Diathesis as a Factor

Dental Disease: A Reflection of Systemic Unbalance

Dr. F. W. Broderick discusses

“DIATHESIS AS A FACTOR IN THE ETIOLOGY OF DISEASE” Part II

 

                We have seen that the two essential results of colloidal disequilibrium, other than the changes in metabolism, are those of a precipitation of hydrated colloidal particles, and changes in the amount of the plasma constituents which they will be able to hold to the colloidal complex. All the symptoms of disease are traceable to these circumstances. Naturally the position in which these precipitations will come about, and the size of the capillaries which will be blocked by them, will not be a matter of chance but will depend upon certain physiological details. McDonagh believes that these are associated with the differences in vascularity of the different tissues and organs. That where the hydration is most pronounced and of the most stable kind the precipitation and nervous tissues, in the heart and kidneys. In the next degree this will be in the skin, the joints, and in the female generative organs; where it is least, in the lungs, and between these two in the organs of the portal system. Where the plasma constituents are in the greatest quantity will be where dehydration is the prevailing feature.

If, then, we consider diseases of these various parts, and add them to our ladder to which we have already attached the dental lesions, we find something like this. In the uppermost rungs we get pyorrhea without gingivitis associated with cerebro-cardio-renal disease; pyorrhea with gingivitis alone, or with dental caries, associated with disease of the portal system; and caries alone or with gingivitis with those conditions which depend upon dehydration and a loss of adsorptive power, such, for instance, as diabetes pernicious anemia, and rickets. I do not think that members of either of our professions will quarrel much with this relationship. But note the association of general and dental lesions here is one of a common origin, not that of cause and effect through sepsis, as is the most usually accepted idea: and this I believe to be the almost constant relation of dental and general troubles. Even in those cases of frank focal sepsis, which are comparatively rare, I deny that the former are caused by the latter. The organisms present in the periapical tissue are most often nothing but simple saprophytes, such as are present in every mouth, which have migrated to the periapical area through the open pulp chamber, and only rarely do these become parasites, and even them simply on account of vegetative disturbance, which was the cause of the original caries which brought about the death of the pulp. The general diseases also rest upon the same foundation, which is that which has produced the suitable soil for the change from saprophyte to parasite. I have no time to develop this argument, but I believe that it follows as a logical conclusion from this visualization of the cause of both dental and general disease.

I should like to say just a few words here upon the problem of the development of what I have called end-points of disease, in which we who are thinking along the lines sketched out in this paper are less interested than you who are called upon to treat them, because you have been unable to recognize the steps by which they were brought about, or to take steps at a time for their prevention when this was possible. I have said that the defensive mechanism of the body lies in the state of the colloidal particles of the blood plasma; these constitute the dynamic particles, in that they are in the circulation and travel around the body, coming into intimate contact with all the cells and organs of the tissues, which are themselves composed of matter in the colloidal state. Now if these particles suffer dehydration or hydration in the manner described, whether the consequence of an invasion of microorganisms or of chemical poisons, their condensing powers will be affected, and when they meet the colloidal particles of the organs and tissues, the static particles again a state of colloidal disequilibrium, will be set up. Once more the more condensed will rob the less condensed of electrons and tend to drive them into solution. Hence will come about changes in organs and tissues of which the changes in the vascular system will be the most important; dehydrated dynamic particles will hydrate the static particles and vice versa. According as to which of these come about, and according to the chronicity or acuteness of the conditions, so will depend the effects upon the organs attacked. The initial action of hydration of static particles will be to bring about an inertia of the organ affected; of a dehydration an increased activity and degeneration (fibrosis). Continued hydration will bring about a fibrosis of the mesanthymatous tissue, and a hypertrophy of the parenchyma; a mixture of hydration and dehydration will produce inflammatory changes. Thus we are able to see how are produced, for example, a parenchymatous nephritis as the result of an acute infection, or a chronic interstitial nephritis by a long continued chemical intoxication; why alcoholics and syphilitics get cirrhotic livers, and why diabetes attacks a certain type of individual, who will be immune from malignant disease. Remembering always that the constitutional, inherent, diathesis of the individual will act, so to speak, by setting the stepping-off place from which the strains and stresses of life commence to act; the sympathetic type suffering more from the acute infections in that they start with colloidal particles more dehydrated, and the parasympathetic type more prone to the effects of chronic intoxications from the fact that they are, by constitution, more hydrated. In the same way we have the explanation why one individual is a caries susceptible, and another immune; and why the former will escape pyorrhea in later life, whereas the latter will fall a victim.

