Journal American College of Dentist
Journal American College of Dentist
Journal American College of Dentist
JOURNAL
4I,etitAm6&ye orY)4t4
Grants-in-Aid
Because of its interest in research, the Board of Regents in 1951 estab-
lished the following grant-in-aid funds:
(a) The William J. Gies Travel Fund, through which grants are made to
research workers "to enable them to visit the laboratories of other investigators
to obtain first hand information on associated problems."
(b) Research Fund for Emergencies, available for aid in the event of loss of
equipment, animal colonies, needed repair and the like.
For application or further information apply to the Secretary,
Dr. 0. W. Brandhorst, 4221 Lindell Boulevard, St. Louis 8, Missouri.
Journal American College of Dentists
Published Quarterly for General Circulation by the
American College of Dentists
CONTENTS
American Academy of the History of Dentistry 131
President's Address, William N. Hodgkin 131
The Significance of the Fauchard Manuscript, George B. Denton 136
Thomas William Parsons, Jr., Arthur H. Merritt 146
Our Recorded and Unrecorded History, E. S. Khalifah . . 150
The Research Institute of the History of Dentistry of Berlin—
Curt Proskauer 158
The Fourth Dimension of Dental Education, Willard C. Fleming,
D.D.S. 163
Calendar of Meetings 175
Ethiconomics 176
Convocation Program 178
The American Association for the Advancement of Science, Geo.
C. Paffenbarger, D.D.S. 180
Prepayment Group Dental Care, Harold J. Noyes, D.D.S., M.D. 208
Writing Award Competition 214
Sections, American College of Dentists . . 216
Copyright, 1957, by American College of Dentists
Contributing Editors
WILBUR McL. DAVIS, Orlando, Fla. (1957) ELIAS S. KHALEFAH, St. Louis, Mo. (1959)
RALPH L. IRELAND, Lincoln, Neb. (1957) J. C. ALMY HARDING, Calif. (1960)
FREDERICK H.BROPHY, New York City(1958) CHESTER V. TOSSY, Okemos, Mich. (1960)
J. MARTIN FLEMING, Raleigh, N. C. (1958) ROBERT A. COLBY, Navy (1961)
Jouw E. BUHLER, Atlanta, Ga. (1959) Wm. P. SCHOEN, JR., Chicago, Ill. (1961)
American College of Dentists
OFFICERS, 1956-1957
President Treasurer
GERALD D. TIMMONS WILLIAM N. HODGKIN
Temple University Warrenton, Va.
School of Dentistry
Philadelphia, Pa. Secretary
President-elect OTTO W.BRANDHORST
ALFRED C. YOUNG 4221 Lindell Blvd.
121 University Place St. Louis, Mo.
Pittsburgh, Pa.
Historian
Vice-President JOHN E. GURLEY
THOMAS J. HILL 350 Post St.
Brecksville, Ohio San Francisco, Calif.
Editor
ALFRED E. SEYLER
18557 East Warren Avenue
Detroit, Mich.
REGENTS
HENRY A.SWANSON S. ELLSWORTH DAVENPORT, JR.
1726 Eye St. N.W. 654 Madison Ave.
Washington, D. C. New York, N.Y.
President's Address
WILLIAM N. HODGKIN
Warrenton, Va.
More years ago than one cares to remember, a young man en-
countered in the records of present Essex County (old Rappahan-
nock), Virginia, a will probated in 1673. Ill equipped at the time
with a general comprehension of history, harboring only rosy ideas
of the sumptuous environment and grandeur of the luxury loving
FFV's as gained from many a novel and other story, and doubtless
hoping to find stimulating evidences of such luxury in his own
background, he read:
"In the name of God Amen, I, William Hodgkin, of Rappahannock in
Virginia, being bound for England and the danger of the sea to undergoe,
having my perfect sense and memory, doe make this my last will and testament,
etc."
Following this usual introductory passage, and after bequeathing
his soul to Almighty God, the testator's bequests from his temporal
estate were disappointing to say the least to the highly expectant
and poorly oriented young reader. There were, for instance, items
such as one ewe and lamb to the eldest son, one heifer to the
youngest son, a bay mare to a brother-in-law; and the sparse furni-
ture, bedding and household utensils, with the remaining estate
in Virginia, to his loving wife, Phoebe Hodgkin. About the only
sop to vanity was found in the bequest of a bay mare and colt "unto
131
132 JOURNAL AMERICAN COLLEGE OF DENTISTS
WINSLOW'S APPROBATION
The Approbation of the surgeon Winslow appears first among
the Approbations in Volume I of the published work and also first
in the manuscript. In the manuscript it appears also at the very
end of the document. Winslow was the royal censor and read
Fauchard's manuscript as part of his official duty. The handwriting
of the Approbation at the close of the manuscript appears to be
somewhat different from any other in the manuscript and was
probably written and signed by Winslow himself. Dagen has also
noticed this point and inferred that Winslow's approval was so
placed on the manuscript to give the publisher official permission
142 JOURNAL AMERICAN COLLEGE OF DENTISTS
to issue the work and safeguard him against action for unlicensed
publication. As it is dated December 8, 1727, Winslow could have
read everything in the manuscript as published, except part of
Observation 4 in Chapter XXXII, in which Fauchard refers to an
incident early in February 1728, and six of the Approbations which
were dated 1728.
