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No abstract

Body temperatures during hot flashes were measured in a menopausal woman. Internal temperatures fell after each flash; lowest: rectal, 35.6 degrees C; vaginal, 35.6 degrees C; tympanic, 35.2 degrees C. Where sweating occurred, the skin temperature fell during the flash and rose after it. Finger and toe temperatures always showed a sharp rise at the onset of a flash with a slower fall after the flash. Only the cheeks showed additional temperature rises; maximum, 0.7 degrees C. The heart accelerated 13% at the onset of the flash but slowed immediately thereafter. The flash interval was sharply demarcated by undulations in the ECG baseline. There was never any premonitory sign of the imminence of a flash. A central excitatory state seemed to build up, perhaps by the accumulation of a chemical compound, but not of heat, which was explosively dischargedmthe thermal distress was probably evoked by vascular warming in the cheeks. Dabbing the malar prominences with cold water brought prompt relief.

Elopements from psychiatric units are a frequent but usually low-grade risk. However, they are sometimes followed by harmful consequences, for which the psychiatrist and the hospital may be held liable. We describe management methods developed to reduce such liability. These include a structured observation system and procedures to return elopers to the hospital or to refer them for community-based treatment. Data on 105 elopers and 360 controls were gathered and analyzed. Acceptance of some risk of elopement is inevitable on wards that follow the principle of treatment in the “least restrictive alternative.”