Here, also, we have the explanation why it is that in certain families the prevailing diseases will be those of the cardio-renal system, and in another those of the skin or joints, and the allergic conditions, whereas in a third these are of the portal system or the lungs. We see from this conception of the nature of disease why it is that fundamentally such diverse conditions as dental caries and pyorrhea, hyper and hypochlorhydria, chronic nasal catarrh and mucous colitis, gastric and duodenal ulcers, all forms of chronic arthritis, menstrual disturbances, chronic appendicitis and cholecystitis, all depend upon the same circumstances. We see the connection between anesthetic accidents, such as vomiting and convulsions, and those related to the toxemias of pregnancy, pernicious vomiting and eclampsia; how insulin shock is related to all forms of coma; and why urticarial and seborrhea are not essentially skin diseases, nor glaucoma and cataract diseases of the eye; we get even a possible suggestion as to the real cause of malignant disease. Well may McDonagh propound the dictum that “there is only one disease, and that colloidal disequilibrium.”

Earlier in this paper I said that there was one seeming exception to the doctrine that dental caries was not the product of an acidosis, that it occurred only in one type of individual. There is undoubtedly another type which is prone to develop caries, exemplified by the athletic school boy of 17 or 18, which, when investigated by me does not give the figures of an acidosis, in fact in many cases would seem to tend the other way. This worried me considerably until I found that in almost every instance these presented figures which suggested a state of hypochlorhydria. Now hypochlorhydria profoundly affects the assimilation of the salts of calcium, in that these can only be absorbed in an acid medium. In these cases, therefore, there may well be a calcium starvation. In considering the matter of calcium metabolism in its relation to the causation of dental caries we are up against a difficulty; we have seen that calcium stimulates the sympathetic side of acid formation through increased katabolism; it would seem, therefore, that calcium therapy is contraindicated in caries prevention. On the other hand sufficient calcium is obviously needed in the saliva to provide calcium ions for ionization, for enamel hypercalcification after eruption. I suggest that there is an optimum amount necessary for tooth preservation: below this caries may come about through a calcium starvation, or pyorrhea, if this be less extreme, through an alternation in the calcium-potassium ratio, with an increase in potassium, stimulating the parasympathetic, whereas calcium excess will stimulate the sympathetic and be productive of caries. This definitely contraindicates calcium therapy in caries prevention. Where the calcium starvation is due to a diminished calcium intake, which must be a somewhat rare occurrence, this is better supplied in the form of milk, where calcium salts are provided in an easily assimilation rather than to a deficiency in the diet, giving more calcium will not help matters in that it will all be excreted in the feces. And where the amount both ingested and assimilated is good giving more will rather tend to produce caries than prevent it. There is just one other possibility, viz., that although calcium is assimilated, it is utilized for the wrong purpose, e.g. to neutralize an acidosis; in these cases it will be better to give some simple alkali, such as sodium bicarbonate, which is more easily assimilated than calcium salts, for neutralization purposes, when calcium will take care of itself. Calcium therapy should be reserved for the prevention of pyorrhea.

