The Child, the Elder and the Frail

That sentence has stood at the front of this wiki since The Hand That Heals, and every article since has been written for the body in the middle of it: an adult, of ordinary build, who can lie down and get up, turn over, hold a position, and tell you honestly when something hurts. Forty articles of points, counts, angles, orders and formulas have assumed that body.

This article is about the two ends of the sentence, and about everybody in between whose body will not take what an ordinary body takes. The newborn. The small child. The older child, who is still growing and whose growing is itself a thing that can be spoiled. The frail adult of forty whose bones break at a knock. The elder of eighty who must be helped onto the mat, and the other elder of eighty who walks five kilometres a day and can take everything in the atlas.

Two things must be said before we begin, because the whole article turns on them.

First: this is not a article of softer treatments. A student arrives expecting to be told to press more gently, and finds instead that the adjustments are different decisions, made for stated reasons — a different tool, a different position, a different number of places along the thigh, a substituted point, a barred point, a treatment given lying down that is ordinarily given seated, an order reversed to save a frail spine one turn. Weight is very nearly the only thing that is not adjusted, because weight was never the variable. The Hand That Heals established that: in this therapy we press the blood vessels so that the flow of blood goes towards those glands where it was not reaching before; weight has no part in this. Even if the therapist is of low weight, or applies less pressure, if the place is right the treatment will be just as effective. A therapy that did its work by force would have nothing to offer a two-year-old. This one has a great deal, precisely because it does not.

Second: the reason is the teaching. As in the three articles before this one, every rule here carries the reason that is given for it; where no reason is given, the rule is given plainly and none is invented. You will meet several bars in this article whose reasoning is stated with beautiful precision — the growth plate of a child's long bones is the finest of them — and one or two that stand bare. See also → Between Two Sessions, "Between Two Sessions", which established that principle, together with the two working methods this article assumes: reconstruct a day, never audit a rule, and two rules to a visit, not eleven.

Before any of the specific rules, learn the question that chooses between them. It is not how old is this patient. Age is a poor instrument. It is the commonest instrument, and it is wrong often enough to be dangerous in both directions.

The eighty-year-old who is strong. Men and women arrive at eighty having walked every day of their lives, eaten at fixed hours, slept properly and never broken a bone. Such a patient gets up off the floor without a hand on anything, turns prone and back without being asked twice, and takes an ordinary adult treatment as an ordinary adult. To give him a thin, cautious version of the therapy because of the number on his card is not kindness; it is a decision made without looking, and it will make his course longer for nothing.

The forty-year-old who is not. And into the same room walks a woman of forty who has been on steroid tablets for eleven years for another disease, or who has been in bed for five months, or who has had cancer treatment, or who has a spine that has already given way once. Age says treat her as an adult. Her body says otherwise, loudly, if you know what to look at.

And keep the patient's own report at the centre of it. The standing rule of every session applies here with more force than anywhere else in this wiki: if the patient screws up their face, or tells you that it is hurting, then without arguing change the angle of your foot or reduce the weight. Only they know the pain; you do not. So do not think, "I have seen many patients, nobody has ever said such a thing." The reason the material gives is entirely practical — sometimes, out of fear of that pain, the patient does not want to take treatment from that therapist, or becomes so negative towards the therapy that they stop coming to the centre altogether; arguing in this way will damage both you and the therapy. See also → Before You Touch Anyone, "Before You Touch Anyone".

With a child and with a very old person there is a complication in that rule, and it must be said plainly. Neither of them reports pain the way an adult of forty does. A small child does not say that is uncomfortable; it either tolerates or it screams, and by the time it screams you have already lost it. A very old person, and particularly a very old person in somebody else's house, very often will not complain at all — out of politeness, out of not wanting to be a burden, out of a lifetime's habit of bearing things. So with both of them you stop relying on the sentence and start reading the face, the hands and the breath: a small frown, a hand that comes up off the mat, a breath held. And with the elder you ask afterwards, of the daughter-in-law and not of the patient: was he stiff that evening? did he sleep?

