Wednesday, 30 March 2022

Monet & Me!

Claude Monet & Me. 
 post-impressionism /pəʊstɪmˈprɛʃ(ə)nɪz(ə)m/ ♫ noun [mass noun] the work or style of a varied group of late 19th-century and early 20th-century artists including Van Gogh, Gauguin, and Cézanne. They reacted against the naturalism of the impressionists to explore colour, line, and form, and the emotional response of the artist, a concern which led to the development of expressionism.     Long long ago I went through a period when I fancied myself as an up and coming artist. It only lasted as long as my first few attempts, when even I could recognize a lack of any exceptional talent.  However, one of my pictures was sufficiently passable for my wife to suggest that we have it smartly framed and hung in our home. I was doubtful but she had such confidence in me that I went along with the idea. There was a fine picture framer in our neighborhood and we had some pictures framed from time to time and we were always happy with their recommendations and their work. Cut a long story short,       Betty, the owner, looked at my picture and asked , "Did you say it was his first painting ?" 
   "Yes," said Irene, "Good, isn't it? That's why I'd like to get a really nice frame for it." 
   "It's quite good for a first attempt. I wouldn't recommend spending a lot of money framing it. You could buy a very nice frame for it in one of the 'Big Box Bric a brac stores for a few dollars, that would look quite nice hanging in the basement or in a den. Custom framing is really quite expensive and I don't think you need to spend a lot of money on this." Irene told me the story and ended up saying,    "Well, I still like it. It's better than a lot of the junk you see in many of the artsy stores."  
   Being the thrifty souls we are, we ended up following Betty's advice and I found a frame in a local hobby shop that fitted my picture perfectly. Instead of throwing my work of art out, Irene hung it in the den part of our basement and there it hung for many years.       Five Years later. my office or den in our basement. was a separate room squeezed between tyke playroom and the utility area of the basement.. the kids used to frequently play in the playroom and on this particular day, as I dashed down to the office to sign off various urgent papers,I see my daughter and her little friend, both about nine years old, standing looking at two paintings side by side on the wall. One was a nice little inexpensive print of a picture by the great impressionist artist Monet and beside it was my pathetic work that even Betty the Art Framer, could not bring herself to charge invest my money in! The two girls were pensively evaluating the works of art. Unobserved, I watched them. "Oh, I like that one best," said the little girl. "Yes, I like that one best too," said the other little girl, who happened to be my daughter, dismissing the Monet. I was thrilled!             Years later. It was that stage of life when we were gathering the desiderata of a lifetime and deciding what could be dumped and what sentimental garbage the kids (middle -aged now) might be interested in keeping. As we groped our way through the boxes of toys, kids books and pictures, we tended to reassign items from the 'dump' group back into the 'keep group'. "Hey! Look what I've found here," I yelled, pulling a painting out of a cardboard box. ' It's the painting that Betty the picture framer wouldn't waste MY money framing!. I think it's pretty good now - or perhaps it's that my vision isn't what it used to be. Still, I do recall Rena and her little friend preferring my picture to Monet's." [Monet, Claude /ˈmɒneɪ/ ♫ (1840–1926), French painter. A founder member of the impressionists, his fascination with the play of light on objects led him to produce series of paintings of single subjects painted at different times of the day and under different weather conditions, such as the Water-lilies sequence (1899–1906; 1916 onwards).] Now it so happened that my daughter and her husband had just bought a new condo and high on their list of imperatives was filling those lovely walls with appropriate artistic endeavours. "When she and Bill come to visit next we'll see if she still thinks I'm better than Monet." They came to visit a few weeks later. "We have some nice pictures that I think you and Bill will really like for your walls," Irene said. "They are stored in boxes in the basement. I'll call you when dinner is ready. " "Okay," said Rena, beginning her descent into the basement. Bill followed her down an we heard no more for a while. Shortly after, we heard quite a lot of noise coming from the basement as Bill and Rena made their way back up to the living room. 'Well, did you find anything that you'd like to hang on your walls?" Irene asked. 
    "Yes we did, several things," Rena said excitedly, "but this is what we both like best like of all". They both held out the favoured picture. Here it is:   A genuine Smith!  (I note that modesty prompted me to leave it unsigned.)


