the abbess and her sisters that the ap- parition in the kitchen ... Bell RM. Holy anorexia. Chicago, IL: ... family member, "keeping the secret" in child abuse does ...
convent kitchen on numerous occasions, usually at night. She persuaded the abbess and her sisters that the apparition in the kitchen was the devil, disguised as her and determined to undermine the faith and piety of all who might be taken in by this ruse. In a recognized variant of bulimia, the bulimic person experiences sleep disturbance, night wakenings with a compulsion to eat that must be satisfied before normal sleep returns. People suffering from bulimia usually starve themselves during the day to
avoid the weight gain that would otherwise result from these nocturnal binges. It is a self-perpetuating cycle of unconsciously learned behaviour whereby the bulimic person is unable to use the distraction techniques that permit diurnal appetite control when experiencing sensory deprivation while lying in bed at night when all is quiet and dark. It is not for me to imperil my immortal soul by casting aspersions on the behaviour of others more pious than myself. It is perhaps enough for
me to say that I am currently treating one individual who has St. Veronica's syndrome! James McSherry, MB, ChB Kingston, Ontario
References 1. Higgins GL. Bulimia: a comment on an old case report by Sir Thomas Browne. Can Fam Physician 1989; 35:395-7. 2. Brumberg JJ. Fasting girls: the emergence of anorexia nervosa as a modern disease. Cambridge, MA: Harvard University Press, 1988. 3. Bell RM. Holy anorexia. Chicago, IL: University of Chicago Press, 1985.
Refusing to Keep the Secret
ENDN For some of your patients, every turn of the calendar brings a new set of allergic miseries. But there's more than one season to Beconase relief, Beconase relieved hay fever symptoms more effectively than sodium cromogly-
caterAndBeconase
is prescribed by specialists for perennial rhinitis more often than any other spray. By far. 5
s
Beconase Aq. spray is as
a
effective as the aerosol form6 eand is especially recommended for patients who may have
experienced stinging,
dryness or irritation in the past3 For year round reliefof aliergic rhinitis, prescribe Beconase or e BeconaseAq. The end. Glaxo Toronto, Ontario
Montreal, Quebec
PAAB
BECONASE!A SPRAY FOR ALL SNEEZONS. (becdomethasone dipropionate. intranasal beclomethasone dipropionate spray) For prescribing information see page 1241
CAN. FAM. PHYSICIAN Vol. 35: JUNE 1989
I am flying too much these days, which encourages thorough line-byline reading of the journal and prompts my response to one of the articles in the excellent April issue. In Dr. Higgins' interesting review,1 he does not address our mandatory requirement as citizens to report suspected child abuse, under the child protection legislation in all Canadian provinces and the North West Territories. It is essential that physicians understand this exception to confidentiality, which does not depend on subpoena. While our duty to report is sometimes painful and conflict-ridden for us as physicians to more than one family member, "keeping the secret" in child abuse does not serve the best interests of the individuals, families, or society. Carol P. Herbert, MD, FCFP Vancouver, B.C.
Reference 1. Higgins GL. The history of confidentiality in medicine: the physician-patient relationship. Can Fam Physician 1989; 35:921-6, 914.
Family Medicine Research Update I just finished reading my Family Medicine Research Update, Winter 1989. It was informative and vibrated with enthusiasm about research. I learned about a free analysis program, Epi-Info, a good review article on methods in clinical trials, and about important new family practice studies in Newfoundland, Quebec, and British Columbia. 1239
