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PANEL DENTISTRY
940 In a recent detailed studyof the clinical features of depression, Dr. Aubrey Lewis has shown afresh how essential a preliminary is the full description of the phenomena, if from such common defects as those mentioned there are not to arise false theory and false practice. There is, however, another and sounder way (which may, briefly, be called the phenomenological) of aiming at the integration of physiological and psychological data than that once applied to aphasia and still used for retardation and
metaphor.
inhibition. There can be few who
not dissatisfied with the and uncertainty of a large seeming changeableness of the to data which psychiatrists apply their part verbal symbols and their methods of study. There can be no fixity of material investigated, no adequate testing of conclusions, until functions have been defined in constant terms. These terms must be psycho-biological. They can only be applied after intensive study of the somatic foundations-genetic, constitutional, and physiological-and their associa. tions with mental phenomena. are
PANEL DENTISTRY
LAST year under the National Health Insurance Acts approved societies expended about :E2,000,000 on dental benefit for their members, who qualified for this treatment by spending a like amount out of their own pockets. Anyone on the Dentists Register, whether possessing a dental qualification or not, is eligible to treat insured persons and it is not surprising that complaints should arise, whether against dentists by insured persons or approved societies acting on their behalf, or by dentists against approved societies. The Dental Benefit Council, which consists of dentists, representatives of approved societies, and an official of the Ministry of Health, provides machinery for investigating such complaints and can institute disciplinary action against either party, even to the extent of debarring a dentist from undertaking panel work. The machinery closely resembles that of medical benefit, and all parties have the right of appearance. Many of the so-called complaints against dentists are simply questions of disputed interpretation referred by societies to the Council without any allegation of incompetence on the part of the dentists concerned. Cases of deliberate breach of the regulations or of actual bad workmanship are, in relation to the vast amount of panel Some cases of dentistry, comparatively few. " contracting out " still occur. In the past this usually took the form of the dentist undertaking to supply work of better quality for an additional fee to be paid by the patient. It is a pathetic result of present-day industrial depression that contracting out now takes the form of the dentist arranging to forgo the whole or part of the fee payable by the patient without the knowledge of the approved society. Denture cases provide a large proportion of complaints and there has been an increased failure to provide satisfaction in this respect. It is highly probable that some of these are due to failure on the part of the patient to give that co-operation which is essential in dental prosthesis. This is difficult to prove and the dentist generally must bear the brunt of the failure even though the patient is at fault. It is interesting to note in the Council’s report2 that cases demonstrating a lack of skill in conservative work are becoming more common. In the past the 1 Jour. Ment. Sci., 1934, lxxx., 1 and 277 ; see THE LANCET, 1934, i., 1239. 2 Appendix xxxiii., Fifteenth Annual Report of the Ministry of Health, p. 365.
of panel dentistry consisted in the extraction of teeth and the provision of dentures, but the cumulative effect of dental benefit on the insured population over many years is now being felt. Arrears of extractions, and consequent prosthetic treatment, tend to decrease; there is greater demand for conservative dentistry and a greater appreciation of its value. But it is here that deficiencies on the part of 1921 dentists show themselves. Some of them have little skill in this branch of dentistry and practise it rarely ; complaints arising on this ground are hardly surprising and reflect only on a small section of the profession, which as time goes on will steadily decrease, for all dental entrants must have had a hospital training and thus be fully versed in the conservation of teeth. From the way in which this report has been handled in a section of the press it might be supposed that the whole dental profession was incompetent and engaged in wholesale exploitation of the insured population. So far is this from being the case that the Council, which contains a large approved society element not likely to be unduly tender towards delinquency, says " there is every indication that the standard of the service has not only been maintained during 1933, but has definitely improved both as regards the adequacy with which the dental needs of the insured population have been diagnosed and the satisfactory manner in which the authorised treatment has been carried out." The report itself is a sufficient refutation of such headlines as Growing evils of panel dentistry."
greater part
"
TYPHUS FEVER: ITS PREVALENCE
THE September issue of the Bulletin of the International Office of Public Health contains what amounts to a review of typhus fever in the world at present. According to Dr. E. H. Cluver, who contributes the report on typhus in South Africa, the disease has for long been endemic in the native areas in the eastern part of Cape Colony. The period 1919-1923 may be regarded as epidemic, when the average number of notifications exceeded 8000 annually. In 1924 they fell to 2000 and did not reach this figure again until 1933, when they numbered 2125, the rise being due partly to the loss of immunity. acquired during the epidemic, and partly to aggravation of the economic situation. Owing to their deplorable lack of hygiene, heavy infestation with lice and malnutrition, the disease was more frequent and fatal among the natives than among the Europeans, as is shown by the fact that during the period 1923-33 the European cases amounted to only 544 with 24 deaths (4’4 per cent.) as compared with 22,204 cases with 3005 deaths (13-5 per cent.) among the natives. Dr. Lasret, the delegate for Algeria, reports that in 1933 847 cases were notified in that country as compared with 395 in 1932. The increased incidence, however, only occurred in the Constantine department, where there were 769 cases in 1933 as compared with 276 in 1932. In all the other departments the incidence remained the same or was on the decline. In Chili, according to Dr. Leonardo Guzman, director-general of the Ministry of the Interior, an epidemic of typhus had been in existence since 1917, reaching its height in 1919 with 14,517 cases and 2804 deaths. During the next five years there was a decline, but recrudescences subsequently occurred, and during the period July, 1933, when Dr. Guzman assumed his present position, until Jan. 1st, 1934, there were 15,194 cases with 3258 deaths (21-4 per cent.) throughout the
country. Eighteen departments were heavily infected, while
sporadic cases occurred in the rest.
