Wednesday, 30 March 2022
Saturday, 12 March 2022
The Great Barber-Surgeon-Dentist!
“His pole, with pewter basins hung,
Black, rotten teeth in order strung,
Rang’d cups that in the window stood,
Lin’d with red rags, to look like blood,
Did well his threefold trade explain,
Who shav’d, drew teeth, and breath’d a vein.”
-The Goat without a Beard, by John Gay.
From the Middle Ages to the late eighteenth century when folks had a bad toothache and many other surgical conditions, they went down to the barbershop. The Surgeon Barber's were the practical surgeons of the Middle Ages and looked after many surgical conditions as well as the grooming of their patients.
Dental extractions were one of the commoner procedures of the barber surgeons or of a family member good with pliers, but in those pre-anesthetic days people often pulled out their own teeth using everything from a string tied around the tooth and the other end around the door handle. A good slug of gin, then slam the door and voila - the tooth is out.
The point of all of the above is that before I cut to the chase, I wanted you to know that in 1902 a dental extraction was 25c. Now let's carry on with the story!
My wife developed a toothache and a loose tooth recently. She went to her dentist. The dentist confirmed the loose tooth and decided it should be extracted. The dentist referred her to a specialist which mildly surprised me, since in my day, dental extraction was the bread and butter dental procedure. (see the published tariff above in 1902 the procedure cost twenty-five cents).
The appointment date rolled around pretty quickly and I drove my wife to the dental appointment. Initially, I thought the appointment was to have the tooth pulled. Perish that thought! The appointment was to have the tooth that was to be extracted assessed, the 'surgery' to be planned for a later date. We went into the waiting room, where my wife was given a five page medical history form to complete that I filled in for her. (The print was too small for her failing vision so I guess if I wasn't there they would have had to find someone to do it for her.) Apart from the basic medical history required, the document appeared to be put together mainly to indemnify the dentist in case anything went wrong.
The waiting area was comfortable enough and dominated by a large OLED television screen with one of the best pictures I have seen - at least that's what I think it was. A colorful collage of ocean creatures displayed their magnificently spectacular, spectral antics in a manner that suggested that even for fish and other sea creatures the virtual life superseded reality. A real tank could not host the drama as magnificently. It was obvious that this was going to be one expensive piece of dental surgery. I was enjoying the show when the assistant came to take my wife into the dentist. Since this was the tail-end of Covid (one visitor in the office at a time!) I waited outside, which I was more than happy to do as I had become engrossed in Oceanography.
"Everything okay?" I asked.
She nodded, "Oh yes, I'm going to have it out on Thursday. I hope you don't have an appointment for that time ?" she asked anxiously.
(Now that we are both octogenarians we have so many maintenance appointments from head to foot that we have to be careful that they don't conflict.)
"Did it hurt when he wiggled the tooth to see how loose it is?" I asked.
"No" she shook her head as we both struggled to get our seat belts done up.
"Well," I said impatiently, "What did he say when he looked in your mouth and probed it?"
"He didn't look in my mouth at all," she said, struggling to get the seat belt off."
My wife doesn't hear as well as she used to. I increased my normally loud vocal volume up a notch. "I asked what he said when he looked in your mouth," I shouted. She has the best teeth I've ever seen in a person of our age, and in sixty years this old General Practitioner spent a lot of time looking in mouths.
"Oh, he didn't look in my mouth at all," she said.
"He didn't ask you to open your mouth at all?" I asked
"No! He just put my head in a big thing and took some sort of x ray. I think it was some sort of MRI thing "
Now I know I am old, very old. So old in fact that way back in the days of CB radio, (remember that?) my moniker was "The Dinosaur"!
A week later we arrived at the dentist's office at 1.25pm, for our 1.45 appointment. I was relieved that the same oceanography program was still on.
In no time at all my wife appeared back in the waiting room, biting on a large bloody gauze square with a prescription for an antibiotic, an analgesic, a box of gauze squares as well as a prescription for a mouthwash that dentists prefer.
The price had gone up considerably since the 1902 rates published at the top of this blog, but then so has everything else!
We've come a long way since the tooth fairy used to visit me!!
