What has you here today?    work history (html) about me tajik bookmarks

Kontrollieren, contrôler. 14th of October, 2018 POST·MERIDIEM 05:10

Back at the turn of this decade, when I was an enthusiastic medical student in Connolly Hospital, Blanchardstown, I had a group tutorial with Dr Eamon Leen, an excellent lecturer and the chief pathologist there. He mentioned, apropos of something reasonable and medical which escapes me at the moment, the attack on Mers-el-Kébir, and his interpretation of it was that the main reason for it was the differing semantics of English ‘to control’ versus French « contrôler », German „kontrollieren“ (the Fremdwort borrowed from French and meaning what the French word does.)

The idea was that « contrôler » was ‘to [be able to] check’ in French, but ‘to have power over’ in English, so the British ended up sinking the Vichy French fleet at huge loss of French life (and substantial post-war rancour) because they were led to understand that the Germans would have power over it, changing the balance of naval power in the Mediterranean and on the Atlantic coast.

I had studied French and this wasn’t a difference I had been aware of, but it sounded plausible and I wasn’t about to dismiss something Eamon Leen said without good reason. I searched around a little bit at the time, but there wasn’t anything definitive to be had via Google then. The relevant text of the armistice:

Article 8. La flotte de guerre française - à l’exception de la partie qui est laissée à la disposition du Gouvernement français pour la sauvegarde des intérêts français dans son empire colonial - sera rassemblée dans des ports à déterminer et devra être démobilisée et désarmée sous le contrôle de l’Allemagne ou respectivement de l’Italie.

La désignation de ces ports sera faite d’après les ports d’attache des navires en temps de paix. Le gouvernement allemand déclare solennellement au Gouvernement français qu’il n’a pas l’intention d’utiliser pendant la guerre, à ses propres fins, la flotte de guerre française stationnée dans les ports sous contrôle allemand, sauf les unités nécessaires à la surveillance des côtes et au dragage des mines.

Il déclare, en outre, solennellement et formellement, qu’il n’a pas l’intention de formuler de revendications à l’égard de la flotte de guerre française lors de la conclusion de la paix ; exception faite de la partie de la flotte de guerre française à déterminer qui sera affectée à la sauvegarde des intérêts français dans l’empire colonial, toutes les unités de guerre se trouvant en dehors des eaux territoriales françaises devront être rappelées en France.

I haven’t spoken or listened to much French in the interval, but my usual driving-across-the-country podcast material is in large part in German, and it’s a difference I’ve been looking out for. Now of course podcast material (usually Deutschlandfunk broadcasts of some sort) from today is not amazingly representative of the usual use of German or French in 1940, but it can be helpful for some insight.

And usually, given the big semantic overlap between ‘to [be able to] check’ and ‘to have power over’, it hasn’t been that clear that there has been a difference, and I have an underlying suspicion that current journalists speak and read too much English to be careful about the German meaning. One example where it did came up the other day in a piece from the Bayerischer Rundfunk; one of the commoner anti-hypertensives was recently found to have been adulterated with carcinogens, and this piece went into detail on the international regulatory system for medications, as background. The semantic difference there becomes very relevant, in that the legal situation provides for inspections, but no definite power over the producers (beyond withdrawing the accreditation if the inspections are not up to standard). And, lo and behold, the choice of vocabulary is exactly that described by Eamon Leen.

Anyway. Lesson to take away; historically English and (likely) Standard Average European have had slightly different interpretations of ‘control,’ ideally you should be careful about this in translating SAE, and ideally you should use something like „steuern“ when translating the word into German. And there’s a good chance it won’t matter much if your interlocutors speak lots of English.

And I don’t know if I would have done anything anything differently had I been in the Brits’ position in October 1940, the text of the armistice is not reassuring at all!

Beal. 11th of September, 2018 POST·MERIDIEM 08:03

Word of the day: to beal; to suppurate, to gather, to weep pus. Obsolete in standard English. The OED describes that it is still in use in Scotland, and I can report today that it is used in the area of the East Donegal plantation.

It is either a Norse doublet of boil (in the meaning of a furuncle) or an internal English variant on the word. Cf. German die Beule with the same meaning.

FeverPAIN. 8th of September, 2018 POST·MERIDIEM 11:18

At the beginning of 2018, Public Health England published a clinical decision rule for doctors managing sore throat, advising:

‘[Use] of the FeverPAIN or Centor clinical prediction score to determine the likelihood of streptococcal infection (and therefore the need for antibiotic treatment):’

In the context of a pending non-MICGP post-graduate exam I am obliged to remember this clinical rule and regurgitate it onto the page the day of the exam. I have no plans to use it in practice.