In his survey
metaphor.
inhibition. There can be few who
not dissatisfied with the and uncertainty of a large seeming changeableness of the to data which psychiatrists apply their part verbal symbols and their methods of study. There can be no fixity of material investigated, no adequate testing of conclusions, until functions have been defined in constant terms. These terms must be psycho-biological. They can only be applied after intensive study of the somatic foundations-genetic, constitutional, and physiological-and their associa. tions with mental phenomena. are
PANEL DENTISTRY
LAST year under the National Health Insurance Acts approved societies expended about :E2,000,000 on dental benefit for their members, who qualified for this treatment by spending a like amount out of their own pockets. Anyone on the Dentists Register, whether possessing a dental qualification or not, is eligible to treat insured persons and it is not surprising that complaints should arise, whether against dentists by insured persons or approved societies acting on their behalf, or by dentists against approved societies. The Dental Benefit Council, which consists of dentists, representatives of approved societies, and an official of the Ministry of Health, provides machinery for investigating such complaints and can institute disciplinary action against either party, even to the extent of debarring a dentist from undertaking panel work. The machinery closely resembles that of medical benefit, and all parties have the right of appearance. Many of the so-called complaints against dentists are simply questions of disputed interpretation referred by societies to the Council without any allegation of incompetence on the part of the dentists concerned. Cases of deliberate breach of the regulations or of actual bad workmanship are, in relation to the vast amount of panel Some cases of dentistry, comparatively few. " contracting out " still occur. In the past this usually took the form of the dentist undertaking to supply work of better quality for an additional fee to be paid by the patient. It is a pathetic result of present-day industrial depression that contracting out now takes the form of the dentist arranging to forgo the whole or part of the fee payable by the patient without the knowledge of the approved society. Denture cases provide a large proportion of complaints and there has been an increased failure to provide satisfaction in this respect. It is highly probable that some of these are due to failure on the part of the patient to give that co-operation which is essential in dental prosthesis. This is difficult to prove and the dentist generally must bear the brunt of the failure even though the patient is at fault. It is interesting to note in the Council’s report2 that cases demonstrating a lack of skill in conservative work are becoming more common. In the past the 1 Jour. Ment. Sci., 1934, lxxx., 1 and 277 ; see THE LANCET, 1934, i., 1239. 2 Appendix xxxiii., Fifteenth Annual Report of the Ministry of Health, p. 365.
of panel dentistry consisted in the extraction of teeth and the provision of dentures, but the cumulative effect of dental benefit on the insured population over many years is now being felt. Arrears of extractions, and consequent prosthetic treatment, tend to decrease; there is greater demand for conservative dentistry and a greater appreciation of its value. But it is here that deficiencies on the part of 1921 dentists show themselves. Some of them have little skill in this branch of dentistry and practise it rarely ; complaints arising on this ground are hardly surprising and reflect only on a small section of the profession, which as time goes on will steadily decrease, for all dental entrants must have had a hospital training and thus be fully versed in the conservation of teeth. From the way in which this report has been handled in a section of the press it might be supposed that the whole dental profession was incompetent and engaged in wholesale exploitation of the insured population. So far is this from being the case that the Council, which contains a large approved society element not likely to be unduly tender towards delinquency, says " there is every indication that the standard of the service has not only been maintained during 1933, but has definitely improved both as regards the adequacy with which the dental needs of the insured population have been diagnosed and the satisfactory manner in which the authorised treatment has been carried out." The report itself is a sufficient refutation of such headlines as Growing evils of panel dentistry."
greater part
"
TYPHUS FEVER: ITS PREVALENCE
THE September issue of the Bulletin of the International Office of Public Health contains what amounts to a review of typhus fever in the world at present. According to Dr. E. H. Cluver, who contributes the report on typhus in South Africa, the disease has for long been endemic in the native areas in the eastern part of Cape Colony. The period 1919-1923 may be regarded as epidemic, when the average number of notifications exceeded 8000 annually. In 1924 they fell to 2000 and did not reach this figure again until 1933, when they numbered 2125, the rise being due partly to the loss of immunity. acquired during the epidemic, and partly to aggravation of the economic situation. Owing to their deplorable lack of hygiene, heavy infestation with lice and malnutrition, the disease was more frequent and fatal among the natives than among the Europeans, as is shown by the fact that during the period 1923-33 the European cases amounted to only 544 with 24 deaths (4’4 per cent.) as compared with 22,204 cases with 3005 deaths (13-5 per cent.) among the natives. Dr. Lasret, the delegate for Algeria, reports that in 1933 847 cases were notified in that country as compared with 395 in 1932. The increased incidence, however, only occurred in the Constantine department, where there were 769 cases in 1933 as compared with 276 in 1932. In all the other departments the incidence remained the same or was on the decline. In Chili, according to Dr. Leonardo Guzman, director-general of the Ministry of the Interior, an epidemic of typhus had been in existence since 1917, reaching its height in 1919 with 14,517 cases and 2804 deaths. During the next five years there was a decline, but recrudescences subsequently occurred, and during the period July, 1933, when Dr. Guzman assumed his present position, until Jan. 1st, 1934, there were 15,194 cases with 3258 deaths (21-4 per cent.) throughout the
country. Eighteen departments were heavily infected, while
sporadic cases occurred in the rest.
In his survey