DATE OF THE MANUSCRIPT
At the beginning of Chapter XXIV of Volume II, Fauchard
declared that he had been ready to publish his book in 1723. Some
commentators have conzluded that the manuscript was completed,
and without further change, was reserved until publication in 1728.
This can hardly be true, since the book contains a great deal of
material regarding circumstances which occurred after 1723 up to
early in 1728. The basic text in the hand of the copyist, however may
have been prepared earlier, and the later material may have been
added in the hand of Fauchard or a collaborator. It is interesting
to attempt to fix approximately the date when the original copyist
finished his work. A check on the dates of cases published (in
Chapters XXIII-XXXVII of Volume I) shows that the latest date
of a case written in the hand of the copyist is April 5, 1724, and
that the earliest date of a case appearing in the hand of Fauchard
or a collaborator or a second scribe is May 15, 1724. It is likely,
therefore, that the basic manuscript was completed by the scribe
shortly after the April 1724 date. It is to be noticed that the date
of Devaux's Approbation (March 29, 1724) is very close to this
latter date. A considerable amount of the manuscript, probably all
that was written after 1724, is not in the hand of the original copyist.
There is some indication that the original scribe worked on the
manuscript more than once. For instance, the number of cases
in a chapter, given in the chapter heading, will often be corrected
as many as three times, all but the final number being stricken out.
In one instance, Chapter XXXII of Volume I, the original number
of cases was two; then a third case was added in the hand of the same
scribe; and finally a fourth case in the hand ascribed to Fauchard.
The third case, it may be inferred, was added by the scribe at a
second writing, possibly between 1723 and 1724.
DEVAUX'S CONTRIBUTION
Of the many marginalia, only one appears to be a criticism of the
text. Having occasion to mention the celebrated surgeon Dionis,
the text gives a lengthy recital of the qualifications and distinc-
tions of that notable. The passage has been bracketed by the com-
mentator and in the margin he has remarked: "This should be
put in a note in order not to interrupt the continuity of the narra-
tive" (la suite du cours). This comment is certainly not a direction
to the printer, but a suggestion for the author, since the reason for
the change is stated. If Devaux, the critic, added anything to the
manuscript, this certainly would be his correction. The note is
written in an uneven hand very much like the marginal notes
at the head of each chapter indicating their proper position in
the book. These facts suggest strongly that Devaux was responsible
AMERICAN ACADEMY OF THE HISTORY OF DENTISTRY 145
for the final arrangement of chapters. It also suggests that he did
not write the chapters himself, for if he had, he would have or-
ganized them in the beginning as they were finally arranged.
SUMMARY
This preliminary study has been productive in clearing up the
following:
1. The manuscript has the complete text of Fauchard's first
edition, 1728, consisting of first and second volumes.
2. It was not a preliminary manuscript, but was the one used by
the printer.
3. The marginalia are either revisions of the text or directions
to the printer; in only one instance is there an apparent criticism
of the text.
4. Although the problem of various handwritings in the manu-
script has not been settled,
a. It is unlikely that any extended passages of the document
are in the hand of Devaux.
b. The considerable sections ascribed to Fauchard's hand are
not impeccable but they are creditable as regards correctness
and style.
c. Many of the emendations, sometimes ascribed to Devaux,
are probably in the hand of the scribe who copied most of the
work.
d. There was probably more than one copyist, one that made
additions after 1724.
e. Somebody in the printer's establishment made notes on
the manuscript, notably the signature marks.
f. Winslow's Approbation at the end of the manuscript is
probably a holograph.
5. There are some slight variants from the manuscript in the
published book.
6. The organization of the work as published is very different,
as regards arrangement of chapters within each volume, from what
it was in the manuscript before revision, and it is notably more
logical.
7. The manuscript reveals nothing that points toward substantial
collaboration by Devaux or anybody else, although of course it
does not preclude that possibility.