Here are its weaknesses as they occur to me:

  • The first line antibiotic for sore throat is phenoxymethylpenicillin. Don’t let the extra five syllables distract you; this is just penicillin. Penicillin. Penicillin has been in clinical use since 1942, and there is very very limited value to improved antibiotic stewardship for it; anything that was going to develop resistance to it, has developed resistance to it, more conservative deployment of it is very very unlikely to lower levels of MRSA, nor, on the other hand, is it likely to provoke resistance among T. pallidum.
  • The study the FeverPAIN score is based on, to its credit, uses several different swabs to pick up the Streptococcus that is the cause of most bacterial pharyngitis. Still, guess what? The sensitivity of every test we have available to pick up the specific pathogen of most infectious disease is terrible. 38% in a 2015 US study of community-acquired pneumonia significant enough to require hospitalisation, with the resources of the US federal government behind it. There is every reason to think a significant proportion of those with negative near-patient testing for Streptococcus actually had that bacterium.
  • The guidance is hedged so that, basically, if one is worried about the patient, one should go ahead and prescribe antibiotics. Well. Wasn’t that what we were doing anyway? Except, if the patient had immunocompromise I certainly was starting with co-amoxiclav rather than phenoxymethylpenicillin.
  • Personally, I come to this from an odd angle, in that I have the constitution of a horse, and so for years I listened to the guidance of, ultimately, the microbiologists, and just got on with things when I had a respiratory tract infection, without real problems. Then I got married, I got an RTI with cough productive of green sputum, struggled through, and then gave it to my wife, who was wiped out for a week or so. So, next time I got an RTI with cough productive of sputum, I took an antibiotic. Guess what? Even if the number of days one is symptomatic doesn’t change, it’s far far easier to work when antibiotics are doing their job against your bacterial infection.
  • And, of course, the people you’re not that worried about, and for whom you would consider withholding antibiotics, are the people healthy enough to have a job and to pay tax. And, well, having a job and working matters, those people have people depending on them for rent and clothes and home heating, and their taxes are where all the medical care for everyone else ultimately comes from.

In summary; if you’re a doctor reading this; if there is any whisper of a sore throat being bacterial, give the patient the penicillin. The patient will be happier and likely less sick, there will be little to no further resistance to penicillin in the community, and you won’t have to think about wasting time with penicillin if they re-present because of a resistant organism.

VTE Dublin 2017, and its Ultrasound Workshop. 19th of September, 2017 POST·MERIDIEM 11:01

I want to make a shout-out Cian McDermott, Andy Neill and everyone else involved in organising and running the Ultrasound Workshop at the VTE Dublin conference. Excellent sessions, great instructors, wonderful to have formal instruction on ultrasound for DVT, PE, and an introduction to echocardiogram.

I’m a GP trainee in Donegal who does Emergency Medicine as a side specialty, taking the exams and working lots of shifts in Northern Ireland. There’s a lot of cross-over between the two sets of generalists, and if anything, there’s even more reason for GPs to be putting ultrasound probes to people than ED doctors; ‘I haven’t felt my [unborn] baby move in just over a day’ should never go to the Emergency Department, absent bleeding or pain; poor local access to echo means I have a patient currently who probably has a new right-to-left ventricular shunt across a VSD, but her best chance of having that confirmed in the next 18 months is my buying something like a Philips S4-1 and putting it to her chest.

Thankfully, my first ED shift after the workshop wasn’t as eventful as that of Dan Horner. I only had a thirty-something man with back pain and light-headedness, who happily had a normal abdominal aortic diameter, and a non-EU expectant mother with a headache, at 18 weeks gestation, who couldn’t access the usual antenatal care because the Home Office was siting on her documentation. She was very glad to see her singleton intrauterine pregnancy with good fetal movement, good heartbeat and an abdominal circumference appropriate for dates.

So, in sum; ultrasound, great, VTE Dublin ultrasound workshop, fantastic!

Ben Goldacre’s Bad Pharma 30th of September, 2012 ANTE·MERIDIEM 01:06

I ordered Ben Goldacre’s new book, Bad Pharma, and noticed the braille on the cover. Here it is (possibly upside-down, but I don’t think so):
⠄⠒⠎⠥⠍⠑ ⠄⠊⠍⠍⠇⠽
I’m disappointed! The good doctor requested suggestions for two words to put up there, but as far as I can see it’s just ‘:Sume Immly.’ I’ll be unimpressed if it’s just nonsense, but I’m open to correction.

Word of the day: دیدن، بین /didæn/, /bin/ are the infinitive and present stem of ‘to see’ in Persian.

Last comment from zocky on the 5th of October at 0:08
⠄ is the abbreviation marker (used before both words), and ⠒ is the abbreviation for "con"

So it says "consume immediately".

[No older comments for this entry.]