Fax for the Memories

Fax machines were once cutting edge. “I just got a sandwich faxed to my desk!” claimed a colleague in the early 90s.

He wasn’t quite right, as it happens, since only his order was transmitted by fax.

Photo by Griszka Niewiadomski from FreeImages

For those who aren’t sure how a fax works, the gist is that the original document is scanned, converted into a bitmap, then transmitted down a phone line as audio-frequency tones. The receiving fax machine deciphers the tones, recreates the image, and prints it more or less legibly.

Before email, fax was the only way to send a sizeable amount of data quickly without an expensive courier. It made it possible to send letters quickly and, for reporters, to submit articles to newspapers on the day without dictating them to copy-takers.

It also enabled my mother, who lived abroad and had, like most seniors, a keen interest in the weather, to keep me updated without phoning.  I well remember the message in which she said it was SNOWING! (underlined three times). She seemed a bit miffed when I faxed back to ask what she expected from Switzerland in January.

Photo by Martin Wehrle from FreeImages

I also had a relative in the Middle East who liked using fax. She generally rang first to tell me her message was on its way, and her pronunciation was different to most. As my children enjoyed putting it, “Aunt Delia likes sending fux.”

The desktop fax came into existence around 1948, but it wasn’t widely used until the 1970s and 1980s. Some machines used dedicated lines, while others shared with a regular phone by means of a switch which didn’t always work. Well, mine didn’t.

Another snag is that one rarely knew how many pages would come in, so the supply of paper had to be kept topped up. My roll of thermal paper often ran out inconveniently mid-flow, like a loo roll. And the paper, being thermal, was useless for archiving as the print soon faded like a receipt. You’d have to photocopy the image or message to preserve a record.

Photo by Joanna Kopik from FreeImages

Some machines were advanced and did colour, but smaller businesses, like individuals, tended to have basic models and the image definition wasn’t great. When I was arranging the funeral of a cousin, there was a choice of coffins. As it wasn’t clear over the phone how they differed, the undertaker offered to fax over images of each one. This generated a long ribbon of paper with blurred photos that looked identical. Still, I expect the details made little difference to dear cousin Gladys at that stage.

The arrival of email meant the end of the fax for most, but the NHS doggedly continued to favour faxes for important communications such as urgent referrals, citing confidentiality as the reason. Emailing was banned for transmitting patient info – despite the fact that NHSmail is encrypted. Perhaps nobody at the top considered the risk posed by a clutch of paper messages sitting in the out tray of a machine for all to see.

Thus the NHS became the biggest purchaser of fax machines. Some hospitals had over 600 of the things each, and of course GP practices needed them too, using up money that could have found its way into patient care.

Now the NHS has seen the light and the new GP contract decrees that by April 2020 all GP practices should become fax-free. Some already are, but it’s possible that not all practices, or the agencies they deal with, will be prepared to unplug their faxes despite the 17 pages of guidance on the subject. The death throes of the fax, I suspect, could go on for a while.

 

The Most Disgusting Diseases in the World (and how to catch them) – part 3

If your stomach has now settled post-Christmas, you may be ready for the final instalment of the most disgusting diseases in the world. Those who were born a lot longer ago than yesterday may notice that it’s in the same vein for which the late lamented Punch magazine was known.

Should you fancy a condition that goes the distance, consider keeping a pet worm like dracunculus medinensis, aka the Guinea worm. The best place to pick one up is in Africa with your drinking water. Maintenance is dead easy. There’s no need for an aquarium, hutch, or a garden, as it lives just under the skin.

I remember one patient who had his worm for so long that he named it Ali, which seemed the best bet as he couldn’t tell if it was male or female. Ali kept him company for some time, forming little red bumps all over him, until the day she (as we discovered) tried to escape through a huge blister on his arm.

When the blister finally burst, the little dracunculus poked through. Ali turned out to be several feet long. She had to be wrapped around a stick and pulled out gently to avoid breaking her during her outward journey which took two and a half weeks. Bon voyage, Ali!

You needn’t leave these shores to catch something sensational. Syphilis is all Columbus’s fault since, or so the story goes, his sailors brought it back to Europe in 1493.

An epidemic of syphilis spread from Naples throughout Europe in the 16th century. The English and Italians called it the French disease, the French called it the Neapolitan disease, and pretty well everyone thought of it as the Great Pox because smallpox was small potatoes by comparison.