222 E. Superior St.
146 JOURNAL AMERICAN COLLEGE OF DENTISTS
BIBLIOGRAPHY
1. Dagen, Georges. "Etude sur le manuscrit de Fauchard." La Semaine
Dentaire 14:1230-1239, 1932.
2. Viau, George. "The Manuscript of Fauchard." Dental Cosmos 65:823-826,
1923. Also in French L'Odontologie 63:389-395, 1925.
3. Weinberger, Bernhard Wolf. "The Works of Pierre Fauchard (1678-1761)."
Section XII of his "Dental Literature; Its Origin and Development." Journal
of Dental Research 6:351-359, 1924-1926.
4. Denton, George B. "The Most Famous Dental Book." Bulletin of the
Medical Library Association 24:113-123, December, 1935.
What history is and what its objectives are have been variously
is
stated, and these range from Henry Ford's dictum that history
bunk, and Voltaire's (or is it Napoleon's?) "a fable agreed upon,"
past
to Henry Sigerist's scholarly statement that "history is the
seen through the medium of the human mind," and though it deals
with a dead past, it is never dead itself, but "one of the most power-
ful driving forces of life."1
In a sense, the study of history is part of the humanities, which
are "distinct from sciences and social sciences in being centered
r
about the meaning of life to man as an individual."2 In anothe
sense, history may be considered a great discipl ine of the social
sciences.
On the writing of history, Sigerist says that it "is a highly respon-
d
sible task. The historian must submit to the iron discipline impose
upon him by the methods of historical researc h. They set sharp
limits to his interpretations and forbid him to ascribe to an indi-
e
vidual either actions or words unless he has documentary evidenc
for them. . . . The picture he gives of the past must be true, for
or
only true history is fertile; faked history, written uncritically,
frivolously for purposes of propaganda is always destructive. . . .
of
The poet, the novelist, and the dramatist also recreate aspects
the world. They too must be true if they want to be persuas ive, but
they enjoy much more freedom than the historian. They may create
people, while the historian can only recreate them."3
Judged by these strict rules of Sigerist, our recorded dental history
ship
has not often been written critically. In fact, laxness of scholar
and of accuracy seems to find favor with some publish ers and
editors. And when critical reviews of such histories are written , they
ly
are not published. In so doing, we fool only ourselves and certain
of the rest of the world about us.
not the scholars and historians
nce
When a profession restrains and tone's down even the sembla
under
of critical analysis of so-called literature, scholarship sails
false colors, if it sails at all.
To be more specific, I have in mind a history book that was
150
AMERICAN ACADEMY OF THE HISTORY OF DENTIS
TRY 151
published some years ago.4 It was badly written, replete with
errors,
to say nothing of its complete lack of documentation. A critica
l
review of it was prepared by one whose life-work has been
history
of dentistry, and who is better qualified than most of us to evalua
te
historical material. His evaluation of this book was reject
ed for
publication. Had it been accepted and published and then heede
d,
the same gross and inexcusable errors would not have reappe
ared
in later editions of the same book.
In the most recent editions and under his picture, Arthu
r D.
Black is referred to as the contributor of an accompanying
article
on the development of operative dentistry,6 yet nowhere in
the
book could that article be located. Here, Wilhelm Konrad Röntg
en,
after the misspelling of his middle and last names,7 is said
to have
made his epochal discovery at the University of Strasbourg, while
in another chapter Wilhelm becomes William, Konrad and Röntg
en
are again misspelled, the scene of the discovery moves from
the
University of Strasbourg to the University of Wurzburg, Germa
ny,
and Wurzburg is incorrectly spelled "Wurtzberg."
Of Sir William Hunter the book says that he gave his
famous
lecture (on the role of oral sepsis) in 1910;9 somewhere else
in the
book the date becomes 1911.10
The dates for S. P. Hullihen, the so-called father of oral
surgery,
are given as 1810-1857; his medical degree is stated to
have been
acquired from the Medical Department of Washington Colleg
e at
Baltimore, whereas his dental degree is said to be honorary.11
Some-
where else in the book Hullihen becomes Hullien at least
twice,
the dates change to 1828-1895, and both degrees become honora
ry.12
The author tells the reader that Edward H. Angle remov
ed to
St. Louis in 1887; three lines farther on in the same paragr
aph the
date changes to 1895; and, as a Missourian, I object to the
spelling
of Missouri to end with "y".13
To spell Greene Vardiman Black's given name as the color
green,
and to do so repeatedly, though no sin in itself, reveals
carelessness
of authorship which is no attribute of any book.14
These are only a few of the errors which were spotted
at random,
and although some of them are not serious errors, they
all detract
from the weight of authorship which the student of dental
history
likes to attribute to his source of knowledge. Furthermor
e, without
documentation a history book becomes one of opinion.
