is either the wrong size for her or has been inserted incorrectly.) No need to get up after intercourse to douche or remove the device. In fact, the diaphragm should be left in place for at least eight hours after in-tercourse. Whether or not intercourse takes place, the diaphragm may be safely left in place for twenty-four hours or even longer. However, if intercourse is delayed more than two hours after insertion of the diaphragm, additional jelly or cream should be inserted. (It is not necessary to remove the dia-phragm.) If intercourse is repeated, insert more cream or jelly and leave dia-phragm in place. DISADVANTAGES Women must first be "measured" by a medical practitioner. The proper size must be determined if the method is to be at all effective. The practitioner will then instruct her on how to insert and remove it properly. Cannot be obtained without a prescription. Must be used whenever intercourse takes place. Sometimes this means an interruption in order to insert the diaphragm, if intercourse at a particular time was not anticipated. Women who have a strong aversion to inserting a device into the vagina will obviously not be happy with this method. Women must be measured following pregnancy, miscarriage, abor-tion, gynecological surgery, or weight gain or loss of at least ten pounds. CONDOM The condom, or rubber, is made to be placed over the male organ (penis) just before sex relations. It keeps the man's fluid (semen) with its sperm from getting into the woman's vagina. Originally designed as a prophylactic to guard against contracting venereal disease, the condom has gained popularity steadily as a contraceptive device as well. Improved production methods and materials plus federal government quality control checks have greatly reduced the possibility of defects and made this a good, effective method, if properly used. The condom may be used by itself, or the woman may use contraceptive jelly, cream or foam at the same time for added protection. When putting on the condom, at least a half inch of space should be left at the tip to collect semen, if the type of condom being used does not already have a nipple-like "sperm bank" at its tip. To ensure that the condom doesn't slip off as the male withdraws, he or his partner should hold on to the top (open end). ADVANTAGES Best method for the man who prefers to be in complete charge of contraception. Guards against VD. Handy as a supplementary method for the balance of a monthly cycle of pill-taking if the woman forgets to take a pill. A good method to use after childbirth, before the woman has had a chance to have a diaphragm refitted, or before her medical practitioner thinks it wise to prescribe pills or insert an IUD. An effective alternative when the woman is reluctant to equip herself with any birth control device-for whatever reason. Inexpensive, conveniently available in every drugstore (no pre-scription needed), easy to carry. DISADVANTAGES Care must be taken in putting it on properly, which may interrupt love play. Withdrawal must take place fairly soon after the man's ejaculation so the condom does not loosen and slip off, or fluid escape into the vagina. Some men report dulling of sensation during intercourse. Prelubricated condoms may seem to the user to be somewhat "messy." After long shelf-life, latex may tend to dry out and tear during use unless used with jelly or cream. FOAM, JELLY OR CREAM A simpler technique for the woman to use than inserting a diaphragm, though not rated as effective. The spermicide products are designed to be used without a diaphragm or other contraceptive device. The woman merely inserts a measured dosage of the spermicide into the vagina, just prior to each intercourse, with a special plastic applicator pro-vided for that purpose. The contraceptive action of these preparations is twofold. The spermicidal ingredients work to kill the male sperm while the foam, cream or jelly base provides a "barrier" over the cervix that helps prevent sperm from entering the womb. These products are not the same as the creams and jellies intended for use with a diaphragm. ADVANTAGES Can be bought without a prescription. However, since not all products are equally effective, it is still wise to ask a doctor's advice as to which is best. No fitting is necessary, such as that done before obtaining a dia-phragm. The woman needs no special training in how to use the method. The instructions that come with each product provide complete directions for use. Nothing to remove after intercourse. Douching is not necessary. But if a woman does desire to douche, she should wait six hours after intercourse. Need be used only at those times when intercourse takes place. Is an inexpensive method to use. Products are mildly lubricating, which may be an advantage in some cases. Provides some protection from VD. DISADVANTAGES Must be applied just before intercourse, which may mean interruption of love play. If intercourse is repeated, another applicator full must be inserted be-forehand. One application provides protection for only one intercourse. Applicator must be washed with soap and water after each use. Some women experience itching, burning, or soreness of the vagina after use of a spermicide. Changing brands may help. RHYTHM ("NATURAL" METHODS) The rhythm method is perhaps the simplest of all contraceptive proce-dures. It is also the most difficult to use effectively because of the complex problem of determining the "safe" days. Three biological facts provide the basis for the rhythm method: A woman normally produces only one egg during each menstrual cycle. This egg lives only about twenty-four hours, and it is only during this period that it can be fertilized by the male sperm. The sperm lives for only forty-eight hours, so it is only during this two- day interval that it