Wednesday, 23 February 2022
When I was born in 1935, no-one asked my mother if she'd like me vaccinated against small-pox, they told her I had be vaccinated. Neither her permission nor my father's was required. Although she had no special medical knowledge, she, like many others, did have enough perception to realize what a killer smallpox had been and was happy to have her newborn protected against it. That general realization was sufficiently widespread and the vaccination sufficiently accepted as being effective, that the lethal disease has been wiped off the face of the earth. People showed off their small ugly vaccination scar on their upper arm with pride! When I was growing up, the countryside in Ireland was peppered with TB Sanatoria. Now there are none. Not many years later tuberculosis was preventable by vaccine or treatable and when my daughter was born no one asked her mother or me if we would like her immunized against that scourge. The same applied to numerous other serious diseases that had crippled or killed people, particularly children. Diseases like polio (infantile paralysis), diphtheria and a myriad of other diseases. Much of the population was aware of the patients who lived out their lives in an 'iron lung' to breath for them or spent their life wheel chair confined and so were relieved when their children had their vaccine even though the approval was post facto. Widespread dissemination of infectious disease has largely been avoided in recent years thanks to immunization. Unfortunately, the public as expert as they believe themselves to be are largely unaware of why they have enjoyed protection from so many potentially lethal infectious diseases. Unfortunately, many of the experts are lacking in historical perspective and fail to appreciate how much of the success of modern medicine is due to the contribution of Edward Jenner and 'The Dirty Dairymaids of Devon'.In 1796, Jenner carried out his now famous experiment on eight-year-old James Phipps. Jenner inserted pus taken from a cowpox pustule and inserted it into an incision on the boy's arm. (He'd be sued and crossed off the medical register for that today!) He was testing his theory, drawn from the folklore of the countryside, that milkmaids who suffered the mild disease of cowpox never contracted smallpox, one of the greatest killers of the period, particularly among children. Jenner subsequently proved that having been inoculated with cowpox Phipps was immune to smallpox. He submitted a paper to the Royal Society in 1797 describing his experiment, but was told that his ideas were too revolutionary and that he needed more proof. Jenner experimented on several other children, including his own 11-month-old son. In 1798, the results were finally published and Jenner coined the word vaccine from the Latin 'vacca' for cow.
Jenner was widely ridiculed. Critics, especially the clergy, claimed it was repulsive and ungodly to inoculate someone with material from a diseased animal. A satirical cartoon of 1802 showed people who had been vaccinated sprouting cow's heads. But the obvious advantages of vaccination and the protection it provided won out, and vaccination soon became widespread. Jenner became famous and now spent much of his time researching and advising on developments in his vaccine. Jenner carried out research in a number of other areas of medicine and was also keen on fossil collecting and horticulture. He died on 26 January 1823. His discoveries and their offshoots developed by others have probably saved more lives than any other medical management.
So, the anti vaccine luddites can rant and roar as much as they like: study the facts carefully and apply simple logic and the answers will usually become obvious. Meanwhile, each and every one of us should be grateful for the vaccines that have saved so many lives - and let there be no doubt about it, they did save many lives.
Tuesday, 15 February 2022
The Surgeon Poet.
I got a little ahead of myself, launching into quotations from the book before relating the difficulty in getting hold of a copy of it. At first I set out to buy a copy, after all, Amazon has everything.
They had one copy available and t was over a thousand dollars (Yes, a were dollars!) I didn't want to own a copy of the book, I just wanted to read through it to see if I was missing anything by postponing the search for fifty-five years! Being a 'Life Member' of the Canadian Medical Association and of the College of Family Physicians of Canada, I knew I would have no difficulty in accessing the text on line. I was quite prepared to pay the going rate for online access. I checked them out, I even phoned the librarian of the CFPC without success. Fortunately, I mentioned my frustration to a family member who is faculty at Canada's senior University and he offered to try to access it for me.
Lo and behold, the entire canon became available to me in a short time, for which I was extraordinarily grateful because as I continued my on - line search any sort of copy was unacceptably expensive. Interestingly, the copy to which I had access was last accessed several years ago, after several years in limbo.
During the first world war Cope served in the Royal Army Medical Corps as a Major and was no 'behind the desk' officer. He saw active service in the Middle East from 1916-1919. In the WW2 he was a senior officer of the Emergency Medical Service. Two clinical volumes of the 'Official History of the War if 1939-1945 were edited by him.