Yet the publishers say, in a personal communication to
me, that
152 JOURNAL AMERICAN COLLEGE OF DENTISTS
for receiving this title. A large part of these theses were required
in the field of the history of dentistry. Most of them were written
under the guidance and supervision of Karl Sudhoff, the world-
famous Head of the Institute of the History of Medicine at the Uni-
versity of Leipsig, and based, without exception, on the original
texts.
Sudhoff himself had just published his excellent History of Den-
tistry in 1921, the still unsurpassed work in this field. It is indeed
regrettable that this brilliant book is not yet available in an English
translation.
Sudhoff's work and that of his students introduced a dental-his-
torical movement, the heroic age of the history of dentistry in Ger-
many, which flourished during the twenties and the beginning of the
thirties until Hitler came to power. The quantity and the quality
of these publications and some exhibitions of my collection in var-
ious cities of Germany, and in 1926 in Philadelphia, on the occasion
of the Seventh International Dental Congress, stimulated interest
of some influential men of the Reichs-verband der Zahniirzte
Deutsch lands (The German Organization of Dentists) in the history
of dentistry. The result was that in 1927 the German dental asso-
ciation took over my collection and established a Museum and a
Research Institute of the History of Dentistry of which I became
Director.
The founding of this Institute was an important step, not only in
the development of the history of dentistry, but also in the history
of dentistry. Up to that time it was a matter of individual interest
of some historically minded dental practitioner who was respon-
sible for the development of dental-historical literature and for
collecting dental-historical material.
The collection, located in the Deutsches Zahnarztehaus (German
Dentists Building), was now installed in the Billowstrasse in Berlin
in especially designed show cases. The office of a dentist of about
1820, consisting of his operating room and his laboratory, equipped,
not with replicas, but with the original old furniture, apparatus
and instruments of that time, was set up.
The Museum depicted the evolution of dentistry, from fetish,
amulet and charm worship, through worship of Apollonia,1 the
saint to whom people pray for relief from toothache, up to em-
piricism, followed later on by rational and experimental procedure.
AMERICAN ACADEMY OF THE HISTORY OF DENTISTRY 161
163
164 JOURNAL AMERICAN COLLEGE OF DENTISTS
caries much more effectively: in fact, to about the same degree that
the medical profession can control diabetes. Obviously, our next
step is toward the prevention of these conditions. This step can be
taken only through the increased knowledge of etiology. This is
synonymous with research. We need a great deal more research be-
fore we can add dental caries to the list of preventable diseases,
and prevention of periodontal disease appears to be still further in
the future.
There has been some measurable change in dental research, but
unfortunately, most of the research has come from relatively few
schools and institutions, one can point with pride to the research
on fluorosis of the teeth and to the increased productivity of the re-
search reports in our journals and at our meetings, but as one ex-
amines the dental curriculum, one cannot help but wonder what
measurable effect this has had on the dental faculties and the dental
courses of instruction.
We have come to realize with awful clarity that we are lacking
not only in research, but particularly in the manpower to perform
it; and even given the manpower to perform the research, we are
lacking the teaching faculty to apply it. Our dental faculties are
largely populated with clinical dentists, the majority of whom pos-
sess unusually fine clinical competence. However, most of these men
have little basic science preparation or a window-front dressing
which is old and fly-specked through disuse. Here and there, of
course, one sees an exception, yet the highlight cast by these excep-
tions only emphasizes their rarity. The realization of this important
shortcoming has resulted in a great and frenzied quest for qualified
research people and teachers. All sorts of schemes have been de-
veloped: the Yale Plan, the Harvard Plan, the Rochester, Zoller,
Guggenheim and other graduate and postgraduate programs, includ-
ing the Army, Navy and Air Force graduate and residency plans.
And recently the U. S. Public Health service has begun to emphasize
teaching programs and training centers.
There is no doubt that during these fifty years dentistry has come
to occupy a shoulder-to-shoulder relationship with the other health
sciences, the calibre of the dentist and the dental student has greatly
improved due to the expansion of educational requirements and to
our increased stature through public acceptance of the dental pro-
fession.
This is all progress of which we can be and are proud, but if we
THE FOURTH DIMENSION OF DENTAL EDUCATION 169
cies. The student performs almost isolated from the rest of the world
by the pressure of his course requirements. The emphasis is still on
the attainment of skills with the newer knowledge being sandwiched
in here and there.
