- Email: [email protected]
PHARAOH FACIES
791 as a draught statim, and instruct the becalmed parent to make hot tea for herself and the
acid in water
This revives the one and supplies further tannin to the other. No untoward results have been brought to my notice. ALFRED JORDAN. London, N.17.
child.
of almost supreme indifference to all that was going on that recalled to me those historical notes on that government administrator in Ancient Egypt, the Pharaoh who hearkened not to Moses, the founder of public health. I feel sure that anyone who has met deafness of sudden onset, in its early phase, will agree that this simile is
quite appropriate. APPLICATION FOR HOSPITAL POST SiR,-Let me hasten to assure your correspondent "A.B." that he is perfectly correct in his letter last week when he says : " It would seem that more tact and consideration are applied in obtaining the services of a cook than those of a doctor " ; and let me add that even more tact and consideration have to be applied in retaining those services once they are obtained. This is, of course, only one aspect of the dismal situation arising from the inexorable law of demand and supply ; cooks and maids are nowadays almost unobtainable, while anything from 30 to 70 physicians and surgeons are scrambling for every precious vacancy offered in their respective specialty. When contemplating the huge pass-lists for the higher qualifications, one wonders when this oversaturation of the market for specialists will finally reach its logical conclusion, with holders of the M.R.C.P. and F.R.C.S. scrubbing the floors and washing the dishes, while the cook-generals and housemaids on the house committee dictate the treatment of the
patients.
year ?
-
PHYSICIAN.
DOSAGE OF SULPHETRONE SiB,—The oral dose of ’Sulphetrone ’ to be aimed at is that which gives a blood-level of 7-5-10 mg. per 100 ml. As Dr. Ewing indicates in his letter on Oct. 30, the oral dose which is finally administered varies considerably, but is usually 6-10 g. for adults, or 3-6 g. for children. The incidence of side-effects is reduced when the gradual scheme of dosage suggested by Madigan is employed. It is our view that should absorption be so faulty as to necessitate daily adult doses in excess of 12 g., or children’s doses in excess of 6 g., recourse should be had to the parenteral route for at least a proportion of the drug. It should be remembered that there is always a potential reservoir of drug in the gut, unabsorbed, or re-excreted by the ileum ; normally this is lost to absorption by passage into the caecum. This picture is reversed with stasis, when sudden rises in bloodconcentrations have been observed. It is clearly unwise to increase unduly the concentration of drug in the gut, and adult oral doses in excess of 10 g., or sometimes 12 g., daily are not to be recommended. Tuberculosis Chemotherapy Unit, County Hospital, Farnborough, Kent. D. G. MADIGAN Wellcome Research Laboratories, GEORGE BROWNLEE. Beckenham, Kent. PHARAOH FACIES
SIR,-Expressions such as " facies Hippocratica," " typhoid facies," and " adenoid facies," not to mention and others, have long since received " risus sardonicus official sanction. I have been wondering how the expression " Pharaoh facies " would be received if suggested "
as an addition to the list. I believe it fully fits a very well-defined clinical entity-the preliminary phase of all forms of deafness of sudden onset. Thus it is found typically in salicylate poisoning and cinchonism.
My first observation, made over ten years ago in a hospital outpatient department, was on a patient suffering from the former condition. She was a young girl presenting a picture of almost complete indifference to any attempt at normal communication with her on the part of physician, nursing staff, and orderlies-until finally
in
seen
in
patients
with deafness of
described above. London, W.1.
S. HALES.
Parliament Removal of
a
Mental Patient
IN the House of Commons on Nov. 1 Mr. E. Mo1B. CooPER-KEY drew attention to an unwarranted intrusion "
While on the subject of comparative values, let me end by asking what we are to think of the generous terms of the Spens reports while certain dentists in the N.H.S. are now earning money at the rate of 224,000 a
Pharaoh facies is not
gradual onset, who have had ample time to adapt themselves to changing conditions-for example, those with progressive labyrinthim deafness or presbyacusis. I believe, however, that colleagues will agree that Pharaoh facies aptly describes the preliminary expression of the patient in noise deafness, ’concussion deafness, and shellshock deafness, before lip-reading or other devices have been learned, and occasionally in the deafness complicating epidemic cerebrospinal meningitis, measles, mumps, or typhoid fever, and the deafness found in certain forms of drug idiosyncrasy and poisoning, as
a
question
was
put
to her
writing.