Syphilis is far more contagious than leprosy, as just a few minutes in a shared bed will do. A bed may even be superfluous. One man, inspired by notices in public WCs, claimed to have caught the infection in the loo. “That’s a filthy place to take a woman,” replied the consultant.

Syphilis can mimic anything from tonsillitis to athlete’s foot. It all depends on the stage of the infection.

Early syphilis can be just a painless ulcer called a chancre (pronounced Shankar, which is most unfair on Ravi and family). A few months later, the secondary stage produces symptoms like fever, headache, general malaise, aches and pains, mouth ulcers, enlarged lymph nodes, and rashes. Of course, that’s pretty much what everyone goes to the GP with.

Late syphilis takes years to develop, and it’s downhill from there. Nerves in the legs no longer transmit signals about position, which is one cause of the stomping gait you can see all over London. It also makes you fall into the handbasin when you close your eyes to wash your face. If very wobbly, you may fall into the toilet unless you’ve closed it.

No account of dreadful diseases would be complete without that scourge of the western world that has medics clamping their hands over their mouths and recoiling in horror. You may not be able to get a hospital referral, or, if you do, you’ll find yourself being bundled out of the clinic as soon as possible, usually while you’re still talking, so that the consulting room can be fumigated forthwith.

They may offer you surgery, but you may not live long enough to get to the top of the waiting list. Should you manage to reach the operating theatre, the procedure is likely to be relegated to the most junior doctor because nobody else wants to do it. Blood and pus often pour out, and the hapless trainee surgeon may throw up as a result. The patient has it relatively easy by now, as the whole gory mess is soon tidy and bandaged.

Unfortunately, this unsavoury condition is on the increase. Experts call it IGTN and claim that it spreads via shoe shops. It will impair games of footsie-footsie. It may even interfere with walking.

Like many disfiguring conditions, IGTN has a long incubation period. As I’d like you all to enjoy a healthy and happy New Year, I believe the public should be told more about this disorder. I particularly look forward to the day when every pair of winkle-pickers carries the government health warning Wearing shoes may cause ingrowing toe-nails.

 

The Most Disgusting Diseases in the World (and How to Catch Them) – part 2

Following on from part one, and in the same vein for which Punch magazine was known, I bring you four more of the most disgusting diseases in the world.

I had to include acromegaly as the insistence of my son whose interest in endocrinology began at the tender age of four when we were on holiday in Switzerland and happened on a particularly florid case of the condition. By then, the diagnosis could have been made from a cable car 50 metres away (which it was).

“Mummy, why are that man’s hands so big? And why has he got pillows instead of shoes?” He pointed, I told him not to, and so on, until I noticed the man in question who really was sporting pillows strapped to his feet.

I explained about the pituitary gland and growth hormone, and my youngster thereafter abandoned Postman Pat books in favour of the British Medical Journal.

However florid acromegaly may become, the onset is invariably subtle, with coarse skin, greasy hair, an increase in hat size, a little deepening of the yodel, and difficulty making watches or doing up lederhosen. To avoid resembling our Alpine acquaintance, it’s best to seek help while you can still fit into your ski boots.

Even pillows may not be roomy enough if you’re infected with wuchereria bancrofti. Everyone seems to have heard of elephantiasis but there are two important things to note: you don’t catch it from elephants, and it usually begins with just a few enlarged lymph glands on the groin. Walking is therefore still possible, for a while. Swelling sets in later, often only in one leg, and sometimes in the scrotum too, should you possess one.

Eventually the skin develops rough folds and warty outgrowths, and the scrotum, if affected, can hang down to the knees, which poses problems at the tailor’s, and elsewhere. Prevention is key. Use a mosquito net, and avoid falling into Burmese septic tanks if you want to wear both legs of your trousers at the same time.

If you dislike rodents, you’ll hate Lassa fever. Transmitted by rats, it was discovered in the Nigerian village of the same name, which you might like to make a note to avoid on your travels.

After it was first described in 1969, the department of health send circulars so that no GP would miss this diagnosis.  As the years passed, I never saw a case, but the bumph was useful for wobbly dining tables.

Lassa has an insidious onset with symptoms that resemble other conditions, like fever, malaise, a flushed face, red eyes, nausea, and vomiting. Later, the nose, gums, mouth, stomach, and lungs bleed spontaneously – a plague of blood, with a high mortality rate. As I recall, Lassa is similar to other haemorrhagic fevers such as Marburg-Ebola, Green Monkey Disease, and Crimean-haemorrhagic-Congo-Hazara fever, though I’d have to check under the dining table to be sure.

