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While the patient is talking, one begins to get a feel about the patient. One may hear snippets about their partner, the family or the workplace and begin to understand their feelings about sex and contraception. Family intentions are very important and relevant to the discussion of different methods. Listening carefully may reveal the sort of conflicts mentioned earlier in this book.

A common practice in family planning clinics is for patients to see the nurse for history-taking and then go in to see the doctor. While fully acknowledging that many patients develop rapport with nurses better than with doctors, this split type of consultation can have disadvantages. Highly trained nurses can run their own consultations independently (the so-called delegation session) unless a medical problem arises or an IUD insertion is required.

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Miss B. originally attended with her partner for a new patient interview. They were an incongruous pair: he was grubby with a marked local accent, wearing torn jeans and with his hair in a pony-tail, while she was a slim, neat girl with a well-educated voice. He did all the talking and was concerned because she was always feeling ill. Some tests were arranged and the doctor was relieved when she reattended by herself. Miss B. ignored the test results and reassurance offered. Her boyfriend had told her to get a coil fitted. She said that after the enquiries at the last consultation (when he had assured the doctor that contraception was not a problem), he had thought about it and decided that as he did not want any children about the place, she had better get fixed up. Suggestions that she might have some opinions or feelings about it were met with a look of incomprehension and after battling for a while – ‘I must have a coil today’, she kept saying – the doctor gave her some leaflets to read and arranged to see her with her period the following week. At that consultation, she arrived in complete distress, her boyfriend having been picked up in possession of drugs. Decisions were postponed. Next time she was more composed and ‘they’ had decided she would go back on the Pill, which she had taken ‘for several years’. Further enquiry revealed that her boyfriend was on remand and likely to be sent to prison. Naively the doctor enquired why contraception was necessary, only to discover that Miss B. lived in a multi-occupied house and without her boyfriend’s presence would be expected to be available to the other men living there. The doctor, sure by now that there were deep underlying problems, probed and listened and encouraged until the girl, relaxed and open, was able to reveal that she had been dominated totally by her authoritarian solicitor father and sexually abused by him until she was 20. She had then met her present boyfriend through her black sheep brother who had rebelled against her father and was into drugs and various criminal activities. She had been thrown out of her home only to join another abusive environment, and had no idea

of how to take control over her own life or sexuality. She saw herself as available to be used and only considered contraception as a necessary part of this.

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Straightforward advice about the safety of combined oral contraception in the low-risk woman until the age of 45 or more can be sufficient, and the safety of the progestogen-only Pill up to the menopause is well known. Reassurance that the IUCD can often be retained longer than five to six years may put the patient’s mind at rest. Someone who has used the cap with no difficulty and is now in her 40s is unlikely to conceive with this method.

For those women whose partners have successfully used a sheath for many years, a failure is very unlikely, and a request for a change of method may be an indication of some other problem. For a man who is suffering some degree of impotence, the need to stop to put on a condom can be the last straw. If a woman is requesting contraception for the first time, or after using other methods for a long spell, or perhaps with a new partner, the sheath may be a little risky, especially if she is very definite about her need to avoid a pregnancy.

If the patient is allowed to express the feelings that have brought her to the consultation, reassurance and explanation may be sufficient. However, if her anxieties are not related directly to the method, the underlying difficulties should be explored further.

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Among the commonest interpreters available for immigrant couples are their children. These are the least suitable in my view. Either the clinician limits his enquiry severely, to spare the child distress, or, inured to the vulnerability of non-white children, he uses them indiscriminately. In the experience of Tower Hamlets general practitioners, stress-related illness has a high prevalence in Bengali children, and the role of go-between must increase their anxieties. Husbands who have preceded their wives to the UK often have sufficient English language skills to interpret. Such help for the woman is still quite different from having access to an impartial translator of her words, and there is a confusing overlap in the triangular consultation. The problem cannot be solved easily by bringing in an independent translator. Our own antenatal clinic was served by Bengali women who had been trained to act as interpreters for maternity services. Husbands of the pregnant women would usually ask them not to come in to the consulting room, for if they did the husbands saw that as a very obvious mark of their own inadequacies. Immigrants from a village culture are also understandably wary of the network of gossip.

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If patients have problems with mobility or mental handicap it may be necessary to see them on their own territory when familiar surroundings can provide a greater sense of security. Few general practitioners will have any difficulty in the home environment, but for other doctors the loss of the secure consulting room setting can increase their sense of unease.