The first adjustment, and the largest, is what part of the therapist reaches the patient.

Deciding to use the hand is only half of it. How the hand is laid is the other half, and it is where the new therapist of the opening story came to grief. (Figure 41.1)

That last sentence is the reason, and it is worth reading as the clinical statement it is rather than as a comment about children being difficult. A crooked palm, an edge or a fingertip does not deliver less pressure — it delivers the same pressure through a much smaller contact, which is to say a great deal more of it, concentrated. A child's crying is an accurate instrument. It is telling you that you have made a small hard tool out of a large soft one.

Watch

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Pan

The ladder of tools, from most to least

Foot, hand, single points, feather touch — and who goes on each rung

Put the whole thing in order and you have a ladder. A therapist's job is to start at the right rung, and the right rung is chosen by the body in front of them. (Figure 41.2)

1. 2. The hand. Very small children. Old and weak persons. Every patient with osteoporosis — hand only. The palm laid as above; for an adult, the palm and the heel of the hand as the point requires.

3. Individual treatment points, given singly. For the patient who cannot take a formula at all. The statement is exact: individual treatment points alone do not set right a disorder, but they can certainly be used to give instant relief from individually annoying symptoms, and they can also be used as starters — and the footnote naming who this is for is the important half: especially in the case of patients who are bed-ridden, or who suffer from severe pains in the joints. Such patients may not be able to bear the therapist's pressure during the regular treatments, even if such pressure is applied by hand.

4. Feather touch. The lightest treatment there is: a touch so light that powder on the skin is not wiped off by it. This is the treatment for the patient who can be given nothing else — a newborn, a woman in the last weeks of pregnancy, a man whose bones break at a knock, a patient in the acute days after a stroke, somebody in too much pain to bear a palm. It is beneficial in paralysis, stiffness, pains and in all diseases of the brain.

Rung three deserves a moment, because students skip it. It is the rung for the patient whose pain is the obstacle to being treated for the pain — the bed-ridden woman with motor neuron disease, the man whose every joint hurts, the patient four days after a fracture. For them the formula is not available yet. What is available is one point, chosen for one symptom, given once, to buy the relief that makes tomorrow's session possible. The material's own words for it are instant relief and starters, and both halves are honest: it is a beginning, not a treatment, and it is not pretended to be one.

The second adjustment is where the patient's body is put. Two rules do most of the work here, and both are written. (Figure 41.3)

The whole group of treatments ordinarily given with the patient seated on a chair — Medulla, Mesencephalon, Dorsal, and the others taught with them — carries one standing exception at the head of the group:

The second rule is subtler and is one of the most instructive things in this wiki, because it shows a therapist trading a known quantity of effect for a known quantity of comfort, and saying out loud what the trade cost.

In the LSTF formula, the physiologically preferred order gives Adr first and Thrd afterwards — because Adr tends to make the thymus hypo and the thyroid a little hypo with it, so that giving the thyroid first and Adr afterwards will not give a full hundred per cent result; it will come out a little less.

But in that order the patient must be turned supine → prone → supine: all the points up to Mu° are given face up, Adr requires face down, and Thrd face up again.

Three further position rules bite harder on a small, old or frail body than on an ordinary one. All three are established elsewhere; they are named here because the patients in this article are the ones who are injured when they are forgotten.

The pillow that is uniform. For WD a pillow is not needed as a rule — but if someone's muscles are very weak, then the pillow must be uniform: not soft in one place and hard in another. Best of all is a folded sheet. A slack limb does not hold its own shape over a lumpy support; it drapes into the hollows, and the load arrives wherever the pillow happens to be hard. A folded sheet has no hollows.

