1. Electrodessication and curettage.

This method of treatment involves the application of an electric current of low voltage and high amperage. The heat produces cell death, and a spoon-shaped curette is then used to remove the dead tissue. This cauterization and curettage is performed sequentially until only normal tissue remains.

2. Cryotherapy.

This involves the application of an extremely cold material, such as liquid nitrogen ( — 196°C) or solid carbon dioxide (-79°C). Freezing of the tissue also produces cell death. Experience is required to assess the time needed to obtain sufficient depth of freezing to eradicate the tumour. Only superficial B.C.C.s, not nodular ones, are suitable for this form of treatment.

3. Surgery.

Sometimes excision and suturing, with or without skin grafting, may be necessary or preferable. However if the lesion is small, accessible and in certain specific regions, this is not normally required. It is the most suitable treatment, though, for recurrent tumours.

Other methods of treatment include Mobs Chemosurgery for difficult tumours, and radiotherapy for elderly people with tumours not overlying bone or cartilage and not exposed to wear and tear’.

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These are symptoms that do not appear until some time after the menopause, but which tend to get more noticeable and troublesome as the years go by:

• bladder problems, such as stress incontinence, and needing to empty the bladder frequently and without warning

• recurrent bacterial infections of the vagina and urethra (the passage through which urine is discharged)

• vaginal dryness

• pain during sexual intercourse

• generalised muscle aches and pains

• thinning skin and hair

• Bleeding and shrinking gums sometimes improve with HRT.

• Many women experience ill-defined muscle and joint pains around the time of the menopause, especially in their hands, wrists, elbows, knees, shoulders and lower back. These are often misdiagnosed as arthritis, and this particular type of joint pain usually improves with HRT. Women whose arthritis gets worse around the time of the menopause may find HRT brings some improvement.

• The causes of hair loss and brittle nails are not very well understood; these problems may be linked more to increasing age than to a fall in hormone levels.

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Interest in herbal and other alternative therapies (also called complementary therapies) has escalated in many industrialised countries since the 1970s. The reasons are complex but probably include an increasing scepticism about science, and a public that is less willing to accept the truth of statements by ‘experts’ including medical practitioners. Periodic national health surveys in Australia from 1977 to 1990 show progressive increases in the number of consultations with alternative therapists. At the same time numerous doctors and others involved in health care have highlighted problems with medical knowledge, for example the limited perspective which drives certain treatment approaches. Recognition that other perspectives may have something valuable to offer is evident among practitioners and trainees of mainstream Western medicine.

A recent survey in Britain showed that 80% of doctors want to include some form of alternative medicine in their practices; and a recent study of Australian fourth year medical students found that an overwhelming majority of 92% were keen to study alternative medicine as part of their degree. The students were most interested in meditation, nutritional medicine, acupuncture, naturopathy, Chinese herbal medicine, homeopathy, hypnosis and the ancient Indian treatment, ayurvedic.

A criticism commonly made about alternative therapies is the lack of solid scientific evidence about their effectiveness and safety, a problem compounded by the lack of quality control in the manufacture of some substances. These therapies have, for the most part, not been submitted to the sort of evaluation of efficacy (double-blind trial) required in recent decades for drugs used in orthodox medicine. While some alternative therapies have stood the test of time, having been used for centuries in some countries, careful long-term studies of risks and benefits tend to be lacking or only recently initiated. Ironically, while orthodox medicine is becoming more open to alternative approaches, alternative medicine is now being submitted to increased scientific scrutiny. As evidence of this, the manufacture of herbal medicines in Australia has been governed by an act of federal parliament since 1993 and the Australian government recently established a Traditional Medicine Evaluation Committee within the federal Department of Health.

Many of the alternative therapies share a common philosophy that life-giving energies and substances help maintain the human body in good health and balance. Ill-health is regarded as the result of a loss of balance caused by a sub-optimal lifestyle or an accumulation of toxic substances, including the products of infectious disease. To correct disturbances to the body’s balance, or to maintain the existing equilibrium, the alternative therapies adopt a holistic treatment approach that emphasises the patient rather than a problem organism or toxin. The focus is on an individual’s ability to overcome disease with the help of substances that clean and strengthen the body, rather than on the disease-destroying abilities of particular pharmaceuticals.

It is sometimes assumed that because herbal products and nutritional supplements are of natural origins they are therefore free from serious ill-effects. Unfortunately this is not always so. All herbal and nutritional supplements should be used cautiously and monitored regularly by a skilled practitioner, because adverse effects can occur—just as they can with orthodox medicines.

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According to Sigmund Freud, the father of psychoanalysis, most dreams which appear to be asexual are in fact symbolic of some sexual nature. In the days of Freud there were no sleep laboratories and no one knew anything about REM sleep and dream erections. However, it is common knowledge among men that they have erections in the morning. Now we know, of course, that this is because they wake up in the morning in the midst of one of these recurring dream erections. Freud could have also observed that whenever he was dreaming he had an erection. This could have influenced his theory put forth in The Interpretation of Dreams. He maintained that sexual drive was the primary motivation of most dreams, and he even had a list of sex symbols to go along with his theory. Freud, if alive today, would say that dream erections are caused by the sexual nature of dreams, even if the dreams appear to be asexual to the dreamer. Freud placed a great emphasis on sex in all his dream interpretations. Could this be because of his observations of his own erections associated with every dream? But are there other explanations?

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