A benevolent dentist

BEING A RETIRED dentist, I could not resist viewing a special exhibition held at the Museum of Freemasonry in Freemasons Hall in London’s Queen Street near Covent Garden. As a curious Londoner, visiting an exhibition in this imposing building had an additional attraction: a chance to see inside an edifice I have walked past many times, always wondering about it without ever entering it. I was alerted to the special exhibition by a message from a friend in Bombay, who keeps a close eye on current cultural events both in Bombay and London. She thought that this show would interest me because it is about the activities of a dentist, Bartolomeo (also known as ‘Bartholomew’) Ruspini (1728-1813).

Born near Bergamo in northern Italy, son of a minor member of the aristocracy, Ruspini was recognised as a surgeon by The College of Physical Sciences in Bergamo in 1758. He decided to specialise in dentistry and to further his skills, he travelled to Paris, which was then recognised for its training in this field. In those days, dentistry was not a recognised profession as it is nowadays. Most people who had dental problems, sought the assistance of hairdressers, blacksmiths, and others without any professional training. To distinguish himself from these untrained people, he called himself a ‘surgeon dentist’(https://en.wikipedia.org/wiki/Bartholomew_Ruspini). Today, the people, whom you might call ‘dentists’ are in fact ‘dental surgeons’.  I was qualified to practise dentistry, and one of my dental degrees was ‘Batchelor in Dental Surgery’.

Ruspini arrived in England by May 1752. He married his first wife, Elizabeth Stiles, in 1757, five years before he was accepted as a member of The Burning Bush Lodge of the Freemasons in Bristol. Later, Ruspini went on to establish several new Freemasons lodges (https://rmsghistoryextra.wordpress.com/tag/elizabeth-orde/).  By 1766, he was practising in London under the patronage of the mother of King George III. He had already treated royalty, so great was his reputation as a healer of dental problems.  His acceptance into high society was no doubt facilitated by his renunciation of Roman Catholicism and his second marriage, in 1767, by which time his first wife had died, to Elizabeth Orde. The couple were to produce nine children, five of whom survived infancy. Two of his sons became surgeon dentists.

In an England, which was then not particularly friendly to foreigners, Ruspini was accepted well because of his good nature, excellent clinical skills, and great ability to get on well with people and to ‘network’ in high society. He was highly regarded as a Freemason. His skills on the dance floor, delight in display, and flamboyant character made him a wonderful masonic master of ceremonies. In keeping with the ideals of Freemasonry, Ruspini exhibited much benevolence: hospitality, generosity, kindness, and charity. An example of the latter was his important involvement in the founding of the Royal Masonic School for Girls (in 1788).

Ruspini had his main residence at 32 Pall Mall in London, but also visited Bath frequently. He was famed for his patented styptic, a substance that stemmed haemorrhage. He also created a dentifrice as well as an elixir for easing toothache.

In 1768, Ruspini published the first edition of his “Treatise on Teeth”. I found a copy of its eighth edition whilst searching online. The book is well-written and easy to read and, in many places, not too out of date. It would do first-year dental students no harm to read this informative book, well at least as far as the sections on “The Disorders of the Teeth”.  This section has become somewhat dated, but not altogether so. For example, the author advises that disorders might arise from:

“… any particles of food that stick between the teeth and putrify … the excessive use of smoking and chewing tobacco … sugar, when used immoderately, is another enemy of the Teeth … All mineral exhalations are also very pernicious, as we see by daily experience in all those persons who work in any of the quicksilver, lead, or copper mines etc…”

Of the causes of caries (tooth decay), Ruspini gives several, but does not mention sugar in connection with this common problem, despite what he wrote in the quote above. However, he did consider that sugar was important in another disorder:

“Children who eat too much sugar, or sweetmeats, generally have their gums corroded; confectioners and chemists are subject to this disorder …”

Although much can be criticised as being out of date in his book, Ruspini did a wonderful job of describing concisely and clearly what was known about dental anatomy and pathology in his time. Part of the book is dedicated to clinical case studies. One of these concerned:

“…Captain Nelson, of the Royal Navy, whom I accidentally met at Portsmouth…”

Ruspini cured him of a painful fleshy growth in his mouth, which other surgeons had wrongly diagnosed as syphilitic.

The book ends with adverts promoting Ruspini’s styptic balsam, elixir, and dentifrice powder. A copy of this book and another about his styptic are on display at the special exhibition in the beautiful library at Freemasons Hall. Other exhibits included documents, drawings, cartoons, and a few other objects. For me the great thing about the exhibition was not its contents but introducing to me a truly remarkable member of my profession.

