NOTICE BOARD PERSPECTIVE


By Dr Ivor Felstein, Retired Consultant Geriatrician


Fame, fortune and arthritis


IT is not an unreasonable assumption that arthritic problems have been with the human race from the beginning, certainly since men and women became truly upright and mobile. One of my earliest memories of my


Scottish family seniors was of several aunts and uncles applying various lotions and creams to knees, feet, necks, shoulders and wrists. Less reachable areas required the help of the local district nurse (when available) or caring friends and family. They also tried pain killers, of which aspirin was the most popular and later codeine as a close second. Heat, in the form of rubber or


stone hot-water bottles or warmed cloth pads, was likewise popular to essentially the same purpose: the relief of ache and stiffness in the joints and muscles. Initially the benefits of controlled exercise were not considered at all. Gradually however, the input of physiotherapists was acknowledged and approved. Hospitals saw the growth of physiotherapy departments with experts and appropriate apparatus serving inpatient and outpatients, as well as orthopaedic day patients and the elderly medicine and day hospital blocks. I recall that when I was about age 11


or 12 there lived in our Glasgow flats a widowed senior lady, herself a retired nurse. She stayed with her daughter (also a nurse) and claimed that “all her joints” were arthritic. She would send me to the local pharmacist to buy “methylated spirits” for her. Her intent, she explained to me, was applying it to her joints as an external rub. I was happy to help her. I did not appreciate until many years on that she also drank the stuff. In my medical student days in the


early 1950s, one of the better known arthritis experts in the UK was Frank Dudley Hart. As I recall, Hart wrote the first modern encyclopaedia of arthritis which he described as his “pocketbook of arthritis” – a modest title. Arthritis features in a range of unlikely conditions. I recall travelling to Connecticut in the USA some years ago during an outbreak of “tick arthritis” around the town of Lyme – now known far and wide for its tick connection through the condition Lyme disease. Some drugs can initiate an arthritis complaint. For example, in the years before penicillin, we used sulpha drugs. A presumed allergy to these occasionally provoked allergic arthritis. In earlier centuries, the former


apothecaries and barber surgeons spoke of “rheumatics”, a more vague term which included problems of muscle, ligament, cartilage, skin, bone and even emotional upsets! The old English word “rheum” originally meant “catarrh” (though I recall the translation being rhubarb in Greek,


rather inexplicably). Again in the 1950s and earlier in my childhood days there was the fleeting and flitting arthritis with high temperature described (and feared) as rheumatic fever. The anxiety came from the risk that after the joints settled, one in three patients developed persistent heart valve and heart muscle problems. Thankfully cases in the west fell significantly after the 1960s, probably due to the widespread use of antibiotics. So what about famous arthritis


sufferers? The doctor, Thomas Addison, gave his name to several illnesses. He suffered from depression as well as rheumatoid arthritis but had no answer to what ailed him. Even so he helped establish the fame of Guy’s Hospital and himself. The brilliant writer George Orwell suffered back pains as well as arthritis in his wrists. This did not stop his completing his classic bestseller, 1984. Another modern writer, Joseph Heller of Catch 22 fame, also suffered from arthritis. Among outstanding film stars and


entertainers with arthritis, I recall James Coburn retiring because of rheumatoid arthritis. There was also Lucille Ball, Rosalind Russell, Edith Piaf and Kathleen Turner. Sammy Davis Jr, singer, actor and tap dancer later became restricted by bilateral joint complaints yet still managed some public appearances to demonstrate his former brilliance on the dance floor. No doubt this helped his


mobility too.


practise investigations. Proper examination and good record


keeping are essential. Says Rachael Bell: “The only defence to a claim made following delayed diagnosis is if adequate examination of the patient was made, backed up with proper notes in the


dental record. “Where there is an allegation of failure


to diagnose an oral malignancy, we would be looking for notes in the records of an extra-oral examination, soft tissues being examined and the findings – even if the findings are that the tissues are healthy.


The notes also need to reflect whether smoking cessation and alcohol-related advice has been given and what was said. If there is any doubt about an intraoral lesion then refer early, keep a copy of any referral letter and any response from maxillofacial services.”


suitable CE-marked alternative. For more details go to www.tinyurl.com/d9vk3c5 ● DELIVERING DIGNITY GRANTS The Queens Nursing Institute Scotland (QNIS) is to fund nurse-led quality


WINTER 2013


improvement projects from 2013- 2015. Grants of up to £10,000 will be awarded to projects “carrying out or implementing new research into practice in community settings in Scotland”. Community settings are defined as places where older


people live – at home, in care homes or community hospitals. To find out more visit www.qnis.org.uk ● ATTENTION 1963 GLASGOW DENTAL GRADUATES A Golden Anniversary Reunion is being


planned for University of Glasgow Class of 1963 BDS graduates on 11 and 12 June, 2013. If you graduated from Glasgow in 1963, or know someone who did - please Contact Richard Day on rm.day@ virgin.net or 0141 942 3182 .


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