Rude health: Walter and Cecil
Is there any truth to our modern caricature of demon dentists, asks Maurice Gueret, as he drills down into the relationship
The saga of Walter, the dentist with unnaturally white teeth, and the fatal cavity he inflicted on Cecil the lion filled our voyeuristic screens this summer.
The day after the story broke, I walked Dublin's great south wall to Poolbeg lighthouse. The tide was turning and two fishermen with long beach-casters were reeling in, astride the rocks. I could see their rods straining with more than just a lead weight. Within seconds of my arrival, they had each landed a catch of mackerel. The hooks were extracted and the fish were left to suffocate on open ground. I watched their final desperate struggle as they tried to flip themselves back to mother sea. It took about five minutes for the writhing of impending death to stop. It saddened me. Just a little. I turned and walked back. And wondered if the fishermen might have been callous dentists on their afternoon off.
By this time next year the world and his mother will have forgotten the names of Walter and Cecil. The bandwagon of outrage will be camping out elsewhere. But that image of a cruel and greedy big-game-hunter dentist will remain. It's not easy to explain our complicated relationship with tooth specialists. My suspicion is that its root is filled with money, pain and promises, with perhaps a splash of blood and professional jealousy for good measure. One newspaper went to Walter's home town to interview a few of his patients. He was a good family man who liked nothing more than whitening teeth and shooting a few black bears. But one former patient drilled a bit deeper. She remembered him as 'money-hungry'. When asked to explain what she meant by this, she said her family stopped attending because he would ask for money even before he began working on their teeth. I guess safari hunt organisers do the same.
Unlike doctors, most dentists have not been persuaded to take pay cheques from the State or from health insurers. Everything is extracted directly from the patient. The most famous dentist in history was a Parisian showman called 'le Grand Thomas' who plied his trade with pliers at the time of Louis XV. Thomas was a heavyweight charlatan who dressed in a scarlet coat and publicly yanked rotten teeth from passing trade on the Pont Neuf bridge. He liked to work to the accompaniment of two paid musicians, and he subsidised his dentistry by selling quack remedies in horse-size doses from a cart. A colossal molar tooth, said to have once belonged to the giant Gargantua, hung from his cart. Le Grand Thomas made grand claims and promises for everything he did. Were he alive today, he would have one of those impossibly white websites that promote modern dentistry.
We commenced our examination of the human body a couple of weeks ago and today we reach the armpit, or as the beauty industry prefers, the underarm. We medics have our own term. This oft-pungent region of the upper arm is known on your patient chart as the axilla. Anything remotely to do with it is called axillary. So if you stick a thermometer in there you are checking the axillary temperature, usually half a degree cooler than in the mouth. If your doctor requests a good feel of the roof of the armpit, she is usually palpating for little lumps called axillary nodes. Enlarged glands in this area can be a sign that your lymphatic drainage system is working overtime. The best way to find these is to raise the arm above the horizontal so that fingers can be pushed high into the skin of the armpit. The doctor will then lower the arm as she continues to palpate along the chest wall. Most of the soft borders of your armpit consists of various muscles of the shoulder and chest, but the axillary contents include loose fat, glands, blood vessels and important nerves. The surface of the armpit is a common site for annoying little skin tags. It also likes to harbour rashes, boils and abscesses. It's a landscape that's very rich in sweat glands and prone to a condition called hyperhidrosis (over-sweating) and hidradenitis (where the sweat glands get painfully infected). We will monitor your blood pressure next week.
Niall has been in touch about death certificates, namely one that he found from the late 1800s while he was doing some genealogical research on his family. Underneath "cause of death" and just above the signature of the doctor, he found the words "visitation of God". And every quack knows that's a fatal condition in any religion.
Ireland has a hard-won international reputation for political stagnation and protecting vested interests from radical ideas. It accounts for much of our dissatisfaction with public services. Our conservative near neighbours in the UK have no such qualms about discussing change. The latest radical idea from across the Irish Sea is the one that says fire services should be merged with police services. Whether it happens or not is immaterial; it's a fresh idea and worthy of consideration. The impetus behind the concept is the stark statistic that fire-fighters spend just 2pc of their working time actually fighting fires. Merging all emergency services, whether ambulance, fire, police, helicopter or military, would be no mean feat, but the advantages of having these fit, able and highly trained personnel actually working together could be enormous. And if it works, there might just be a few doctors who could sit down and work together too!
Dr Maurice Gueret is editor of the 'Irish Medical Directory'
Sunday Indo Life Magazine