Anyone who’s unconscious when arriving by plane from West Africa runs the risk of his drunken state being mistaken for Lassa fever, with the result that masked attendants whisk him off to a plastic tent in the nearest isolation unit until the tests are back. I need hardly add that the outlook is far worse when Lassa fever is mistaken for excess alcohol.

Next up is typhus, not to be confused with typhoid. Typhus is caused by germs called rickettsiae which breed in the gut of the louse, and spread to humans via louse faeces. Louse bites are itchy, and scratching them rubs infected droppings into the skin.

Weakness is one of the early symptoms, and it all goes downhill from there, eventually, if untreated, leading to multiple organ failure.

As alarming as typhus is, Tsutsugamushi fever (aka scrub typhus) is much more popular with medical students, because it has so many syllables and because it forms a painless but picturesque ulcer covered with a crust. More importantly, unlike other forms of typhus, an attack of Tsutsugamushi gives no immunity against further infection. Medics can therefore imagine repeated episodes of scrub typhus at each outbreak of acne, and some of them have been known to scratch for years after exposure to a single lecture.

In the next instalment of The Most Disgusting Diseases in the World (and How to Catch Them): head, shoulders, knees, and toes.

You may also like to catch up on The Most Disgusting Diseases part one.

The Most Disgusting Diseases in the World (and How to Catch Them) – part 1

Putting my decades of medical practice to use, I bring you the chance to brush up on all the gruesome diseases you don’t remember, especially if they’re ones you never knew about in the first place.

It’s tongue in cheek, but, if you’re squeamish or easily offended, you may prefer a blog about macramé instead.

Feeling out of sorts lately? If friends think you look tired, colleagues call you burnt out, and Great-Aunt Frieda reckons you need a tonic, better check out your appearance in the bathroom mirror. Are your fancy new glasses slipping down your nose? If so, either you’ve been too busy to pop into Specsavers to get them adjusted, or that jaunt to South America didn’t agree with you.

You may have got New World Leishmaniasis. Don’t let the name fool you. It’s as old as the hills, and it’s still a neglected disease. The parasite finds a sandfly to hang out in, until the sandfly finds you. Within 18 months or so, the bridge of the nose collapses. Leishmaniasis also destroys the mouth and tongue, so that bottle of Gevrey-Chambertin you’ve been saving tastes just like British sherry. Soon, however, you will no longer care.

The cause of all the trouble is the innocent-looking leishmania parasite with a cute little tail. Rather like a spermatozoon, actually. But, unlike pregnancy, leishmaniasis can be avoided by simple measures such as sleeping on the roof. Sandflies can’t fly much higher than three metres. 

What could be worse than leishmaniasis, apart from income tax, baldness, and wheel clamps? It’s the infection so dreadful that doctors often refer to it as Hansen’s disease to avoid inducing panic in the waiting room. The condition starts with a bit of catarrh then progresses to muscle pains, enlarged lymph nodes, and sometimes a patchy rash.  If you’re any kind of hypochondriac at all, you’ll suspect from the very first sneeze that this is leprosy.

Soon you lose a little pigmentation, then a few fingers because they’re numb and you chop them up with the celery. By the time leprosy bacilli gets into their stride, the face is covered in boils and bumps, and friends are apt to be too busy to see you. There may be other complications including inflamed testicles and a spleen the consistency of sago. But enough. More details might be in poor taste.

Leprosy is highly infectious. Or else it isn’t. The experts don’t all agree. If your doctor rushed out of the consulting room, you’ll know which school of thought she favours. One study showed that the only sure way of contracting leprosy is to share a bed for twelve years with a leprosy patient. So there’s really no need to avoid waiting rooms, though you might want to steer clear of lactating ladies with leprosy because they shed the bacilli like there’s no tomorrow.

Actually, there is a tomorrow because leprosy is curable. Too bad that treating an entire village for a month costs nearly as much as a good lunch for four, not including service. 

In the next instalment of The Most Disgusting Diseases in the World (and How to Catch Them), I’ll be talking about conditions affecting hands, feet, and other members.

My earlier version of this series originally appeared in Punch, an iconic magazine that eventually succumbed to circulation problems.

How Was IKEA for You?

The thing with going to IKEA is that it invariably takes three hours, which still isn’t enough to shop and to scoff a bargain plate of meatballs or fish and chips in the café.