If the doctor feels overwhelmed by the size of the problem it can be valuable to break it down into smaller parts, remembering that ‘the longest journey starts with a single step’. The areas of need can be divided into three parts; emotional needs, physical or practical needs (that is, ‘how to do it’) and contraceptive needs.

The first two areas of need may appear more difficult and may arouse more anxieties because, if the patient is able to achieve sexual intercourse, then the whole question of the advisabilty of pregnancy and the need for contraception will follow.

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The main pests attacking herbs are very few: Grasshoppers, the large bright green variety as well as the speckled brown, dearly love some of the more succulent herbs like comfrey, catnip, and lemon balm, especially if the weather is humid; caterpillars, particularly the green “loopy” type, can strip young plants of tarragon, lemon and garden thyme and basil, and the young leaves of salad burnet and marjoram, unless a close watch is kept; and the slugs and snails roll up in numbers each night at the prospect of fresh horseradish leaves for supper. These, however, seem to be the limit of the insect pests, with the exception of a few aphis which sometimes colonize on the fennel or dill stems below the flowers. The general health of the plants, the state of the soil in which they grow, and the natural food given to them, all help to protect them when insects and snails are about. A well-cared-for garden will have fewer insect pests than a neglected one.

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For the gardener, yarrow pairs off with comfrey as a compost activator. In the chapter on Soil Fertility, I have mentioned the homoeopathic dose of yarrow for the compost heap. It is a natural vegetable activator that can halve the time taken for a bin of decomposing bits and pieces to become rich black compost. One or two of the tiny leaves, snipped small and mixed well through, can “send off” between one and two cubic yards of compost. The staggering chemistry involved in this process alone should give us great respect for yarrow.

Yarrow is beloved by homoeopathic physicians. A fresh leaf of yarrow pressed high up into the nasal passage can cause a nose-bleed and thus relieve the pressure of some types of migraine. A homoeopathic dose of yarrow can staunch a nosebleed. Let a qualified homoeopath deal with these processes; they can be tricky if not properly understood.

The plant itself is a showy thousand-leaved tufted clump, throwing up flowering stems in spring and sometimes right through the summer, bearing Schiaparelli-pink heads of tiny daisy-like blossoms. There is a white variety, too, the pink being a “sport” from this pastureland and meadow kind. Hill, an old English herbalist, says “When accidents of growth give a blush of red to the flower, it would be thought, if found in America, a glorious acquisition to our gardens.” Because it grows like a weed in Europe and Britain is no reason to exclude it from a flower garden. I find its spring and summer appearance most attractive, and in autumn and even winter new suckers spread out from the base of the clump and can be potted or planted elsewhere.

Yarrow is seldom troubled by insect pests, although the occasional grasshopper or snail may in desperation try a few of the young leaves if not much else is available.

There are several varieties suitable to grow in the herb garden. Achillea millefolium is the best medicinally, but there is also a small yellow-flowered kind, Achillea tomentosa, with greyish-green leaves in a miniature cushion, and Achillea magna with stiffer bigger leaves of a pale green, a most attractive plant.

Yarrow will enhance the flavour, strength and health of other herbs grown near it.

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Rosmarinus officinalis LABIATAE

In America, in 1550, an unknown author who wrote “A Lytel Herball” said, “Take the flowers of Rosemary and put them in a lynen clothe, and so boyle them in fayre cleane water to the halfe and cole it and drynke it for it is much worth against all the evyls in the body.” He (or she) was confirming the age-old power of rosemary as a beneficial herb for all parts of the body.

The gipsies revere this herb above all others for its beneficial effect on skin and hair. Pure rosemary oil (obtained commercially by distillation) is the best conditioner in the world for tresses either fair, dark or burnished copper, and keeps the scalp in good condition too. Many shampoos now contain it, but the pure oil gives a wonderful result. Rub a few drops well into the scalp (it will not make the hair greasy), and repeat regularly after each washing and drying of the hair. Silky, soft and healthy hair will be the result. You can also make a tonic rinse from fresh rosemary. Take a small handful of the sprays, chop or bruise well in a mortar, then add a large cup of boiling water. Let stand for an hour or longer if you wish. Use after the normal rinsing, and do not dry off too hard with the towel. The more rosemary is left the sweeter your hair will smell. Rosemary water will tone up your skin, too. You can even drink it to deodorize and sweeten your breath. It is the chief ingredient in true eau-de-Cologne.