If dental education is going to assume its part in providing the
necessary manpower requirements, it is going to have to do some
self-analysis and initiate certain fundamental changes. This is going
to be very difficult (one thinks of, but hesitates to use the word "im-
possible"), because these changes will affect all the other segments of
the dental profession, and will necessitate a change in the "follow-
the-leader" attitudes we seem to have adopted in recent years. It
may mean that our greatest need in the future will be to break with
the traditional dictums of today's leaders, and one is tempted to par-
aphrase Winsor's "Space-Child's Mother Goose":
Little Bo-Peep has lost her sheep
And Univac Computer has failed to find them,
But, they will meet face to face
In fourth dimensional space,
Preceding their leaders behind them.
voted down, but its need soon became so obvious that it has finally
been approved. In fact, it was only a few months ago that the
American Dental Association announced that, together with the
Rockefeller Brothers Fund and the Hill Family Foundation, it is
supplementing the Kellogg Foundation Grant of a quarter of a mil-
lion dollars and other grants to make this total survey possible.
If dentistry is to catch up with the rest of the world around us,
our first and most important objective must be to provide the dental
manpower to meet the demand for dental service in the years ahead.
Undoubtedly, that segment of the profession dealing with dental
education will be a most important part of the over-all survey, be-
cause it is the schools that provide the source of dental manpower.
What can we anticipate from such a detailed survey of the dental
curriculum—a survey which it is hoped will correlate the objectives
of dental education and the profession within the always moveable
framework of an ever-changing society? One thing we can hope for
is that it will not be the curriculum survey of the thirties brought
up to date with the publication of a "Revised Red Book," with
neatly prescribed courses, and the implication of a "One and Only"
program. The curriculum survey of the thirties was an admirable
contribution; in fact, on a par with the Gies Report of the twenties.
However,since the thirties, dental education has grown past the state
of "Father Knows Best."
Great latitude should be allowed and educational experimenta-
tion encouraged, not frowned upon and actually opposed as it has
been in the past. Attempts to standardize and force into patterns
should be avoided. Practically all of the schools are integral parts of
universities and can be trusted to embark on legitimate programs.
Prescription of predental subjects should be liberalized. For ex-
ample, physics may be dropped in some schools and the humanities
emphasized. It must be clear that we cannot inject a dental student
with even a fraction of the new knowledge. Therefore, in his prepro-
fessional years, should we not prepare the student to find his way
around in the Land of Knowledge, stimulate his intellectual curios-
ity, and provide him with methods of obtaining information and
with habits of learning that will give him a liberal approach to his
professional education?
Selection of students must be reappraised. We have rather good
measuring devices today to identify the student who has promise of
developing as a competent practitioner, but little or no way of iden-
172 JOURNAL AMERICAN COLLEGE OF DENTISTS
than 300 students. Theoretically, this school would have the space
and facilities for a student body of 400 and would be able to admit
graduate classes of 133, or an increase in its output by one-third.
Obviously, there are practical problems such as staffing, size of class-
rooms, the special facilities of the clinical years, loss of student
summer employment, to say nothing of the uprooting of old habits
and traditions.
This is not offered as anything like a final solution, but is present-
ed as an example of the type of thinking which will be essential to
the ultimate solution of the manpower problem: a willingness
to break with tradition if necessary and to experiment in the
field of administration as freely as we know we must in the science
laboratories.
In conclusion, let us again think of those airplanes rushing
through four dimensional space, and let us admit that there are fast-
er planes from which dentistry's plane seems slightly off course, but
let it be pointed out that the occupants of that small aircraft started
the correction of their readings when they decided on the over-all
survey of dentistry. It is my belief that we, as dentists, have faced up
to solving the problem of relating dentistry and dental education
to the world around us. We have come to the realization that if
we do not, non-dentists will do it for us, and history has shown
that when problems are solved by legislatures it is only the quanti-
tative aspects that are solved. We are strongly aware that the people
granted us, through licensure, a monopoly to practice dentistry
and for this expect us to produce competent dentists and to render
good dental service. This we have done and are doing. Further than
this, the people expect us to provide leadership and guidance in
the field of our competency. This we recognize, even though it
leads us out of the present dimensions of practice. We know that
the members of a profession must be concerned with the total wel-
fare of the people, not a segment—particularly our own segment.
When we think of ourselves only as a profession with isolated
problems to be solved, it is three dimensional thinking. When we
think of ourselves in relation to the world around us, we are ap-
proaching fourth dimensional thinking, even if this means "preced-
ing our leaders behind us."
CALENDAR OF
MEETINGS
CONVOCATIONS
BOARD OF REGENTS
175
Ethiconomics
EDITORIAL
PROGRAM
MORNING MEETING, 9:00 A.M.
Pompeian Room, Eden Roc Hotel
INVOCATION
EXECUTIVE SESSION
Minutes
Report of the Secretary
Otto W. Brandhorst, St. Louis, Mo.