IKEA Wednesbury was no different. The shop has everything, mostly things my son and I didn’t know we needed yet soon realised we couldn’t live without.

PS 2014 light. Image from ikea.com

The PS 2014 light is a case in point. By pulling its strings, you can make it open and shut, just like a transformer. Although, unlike a transformer, it is still a lampshade whatever you do. Bargain at £60 and would look great in my son’s new home. Now, what were we here for?

I get distracted by a couple arguing about the configuration of wardrobes and whether they really need a sofa bed (and which set of in-laws they can stand having as guests). Meanwhile, their kids have a pillow fight.

The cognoscenti may take crafty shortcuts through the store, but my son and I prefer not to miss anything, and the trolley soon filled up.

I’d brought my IKEA Family Card, which is why I got an email a week or so later asking for feedback on TYSNES, VILDKAPRIFOL, FLITIGHET, and TOKIG.

I’m not sure where IKEA get their product names, but then I don’t know a word of Swedish except Volvo and that’s Latin. Turns out they use many Scandinavian languages and place names in naming their wares, as this post explains

TYSNES. Image from ikea.com

TYSNES is a village in Norway. It’s also perfect for the bathroom windowsill, especially at just £19. As for the VILDKAPRIFOL, sorry, but, despite the attractive blue pattern, they’re still in the carrier bag.

VILDKAPRIFOL. Image from ikea.com

The FLITIGHET are great, but then what could go wrong with plain white side plates? Alas, I can’t comment on the TOKIG. I’d wanted a salad spinner for ages, but had forgotten that I’d taken the train, so the thing had to stay at my son’s in Birmingham instead of coming home with me.

The thing is, you can forget a lot after 90 minutes in IKEA, and common sense goes out the window. Perhaps that’s why, when nearly leaving the store, it’s almost impossible to ignore the Bargain Corner. The trolley is never quite laden enough to resist the charms of knock-down prices for knocked-about products, like a coat rack with a couple of hooks missing.

IKEA neglected to ask for my views of the humble RӦRT, a fine wooden spoon with endless possibilities. Have you never made spoon dolls? Admittedly my children have long grown out of such rainy day activities, but all you need for this wholesome fun is a Sharpie (or, better, a Magic Marker with a scent that takes me right back to the sixties), and then some fabric for a dress. Why, I could even use one of those pretty VILDKAPRIFOL tea towels.

IKEA also forgot to solicit my opinion of the BӒSTIS. I deem it 75p well spent as it prevents everything I own from turning ginger. It’s well named, too, as Bast was the Ancient Egyptian goddess of cats and her cult centre was Bubastis.

MISHMISH. Not available from IKEA

Far and away my best buy was, on that occasion as on most others, only 50p. Aptly named, the FRAKTA is generally purchased by the checkout when everyone is a bit fractious, even they’ve managed not to drop a BILLY bookcase on their foot.

The FRAKTA after deployment

It may not look much, but it is a workhorse. As the catalogue has it, Be it shopping, doing laundry or going to the beach, it goes wherever you go.”

Except it doesn’t. I always leave mine at home and having to buy another carrier bag at the store.

We caught up at the checkout with the quarrelling couple and the bouncy children, by then pacified by the promise of ice cream. Shopping at IKEA can be stressful, but it doesn’t detract from the chain’s iconic status.

Do you have a great IKEA story? Perhaps you even know someone who met their partner there, as opposed to just arguing with the one they went shopping with. I’d love to hear from you.

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You may also enjoy this post on Feedback Frenzy.

One Year Older, Still Alive and Kicking

On my birthday just recently, I experienced a disconnect between the joy of being the birthday girl and the reality of being, frankly, older than I’ve ever been before. One day, I’m scoring goals in the back garden. The next thing I know, I sit down with an audible Oof! at every possible opportunity.

If you’re anything like me, you don’t always appreciate how fast things are changing until something pulls you up short. Like the photo that shows how short you are compared with your children. Or a birthday card like this one.

What presents might be heading my way? Another pair of slippers, maybe, or a voucher for Specsavers. Material gifts lose some of their appeal as the years slip by, as does blowing out candles on a birthday cake. I don’t have that kind of puff. Or a fire extinguisher to hand.

But I’m not a grumpy old thing who pads around in her gardening clothes and moans about the passing years. On my birthday I dressed up in my new shoes.

Along with a top from Help the Aged. Don’t tell me the shop is now called Age UK. This purchase goes way back.

