The Monthly Review of Dental Surgery The Journal of the British Dental Association No. VIII. October, 1880. Vol. I.
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THE MONTHLY REVIEW
THE JOURNAL OF THE BRITISH DENTAL ASSOCIATION
|No. VIII.||OCTOBER, 1880.||Vol. I.|
The subjects rightly embraced in a Medical education,and the degree and manner in which those subjects shouldbe respectively studied, have been freely discussed inmany places during the last few weeks. Dr. MichaelFoster in an “Address in Physiology,” of unsurpassedinterest, contends without contradiction that no medicalsubject—now that the entrance upon medical studies ispreceded by a tested preliminary education—need bestudied as heretofore as a mere mental training, andproposes that topographical anatomy, which has hithertobeen so studied, should, to a certain extent, give way infavour of a more complete knowledge of physiology. Theaddress must, and no doubt will, be read by all interestedin medical education, whether general or special. Thefollowing quotation will answer our present purpose:—
1. Address in Physiology, delivered at the Annual Meeting of theBritish Medical Association, 1880.—Published in British Medical Journal,August 21st, 1880.
“I think I am not overstating the case when I say that, in the twoyears (or less than two years) which the medical student devotes tostudies other than clinical, 60 or 70 per cent. of his time—in somecases even more—is spent on the study of topographical anatomy. Thatstudy may be regarded in two lights—as a discipline, and as practicaluseful knowledge. The late Dr. Parkes, in a remarkable introductory466address which he delivered at University College, London, many yearsago, insisted most strongly that its value as a discipline was far higherand more precious than its direct utility; and I imagine that the moreone reflects on the matter, the more clearly this will appear. Thedetails of topographical anatomy have this peculiar feature, that, thoughthey can only be learnt with infinite pains and labour, unlike otherthings hard to learn, they vanish and flee away with the greatest ease.I would confidently appeal to my audience of practical men, how muchof the huge mass of minute facts, which in their youth they gatheredwith so much toil, remained fresh in their minds two years after theypassed the portals of the College; and how much now remains to thembeyond a general view of the parts of the human frame, and a somewhatmore special knowledge of particular regions, their acquaintance withwhich has been maintained by more or less frequent operations. I wouldconfidently ask them what is the ratio, in terms of money or any othervalue, which the time spent in those early anatomical struggles—sayover the details of the forearm—bears to the amount of that knowledgeremaining after twenty, or ten, or even five years of active practice, orto the actual use to which that knowledge has been put.
“No, it is as a discipline, and not for its practical utility, that anatomyhas been so useful; and this, indeed, may frequently be recognised inthe questions set at examinations. When the candidate is expected todescribe, within the error of a few millimètres, the structures traversedby a bayonet thrust obliquely through the neck, or is invited to reproducewritten photographs no less exact of the parts which, from skin toskin, underlie a triangle or quadrangle drawn in ink on the front or backof the thigh, it is clear that the examiner has in view, not the needs ofpractical life, but an easy means of testing the proficiency of the studentin mnemonic gymnastics. Of the value of anatomy as a discipline, therecan be no doubt. In past years, it has served as the chief culture ofthe medical student—as the chief means by which the rough materialcoming up to our great medical schools were trained to habits ofaccuracy, of exactness, of patient careful observation; and theirmemories strengthened by exercise for the subsequent strain whichwould have to be put upon them by more strictly professional learning.In this aspect, the very sterility of the subject was a virtue. Themere fact that the separate details seemed to hang loosely, isolated inmental space, held together by no theory, by no ideas, inasmuch as itmade the learning a harder task, increased its disciplinary value. Mostwisely did the leaders of our profession insist that no trouble orexpense should be spared to afford the neophyte this preparatoryscientific training; and that, as far as examinations and the like can go,no pains should be spared to compel him to avail himself of the opportunitiesoffered. Indeed, viewed as a branch of education, the machineryof anatomical instruction has for many years past not been equalledby any.”
467Professor Burdon-Sanderson in his introductory lecture,says,—
“The precious years which immediately precede a man’s entry onprofessional duty, are far too valuable to be wasted in learning anythinghe does not intend to retain.”—British Medical Journal, October 9th,1880.
The observations of these most distinguishing physiologistsand teachers, support the view which has been takenrespecting the education of the Dental Surgeon, from thetime the College of Surgeons was in 1857 asked to establisha Dental department, up to the determination of the Dentalcurriculum by the Medical Council in 1879.
An education equal in degree, but different in kind tothat of the General Surgeon—an education which embracesa knowledge of the general principles of Medicine andSurgery, and a special, precise, and practical knowledgeof Dental Surgery, was asked and given, the degree ofeducation progressing as the attendant circumstancesallowed, up to its present advanced condition.
The place assigned by Dr. Michael Foster to topographicalAnatomy in Medical education, will certainlyhold good in the education of the Dental Surgeon. Physiologyand Chemistry, subjects now inseparable and ofsurpassing interest, are equally necessary to the Specialand General Surgeon.