Members of the public visiting Freemasons Hall in Queen Street are encouraged to see the magnificent collection of items and documents relating to freemasonry before seeing the exhibition dedicated to Ruspini. The museum contains a rich variety of exhibits, many of them displaying the Freemasons’ passion for the use of symbols, and most of them objects of great beauty. Not knowing anything about Freemasonry, this first visit to the museum was for me more a dazzling visual experience than a learning opportunity. On a subsequent visit, I hope to spend much more time examining the artefacts and their informative labels.

The Freemasons Hall is a ‘larger-than-life’, exuberant work of architecture and construction. It is the headquarters of the United Grand Lodge of England as well as the Supreme Grand Chapter of Royal Masons of England. The present building was designed by the architects Henry Victor Ashley (1872-1945) and Francis Winton Newman (1878-1953). It was built between 1927 and 1933 to commemorate the 3,225 Freemasons who died whilst on active service in WW1. Some say that the building is art-deco in style. This is the case, but there are also many elements in the design suggestive of a modern version of neo-classicism.

I am grateful to my friend in Bombay for introducing me to Ruspini and by doing so, giving me a reason to visit the remarkable London headquarters of the Freemasons.

Extracting the truth

EXTRACTING TEETH IS still a significant part of the job of a dentist.

When I qualified as a dentist in 1982, I joined the practice in Rainham (Kent) run by Julian U. He was a generally competent dentist and very skilful when it came to extracting teeth. If, as it happened from time to time, I was having difficulty removing a tooth, he would come into my surgery to apply his skill and experience to the problem at hand. Whenever he did this, he would work on the offending tooth, but would stop when he knew I would be able to complete the operation.

Julian could have easily finished the job himself, but he left it to me to do this for a good reason. He knew that if I removed the tooth, the patient would believe that it was my skill that contributed to the successful conclusion of the operation and therefore would not lose confidence in me.

Later in the day, after the patient had left, Julian would explain to me why I  had had difficulties and how to avoid repeating the problem. He was a great mentor as I began my career in dentistry.

The NHS used to pay a standard fee for an extraction. If an extraction proved to be particularly difficult, involving bone removal for example, the practitioner could write to the NHS explaining why the operation was not simple and enclosing a radiograph (xray image) of the tooth in question. In these cases, the NHS used to pay a larger fee than the standard one.

On one occasion when I had not taken a radiograph prior to an extraction because I  had assumed it would be simple, the operation proved to be very difficult. After completing it, I  applied for the supplementary fee but did not receive it because I  had not submitted a preoperative radiograph.  I was furious not only because I had not been adequately remunerated for my effort but also because my word had been doubted.

Some months later,  a distressed couple brought their infant to my surgery. The child had chewed on a keyring and it had got stuck between two teeth. Carefully, I cut through the ring and thereby removed it from the kid’s teeth.

Still smarting from my failure to convince the NHS that my extraction of a few months earlier was truly difficult, I  wrote up my keyring removal and applied for a fee for this unusual procedure.  I explained that neither had I taken a radiograph (because it was unnecessary) nor was I  able to send them any evidence, such as the remains of the keyring because the parents had wanted to keep them. I waited patiently for the NHS to reply, which they did. To my great surprise,  they believed my story without me sending any evidence and paid me a decent fee. Nowadays, it would be unwise to perform any extraction without having taken a preoperative radiograph. This is not for the purposes of seeking enhanced remuneration but to protect the practitioner should the patient decide to make a complaint against the dentist. Sad to say, but by the time I retired, preventive dentistry acquired a new meaning. In addition to preventing dental disease in patients, it has also come to mean preventing the dentist from litigation and defending him or her when malpractice is alleged.

The saint and her teeth

SAINT APOLLONIA WAS born in the 2nd century AD. She was one of a group of virgin martyrs who was killed in 249 AD during an uprising against the Christians in the Egyptian city of Alexandria. Prior to being murdered, she was tortured by having her teeth pulled out and damaged. Since then she has been regarded as the patron saint of dentistry and those suffering from toothache and other dental problems.

St Apollonia by M Landy

When I was a dental student back in the early 1980s, I did some research with a view to writing an article about Apollonia for the dental school’s journal. While carrying out my investigations, I came across an article (I cannot remember where) which described a sacred relic, one of Saint Apollonia’s teeth, which is held in a church somewhere in northern France. I cannot recall where this tooth resides, but I have not forgotten something that was written about relics in general in that article. That is, according to the writer, one of the miraculous properties of sacred relics is that they can self-replicate.

Since working on that unfinished article, I have hardly given Saint Apollonia a moment’s consideration until today when we visited an exhibition based around the works of the German artist Lucas Cranach the Elder (1472-1553). This wonderful exhibition is being held at Compton Verney, a fine old house built 1714 in Warwickshire and set in gardens very capably designed by Lancelot ‘Capability’ Brown (c1716-1783), until the 3rd of January 2021.

