The Dental Problem and Preventive Medicine

By SIR GEORGE NEWMAN, M.D.
It is a strange and arresting fact that though the recorded history of medicine covers more than 6,000 years it is only n the last three or four hundred years that mankind has learned the elements of the scientific art of preventing disease. The great pestilences of the ancient world swept over the human family uncontrolled. The scourges of leprosy, plague, typhus, cholera, malaria, scurvy and smallpox have been banished from this country, and, speaking generally, we only suffer them when we choose not to prevent them. Yet in former times they have slain millions in these islands and changed the course of our national history. Man is slowly becoming, with strict limitations, master of his fate. He has discovered or invented means by which, though he cannot abolish death, he can, if he will, lengthen his days and increase their capacity and enjoyment. As he learns the causes of disease and its course he can contrive rational and scientific methods of restricting or defeating it. In this way even his ordinary diseases may be avoided or prevented –oral sepsis and certain forms of anaemia and toxaemia are coming under control, and typhoid, tuberculosis, rickets, diphtheria, scarlet fever and syphilis show marked decline in morbidity and mortality.
When we ask ourselves how all this has come about, we find that, though some of it is due to profound biological influences, most of it is owing to the interpretation and application of new knowledge and of the inventions and discoveries of man’s mind, which have made brilliant and unique the age in which we live. For instance, during the last hundred years anaesthesia, the communal use of Jennerian vaccination, the constancy of the internal environment of man’s body (Claude Bernard), antiseptic surgery (Lister), the disclosures of bacteriology from 1870-1910 (Pasteur and others), the meaning and course of the process of infection (Koch), the parasitology of tropical diseases (Manson), chemotherapy (Ehrlich), the X-ray (Rontgen), and radiology (Becquerel and Curie) have all been revealed, established and applied. Nor must we forget the tremendous influence of the beginnings of the development and control of the food supply, of public water supplies, of daylight saving, of industrial welfare, and of all the manifold spheres of sanitation. These discoveries and inventions

Causes of Dental Disease
It has long been known that the predisposing cause of dental defect in civilized countries in all classes is to be found in the dietary, and the exciting cause in bacterial and chemical action. In 1906 and 1907 Parliament enacted two measures, for the public feeding of school children and for their medical inspection and treatment. This legislation was held at the time to be “socialistic” and revolutionary. But it came none too soon. It received at first only a tardy acquiescence, but now an enlightened public opinion not only fully accepts such measures in principle, but demands their extension and ever wider application.
In 1904 there appeared the epoch-making Report of the Committee on Physical Deterioration (appointed by the Lord President of the Privy Council), which set out in vivid form the social and physical conditions of the people of this country thirty years ago –overcrowding, alcoholism, malnutrition, poor dietary, lack of cleanliness, improvidence and ignorance, venereal disease, tuberculosis, insanity, dental disease, and mental defect. It was a sorry and miserable story. We have been the happy witnesses of an immense improvement all round, attributable in no small degree to enlightened reform legislation and to a better educated, better fed, better clothed, better housed, and more sober population.
Malnutrition Exists
But the nutrition problem remains and is crucial in relation to dental caries. A year or two ago it was widely stated that even now, thirty years later, actual “malnutrition” (which means a morbid state of long-standing under-nutrition and emaciation, with underweight of body) was both prevalent and increasing. But it was found that this proposition could not, on the evidence available, be sustained. For it is common knowledge that today “malnutrition” is neither generally prevalent nor increasing. Obviously one cannot have widespread malnutrition among a whole people at the same time as a steadily falling sickness rate and death rate of nutritional diseases and a rapidly rising standard of health. One has only to look at the people to observe the great improvement in their physique and health as compared with