can fertilize the female egg. The obvious conclusion from these three facts is that there are really only seventy-two hours-a mere three days-each month when intercourse can lead to pregnancy; the two days before the female egg is released, and the full day afterward. If a woman could avoid having intercourse during this time, she would be in no danger of becoming pregnant. That is the idea behind the rhythm method. A woman using this method must refrain from having intercourse on the days when she can become preg-nant. Put another way, she must limit her sexual activities to the days during each monthly cycle which are known to be "safe." The "ovulation" or "mucus" method refers to a way a woman can deter-mine between periods whether or not she is in her ovulatory, or unsafe, phase, by paying close attention to sensations of wetness or dryness from the vagina. This method is sometimes called the Billings method, after the Australian doctor who first described it. Note: It is important to have instruction from a clinician to apply this method to your body. ADVANTAGES No prescription is necessary, nor is any sort of "fitting" required. Medical guidance, however, should be sought, for without it your chances of success with this method are apt to be slim. No special equipment or contraceptive materials are necessary. You do need a calendar, of course, and possibly a thermometer. It is not necessary to take any drugs or to insert anything into vagina. There is no need to interrupt relations to arrange for adequate protec-tion. (It is absolutely necessary, though, to avoid intercourse completely on those days which are suspected of being unsafe.) No side effects or allergic reactions from contraceptive materials. DISADVANTAGES A written record of periods must be kept for at least a year prior to attempting to use the rhythm method since success depends on accurate pre-diction of time of ovulation. A daily record of body temperature (taken immediately upon awak-ening with a specially marked "basal body temperature thermometer") is also advisable. This record alone is not enough, however, since illness or other factors may affect body temperature. It is not safe to use this method during the first few months after childbirth. If a woman has vaginitis, which produces its own discharge, the ovu-lation (mucus) method cannot be used. WITHDRAWAL Withdrawal, or coitus interruptus, refers to the withdrawal of the male organ (penis) before the man "comes," so that sperm are not deposited in or near the vagina. This method is not too reliable and should be used prefera-bly only when no other method is available. ADVANTAGES No drug or chemical is needed to use this method. It is available any time, anywhere. It does not cost anything. DISADVANTAGES Failures may occur because of poor control, carelessness or because sperm are sometimes released before the man's orgasm, or climax. Worry that withdrawal will not take place in time may lessen enjoy-ment of intercourse for either or both partners. The woman, if she is slower to reach orgasm than the man, may be left unsatisfied or frustrated after withdrawal takes place. QUITE INEFFECTIVE METHODS Vaginal foaming tablets, sold at drugstores, are inexpensive and no pre-scription needed. They are simple to use. The high failure rate of this method is due to the fact that the spermicide does not get evenly distributed through the vagina. The tablet should be moistened with saliva or water and immedi-ately inserted deep into the birth canal at least fifteen minutes before each sex act so it has time to dissolve. A new tablet should be used before each sex act. Tablets lose their effectiveness one hour after insertion whether inter-course has taken place or not. Douching, if desired afterward, should be postponed until at least six hours after the last sex act. Vaginal suppositories are small and waxy, and sometimes contain a sperm- killing chemical. A suppository is inserted into the birth canal ten to fifteen minutes before each sex act so it has time to melt at body temperature. Some-times it will not melt quickly enough, or it may be incorrectly inserted. It is not reliable enough to be recommended. INEFFECTIVE METHODS AND MYTHS. BEWARE OF BOTH Douching as a method to avoid becoming pregnant is risky. Douching con-sists of washing out the birth canal with a solution of one kind or another in •the hope of removing the sperm. Since sperm enter the womb seconds after a man "comes," it is impossible to wash them out with a douche, even if imme-diate. Sometimes the force of the water actually helps to wash the sperm into the womb. Some believe that if they "hold back" during intercourse, not allowing themselves to reach orgasm, pregnancy is impossible. This belief is based on the misconception that women, like men, ejaculate in orgasm a substance which is necessary for fertilization. This is not true. There is no truth, either, in the belief that as long as a woman is nursing a baby she cannot conceive. Because of hormonal balances, during early months of breast feeding ovulation may be delayed, but this protection does not last long, nor is it reliable. Certain products-sprays, douches, suppositories-are sold as aids to "feminine hygiene." In some cases, these widely advertised products hint at birth control in order to fool buyers. Many women buy these products in the mistaken belief that they will prevent pregnancy. Not so! If you want more information about birth control, pregnancy detection, sterilization, infertility referral, problem pregnancy counseling and referral, or any other matters relating to reproductive health care, Planned Parenthood Association can help you. credit: Deborah Roach, Planned Parenthood Association/Chicago Area, 55 East Jackson Boulevard, Chicago, Illinois 60604. DESTROYING THEIR MORALS WITH CONTRA