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The scented geraniums are all hardy perennials and will grow easily and quickly from stem cuttings with a “heel” of old wood, and I have taken these as late as May with good results. All the varieties mentioned will withstand heat and dryness, and can be used as street or footpath plantings where other less hardy herbs might fail. They can also be increased by layering; but they grow so easily from cuttings that striking these is a sure-fire way to gain a good stock of new plants to give away come Christmas, or to swop with gardening friends.

Rose-scented Geranium Pelargonium graveolens A beautifully-formed plant, with a semi-trailing low-growing habit, and a slight orange cast on some of the leaves. The most delicious perfume, and a quick grower.

Lemon-scented Geranium Pelargonium limonium Large deeply cut leaves with a strong perfume, growing into a big bush which can reach 5 or 6 feet in height unless cut back hard occasionally to keep it within bounds. The tiny pinkish-mauve flowers appear in the spring. There is also a lemon-scented variety called Pelargonium crispum variegata, with a compact low habit of growth and tiny curly green leaves, paler yellowish-green at the top of each stem.

Peppermint Geranium Pelargonium tomentosum A delightfully soft velvety plant with ivy-shaped leaves and inconspicuous white flowers. It is a low grower, tending to trail about, and likes a little less sun than the others. Very easy to propagate from cuttings.

Coconut Geranium Pelargonium enossularoides Dark green rosettes of leaves from which come long horizontal sprays of deep pink flowers in spring and summer. These flowering stems lie along the soil, and where they touch, a new rosette of leaves forms to start off another plant. Soon you will have a very big patch of geranium unless you dig up the new plants and put them elsewhere. It is ideal for quickly covering banks or nature strips, and very hardy. Full sunshine and plenty of water when the flowering stems are spent will ensure better coverage by the new plants. The scent is of true coconut, slightly bitter, and should not be added to pot-pourri.

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Anthemis nobilis is English or Roman camomile. It was one of the nine sacred Saxon herbs, and was said to be under the sign of the Sun, a tribute to its very beneficial qualities. German camomile, too, was used for gastro-intestinal disorders as a soothing, warming, healing agent, and an aid to good digestion and sound sleep. It is often used as a children’s tea, being very mild in its action. Some Continental hotels still serve it to their guests as a nightcap at suppertime. It has a distinctive flavour of its own, and a slightly “slippery” taste. It gives me the same sensation on my tongue as a fine silk does on my skin. Perhaps “slithery” would be a better description.

Two teaspoons of the dried flowers in a cup of water brewed in the usual way and taken at bedtime should ensure a happy digestive system and a good night’s sleep.

The name of the herb comes from the Greek chamai—on the ground, and melon—an apple. The Spanish sherry Man-zanilla is flavoured with camomile.

The pure oil of camomile, which is used in hair and skin preparations, is a beautiful blue when distilled, becoming greenish-brown on keeping. Here is a rinse for your hair which should improve both its colour and general health.

Fair Hair Rinse

Boil | ounce of dried camomile flowers in 1 pint of water for 20 minutes. Allow to cool, and use as a final rinse after all shampoo has been rinsed off thoroughly. Leave this rinse on the hair for a beautiful perfume, too. Natural blonde hair will be kept highlighted and beautiful.

Camomile Shampoo

Put 1 tablespoon of mild soapflakes (such as Lux), 1 tablespoon of borax, and 1 ounce of powdered camomile flowers into a basin. Add about \ pint of hot water, and beat the ingredients until they form a thick lather. Wet the hair with warm water, and shampoo with this lather, massaging well into the scalp. Rinse once, and repeat. Rinse finally with warm water.

Camomile planted amongst other shrubs and annuals helps to keep them, and the soil near them, healthy and disease-free. It has often been called a plant “tonic”. Use it around the edges and in the odd spaces in your herb garden. Camomile tea has also been found very useful for the gardener. In England recent testing has proved the findings of many home gardeners, that it will prevent “damping off” of seedlings. It is prepared for garden use by steeping a handful of dried blooms in cold water for several hours, then watering the solution over the seed boxes. Unfortunately there was no specification in the publication I read as to how much water to use with the handful of blooms, so this will be a matter of experiment for you. It will certainly not harm any plants at any reasonable concentration. I have found one pint of water the best amount to use myself, and no damping off of seedlings has resulted since its use.

Any tea left over can be poured over the compost heap. Camomile extends its tonic properties even here, and will help keep the bin sweet whilst adding its personal store of mineral content, especially calcium.

You can also make a brew of the tea and add it to your bath water, for any redness or inflammation of the skin. It is gentle and soothing for sunburn.

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