This is a typical history. During this preliminary phase she was really out of touch with the world around her, having had no time to familiarise herself with lipreading, finger-spelling, and gesture. It was this attitude
and abuse of power by public servants." Mrs. Salter, he said, lived with her daughter, a mental deficient, in a basement flat in Hastings. On Oct. 8 Mrs. Salter went shopping, leaving her daughter alone in the flat suffering from gastric trouble. On her return she found two policemen and an official from the Ministry of Health had forced an entry. She ordered the men to leave. They informed her that the entry had been authorised by a high authority and she was asked for her keys. She refused again, and asked the men to leave. They then informed her that her daughter was to be removed to a mental hospital. A police surgeon arrived who produced a roughly drawn certificate to the effect that Mrs. Salter and her daughter were of unsound mind and should be removed to the local hospital. At the hospital Miss Salter was removed to a private a justice was summoned, and she was pronounced of unsound mind. At 7.30 P.M. Mrs. Salter was released and told that if she called next morning she would be able to see her daughter. But in fact, her daugher was removed an hour later to Hellingly Hospital.
room,
Mr. Cooper-Key said that the local authorities sought to justify their action under section 14 (1) of the Lunacy Act as amended by the National Health Service Act. This provided that if a duly authorised officer (a) had reasonable grounds for believing that a person was of unsound mind, and (b) was satisfied she was not under proper care. he should, not may, within 3 days give notice to a justice. Mr. Cooper-Key did not complain of the provisions in paragraph (a) in this case, but was it seriously suggested
that a devoted mother’s attention and nursing was not proper care ? Under section 72 of the Lunacy Act, as amended by the National Health Service Act, any patient resident in an asylum should be discharged on application by On the following Tuesday the appropriate relative. Mrs. Salter accordingly went to the asylum and demanded the return of her daughter, who was at once discharged. There had been no question of course of this patient having either homicidal or suicidal tendencies. As the law stands, Mr. Cooper-Key pointed out, local authorities have the power to remove an individual against the wishes of her parent, but the asylum must release her immediately on application by the parent. He submitted this rendered nonsensical the administration of the Act. Mr. JOHN EDWARDS, parliamentary secretary to the Ministry of Health, in reply, related how, in consequence of information received by the medical officer of health for Hastings, a duly authorised officer visited Mrs. Salter’s flat. He heard peculiar noises coming from a room, but got no response to knocks on the door. Looking through the .
s
acid in water
This revives the one and supplies further tannin to the other. No untoward results have been brought to my notice. ALFRED JORDAN. London, N.17.
child.
of almost supreme indifference to all that was going on that recalled to me those historical notes on that government administrator in Ancient Egypt, the Pharaoh who hearkened not to Moses, the founder of public health. I feel sure that anyone who has met deafness of sudden onset, in its early phase, will agree that this simile is
quite appropriate. APPLICATION FOR HOSPITAL POST SiR,-Let me hasten to assure your correspondent "A.B." that he is perfectly correct in his letter last week when he says : " It would seem that more tact and consideration are applied in obtaining the services of a cook than those of a doctor " ; and let me add that even more tact and consideration have to be applied in retaining those services once they are obtained. This is, of course, only one aspect of the dismal situation arising from the inexorable law of demand and supply ; cooks and maids are nowadays almost unobtainable, while anything from 30 to 70 physicians and surgeons are scrambling for every precious vacancy offered in their respective specialty. When contemplating the huge pass-lists for the higher qualifications, one wonders when this oversaturation of the market for specialists will finally reach its logical conclusion, with holders of the M.R.C.P. and F.R.C.S. scrubbing the floors and washing the dishes, while the cook-generals and housemaids on the house committee dictate the treatment of the
patients.
year ?
-
PHYSICIAN.