Report of the Treasurer
William N. Hodgkin, Warrenton, Va.
President's Address
Gerald D. Timmons, Philadelphia, Pa.
Report of the Necrology Committee
Coleman T. Brown, Tampa, Fla.
Report of the Nominating Committee
Willard C. Fleming, San Francisco, Calif.
Indoctrination
Jay H. Eshleman, Philadelphia, Pa.
THE PROGRAM
PANEL DISCUSSION
TOPIC: "CONTINUING EDUCATIONAL EFFORTS AND OPPORTUNITIES FOR
PROFESSIONAL ADVANCEMENT"
PARTICIPANTS:
"THE PHILOSOPHY OF THE PROFESSION IN THE SHARING OF KNOWLEDGE AND
THE BASIC PRINCIPLES TO BE CONSIDERED IN A CONTINUING EDUCATIONAL
PROGRAM"
Cyril F. Strife, D.D.S., New York, N. Y.
Chairman, Committee on Continuing Educational Effort
"THE NEED FOR CONTINUING EDUCATIONAL EFFORT BY THE PROFESSIONAL
MAN AND OPPORTUNITIES AVAILABLE"
Philip E. Blackerby, Jr., D.D.S., Battle Creek, Mich.
Chairman, Committee on Education
"CONTINUING EDUCATIONAL OPPORTUNITIES AT THE UNIVERSITY OR DENTAL
SCHOOL LEVEL"
Francis J. Conley, D.D.S., Los Angeles, Calif.
Vice Chairman, Committee on Education
178
CONVOCATION PROGRAM 179
"OPPORTUNITIES THROUGH STUDY CLUBS, SEMINARS, ETC."
George W. Redpath, D.D.S., Portland, Ore.
Vice Chairman, Committee on Continuing Educational Effort
"SCIENTIFIC LECTURE PROGRAMS: THEIR CONTRIBUTION TO CONTINUING
EDUCATIONAL EFFORT"
Charles S. Kurz, D.D.S., Carlyle, Ill.
Chairman, Council on Scientific Session, American Dental
Association
"THE PREDOMINANT ROLE OF LITERATURE"
Thomas F. McBride, D.D.S., Columbus, Ohio
Chairman, Committee on Journalism
GENERAL DISCUSSION
(Doctors Strife and Blackerby will also act as moderators of this discussion)
ABSTRACT
2. Vertigo Attributable to Mandibular
Joint-Dental Bite Abnormalities
Herbert T. Kelly
Graduate School of Medicine
University of Pennsylvania
And David J. Goodfriend
Philadelphia, Pa.
Anatomical, histological, x-ray and clinical data show the patho-
genic effect of mandibular joint abnormalities upon the ear and
the role they play in the etiology of vertigo. The differential diag-
nosis of mandibular joint-dental bite abnormalities, methods for
their correction, and the criteria of these corrective procedures
in the treatment of vertigo are discussed.
ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE 183
This work follows a previous study by one of the authors (DJG)
which was reported in the Archives of Otolaryngology of July,
1947. This previous study showed a high statistical correlation
between mandibular joint abnormalities and certain symptoms of
which vertigo and neuralgia occurred most frequently; and were
the most responsive to the correction of mandibular joint-dental
bite abnormalities.
The problem of vertigo is broad and complex. Medical literature
shows that vertigo may be caused by innumerable diseases including
those of the ears and eyes, brain tumors, and abscesses, meningeal
involvements, infections, arteriosclerosis, cardiovascular diseases, and
many others; as well as by abnormalities of the mandibular joint.
The purposes of this present work included determination of the
statistical incidence of the mandibular joint cause of vertigo in
medical practice, and of the effectiveness of dental procedures in
the treatment of vertigo. All patients of the Medical Department
of the Urologic Clinic of Philadelphia were studied during a period
of three years. Of about 600 patients observed, 65, or about 10 per
cent had case histories of a group of symptoms which we classified
as vertigo. These symptoms included light-headedness, lateral walk-
ing, disturbances of equilibrium with change of posture, slight
to severe dizziness, nausea, vomiting, and clouding and complete
loss of consciousness. Of the sixty-five patients with these symptoms,
sixty-three had mandibular joint abnormalities and dental bite
defects which were suspected to be factors in the etiology of their
vertigo. Fifty-four patients cooperated in accepting treatment of
their mandibular joint-dental bite abnormalities. Fifty-two or 96.8
per cent of the 54 patients were relieved of their vertigo symptoms
to the extent that indicated that mandibular joint abnormality
was the primary cause of their vertigo.
