Book Review

BOOK REVIEW

THE PRINCIPLES OF DENTAL MEDICINE

And

The Medical Aspects of Dental Disease

By

F. W. Broderick, M.R.C.S. (Eng.), L.R.C.P. (Lond.), L.D.S. (Eng.)

Published by C. V. Mosby, St. Louis, Mo.

Reviewed by

E. Melville Quinby, M.R.C.S., L.R.C.P., D.M.D.

 

In reviewing Dr. Broderick’s book, Dr. Quinby has considered it of too great importance to discuss it in one article. He therefore will present a series of articles dealing with Dr. Broderick’s work.

                BIOGRAPHY

Hon. Dental Physician to the Royal Victoria and West Hants Hospital; Hon. Dental Surgeon to the national Sanatorium for Diseases of the Chest, Bournemouth; Cartwright Prizeman, Royal College of Surgeons, England, 1926, 1931.

                Before entering upon the task of a critical review of the work under notice, it may be interesting to call attention to the book titles or captions of the said work, and point out the significance thereof.

Wm. Broderick was fortunate to acquire a sound, practical training in surgery, medicine, midwifery and diseases of women, in token of which, he acquired the Conjoint Diploma of the Royal College of Physicians of London, and the Royal College of Surgeons (Eng.), and in addition took the regular course in dentistry—L. D. S. (Eng.).

With his background of education in general medicine, it is not to be wondered at that Wm. Broderick writes of “Dental Medicine,” and the “Medical Aspects of Dental Disease.”

Also please note in the list of his appointments the title Dental Physician, in one case; and Dental Surgeon, in another.

In other words—the basis of Wm. Broderick’s work is general medicine and general surgery in contra-distinction with the work of the average dental practitioner who is largely employed in the technical repair of a broken down dental machine, the breaking down being due to a want of appreciation of, and application of the physiological physical, chemical and psychological processes in the background of diseased tissue in any part of the body.

In the etiological field, bacteriology has ruled the roost for the past fifty years—since in fact, Pasteur and Lister. Many years ago, however, Sir Archibald Ganod, successor to Sir William Osler in the chair of the Regins Professorship of Medicine at Oxford University, suggested the necessity for a recognition of biochemistry as a potent factor in the determination of health or disease in mankind. Ganod is quoted—“To our chemical individuals are due our chemical merits as well as out chemical shortcomings, and it is very nearly true ta say that the factors which confer upon us our predispositions to our immunity from the various mishaps which are spoken of as diseases, are inherent in our very structure, and even in the molecular groupings which confer upon us our individualities, and which went to the making of the chromosomes from which we sprang.”

This means that disease is the reaction of the body to some insult, and that this behavior will be fundamentally the same whatever the particular insult may be. Furthermore, the response to an insult will depend upon the physiologic normal to the particular individual, and this will differ from one person to another, and will influence his response according to his individual make-up.

Many times have we wondered why A and B exhibiting similar symptoms, and treated alike have demonstrated entirely different results from the treatment.

The scientific reason for this apparent paradox is explained in “Dental Medicine,” i. e. for all who are willing to study and not be dismayed by the complexities and paradoxes (apparent) exhibited in a research connected with health or disease of Homo Sapiens.

The problems of medicine and their solution have engaged the attention of philosophers and doctors for many generations. Galen and his doctrines ruled the world of medicine for 1400 years. Until Paracelsas (1493-1541) appeared to act the part of grant killer and reach the principles of Nature’s medicine; and this because the pioneer of modern therapy which he undoubtedly was, contemporary and later critics notwithstanding.

Not yet, however, has the final chapter on etiology been written with respect to health and disease; and this new concept of dental or general medicine should be approached with a broad-minded consideration of this fact.

One should not be discouraged by a primary inability to grasp the full significance of the various hypotheses of a new and startling character, perhaps, which are advanced in this work.

This second edition of “Dental Medicine,” introduces an entirely new approach to our problem. A grasp of which demands freedom on our part from arbitrary predeterminations, prejudice or egotism.

To use the analogy of the Courts of Justice, our prisoner is innocent until proved guilty.

The fact that this new approach involves a much greater knowledge of biological chemistry than we have dreamed of, or that a recognition of the principles especially of colloidal chemistry are essential to a successful understanding of the New Deal in medicine, should be no barrier to a research on those lines.

To argue that colloidal particles in the blood serum are not the deciding factors in metabolism would for the most part, be foolish, as very few of us have ever heard of colloidal particles, and fewer still have ever seen them by means of the only instrument capable of demonstrating them, viz.—an ultra-microscope.*

In the British Dental Journal, issue of March 16, 1936, writer states “there is no doubt that with dentistry as with other special branches of medicine, there has been too great a tendency to assume that dental diseases were purely local in their causation, and that there treatment must equally be local. Wm. Broderick’s insistence that they are symptoms of a general syndrome depending on alterations in metabolism is a useful reminder that the teeth and supporting tissues as parts of the body, may react for good or ill to change the bodily state.”

The same writer calls attention to the amount of space given in the book to abstruse problems in biochemistry, and then asks—“Since the whole of his conceptions of the causation of dental caries and pyorrhea depends on the correctness of the view put forward, it is pertinent to inquire how far they have received the blessing of physiologists and chemists who possess that degree of special knowledge which can assess properly the validity or otherwise of William Broderick’s hypotheses.”

This is undoubtedly a pertinent inquiry and merits attention; but an attitude of disbelief in a theory whose background demands an understanding of chemical factors with which most of us are unacquainted does not deserve sympathetic consideration.

There are some quotations from the Prologue of this book which should be emphasized by repetition herein.

“The divorce of the practice of dentistry from that of medicine brought about by the Dental Act of 1878 (London) by which was produced the separate and distinct profession of the dentist, was perhaps justified at that time, where the art rather than science of dentistry was regarded as the more important factor. But the enormous advance of scientific medicine since that date, an advance shared to some extent by scientific dentistry, is showing the disadvantages which have accrued from the separation.

“Notwithstanding an immense amount of painstaking work undertaken during the last twenty years, we seem to be but little nearer to the solution of our problem of the true understanding of the causes of the prevalence of dental disease amongst civilized peoples.”

“I believe that the whole cause of our failure lies in two mistaken conceptions: the first of which is that dentistry can stand alone apart from medicine. . . . Thus we are attempting to treat dentistry as a particular specialty of medicine with but few or no connecting links, and secondly, the far reaching fallacy of the infallibility of the experimental research laboratory against the findings of which all clinical evidence must be weighed and found to balance.”

In commenting upon the shortcomings of specializing in practice the author says: “It would seem that the master mind of Sir James Mackenzie first grasped the weak spot in the practice of medicine, and that in his condemnation of specializing and all that this entails, there has been pointed out the road that medical science must travel towards the next and greatest step in preventive medicine: the discovery of the very origins of disease.”

The main object of this work of Broderick’s then, is to stimulate a mental orientation on the part of all health workers: too, in other words, to spend as much time in studying the anterior aspects of the problem at any rate, as is given to the posterior, or end results.

There is probably no 100 per cent therapy, but it is obvious that, if we can determine the cause of an ailment, and nip it in the bud, treatment becomes commonplace.

____

*N.B.—The writer made his first acquaintance with colloidal particles in the chemical engineering laboratory of the Massachusetts Institute of Technology in charge of Professor Hansen, a few weeks ago, after fifty years in this field.