I should like to round off this paper with a few words on the action of drugs. If diseases, and the consequences of disease, are brought about fundamentally by disturbances of vegetative balance, then treatment must be directed to regaining this balance. If the main factor in vegetative imbalance is colloidal disequilibrium the effects of drugs which improve the patients’ condition must be through the changes brought about in the affected micellae. This would seem to be the case. Whether we are utilizing simple preparations such acids or alkalies, or the salts of calcium, pharmacological preparations such as digitalis or morphia, organo-therapeutic substances, or the more complicated drugs with which the organic chemist are now supplying us in such in such great variety, the effect of all appears to be primarily upon the colloidal state. Acids and alkalies dehydrate and hydrate respectively. The cations of the calcium salts are essentially dehydrators. Digitalis, for example, acts by breaking up the masses of hydrated particles which have become precipitated in the heart; thyroid and adrenal extracts, according to McDonagh, are the normal dehydrators of the body, the latter acting rapidly, the former more slowly; if the action of these be studied it will be seen that this is indeed the case. Insulin, on the other hand, he believes to be the normal hydrator. When we remember that hydration increases the adsorptive properties of the colloidal micellae, through which they are enabled to draw more of the constituents from the blood plasma, we see the administration of insulin can bring about a hypoglycemia. Its action is not, in fact, essentially upon blood sugar at all, but only incidentally. The explanation of the action of the parathyroid hormone on calcium metabolism is similar. If these were provided simply to regulate the metabolism of carbohydrate and of calcium it would appear natural to expect other hormones to regulate that of the other constituents, which is hardly possible. As upholding this suggestion I should like to mention some experiments of my own. I use insulin in certain cases of rampant caries in non-diabetic children. As a result of the injection of small quantities daily, not only is there a very great increase in the alkalinity of the saliva, reaching in some instances as high as pH 8.4, in one or two days, but I have been able to bring bout, by this means, the clinical entity of “arrested caries” in the short space of three weeks, a condition in which the exposed dentine hypercalcifies and becomes as hard as stone, and quite resistant to decay. As to how far this method can be utilized as a routine procedure I do not wish to discuss in this paper, but insulin is now being used for a number of non-diabetic conditions, particularly in Germany, in all of which there is an acidosis element.

With regard to chemotherapy and the use of complicated synthetic drugs we are perhaps delving rather deeply for a meeting such as this. Sufficient perhaps to say that since Ehrlich’s discovery of arsenobenzene (“606”) this method of treatment has made great strides, and a large number of useful drugs had been upon the market. Some of these I use continually in my practice for the prevention of dental lesions, and incidentally in the treatment of other conditions associated therewith. These have very complicated formulas, and depend for their action upon the release, within the body, of electrons which will alter the oxidation-reduction potential, as this is now conceived by the chemico-physicists. Their effect, therefore, must be physical rather than chemical, and, as such, upon the colloidal state. It is suggested even that the action of the vitamins is not by virtue of their chemical composition, but physically upon the colloidal particles, some acting as dehydrators, others as hydrators. Vitamin D, for example, hydrating, and vitamin C dehydrating. If you will think this out, along the lines of this paper, you will see that the symptoms of the various vitamin deficiencies might well be brought about through colloidal disequilibrium.

Of the psychological factor in disease I will only say that it seems to me that the vegetative system alone can provide the links between psychological disturbances, such as those of the emotions, repressions, and conflicts, and the physical changes which may be brought about through the medium of an altered chemistry. If I have seemed to be too dogmatic, believe that this was unavoidable when dealing with so vast a subject in the available. If I have carried along too fast blame my enthusiasm, for I truly believe that here we have a conception which is destined to revolutionize the practice of medicine, and to make possible, at last, the prevention of dental disease. I conclude with a quotation from the writing of Professor Schade: “The physic-chemical investigation of the human body extends far beyond the cellular-pathological conception of Virchow. As in all branches of biology, medicine, thanks to the quickening influence of colloidal chemistry, is on the verge of a new era. Medical research has broken a new road for itself in still another direction: instead of the earlier humoral pathology which explained all disease upon a basis of disturbance of the ‘humors,’ there arose, as a consequence of the development of a microscopic technique, a cellular pathology, according to which the cell was regarded as an entity controlled by its own laws, whose independent behavior was etiologically determinative. Now behind the cell we find the micellae as part of a colloidal system. Everywhere in the body, in the cells, in the intracellular tissue, in the blood, and in the body fluids, are found colloids, practically every process bears the imprint of their individuality. Striking new results of far-reaching importance have led a not inconsiderable number of physicians to believe that in colloidal research lies the key to profound penetration into the mysteries of etiology. The vivification of medicine by colloidal chemistry justifies us in calling this a new era.”