These included many who had been treated medically for many
years without permanent relief of their vertigo symptoms. One
had suffered with these symptoms for over 20 years and had sub-
mitted to two cranial operations. Another had retired from an
important executive position because his condition was aggravated
by a seeming fusion of voices which came from different directions
of the conference table. The third had been diagnosed as one who
suffered from altiphobia and claustrophobia. Her vertigo symptoms
made her fearful of steps. As a result, she was reluctant to travel.
The most serious cases were those where vertigo resulted in a
184 JOURNAL AMERICAN COLLEGE OF DENTISTS
Symposium: Part I
II. A.M. Session. The Human Dentition in Forensic
Medicine
Geo. C. Paffenbarger, presiding
I 5. Insulinase-Inhibitors
Arthur Mirsky
Department of Clinical Science
School of Medicine, University of Pittsburgh
Pittsburgh, Pa.
The destruction of insulin in vitro and in vivo is dependent
upon the action of an enzyme system, insulinase, which is relatively
specific in catalyzing the hydrolysis of insulin. This system is in-
hibited irreversibly in vitro by Cu, Zn, Hg, iodoacetate, p-chlo-
romercuribenzoate and a large number of other sulfhydryl poisons.
In contrast, with the irreversible non-specific inhibitors of insulinase
is the competitive type of inhibition produced by an hepatic factor.
The hepatic factor appears to be a small peptide and is effective in
enhancing the hypoglycemic action of insulin in the rat. Similar
ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE 199
insulinase-inhibitory activity is exerted by three hour acid hy-
drolysates of a variety of proteins. Studies of such hydrolysates led to
the observation that L-tryptophan inhibits the destruction of insulin
by the intact mouse. The oral administration of L-tryptophan pro-
duces a significant hypoglycemia in the normal but not in the severe-
ly diabetic rat. Studies of various metabolic derivatives of L-tryp-
tophan revealed that a similar insulinase-inhibitory and hypoglycem-
ic action is produced by anthranilic acid, niacin, nicotinuric acid,
indole-3-acetic acid, 5-hydroxytryptophan and 5-hydroxytryptamine.
Since indole-3-acetic acid is a natural plant growth regulator and
since the other effective compounds fulfill some of the known struc-
tural requirements for plant growth regulatory activity, the in-
sulinase-inhibitory and hypoglycemic action of other plant growth
regulators were studied. Nearly all known synthetic plant growth
regulators were found to act as did indole-3-acetic acid. Studies with
man revealed that indole-3-acetic acid produces a small but signif-
icant hypoglycemia in normal subjects and a more marked hypo-
glycemic response in patients who developed diabetes mellitus after
40 years of age. These studies support the hypothesis that in the
majority of instances, diabetes mellitus in man is due to an increase
in the destruction of endogenous insulin consequent to a decrease
in the synthesis of an insulinase-inhibitor.
sue has been polarized, the methods used to educate the public have
been inadequate. The major approach has been to dismiss the op-
position to fluoridation as "crackpot," and to rely on the prestige of
scientific authorities.
That this approach is inadequate was demonstrated in the city
of Northampton, Mass., in which a referendum on fluoridation was
held, and in which the issue was defeated by a two to one vote. The
writer carried out two public opinion polls; one before the refer-
endum, the other a year after it. The first of these polls, in which the
results of the referendum were predicted accurately, found that by
and large, those people who voted for fluoridation had accepted the
authority of the scientists who were for it. Those people who voted
against fluoridation were unwilling to accept this authority. It was
found also that the bulk of the opposition was concentrated among
older, less well educated individuals in working class and middle
class circles, especially among people without children. Those for
fluoridation were primarily younger, better educated, middle-class
and professional people with young children.
The second survey attempted a more comprehensive study of the
psychological processes back of opposition to or acceptance of flu-
oridation. In this poll, the respondents in the sample were asked to
indicate why they had voted for or against the measure. Those in-
dividuals who were for fluoridation mentioned most often that it
was "good for people," and that "authorities are for it." Only ten
per cent had any clear idea of the reasons for its adoption. In-
dividuals who were against the measure most frequently gave as
their reasons, their opinion that the measure was ineffective or un-
necessary, that it was harmful, that authorities were against it, and
that it violated individual rights or tampered with nature.
Among the voters for fluoridation, those who had higher educa-
tional levels more frequently mentioned the fact that "authorities
were for it." Those with less education more frequently had a clearer
idea of the benefits to be derived from the procedure. Apparently,
the few less well educated people who were for fluoridation were
those who had really been convinced of its merits.