No pillow under the head or under the back, unless it is needed. The footnote that runs along the bottom of the whole supine section — place the pillow at the proper place as needed, but never under the head or under the back — is a spine rule, and a thin old spine is where it matters most. The written exception stands: those who have cervical spondylosis may become giddy while taking the Pan treatment, and they may be given a thin pillow under the head. Supine

Lying down and getting up by rolling onto the side. Every patient is taught it; the frail patient is taught it twice and shown it. Down with the knees bent, straightening the legs afterwards; up without a jerk — otherwise the fluid inside the ears that maintains balance is churned up, and they may become giddy. And the material adds a note of manners that belongs particularly here: sometimes even old patients, returning after a gap of some days, forget. Do not ask them why they cannot remember. Explain calmly, again. What is ordinary for us is new for them, so forgetting is natural.

The third adjustment is the most easily missed, because it looks like arithmetic.

Many of the commonest points — Gas, Gas 'I', Gal, Spl, Liv, Mu, Lt. Ov., Rt. Ov. and WD — are not given at one spot. They are given at a number of places along the limb, working from one joint to the other. How many places is not a fixed number. It depends on the length of the patient's thigh and on the width of the therapist's foot, and there is exactly one rule that governs the whole thing.

The therapist's own size is a variable. This is the sentence that surprises students most, and it is the one that proves the rule is about coverage: a therapist who is a child has a narrow foot, so the same thigh needs five placements rather than three — and that too is correct. Nothing about the patient changed. Nothing about the treatment's effect changed. The geometry changed.

Two places for a very small child. Not because the child is delicate; because the child's thigh is short and a palm covers half of it.

And this is a matter of experience is kept exactly where it stands. It is attached to the two-places figure, and it is the wiki's standing label for a rule that rests on observation rather than on a stated mechanism. Preserve it.

Now the count — and here is the thing students expect to be adjustable and which is not.

Where a point carries such a sentence, use it. Where it does not, do not invent one: the honest adjustment for a patient who cannot bear a treatment is a different tool, a different position, or a different treatment — not a secretly shortened count.

Lighter formulas exist, and they are named

The light version is not a dilution — sometimes it is said to be better

The last kind of adjustment in this part is not made by the therapist at all. It was made when the formula was written. Several of the most-used formulas exist in a heavy version and a light one, and the light version is not a dilution — in more than one case it is described as better.

That last line is the one to write on the card of a very old patient. Organ Clearance, daily or twice a day, for small children and elderly people, is a written permission for a frequency that would be unusual in an adult course, and it fits the two groups for whom a long single session is hard and a short frequent one is easy. The name says what it does: it removes the obstructions of the blood arteries going to all the organs of the body, by which the pain of the organs beside the navel comes out.

And Jeevan Dhara carries an observation about old people that is worth quoting to their families. The treatment from which the abdominal pain comes out at once also produces, even in the elderly, and in those who have no particular complaint, an immediate freshness and briskness; many to whom it was given began to say that they had received a new life — which is where the formula's name came from. Especially to people of greater age, after this treatment is given, it feels as though they have obtained new life.

This is the page this article exists for.

Every rule in it is taught in its own place, beside its own point or in its own article. Gathered, they become a single sheet you can look at with a frightened three-year-old on the mat and a mother watching your face.

Table 1 — The body in front of you, and what changes

Two columns that are not in the table, because they are not a body type. Pregnancy is Treating Women's and has its own gathered table of twenty-six withholdings. Every disease and condition with its blocked points is When the Hand Must Stop's. Use all three sheets together: this one asks what kind of body, Treating Women asks what state is she in, When the Hand Must Stop asks what disease does he have. A patient can be caught by all three at once. (Figure 41.4)

The mother's half of a birth — the room, the pain, the smell, the cord, her milk, her water, her calcium and her rest — is Treating Women's, and is not repeated here. What follows is the child's half, taught whole. It begins on the same page where that article stopped.

Four — the hedge, which is kept exactly. Of the nursing-home practice of a full wash and scented powder, what is said is perhaps not right for its body, and this is a matter to think about. It is not stated as a prohibition and it is not to be taught as one. A therapist who converts perhaps not right into never do this has made the material say something it declined to say — and a family who is later told by a good doctor that a bath is not harmful will then distrust the twelve things you told them that were exact.