The position of Medicine and Surgery is not quiteparallel. The general principles of each must bethoroughly known, but it is not necessary that the DentalSurgeon should be practically acquainted with all thedetails that pertain to any other branch of either than thatwhich he selects to practice. It is not needful that heshould become a skilful midwife or oculist, or that he shouldbe skilled in the treatment in any other class of diseasesthan those to the treatment of which he proposes to devotehis life. For if he does acquire such detailed knowledge,468it will, when no longer used, “fade like a raindrop upon aporous stone,” and the time devoted to the acquisition willhave been wasted, and, perhaps, worse even than wasted,for the subject may have been studied at the cost of neglectof the practical study of his speciality. It does not admitof doubt that the high degree of manual skill, withoutwhich the professed dentist is but a shameless pretender,can be acquired best, perhaps can be fully acquired onlyduring youth; that if the acquisition be put off till a medicaleducation is completed, the golden opportunity will havebeen lost. Mr. Fawcett tells us that the blind may acquiremanual skill sufficient to secure independence, but that itcan be gained only during youth. The adult blind, he says,have a greatly diminished power of learning.
The time may come when the principles of Medicineand Surgery will be taught before their special applicationto any particular class of disease, and their modificationresulting therefrom is entered upon. Till that time arrive,it will be in the interest of the Dental Surgeon to studywith the utmost care the general principles and theirapplication to his own speciality, and to acquire, while hecan, a very full and perfect knowledge, practical, as wellas scientific, of Dental Surgery, before he enters upon adetailed study of their application to any other branch orsubject of Medicine or Surgery, the practice of which hedoes not propose to follow, and a trustworthy knowledgeof which can not be retained or extended in the absence ofcontinuous general practice.
The qualified surgeon who has devoted himself to thepractice of dentistry, may be legally qualified to treat anyand every kind of case, but would he be morally right inundertaking the treatment of a case, say of fever or ofstone? all his knowledge of which diseases lies in a mistymemory of facts brought before his notice, and studied for469a pass examination in long past student days. As amatter of fact, the dental surgeon of necessity limits hispractice to his speciality, and the general surgeon as afurther fact, where selection is possible, declines to takeDental cases, though legally entitled so to do. In theabsence of special training, he cannot be expected topossess the special knowledge requisite to successful treatment,and to add the Dental to the over loaded Medicalcurriculum, would be to greatly increase the rejectionswhich, in the case of the College of Surgeons, have alreadyrisen to the formidable amount of upwards of thirty percent. of the candidates for diplomas. Hence it is that Dr.Michael Foster, in asking for more physiology, asks for lesstopographical anatomy.
The Dental curriculum requires for its honest fulfilment,the whole of the assigned four years, and more must notbe attempted in the same four years, for to repeat thewords of Professor Burdon-Sanderson,—“The preciousyears which immediately precede a man’s entry on professionalduty, are far too valuable to be wasted in learninganything he does not intend to retain,” to which may beadded, or which his subsequent occupation will not allowhim to retain. If then more medical knowledge is requiredof the student than is embraced in the dental curriculum,more time must be given for its acquisition.
Transplantation and Replantation.
At the period when transplantation was systematicallyperformed, the operators kept themselves supplied withan assortment of dried teeth, i.e., sound teeth, obtainedgenerally from the dead subject, to make use of in case thetooth to be transplanted should not prove adaptable to its470new abode. The process is not spoken favourably of, asthe results were mostly unsatisfactory, but at times suchteeth became perfectly firm, and even resisted the greatestefforts at their removal. We can hardly for one momentsuppose that teeth in the condition these were could haveever become attached to a living alveolo-dental membrane,and the difficulty of accounting for this firmness wouldhave been great indeed, had it not been already solved forus. In Langenbeck’s Archiv. für Chirurgie, vol. iv., is apaper on “The Replantation and Transplantation of Teeth,”by Dr. A. Mitscherlich, which deserves to be better known,and which, apparently, cannot have come under theobservation of those who recently contributed to the Lanceton the subject, the excuse for which is less, since it hasbeen translated into English. The author, in addition tomuch interesting and original matter, records the followingexperiment. In the upper jaw of a dog of a year old, Dr.Mitscherlich inserted into the socket of an incisor he hadremoved, a similar tooth taken from a dog’s skull, andwhich he retained in situ by means of a silver wire passedthrough a hole in the tooth, and a hole bored through thealveolar process of the jaw. “After six weeks thedog was killed, having been given during the last fewdays three grains of picronitrate of potash three times aday; the carotids were immediately injected. Themuscles, like the gums, were coloured yellow: neither,however, in the implanted tooth nor in the sound ones wasany alteration of colour perceptible. The silver wire wasporous, and no longer held the tooth; it was removed.The tooth was quite firmly seated, and could not be movedin the least by the fingers. The gums, as in the remainingteeth, were accurately applied both to the alveolar process471and also to the tooth itself, and nowhere could any alterationbe found in it. The tooth was sawn through lengthways,together with the upper jaw, with a fine saw, so thatthe pulp cavity was laid bare in its whole extent. Thelatter was only filled with a little detritus, and no trace ofthe pulp was discoverable; none of the injection, too, hadbeen forced into the cavity. The tooth was everywheremost intimately connected with the surrounding parts, andsuppuration showed itself nowhere.