One of the rooms of the exhibition is devoted to works of art inspired by Lucas Cranach the Elder. Two such works by Pablo Picasso are on display alongside various other fabulous modern artworks by slightly less well-known artists. One of these pieces is a mechanised sculpture by Michael Landy (born 1963). This was inspired by the depiction of St Apollonia in a painting by Cranach which is held in London’s National Gallery. In Cranach’s work, Apollonia, dressed in a long, pleated dress coloured red, stands beside St Genevieve (martyred in what is now France), dressed in green.

Landy has created a wooden sculpture, a three-dimensional version of what appears in Cranach’s painting. In the latter, Apollonia is depicted with her hands clasped together around the long handles of a pair of pliers whose beaks are wrapped around an extracted tooth. Landy’s three-dimensional version, which is about twelve feet high, looks remarkably similar to Cranach’s. A foot pedal is attached to the sculpture by a cable. When a viewer presses the pedal, Apollonia’s hands move the pliers towards her mouth and then fall back again. It appears as if she has just pulled out her tooth. I wonder what Cranach would have thought about this rather gory adaptation of his original image.

You have now been warned. If you are a dental phobic and happen to visit this marvellous exhibition, do not, I repeat, do not press that pedal beside Landy’s sculpture. Also, try not to miss visiting this superbly curated show.

Long lasting

A bunch of flowers

Brings endless happiness

And plenty of  good cheer

 

Back in the early 1990s when I was practising as a dentist in Kent and owned a house in Gillingham, my future wife and I visited the local superstore, the Savacentre. Its name has nothing to do with the River Sava that meets the River Danube near Belgrade in Serbia. The shopping mall in Kent is pronounced “saver-centre”.

We wanted to buy some flowers and approached a florist within one of the wide corridors of the mall. He had some blooms of a kind we had never noticed before. We asked him what they were, and his answer sounded like “owlstromeriya”.

We bought a bunch of these attractive flowers and asked him how long we should expect them to survive in a vase. He answered:
“No worries there. They’re good lasters.”

And, he was right.

Alstroemeria, or Lily of the Incas, are native to South America but I guess many of those on sale in the UK are grown elsewhere.

Why I use an Android

android

A wise old friend of mine, Margaret, told me that once when holidaying in rural Greece, she developed an excrutiating toothache. Wary of trusting her teeth to ‘any old dentist’, she decided to go into the nearest town and visiting the local bank manager. She reasoned that the bank manager probably consulted one of the better dentists in the town. So, she visited the manager’s dentist, and was not disappointed.

Once, Margaret told me how she chose a new washing machine. She asked the repairman, who came to service her machine, which models he had to repair most and which caused least trouble. Based on this information, she chose her new appliance.

A decade or more later, I decided to acquire a ‘smart phone’ to replace my unsmart device. The choice was broadly between an iPhone and an Android phone, such as a Samsung model.

Remembering my old friend, who had been dead for several years, I consulted the man who ran a mobile telephone repair shop near where I used to work. I asked him which kind of ‘phone he had to repair most often. Quick as a flash, he said:

“iPhones.”

When I asked him why, he replied that the screens on Samsung models needed replacing less often than those on Androids.  That was enough for me to decide on buying a Samsung.

I have had several models of Samsung ‘smartphones’ since my first. Now, I am using an S8, which has a superb camera.

I am pleased I adopted Margaret’s method of decision making.

Annoying and rude

During the last few years that I practised dentistry, most of my patients brought mobile telephones into my surgery.

You would be surprised how many patients tried to answer their ‘phones when my fingers were in their mouths or their mouths were filled with impression (mold taking) material.

Worse still, were patients who were ‘texting’ constantly when I was trying to explain their treatment options to them.

Once, a patient arrived late, speaking on his mobile phone. He muttered to me that he was in the middle of a telephone job interview. I had no choice, but to let him continue. After half an hour, he told me he was ready for me. I told him that he had wasted my time and his appointment and had to book another one.

In the end, I put up a large sign in my surgery forbidding the use of mobile phones, which was rude and inconsiderate. This solved the problem because, to my surprise, most people obeyed it.

Bad hair day

hair

When I began practising as a dentist, I worked in a small town in north Kent. My working week stated on Monday afternoons. So, Monday morning was available for me to do whatever I wanted. I used to have my regular haircuts on Monday mornings at a barber shop owned by Dave. He often cut my hair and always did a good job.

One Monday morning, I entered Dave’s establishment and as Dave was not around I had my hair trimmed by a young lady. She did a good job but handled my head roughly. She knocked my head around as if it were one of those balls that boxers use for training. I am exaggerating a bit, but there is no denying that having this lady cutting my hair was a stressful experience.

