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DENTAL CARIES AND CIVILISATION.
1210
CORRESPONDENCE PSYCHOLOGICAL ASPECTS OF SURGERY. To the Editor of THE LANCET. SIR,-In your issue of Nov. 21st (p. 1166) Mr. Lawrence Abel describes his American experiences, and tells how he heard about the technique of denervation of the adrenal glands and its curative effect upon soldier’s heart. Can this be that " disordered action of the heart " which was responsible for the invaliding of over 80,000 men during the Great War and is now recognised as part of a psychoneurotic state ?‘? And, if it is, are we to welcome this extension of operative technique and apply it to the innumerable cases of functional heart disorder that occur in civil life, or must we join with Dr. Crookshank in lamenting the results of medicine, surgery, When we and gynaecology, without psychology shall have passed through our present mechanistic phase, and psychopathology becomes part of the ordinary equipment of medicine, such operations will surely find a place among the curiosities of medical history.-I am, Sir, yours faithfully, MILLAIS CULPIN.
point. Nature is the great conlogician. There is no further part of the body ; ergo, it must disappear, remain in germ, so to speak, like the body hair
glands
are cases
server and use for a or
in
inexorable
of man, in case there should be use for it at some future time under changed conditions, when it will develop and grow again. Nature then causes the teeth of civilised man to decay simply because civilised man does not need teeth to masticate the soft foods he eats. Brushing the teeth is a sanitary measure, but it cannot save teeth from decay. Negroes who never clean their teeth have sound teeth as have animals. The English, who have eaten soft foods for centuries, have notoriously poor teeth. Though the decay of teeth is a normal process, dentists are necessary to prevent infection, preserve the appearance of teeth, and save our teeth for the occasional hard foods we eat. But let no one think that this degenerative process that takes place in teeth betokens any weakness of constitution, or that civilisation itself degenerates the body. The civilised man is far more adaptable to various environments and conditions than the savage is. He is immune to diseases that kill the PSYCHOLOGICAL ASPECTS OF GYNÆCOLOGY. savage, and survives diseases, climates, and hardships that overcome the savage. To the Editor of THE LANCET. I am, Sir, yours faithfully, SIR,-Dr. Fairbairn’s Bradshaw lecture and Dr. CHARLES HOOPER. Crookshank’s letter in your issue of Nov. 21st were encouraging reading to those of us who are daily confronted with the futility of mechanistic or even CANCER OF THE CERVIX. of what one might call constitutional gynecology. To the Editor of THE LANCET. I should like to emphasise the point that if the SiR,—The letter of Mr. Wilfred Shaw in your last present state of things is to be improved more is issue contains so many arguments in favour of the of a on the than belief part gynaerequired general view forward by your reviewer concerning the factors and put of in the cologists significance psychological relative frequency of columnar-celled cancer of the a willingness to cooperate with the psychotherapeutic specialist. The majority of women who seek treat- cervix and squamous epithelioma that the latter ment go to the general practitioner. Neither he might well look on his views as receiving considerable nor she will be in a position to give adequate help support from them. The occurrence of squamous to many of such women until not only the theory of metaplasia in adenocarcinomata of the body of the the normal columnar psychology, but a psychotherapeutic technique is uterus, andinitsthefrequencyofinthe external os, might and as an of epithelium region medicine, integral part properly taught a basis of the psychological examination is recognised as being provide support for the occurrence strong a of similar as essential to a complete gynaecological investigation metaplastic change in the columnarcelled cancer of the cervix. That such a change does as is for instance, the bi-manual. occur in the cells of a columnar cancer of the I am, Sir, yours faithfully, " cervix so that they become of F. MARJORY EDWARDS, M.B., B.S. squamoid" type, though not true squamous cells, is probably the cause, part at least, of what your reviewer regards as a
readily
in
common error.
DENTAL CARIES AND CIVILISATION. To the Editor of THE LANCET. SIR,-There is a widespread belief that caries or decay of the teeth is a pathological state ; that it ’, denotes a diseased condition of the teeth, due to I malnutrition, or some hidden weakness or defect of I body, or lack of care of teeth. People are inclined to think that good health and strength, and normalcy of the body and its parts and functions, are accompanied by sound strong teeth. But I venture to say that in a state of civilisation it is the normal person whose teeth decay at a comparatively early age, and the abnormal person whose teeth are unaffected by
’,
decay. Civilised man’s teeth decay in accordance with a law of nature that an organ or part of the body that is in process of disuse shall break down, become .atrophied or rudimentary, and finally disappear. The vermiform appendix and the male mammary
Before proceeding further it is essential to define exactly what we mean by the term " squamous epithelioma." It is obviously not sufficient to define it as a cancer derived from squamous epithelium, as the basal layer of the latter may give rise to a basal cell carcinoma that is not a squamous epithelioma. Neither are epithelial pearls necessary, as it is well known that these are rarely present in the squamous epithelioma of the cervix or vagina, probably because in these regions the keratin layer is normally but poorly marked. The presence of spinous cells however is essential. They are absent in the basal cell cancer and from the squamoid cells derived from metaplasia of the columnar-celled "
"
carcinoma. Therefore the contention of Mr. Shaw that " most of the very early carcinomata of the cervix that one sees can be demonstrated to arise from the squamous epithelium of the portio," cannot be regarded as proof that the resultant growth is a
CORRESPONDENCE PSYCHOLOGICAL ASPECTS OF SURGERY. To the Editor of THE LANCET. SIR,-In your issue of Nov. 21st (p. 1166) Mr. Lawrence Abel describes his American experiences, and tells how he heard about the technique of denervation of the adrenal glands and its curative effect upon soldier’s heart. Can this be that " disordered action of the heart " which was responsible for the invaliding of over 80,000 men during the Great War and is now recognised as part of a psychoneurotic state ?‘? And, if it is, are we to welcome this extension of operative technique and apply it to the innumerable cases of functional heart disorder that occur in civil life, or must we join with Dr. Crookshank in lamenting the results of medicine, surgery, When we and gynaecology, without psychology shall have passed through our present mechanistic phase, and psychopathology becomes part of the ordinary equipment of medicine, such operations will surely find a place among the curiosities of medical history.-I am, Sir, yours faithfully, MILLAIS CULPIN.