The child is lifted with both hands

From any one hand: indigestion, constipation, or loose motions

For every organ to work smoothly it must go on receiving, twenty-four hours a day and without obstruction, blood through the capillaries and messages through the nerves. Within the abdomen every organ has been packed with such skill that no empty or spare space remains. If, through any unusual movement, a difference comes about in the internal gaps between the organs, then pressure can fall upon some capillary vessel or bundle of nerves. These are so fine that from that pressure an obstruction will arise in the blood flow within them. First the stomach will be upset, and then slowly the balance of the whole body will certainly be disturbed.

This is exactly why the elders always warn that small children must never be lifted with one hand — always with both — otherwise the child may get loose motions, or hard constipation, or anything at all.

Three named outcomes, and they are not three ways of saying one thing: indigestion, constipation, loose motions. The reasoning is the reasoning of the whole therapy in miniature — that the abdomen is packed without spare room, that a sideways drag changes the internal geometry, that a capillary or a nerve bundle is fine enough to be obstructed by very little, and that the stomach is the first thing to show it.

Give it to a household as a practical instruction and not as a warning: two hands under the child, one supporting the head and neck, every single time — lifting out of a cot, taking it from somebody else's arms, swinging it up onto a hip. The single-handed lift that this rule is aimed at is the one every busy mother makes twenty times a day with the child on one arm and something else in the other hand. It costs nothing to change and it is changed by demonstration rather than by instruction: put your own arms into the right shape and ask her to copy you.

When the teeth are coming

Half milk and half sago water — and the fever that may stay two days

What is given to a small child at the mat

TF reversed, Rt. Chest early, and the Triangle for control of urine

Three small, specific adjustments belong to children and are easily lost among the formulas that carry them.

TF, reversed. The toe-finger work is ordinarily begun at the big toe of the left foot and worked to the little toe, then the right side in the same way. If children have ordinary loose motions, give the order reversed — start from the little toe of the right foot and work to the big toe, then do the left side in the same way — and it will give immediate benefit. Everything else about TF is unchanged: at every joint of the toes, as many times as the number written, counting as you go, rubbing the three sides so that the nerves under the skin are roused, but not so hard that a wound is made there.

Rt. Chest only, early. It controls the tendency of sudden sneezing, usually accompanied by a running nose, especially in children — provided it is given within the first few sneezes. The condition is part of the indication; given late it is a different situation.

Triangle for piles, for control of urine. Besides piles, anal fissure, fistula and prolapse of the rectum, it is beneficial for control of urine in children and in the elderly — one treatment answering the same complaint at both ends of a life. For an ordinary person three times is enough. Its own bar travels with it: not to those who pass little urine.

Now the adjustment that is unique to children and has nothing to do with pressure at all. There is a period of life in which certain treatments are withheld not because the body cannot bear them but because they would end something that is still happening — and a therapist who does not know this list can, with a correct and well-given treatment, cost a child two inches of adult height.

The hypothalamus makes a hormone called somatostatin, which is an inhibitory hormone. Somatostatin stops growth hormone — so it is inferred that perhaps by this treatment an obstruction may arise in the increase of children's height.

One instruction about children is so specific, and so easily missed among the formulas, that it is set apart here and given its own heading. It belongs to the New Gal family, and it is not a rule about pressure or position at all. It is a rule about what you ask the mother.

The treatment is the New Gal formula, and the same instruction is stated a second time in its list of uses, with two more conditions of the mother's pregnancy added:

This same treatment is to be given to those children whose mother, during pregnancy, had high BP, or any skin disease, or itching.

Take the instruction apart, because every clause in it is load-bearing.

"A long course of treatment." This is for the child who is going to be with you for months — the child with cerebral palsy, the child of dull intellect, the child with autism, the child with a developmental condition — and not for the child brought in on Tuesday with loose motions.