Some hours later, I rang Dave to tell him about my recent visit to his shop. I wanted him to know that if his assistant persisted in treating customers the way she did to me, he would lose business. Dave apologised, and then told me that his young lady had had a bd weekend, a row with her boyfriend. 

I suppose that Monday was what people call a ‘bad hair day’ for me.

 

Bad hair day: a bad day a day with many problems, annoyances, etc. (https://www.merriam-webster.com/dictionary/bad%20hair%20day)

Healing hand

hand

 

In the UK, dentists cannot refuse to treat patients who admit to having serious illnesses such as AIDS (HIV). Dentists are supposed to have taken precautions to protect their patients, their nursing staff, and themselves against the risks of spreading disease by cross-infection. However, human nature being as it is, some dentists fear catching diseaes from their patients despite adhering to the appropriate requisites to prevent cross-infection. Irrationally, they try to ‘palm off ‘ patients whose medical conditions they fear by referring them to dental hospitals and specialist clinics. This is unfair to the patients who are forced to wait for long periods to be seen at these referral places for ‘specialist’ treatment that they do not actually need. I was not one of these over cautious fear-filled dentists. I treated everyone whatever their medical status.

I have treated many patients who have been infected with AIDS and other worrying illnesses such as Hepatitis B and C. I followed cross-infection guidelines and treated them no differently than I did for other patients. 

Many, but by no means all, of my patients were grateful for whatever I had done to deal with thier dental problems. Some of them, but not all of them, used to shake my hand and the end of an appointment or of a course of treatment. I appreciated that. What I noticed over the years was that the patients most likely to shake my hand were those who had been diagnosed with AIDS. I had the feeling that they were really grateful that I was prepared to touch their mouths without making a fuss about, or showing any fear of about their undoubtedly serious medical condition. The AIDS patients seemed to appreciate that I did not treat them as pariahs.

Art and science

ART AND SCIENCE

 

From my childhood until I qualified as a dentist in 1982, aged 30, I drew and painted a great deal. Creating pictures was one of my favourite pastimes. In the late 1970s when I was already studying to become a dentist, I joined a weekly print-making class. It was held in the West Hampstead studio of my mother’s cousin, the etcher/engraver Dolf Rieser (1898-1983; see: https://dolfrieser.com/biography/ ). 

The image above is from an etching that I created in Dolf’s studio. It is a composition inspired by electron micography of intra-cellular structures. At the time I created it, I had just finished a PhD in a biological subject and was studying biology that was considered necessary to qualify as a dentist.  Interestingly, Dolf had also studied biology (genetics) in his youth, receiving a doctorate in the subject. He took to artistic pursuits after completing his studies in biology. Later in his life he wrote a book called “Art and Science” (published in 1972 by Studio Vista). Dolf was an inspiring teacher with a great understanding of compositional technique.

In 1982, I began practising as a dentist. It goes without saying that a dentist’s work involves a great deal of use of the hands and fingers. All day long, five days a week, I was doing the fiddly kind of things with my hands and fingers. Prior to qualification as a dentist, I had used my hands and fingers to create often complex images (drawings, paintings, etchings, and copper engravings). I found that my urge to create images diminished rapidly after I began practising dentistry. I suppose that the clinical activities satisfied my need to employ my manual dexterity in other ways. Sadly, now that I am retired I have not (yet) gone back to creating images. Now my fingers are kept busy at the keyboard, creating books and blog articles.

Head to toes

It's raining again_240

 

This patient of mine was a local school teacher. An educated person, you would imagine.

One rainy afternoon he sat on my dental chair. Then, I reclined it so that he was lying almost horizontal: his head and mouth at one end of the chair and his feet at least five and a half feet from his mouth. I administered the local anaesthetic, waited for anaesthesia to become established, and then repaired the teacher’s decayed molar tooth with a silver amalgam ‘filling’. When the procedure was over, the teacher left my surgery apparently quite content.

An hour or so later, the teacher returned to our practice and asked the receptionist to allow him to speak to me. He entered my surgery and pointed to a mark on one of his brown suede shoes.

“I believe that you must have dropped some of your chemicals on my shoe while you were treating me,” he said.

I looked at the mark and quickly realised that this fellow was hoping to be compensated, possibly for a sufficient to buy a new pair of shoes.

“Unlikely,” I replied, “while I was treating you, you were lying horizontally. Your mouth was a long way from your feet. If I had dropped something, it would not have fallen anywhere near your feet.”

“Mmmmh,” he replied.

“Furthermore,” I added, “it’s been raining heavily all afternoon. Maybe, you picked up that mark while walking along the wet streets.”

The teacher left, and I heard no more about the problem with his footwear. I was left thinking what an unintelligent man he was, and that somebody had qualified as being capable of teaching young people.