point. Nature is the great conlogician. There is no further part of the body ; ergo, it must disappear, remain in germ, so to speak, like the body hair
glands
are cases
server and use for a or
in
inexorable
of man, in case there should be use for it at some future time under changed conditions, when it will develop and grow again. Nature then causes the teeth of civilised man to decay simply because civilised man does not need teeth to masticate the soft foods he eats. Brushing the teeth is a sanitary measure, but it cannot save teeth from decay. Negroes who never clean their teeth have sound teeth as have animals. The English, who have eaten soft foods for centuries, have notoriously poor teeth. Though the decay of teeth is a normal process, dentists are necessary to prevent infection, preserve the appearance of teeth, and save our teeth for the occasional hard foods we eat. But let no one think that this degenerative process that takes place in teeth betokens any weakness of constitution, or that civilisation itself degenerates the body. The civilised man is far more adaptable to various environments and conditions than the savage is. He is immune to diseases that kill the PSYCHOLOGICAL ASPECTS OF GYNÆCOLOGY. savage, and survives diseases, climates, and hardships that overcome the savage. To the Editor of THE LANCET. I am, Sir, yours faithfully, SIR,-Dr. Fairbairn’s Bradshaw lecture and Dr. CHARLES HOOPER. Crookshank’s letter in your issue of Nov. 21st were encouraging reading to those of us who are daily confronted with the futility of mechanistic or even CANCER OF THE CERVIX. of what one might call constitutional gynecology. To the Editor of THE LANCET. I should like to emphasise the point that if the SiR,—The letter of Mr. Wilfred Shaw in your last present state of things is to be improved more is issue contains so many arguments in favour of the of a on the than belief part gynaerequired general view forward by your reviewer concerning the factors and put of in the cologists significance psychological relative frequency of columnar-celled cancer of the a willingness to cooperate with the psychotherapeutic specialist. The majority of women who seek treat- cervix and squamous epithelioma that the latter ment go to the general practitioner. Neither he might well look on his views as receiving considerable nor she will be in a position to give adequate help support from them. The occurrence of squamous to many of such women until not only the theory of metaplasia in adenocarcinomata of the body of the the normal columnar psychology, but a psychotherapeutic technique is uterus, andinitsthefrequencyofinthe external os, might and as an of epithelium region medicine, integral part properly taught a basis of the psychological examination is recognised as being provide support for the occurrence strong a of similar as essential to a complete gynaecological investigation metaplastic change in the columnarcelled cancer of the cervix. That such a change does as is for instance, the bi-manual. occur in the cells of a columnar cancer of the I am, Sir, yours faithfully, " cervix so that they become of F. MARJORY EDWARDS, M.B., B.S. squamoid" type, though not true squamous cells, is probably the cause, part at least, of what your reviewer regards as a
readily
in
common error.
DENTAL CARIES AND CIVILISATION. To the Editor of THE LANCET. SIR,-There is a widespread belief that caries or decay of the teeth is a pathological state ; that it ’, denotes a diseased condition of the teeth, due to I malnutrition, or some hidden weakness or defect of I body, or lack of care of teeth. People are inclined to think that good health and strength, and normalcy of the body and its parts and functions, are accompanied by sound strong teeth. But I venture to say that in a state of civilisation it is the normal person whose teeth decay at a comparatively early age, and the abnormal person whose teeth are unaffected by
’,
decay. Civilised man’s teeth decay in accordance with a law of nature that an organ or part of the body that is in process of disuse shall break down, become .atrophied or rudimentary, and finally disappear. The vermiform appendix and the male mammary
Before proceeding further it is essential to define exactly what we mean by the term " squamous epithelioma." It is obviously not sufficient to define it as a cancer derived from squamous epithelium, as the basal layer of the latter may give rise to a basal cell carcinoma that is not a squamous epithelioma. Neither are epithelial pearls necessary, as it is well known that these are rarely present in the squamous epithelioma of the cervix or vagina, probably because in these regions the keratin layer is normally but poorly marked. The presence of spinous cells however is essential. They are absent in the basal cell cancer and from the squamoid cells derived from metaplasia of the columnar-celled "
"
carcinoma. Therefore the contention of Mr. Shaw that " most of the very early carcinomata of the cervix that one sees can be demonstrated to arise from the squamous epithelium of the portio," cannot be regarded as proof that the resultant growth is a