"On enquiry." The mother will not volunteer it. Seven years have passed; she does not connect her blood pressure in the eighth month with the child in front of you; and nobody has ever asked her. You ask. During this pregnancy, did your BP go up at any time? Did you have any skin trouble, or itching? Three questions, thirty seconds, at the first visit, of every child who comes for a long course.

"Whether they are children of dull intellect, or have come for some other illness." The instruction is not restricted to one diagnosis. The mother's pregnancy is the indication, not the child's disease.

"First to be given only this treatment for ten to fifteen days." Only, and first, and a stated number of days. It is a course that goes before the course — ten to fifteen days of New Gal and nothing else — and then the plan you would otherwise have written. A therapist who gives New Gal alongside six other things on day one has not followed the instruction.

And the best order, where the ampulla is to be opened too: first the ampulla of Vater is to be opened; afterwards the gall bladder is to be stimulated — so, in order: I. Vater formula. II. New Gal treatment formula.

The instruction has a history, and the history teaches the method better than the rule does.

Two further instructions about such children sit beside that one and must be given with their hedges intact, because the hedges are printed.

Chole, after a pregnancy with high blood pressure. If a pregnant woman's blood pressure rises during pregnancy, and after the birth it is found that the child is mentally slow, then giving that child the Chole treatment and other treatments brings considerable improvement in its digestive power within three months — this is a matter of experience. Note precisely what is claimed: considerable improvement in its digestive power, within three months. Not more than that, and the experience label stays on.

(10) Pan, in the same situation — with the question marks the material printed. At the entry for (10) Pan there stands: if the mother of a CP — cerebral palsy — child had high BP during pregnancy, giving that child (10) Pan will benefit ??? The three question marks are the material's own and are not to be tidied away. In the same entry, and equally marked: a child who is very hyper may become even more hyper on being given (10) Pan ??? Both statements are given as open questions, and a therapist who gives (10) Pan to a hyperactive child should know that the material itself has flagged a possible opposite effect.

Old age is not a disease and this wiki does not treat it as one. But two observations about age change what a therapist expects to find, and both are worth holding.

This article's sheet is not addressed to the patient. It is addressed to the parent, the son or daughter, or the carer — the person who will actually carry it out, and who is very often the one who has not been spoken to at all.

Two rules a visit, as always.

Table 3 — What to tell the parent, the son or daughter, the carer — and why

Questions students ask

1. I am twenty and strongly built. Am I allowed to treat a child at all, or should it be given to somebody smaller? You are allowed, and your build is irrelevant to the result. Weight is not the variable — if the place is right, the treatment is just as effective given by a small person as by a large one. What your build changes is the tool: you use your hands, laid the way the rule says, and never your feet. And notice the rule that runs the other way, which will tell you the principle better than any argument — if the therapist is a young child, then even five places may be needed on a thigh where an adult uses three, and that too is correct. The therapist's size changes the geometry. It does not change the therapy.

2. I am a housewife learning this for my family. My mother-in-law is seventy-nine and will never say anything hurts. How do I treat somebody like that? You change your instrument from her words to her face and her family. Watch the eyes and the jaw during the hold — not the mouth. Watch whether a hand lifts off the mat. And ask somebody else afterwards: was she stiff in the evening, did she sleep? Then treat one rung lower than you think you need for the first fortnight, and move up on evidence. A fortnight of the hand costs you nothing. Being wrong about a bone costs everything.

3. I am a doctor. "Small children, very weak persons, and any patient with osteoporosis are to be treated with the hand only." Is osteoporosis really a hands-only condition here even in a well-looking patient? Yes, and it is written as a flat instruction rather than as a judgement call, which I would keep exactly as it stands. Two things follow from it that are worth your attention. First, the bar does not depend on how the patient looks or on how much force you intend to use — which is the right shape for a rule about a tissue whose weakness is silent. Second, it comes with two companions that show the same reasoning: Shukla is withheld because it may increase the pain, and (4) Para is never given alone because given alone it lifts calcium out of the bone into the blood, the full 1,25 DCC formula being required instead. Three rules, one condition, one direction of thought.