The conclusions to be drawn from these findings can be applied
both to an understanding of the specific problem of the acceptance
of fluoridation and to the broader question of education in the sci-
ences. For the former, certain conclusions are possible. Firstly, the
proponents of the measure should have stressed a clearer under-
ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE 205
standing of the issues. In the main, neither those who accepted flu-
oridation in Northampton, nor those who rejected it really under-
stood what it was about. Secondly, it seemed to be an inadequate
device to dismiss the opposition to fluoridation as "crackpot" or ir-
rational. Only a minority was willing to accept this point of view.
There are some general implications in this study for education
in the sciences. The reactions of better educated people in North-
ampton indicated that on the whole, they were either unwilling or
unable to make the effort to follow the sense of the issue. Their
reaction was primarily based on their acceptance or rejection of the
bona fides of the authorities involved. Certainly, there were failures
in the education of these people. What conclusions can we make on
the basis of these failures? Firstly, that the present attempt to teach
the substance of the sciences to all well educated citizens so that the
actual bases for such decisions can more clearly understood is cer-
tainly laudable. However, something more is needed. Apparently,
many individuals must at some point in their lives resign from the
necessity for following the content of issues. Therefore, it is neces-
sary that we, as educators, develop clear-cut criteria as to the accept-
ance or rejection of expertness.
The second report, given in a joint session of AAAS Section Q
(Education) and the American Educational Research Association,
follows:
NOTICE
The National Opinion Research Center of the Uni-
versity of Chicago, at the request of the American Col-
lege of Dentists, and in cooperation with the Walter
G. Zoller Memorial Dental Clinic, is currently engaged
in a study of procedures and problems of dental prac-
tice. Personal interviews with a nationwide sample of
active, practising dentists are now being conducted.
Results of the study, which will be useful to the entire
dental profession will be made generally available in
summary terms toward the end of the year. The main
interest of the study is in the procedures and problems
of dental practice, including their preventive aspects.
Prepayment Group Dental
Care Programs*
HAROLD J. NOYES, D.D.S., M.D.
Portland, Oregon
* Presented before the Texas Section of The American College of Dentists, Mineral
Wells, Texas, December 8, 1956.
208
PREPAYMENT GROUP DENTAL CARE PROGRAMS 209
manner of rendering dental care may be classified into three cate-
gories.
Open Panel in which there is complete freedom of choice of
dentist.
Partial or Limited Open Panel. Here the choice of dentist may be
limited to practitioners having certain qualifications, such as being
members of the A.D.A., state and local societies or those having
agreed to accept patients under the plan.
Closed Panel. In this circumstance there is no choice of dentists or
at most it is extremely limited.
I. Group Dental Health Care Programs, Council on Dental Health, A.D.A. 1955.
PREPAYMENT GROUP DENTAL CARE PROGRAMS 211
aesthetic dental restorations. The amount was to include overhead
and nonprofessional expense not to exceed 8%. In both Oregon
and Washington the union member originally had a choice between
the state dental service and indemnity plan conducted by the same
company as that operating in California except that the total limit
of service was $95.00 and the fee schedule was that accepted for
dentists on the open panel program. There were certain other insur-
ance benefits identical with the California plan.'
OREGON DENTAL SERVICE AND THE ILWU-PMA WELFARE FUND
In the pilot program, representing the first year of operation, there
were 1666 children enrolled and of this number 1260 or 76% visited
a dentist. About 85 children reached their 15th birthday in the pilot
period and a little less than half of them did not see a dentist regis-
tered with the Oregon Dental Service. A total of 243 dentists received
$75,897.00.
There have been certain changes in the program for the current
year, July 1, 1956 to June 30, 1957, as might be expected due to the
relative increase in participating children who have benefited by
complete dental care and are now on a maintenance basis. For new
children in the program the Welfare Fund pays $80.00. This also
applies to children who have not been seen by a dentist for 12
months. However, for children who are on a maintenance or follow-
up basis, an annual amount of $45.00 is paid and this applies to
children transferred from areas where another service agency, indem-
nity program or closed panel has been responsible for their care.
A distinct difference in the current program is that because of lack
of interest in the indemnity plan it was discontinued. This is true
in Washington as well. In these two states only the dental service
program is in operation.
STATISTICS
In the state of Oregon a survey of union children indicated that
the average cost of services excluding the items that the Welfare
Fund felt they could not afford was $92.00. Actually, the estimates
of dentists fell short of this amount $58.68, yet the actual billing was
very close to estimate $59.82. One reason for this discrepancy be-
tween the survey figure and cost realized was the overestimate of the
1. Group Dental Health Care Programs, Council on Dental Health, A.D.A. 1955.
212 JOURNAL AMERICAN COLLEGE OF DENTISTS