And still it hangs.  For their next birthday I'm going to have it professionally framed!
 Someday I may paint another picture!!

Saturday, 12 March 2022

The Dental Fairy V The Great Barber -Surgeon -Dentist.

 





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"!

   THE SURGERY.

      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

Vaccintion Politization.

Vaccination Politization. 

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.


If you have any vaccination views - share them.

Tuesday, 15 February 2022

The Surgeon Poet.

 



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

The Acute Surgical Abdomen in Rhyme.

 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.

 Black Magic & White Poison.

Despite a lifetime of medical practice, it never grew dull. My last two patients that day, after a long day of seeing patients were enough to keep me wide awake. Not far from the teaching practice where I was working at the time was the Oneida Nation of the Thames Reservation.
Patrick , a fifty-five year old native patient, walked in at five o'clock.
"What can I do for you, Patrick ?" I asked him. I knew him quite well.
"Something is interfering with my thinking, Doc," he said.
"What do you mean?" I asked.
"Someone put a curse on me, Doc," he said.
"Tell me about it," I prompted .
" I think it was my cousin," Patrick said.
"Why would your cousin put a spell on you?" I asked.
"I think it was because he thought I was making love to his girlfriend," said Patrick
"When was this?"
"Oh, years ago. I took no notice, I didn't do anything, but he thinks I did, that's why he put the curse on me. Can you get rid of it?"
I knew that what I said next was going to determine whether Patrick was going to follow up with me or not. I took a careful psychiatric history. There were no florid psychiatric symptoms apart from the conviction that a curse had been put on him.
"Maybe I need some medication?" he asked.
"Let's just keep an eye on things for the moment," I said.
"So can you takes off curses?" he insisted.
"We will need to follow up on this." I evaded the question.
"So you can get rid of spells?"
"No, but we can get rid of your problem. I'm not going to write you a prescription right now. I'm going to see you again next week and see how you are doing."
"Okay, thanks. I'm glad you can help me."
I asked several more questions to satisfy myself that Patrick was not going to be a danger to himself or anyone else.
I walked him out to the desk to make sure he had an appointment for follow up in a few days.
"If anything changes in the meantime just come right in ." I called after him.
I breathed a sigh of relief as my last patient of the day walked in to the office.
He was about eighteen years old and had a restless, agitated demeanor. I was alerted when I read the name on the chart, because I had seen the boy's mother not very many days earlier and she had expressed some concerns about her son, Glen.
I invited him to sit him down across from me. I smiled at Glen, attempting to put him at ease but he avoided eye contact.
"What can I do for you today, Glen?" I asked him.
"I have a problem," he said, coming straight to the point. He thrust his right hand into his trousers pocket and pulled out a square tinfoil wrapper.
"I'm hooked on this and I need help to get off it," he said, with obvious agitation. "I feel so nervous all the time and I can't sleep. I lie awake most of the night sweating and twitching and I can't get up in the morning. I've been missing a lot of school."
I looked down at the discarded packet. Duragesic Transdermal Patch, This was not good news. This was Fentanyl,
"Where have you been sticking this?" I asked. A transdermal patch is applied to the skin, through which the active ingredient is absorbed. It is fifty to a hundred times more potent than morphine,
"The kids at school cut them into four and we suck them."
"This is heavy duty stuff," I said. I wanted to know where Glen had got hold of this stuff; this stuff came right out of a hospital. It sure as hell didn't come wrapped like that on the street, I'd have to find out how this was getting on to the street, but I didn't want to frighten him off by going down that street right now because I thought I was getting through to him.
"Yeah, I know. I have to do something about it,"
"I'm going to tell you what you have to do. I have to see you on a regular basis and you've got to join Narcotics Anonymous or Alcoholics Anonymous, you can't do this on your own."
Glen looked doubtful. " I think I can do this on my own, if you can just give me something to help me sleep at night."
"That's not the way it works,"I said. "Right now, you're at a crossroads in you life. If you do things the right way now, you have a chance. If you don't you're on the slippery slope to a life of addiction, detox centres, rehabilitation centres and worse. If you don't want to waste your life, you have a chance to act now."
"Okay," Glen agreed, perhaps a little too readily, I thought, "I'll do it"
I printed a list of of treatment centres near his address.
I said, "I'm going to make time to see you next week and when I do, I want to hear that you're been to an AA or a NA meeting and that you have plans to get set up with a sponsor. I'm going to give you a few pills to help you to sleep, just enough to last you until I see you next week. This is where you'll get help if you want it" I added, handing him the list.
" OK, " he said, "I'll see you next week."
I never saw him again.
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Thursday, 20 January 2022