4. A mother has asked me why we do not wash off the vernix. What do I actually say? Say what is taught, with the hedge in it. The fluid he has lain in is antiseptic — it protects his skin from germs outside. So he is cleaned lightly with warm water, wrapped, given rest and given to you, and the rest of it is cleaned away slowly over about seven days rather than washed off in the first hour. If she then says the nursing home washed him and powdered him, do not tell her they were wrong, because the material does not. It says perhaps not right for its body, and calls it a matter to think about. Say that. She will trust you more for the perhaps than she would for a verdict.

5. In a village, a child has loose motions with teething. Am I meant to give sago water instead of the sugar-and-salt drink? No, and this is the most important thing in the article to get straight. The teething instruction is half milk and half sago water, and it is for the ordinary disturbance of a child cutting teeth who is otherwise himself. It is not fluid replacement and it does not replace it. A child who is actually losing fluid gets the drink taught in Food as Medicine — a packet of oral rehydration salts in exactly the quantity of water printed on it, or six level teaspoons of sugar and half a level teaspoon of salt in one litre of clean water, sipped slowly. And an infant or very small child with diarrhoea is sent the same day while you go on treating.

6. Why does the material tell us to stop the diarrhoea but not the fever? Because it reads them as two different things. Harm reaches the body from diarrhoea — that is the stated reason for stopping it. The fever is read as an instruction from the body: it comes when undigested food has appeared, and the coming of fever indicates that the liver needs rest for a few days. So the sentence is exactly what it says — the fever may stay for two days, so it is not a bad thing. Teach it with its ceiling attached, which is in The Fire and the Ash and in the caution above: this is the ordinary two-day fever of a child behaving like himself, and a list of things that mean a doctor the same day.

7. I am a retired engineer, sixty-six, learning this. The height bars confuse me. Is (2) Pan forbidden to all children? No — read the wording, because the wording is the rule. (2) Pan is not given to children whose height is less, or who are taking treatment from us to increase height. It is a bar attached to a purpose, not to an age band, and it names its substitute: (4) Pan or (10) Pan. (6) Medulla is worded the same way — boys and girls between 13 and 20 who come for treatment to increase height, unless there is special need. The ovary points and WD are worded around the teenage years and around low height. So the question you ask is not how old is this patient but is this child still growing, and is anybody hoping he will grow more?

8. I run a small centre and see mostly old people. Is there anything I can give almost all of them? Two things are written for exactly that. Organ Clearance may be given to small children and to elderly people daily, or even twice a day — it gives benefit to everybody, and short and frequent suits an old body better than long and occasional. And the light Jeevan Dhara, which may be given at any age to remove fatigue or weakness in the body, and of which it is said that people of greater age feel afterwards as though they have obtained new life. Neither replaces examining each patient and letting the findings choose.

9. A patient is bed-ridden and cannot bear my hand anywhere. Is there anything left? Two rungs. Individual treatment points, given singly — which will not set right a disorder, but are used to give instant relief from individually annoying symptoms and as starters, and the footnote naming who they are for names exactly your patient: bed-ridden, or severe joint pains, who cannot bear the regular treatments even by hand. And below that, Feather touch, which is the treatment for the patient who can be given nothing else. Give one point for one symptom and see what tomorrow allows.

10. I have no science at all. What does "the epiphyseal line closes" actually mean? A child's long bones grow at a soft strip of gristle near each end, which keeps making new bone and pushing the ends apart. When growing is finished, that strip turns to bone and seals over, and the bone is then as long as it will ever be. Nothing reopens it. So a treatment that makes the strip seal earlier does not slow a child's growing — it ends it, and whatever height had not yet been made is not made. That is why these particular bars are absolute rather than cautious.

11. Should I be reducing the six seconds for a very old patient? No. The six seconds is not a dose, it is part of what the treatment is, and the counts on chemical points are selectors — give the wrong count and either the effect you wanted does not come or, in some cases, the opposite one does. The written latitudes are three and they are specific: physical points may be given one or two times more for comfort; where a point carries its own ceiling, if the patient cannot bear it, reduce the time; and the number of places along a limb changes with the length of the limb and the width of your foot. Everything else you adjust is the tool, the position or the formula.

