Language Traps

Abstract

My first paediatric job in the UK was a locum junior house officer in 1975. It was at Northwick Park Hospital on the outskirts of London adjacent to the Borough of Harrow, for which the school of that name is an icon. Free access to the school's old squash courts was a much appreciated privilege bestowed upon junior staff at the hospital. The hospital itself was a burgeoning hive of academic and clinical expertise, which included the Department of Paediatrics. I was challenged by an admission in my first week on duty. An 11-month-old girl of Pakistani ethnic origin presented with a febrile convulsion. Investigations revealed hypocalcaemia. My examination identified short stature and, with some biochemical clues, clinical evidence of infantile rickets. I found the extraction of an accurate dietary history difficult because of language problems. As best as I could ascertain, the child had been fed on goat's milk. With some excitement but uncertainty, I conveyed my findings to the senior registrar. This happened to be Harvey Marcovitch, who has enjoyed an illustrious career in paediatrics and journalism, culminating in becoming editor-in-chief of Archives of Diseases of Childhood. Uncertain of the implications, Harvey pursued this to identify whether goat's milk was likely to be deficient in vitamin D. His enthusiastic search took him to the research centre of the hospital to which there was an attached veterinary section. After some hours of fruitless research, he returned to the parents to take his own history and conduct his own examination. He did not identify any dietary indiscretions. With some cynical and disparaging comments regarding ignorant Aussies who have lost touch with the Queen's English, he informed me that the child had never been on goat's milk. In fact, she had been on a very orthodox brand of formula, well known in the UK but not so well known in the Antipodes, called ‘Cow and Gate’.