The Bleeding Plague.

 

an·ti-vax·xer
/ˌan(t)ēˈvaksər,ˌan(t)īˈvaksər/
noun
INFORMAL
  1. 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"
Seven years ago I presciently blogged this:Anti-Vaxxers: Ignorance or Fraud.   In 1998, a British  physician named Andrew Wakefield and twelve of his colleagues published a small case series  in the Lancet, a prestigious British medical journal that suggested MMR (measles, mumps, rubella) vaccine may be  related to  autism.  MMR vaccination rates began to drop almost immediately as a result of that.  Subsequent studies  did not confirm  any such relationship. Ten of the twelve authors refuted the interpretation of the data on the basis of insufficient evidence.  Further, it emerged that Wakefield et al had failed to disclose that they had been funded by  lawyers who were engaged by the parents in legal suits against vaccine producing companies.  Ultimately, Wakefield et al were found guilty of deliberate fraud and fabrication of facts apparently for personal gain.   Wakefield was removed from the General Medical  Council of Britain's  register and was no longer permitted to practice medicine in the United Kingdom or Ireland.and emigrated to America, to lead and encourage the development of the 'Anti-Vaxxer' movement which would lead a significant group, most of whom should  have known better, back  into the dark ages.So how is it that so many allegedly educated elitists buy into this absurd theory that a measure that has done more to promote health and  eliminate devastating disease  is harmful and therefore should be avoided.  How is it that these allegedly educated dopes cannot understand that what is 'natural' often is for people to die of infection, of pneumonia and  of sepsis from an  infected finger?  Can they not understand that it was 'natural' for one  in five children to die during childbirth, along with a  goodly number of mothers?   Can they not understand that pain and suffering is natural and that it  is quite unnatural to remove those natural  warnings?  Do they not take antibiotics when infected or painkillers when in pain?  You bet they do!   Can they not understand that freezing to death is natural and that central  heating and burning of fossil fuels is unnatural?  Can they not understand heat and humidity are natural and that air conditioning is horribly unnatural?  Those poor feckless milksops are to first to cry out for those unnatural balms that they so despised, as soon as they perceive a little pain and suffering.  Of course they really do understand what it is all about.  They want to parade their ignorance as though it were knowledge.  Some believe that their unscientific and uneducated views are "equal" to  those of  scholars and scientists who have spent their lives studying those topics.   They are not, but unfortunately they can still do immense damage and enjoy some credibility, while the herd  immunity that the last generation ensured persists and offers them protection.  Fortunately,  most sensible folks protect their children, but we are likely to see more outbreaks of these once well  controlled diseases as immunity wanes. Meanwhile, the pseudo scientific simpletons will continue to consider themselves as an elite group entitled to  inflict their often ill-founded views on their fellow beings.         Dr. Wakefield and his ilk will thrive as long as they can recruit the un-informed, the misinformed, the self righteous and the gullible!