12. A grandmother is watching me treat her grandchild and keeps telling me I am doing it too gently. What do I say? Tell her the truth, in her own terms, and give her something to do. Mātājī, here we are not pushing the muscle — we are sending the blood where it was not going. If I press harder I do not send more blood; I only frighten him, and then he will not come tomorrow. Then ask her to sit where he can see her and hold his hand. Families who are given a job stop supervising. See also → Before You Touch Anyone, "Before You Touch Anyone".

Questions patients ask

1. (A mother) "He is so small. Will this hurt him?" It should not, and if it does, you will both know and I will change what I am doing at once. This is not given with a fingertip; it is given with the whole soft part of my palm laid flat on his leg, spread over as wide an area as I can make it — which is exactly why it does not sting. My hands stay warm and I go slowly. If he cries, tell me immediately rather than waiting to see whether he settles.

2. (A son) "My father is eighty-eight. Is he too old for this?" No. The treatment is given from a one-day-old infant up to a hundred years. What changes for him is not whether he takes it but how it is given — with my hands rather than my feet, in positions he can hold, with fewer turns, and in shorter sessions more often rather than long ones. What I need from you is honesty about the falls, about any doctor ever having said his bones are thin, and about how he was in the evening after each session, because he himself will tell me he is perfectly fine.

3. (A father) "The doctor has given him medicine for fits. Should we stop it now that we have started this?" No. We use no medicine of any kind here, and we never tell anybody to stop theirs. That is between you and the doctor who prescribed it. Please keep giving it exactly as it is written, keep his speech therapy and his physiotherapy going, and when the time comes that you think things have changed, take him to that same doctor and let that doctor decide. Stopping a fit medicine on anybody's advice but the prescriber's is dangerous, and it would be the one thing that could undo everything we do here.

4. (A mother) "The hospital bathed him and put powder on him the day he was born. Have I harmed him?" No. What is taught here is that the fluid he was born in protects his skin, so it is cleaned away slowly over about a week rather than washed off at once — and of the nursing home's quick wash and scented powder, what is said is only that it is perhaps not right for his body, and that it is a matter to think about. That is not the same as saying harm was done, and I will not tell you it was. From today you can keep him warm, keep him wrapped, feed him, and lift him with both hands.

5. (A grandmother) "My grandson's teeth are coming and he has loose motions and a little fever. Should I take him to a doctor or is this normal?" Both can come when the teeth are coming, and what is given is half milk and half sago water, from which the diarrhoea settles — and it is said that the fever may stay two days and that this is not a bad thing. But I want you to watch four things and come the same day if you see any of them: blood in the motion; vomiting that will not stop; no urine for many hours, or sunken eyes; or if he goes quiet and floppy instead of cross. And if he were under three months old, any fever at all would mean a doctor the same day, no matter how well he seemed. I will keep treating him either way.

6. (A woman of fifty-three) "You keep saying you will use only your hands. Am I that weak?" Not weak — and it is not about strength. You have been told that your bones are thin, and the instruction here is plain: where there is osteoporosis, treatment is given with the hand only, always, however well somebody looks and however much force I was or was not planning to use. It costs you nothing in result. The place and the order are what decide the effect; the weight never was.

7. (A father of a girl of fourteen) "She has painful periods. Why are you refusing the treatment you would give my wife?" Not refusing — choosing differently, and I would rather tell you why than let you think I am being cautious for no reason. Some of the treatments that answer that complaint work by way of oestrogen, and oestrogen makes the growing ends of the bones close early. Once they close, height stops. She is fourteen and still growing. So I will use what I can use safely, and if we reach a point where the choice is a real one, I will put it to you and to her plainly and you will decide, not me. Tell me now how tall you and her mother are, and whether her growing is something anybody in the family is thinking about.

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