I didn’t fancy going out for a celebratory lunch. Not when we have so much in the fridge, and the tarragon on the patio is doing so well this year that it’s a shame not to use it. So risotto it was.

The old joints may be creakier than they were, but I can’t complain. Getting older is a privilege. Give me a head of grey hair and as many laughter lines as Mick Jagger (though, come to think of it, nothing is that funny).

Health problems become more likely as the years pass, but then ill health can strike at any age. Having worked in paediatric rheumatology, I can see just how challenging mobility issues can be at a young age. And of course there are many other conditions that can become limiting.

That’s why I’m delighted to get behind the new campaign from Sport England. It doesn’t have to involve a sport. #WeAreUndefeatable aims to help the two thirds of people with health conditions increase their physical activity in any way they can.

I’d need a really long blog post to cram in all the benefits of moving more. Instead, watch this lot living every moment. The clip lasts just 30 seconds. 

If you have a long-term condition, or know anyone who does, please take a look at some of the inspiration at We Are Undefeatable

Is Your Classic Car a Sex Symbol?

On a sunny summer day, the grounds of Burghley House proved a good place to ponder this question. The occasion was the annual rally of the Rolls Royce Enthusiasts’ Club on the 100th anniversary of the marque, no less. Some of the visitors seemed of similar vintage. But, if the setting of England’s greatest Elizabethan House didn’t evoke lust, the Flying Lady (aka the Spirit of Ecstasy) probably would. 

FreeImages.com/Artur Szeja

Arriving in my neighbour’s Arnage, I thought we fitted in rather well. OH and I posed in front of cars like this classic green Bentley.

If you’re wondering about the definitions of classic, vintage, and veteran, here’s one widely accepted version. Classic is over 20 years old, while vintage is 1919-1930, and veteran is pre-1919.

Some of the motors we saw were for sale, but most were for show, closely guarded by their owners as if their charges were entrants in a teen beauty pageant.

Some, like this Corniche, were watched over by dogs.

The atmosphere seemed designed to prompt extravagance. Sunshine, free fizz, and John Timms’ Jazz Band make such an intoxicating mix that a 1962 Silver Cloud begins to look a steal at just £395,000.

I had my eye on a sky blue Bentley, but doubt I could have afforded its dinky little brother.

Exploring stalls with items for sale, we admired shiny cylinder heads, members’ spares, and picnic sets for a mere £3,000.  I turned away from a perfectly lovely Louis Vuitton suitcase. It was £2,800 and it didn’t even have wheels!

Perhaps the less car-related merchandise would be within my budget. I tried on a splendid coat by Gabriela Rose Ltd. The mirror told me it fitted perfectly. The label told me it was £995.

In the Gallery Marquee, I enjoyed an affordable piece of fudge before wandering off again among the rows of cars. We traipsed as elegantly as one can in a field. Turned out to be easier without shoes. Who knew?

Owners were only too happy to tell everyone about their pride and joy. As it happens, I know something of their fervour. I did own a classic 1973 Beetle for over 25 years. It might not have swanned about stately homes, but Sauerkraut and I clocked up plenty of miles on camping trips to France and Spain.  And Wales. Mustn’t forget Wales. The speedometer gave up the ghost on the way back.

Lacking even the most basic cocktail cabinet, Sauerkraut was a tad low-tech by Rolls Royce/Bentley standards. Did it have air con? Only if you opened the quarter-lights as far as they would go and kept up a steady speed of 70mph. As for heating, what’s wrong with a coat and gloves? My very first Beetle didn’t even have a fuel gauge. Instead there was a lever for deploying a reserve tank when you were out of petrol.

Was my classic car a sex symbol? It was probably more of a fertility symbol, especially with three child seats across the back, a double buggy shoved haphazardly into the front, and a random assortment of toys meant to keep little boys quiet on long journeys.

You won’t find my beloved Beetle standing in front of Burghley House, but it has graced some of the finest NHS hospitals in the land. Here it is at the Canadian Red Cross Memorial Hospital, in Taplow, Berks.

When I went into general practice, Sauerkraut and I got to know every single street in Borehamwood. I recall one particular patient who called for a visit for back pain. When I examined him, I told him his back didn’t seem too bad. “I know,” he replied. “But I want to buy your car.”

Many years later, I sold Sauerkraut to a lovely family from Liverpool who renamed it Carol.

Go on. Give it a wave if you see it.