DOSAGE OF SULPHETRONE SiB,—The oral dose of ’Sulphetrone ’ to be aimed at is that which gives a blood-level of 7-5-10 mg. per 100 ml. As Dr. Ewing indicates in his letter on Oct. 30, the oral dose which is finally administered varies considerably, but is usually 6-10 g. for adults, or 3-6 g. for children. The incidence of side-effects is reduced when the gradual scheme of dosage suggested by Madigan is employed. It is our view that should absorption be so faulty as to necessitate daily adult doses in excess of 12 g., or children’s doses in excess of 6 g., recourse should be had to the parenteral route for at least a proportion of the drug. It should be remembered that there is always a potential reservoir of drug in the gut, unabsorbed, or re-excreted by the ileum ; normally this is lost to absorption by passage into the caecum. This picture is reversed with stasis, when sudden rises in bloodconcentrations have been observed. It is clearly unwise to increase unduly the concentration of drug in the gut, and adult oral doses in excess of 10 g., or sometimes 12 g., daily are not to be recommended. Tuberculosis Chemotherapy Unit, County Hospital, Farnborough, Kent. D. G. MADIGAN Wellcome Research Laboratories, GEORGE BROWNLEE. Beckenham, Kent. PHARAOH FACIES
SIR,-Expressions such as " facies Hippocratica," " typhoid facies," and " adenoid facies," not to mention and others, have long since received " risus sardonicus official sanction. I have been wondering how the expression " Pharaoh facies " would be received if suggested "
as an addition to the list. I believe it fully fits a very well-defined clinical entity-the preliminary phase of all forms of deafness of sudden onset. Thus it is found typically in salicylate poisoning and cinchonism.
My first observation, made over ten years ago in a hospital outpatient department, was on a patient suffering from the former condition. She was a young girl presenting a picture of almost complete indifference to any attempt at normal communication with her on the part of physician, nursing staff, and orderlies-until finally
in
seen
in
patients
with deafness of
described above. London, W.1.
S. HALES.
Parliament Removal of
a
Mental Patient
IN the House of Commons on Nov. 1 Mr. E. Mo1B. CooPER-KEY drew attention to an unwarranted intrusion "
While on the subject of comparative values, let me end by asking what we are to think of the generous terms of the Spens reports while certain dentists in the N.H.S. are now earning money at the rate of 224,000 a
Pharaoh facies is not
gradual onset, who have had ample time to adapt themselves to changing conditions-for example, those with progressive labyrinthim deafness or presbyacusis. I believe, however, that colleagues will agree that Pharaoh facies aptly describes the preliminary expression of the patient in noise deafness, ’concussion deafness, and shellshock deafness, before lip-reading or other devices have been learned, and occasionally in the deafness complicating epidemic cerebrospinal meningitis, measles, mumps, or typhoid fever, and the deafness found in certain forms of drug idiosyncrasy and poisoning, as
a
question
was
put
to her
writing.
This is a typical history. During this preliminary phase she was really out of touch with the world around her, having had no time to familiarise herself with lipreading, finger-spelling, and gesture. It was this attitude
and abuse of power by public servants." Mrs. Salter, he said, lived with her daughter, a mental deficient, in a basement flat in Hastings. On Oct. 8 Mrs. Salter went shopping, leaving her daughter alone in the flat suffering from gastric trouble. On her return she found two policemen and an official from the Ministry of Health had forced an entry. She ordered the men to leave. They informed her that the entry had been authorised by a high authority and she was asked for her keys. She refused again, and asked the men to leave. They then informed her that her daughter was to be removed to a mental hospital. A police surgeon arrived who produced a roughly drawn certificate to the effect that Mrs. Salter and her daughter were of unsound mind and should be removed to the local hospital. At the hospital Miss Salter was removed to a private a justice was summoned, and she was pronounced of unsound mind. At 7.30 P.M. Mrs. Salter was released and told that if she called next morning she would be able to see her daughter. But in fact, her daugher was removed an hour later to Hellingly Hospital.
room,
Mr. Cooper-Key said that the local authorities sought to justify their action under section 14 (1) of the Lunacy Act as amended by the National Health Service Act. This provided that if a duly authorised officer (a) had reasonable grounds for believing that a person was of unsound mind, and (b) was satisfied she was not under proper care. he should, not may, within 3 days give notice to a justice. Mr. Cooper-Key did not complain of the provisions in paragraph (a) in this case, but was it seriously suggested
that a devoted mother’s attention and nursing was not proper care ? Under section 72 of the Lunacy Act, as amended by the National Health Service Act, any patient resident in an asylum should be discharged on application by On the following Tuesday the appropriate relative. Mrs. Salter accordingly went to the asylum and demanded the return of her daughter, who was at once discharged. There had been no question of course of this patient having either homicidal or suicidal tendencies. As the law stands, Mr. Cooper-Key pointed out, local authorities have the power to remove an individual against the wishes of her parent, but the asylum must release her immediately on application by the parent. He submitted this rendered nonsensical the administration of the Act. Mr. JOHN EDWARDS, parliamentary secretary to the Ministry of Health, in reply, related how, in consequence of information received by the medical officer of health for Hastings, a duly authorised officer visited Mrs. Salter’s flat. He heard peculiar noises coming from a room, but got no response to knocks on the door. Looking through the .
s