Monday 19 February 2018

Rude Health: Nation of doctors

The most dangerous medic may be the one who advertises, says Maurice Gueret, who also has a new use for loo roll

A humble toilet roll helped detect pneumonia
A humble toilet roll helped detect pneumonia
Dr Maurice Gueret

A favourite aunt knows that her scribbling nephew likes to collect newspaper clippings. Last month, she sent me a newspaper full of them. Not just any old journal. I received a complete copy of The Nation dating from Saturday, October 17, 1857.

The plume of ma tante Violette goes back a long way indeed. The Nation was the creation of Young Irelanders, Charles Gavan Duffy, Thomas Davis and John Blake Dillon. Its young Catholic and Protestant proprietors wanted to make Ireland a real nation, free from the slightest taint of bigotry. In this, they failed gallantly, but their newspaper gave many doctors a chance to advertise their wares.

Guarantee for every cure

In those days, headlines were relegated to newspaper innards. The front page was exclusively for advertisements. A Dr Curtin promoted himself as the consulting physician at the Hydropathic Establishment (water cures) in Monkstown, Co Cork. He specialised in the cure of diseases to which medicine ceased to give relief, and described his clinic's locality as the Montpelier of Ireland, with salubrity of air and cheerfulness of scenery. Then there was Dr Day of 15 Westland Row. I recognised this address, as it was also once the home and surgery of Dr William Wilde, father of Oscar. Dr Day offered private and confidential treatment of patients whose cases have been "badly treated, neglected or deemed incurable". His fee was ten shillings (the price of 26 newspapers) which, in today's terms, would be in the region of €75. Not bad for a member of the Royal College of Surgeons in both London and Paris. Dr Day consulted every day from 9am to 9pm, and also did a 9am-2pm clinic on Sundays. He gave a guarantee for every cure. Which helps explain why there are severe restrictions on what doctors can advertise these days.


Archbishop Desmond Tutu was asked if he had any regrets. He had just one. It arose whenever he saw a man with a stethoscope. He wanted a career in medicine, but family circumstances blocked his path. I learned of this fact from an award-winning essay on stethoscopes by retired GP Dr Suresh Patek. The doctor was spurred to write the loving piece on hearing that his favourite diagnostic instrument may soon become obsolete, passed over by some class of ultrasonic device. Dr Patek loved the stethoscope so much, he reckons that he purchased a dozen in his lifetime. The original was invented in a Parisian hospital by a Dr Rene Laennec. Stories of them abound among doctors. Some have used them to elicit knee jerks when there is no hammer around. Dr Patek remembers a story from the 1978 World Cup in Argentina when an ailing journalist asked a holidaying British doctor to examine his chest. There was no stethoscope around, so the doctor improvised by stripping a toilet roll of paper and using the tube to make a diagnosis of pneumonia. When the doctor returned to England, he found the story in every newspaper and his surgery full of toilet rolls.

Nitrous oxide

The perils of holidaying in France are well aired each summer. One might be forgiven for thinking it's a plot to keep us all dolphin-spotting in drizzly Dingle. Ferry visitors are asked to keep their cars in sight at all time so that refugees don't take the place of suitcases in the car boot. And the latest scare from the land of Gaul are these anaesthetist burglars who fill your lodgings with sleeping gas and rifle your pockets. The story began in the camper-van vents of holiday halting sites, but it has now spread to the air-conditioning systems of luxury Riviera villas. Last month it was alleged that a Formula 1 driver was the victim of a nitrous oxide attack, in which a £250,000 engagement ring was pinched from his wife. But cold water has been poured on this story by the Royal College of Anaesthetists, who can sniff out real gases from a load of hot air. Nitrous oxide, once known as laughing gas, is a very weak anaesthetic. It's usually mixed half- and-half with oxygen to provide pain relief without losing consciousness, and would be well known as Entonox to sensitive dental patients and mothers labouring in childbirth. The dose of nitrous oxide needed to render someone unconscious is very large indeed, and not the sort of thing that is easily pumped into any sort of sleeping quarters. If you spot a gas tanker the size of a cruise ship outside your mobile home, then it's time to get worried. But until then, just ease up on the red wine.

Clinical journey

Our ongoing clinical journey around the human body continues this week with a peek inside the mouth. Now, I have a confession to make. Most doctors are ignorant of matters pertaining to teeth. It's not our fault. Teeth are barely acknowledged in medical schools, in case students get the idea that they could live a more comfortable and uncomplicated life by switching to dentistry. Doctors do lay claim to the tongue, which I will cover next week, but this week we'll have a look at the back of the throat. Put your head back, open wide and say 'aah'. This simple command raises your palate and, with a good light source allows a good view of the tonsils, the finger-like uvula, the boneless soft palate, and anything lurking beneath your arches, which we call your fauces. The views of your interior can be improved by depressing the tongue with a wooden lollipop stick. We are trained to see ulcers, swellings, redness, blisters, tumours, holes, bruises, pus, big tonsils, membranes, mucous and our favourite, slough. But mostly we see nothing much at all.

Dr Maurice Gueret is editor of the 'Irish Medical Directory'

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