Despite his brilliance, Sir Zachary did not hesitate to use his own errors or omissions as teaching opportunities. Not an easy thing to do. The following few stanzas tell a personal story that many a physician would prefer not to publicize:
I still remember with regret,
Indeed I never could forget
What drove this lesson home to me
And now to you a guide shall be.
All day long I had been busy
And then with fatigue nigh dizzy
They called me to an urgent case
To which I went with laggard pace.
The patients pain had been severe
But when I saw her it was clear
They were much less and since she seemed
To be improving fast I deemed
Perhaps she could be left a while;
My conscience I did reconcile
By thinking that the patient's state
Might still improve if we did wait
And in the morn at any rate
We could if needful operate.
But yet I knew that she was ill
And spite of all felt doubtfull still.
So I went home and had my rest
With hopes all would be for the best.
But on the morn she was much worse
And my delay I then did curse
For at the urgent operation
I found a gastric perforation.
And so the end of my sad tale is
She came to 'exitus lethalis'. (Latin for dead.)
Two morals of this story should be starred -
When very tired be doubly on your guard,
All slackness in the surgeon should be barred.
Then, when not sure and full of hesitation
Don't wait too long before an exploration.
The lesson in this story needs no explanation but it takes a courageous surgeon to use himself as the bad example!
Much of his advice is as relevant today as it was when he gave it. For instance,
"Examine from the head and toes,
Before you dare to diagnose.
More harm is done because you do not look
Than from not knowing what is in the book."
Friday, 11 February 2022
A Memo to Me. (Written circa 1955)
I'm at the stage of life when it is necessary to start eliminating the trivia of a lifetime. Among the cards commemorating birthdays, anniversaries and certificates of all shapes and sizes and the endless albums of photographs, I came across some lecture notes from my earliest clinical years. I was always a prolific note taker so I thought I would review some of my student surgical notes to see if they were as good as I thought (things aren't always!). The notebook that I chanced upon was on abdominal surgery. As I reached the end of the topic I noted that I had scratched in a personal note to myself which read 'The Acute Abdomen in rhyme, be sure to read it. Prof says it is brilliant and hilarious!'
It was forgotten of course, until the message jumped out at me after fifty-five years. I obviously had to take prompt action. I started my search pursuing the usual channels. Secure in my knowledge that 'Mr. Google' knows everything, I typed in the name of the book and found it had been written in the forties by Sir Zachary Cope. Sir Zachary was already internationally famous for his knowledge and text book on acute abdominal surgery. It was the recognized definitive benchmark on this topic in the world. It was published continuously by Sir Z from 1947 to about 1987 and thereafter continues to be updated by a surgeon who had served as his House surgeon.
Not long after the acclaim of his book (and many other publications) Sir Zachary, who despite his protestations to the contrary was something of a poet and a humorist, began work on the book published in 1947, that was to be called "The Diagnosis of the Acute Abdomen in Rhyme". He wrote under the pen name of 'Zeta'. It is this work and its genius in maintaining scientific accuracy with his poetic humour that is fascinating.
Part of his preface goes like this:
"Well, wait and see, at least this I can state
A rhymster needs to think and concentrate,
And chose his words more carefully than those
Who oft repeat themselves in common prose.
Of course I do not claim to be a poet
And at the outset I would have you know it;
So look not for the fanciful sublime
Nor coloured metaphors in my plain rhyme;
My aim, which well may be I shall not reach
Is to amuse you while I try to teach.
So in the future when in doubt who knows?
Some couplet may help you to diagnose."
He goes on into the general principles and with extraordinary prescience in 1947 anticipates the replacement of clinical skills with technology.
This is how he puts it:
"The diagnostic problem of to - day
Has greatly changed - the change has come to stay;
We all have to confess, though with a sigh
On laboratory tests we much rely
And use too little hand and ear and eye.
We culture this, we plant out that with care,
And on the plates with hope we daily stare;
He finishes this paragraph,
"..........but now there is the danger
That student to the patient may be stranger,
And though he deal with culture-tube with ease
Forget the signs and symptoms of disease."
I couldn't have said it better myself!
More about Sir Zachary soon.
Saturday, 22 January 2022
Black Magic & White Poison.
Thursday, 20 January 2022
- a person who is opposed to vaccination, typically a parent who does not wish to vaccinate their child."experts say several diseases that are avoidable are making a comeback due to anti-vaxxers who refuse to vaccinate their kids"