Psychology and the dentist

148 m o r e of these functions. T h e protein c o m p l e x is separable into t h e storer-, radiator- a n d attractor-functioning portions connected b y bridges. T h e r h y t h m m a y fail to pass a bridge or m a y by deflection take an aberrant course. Disease is t h e result of invaders deflecting t h e r h y t h m resulting in a b n o r m a l changes in t h e protein. S u c h invaders m a y be classed as physical (faulty food), chemical a n d microbial. Disease is acute, s u b - a c u t e or chronic according to t h e extent of d a m a g e suffered b y t h e protein, t h e period in t h e cycle w h e n t h e d a m a g e is suffered a n d t h e e x t e n t to w h i c h t h e protein has been d a m a g e d previously. T h e manifestations of disease and the tissues and organs in w h i c h t h e y appear are d e t e r m i n e d b y t h e part of t h e protein w h i c h suffers damage, while t h e kind of lesion resulting is d e t e r m i n e d by w h e t h e r the protein is m o r e o v e r - e x p a n d e d t h a n over-contracted. Disease is first acquired and t h r o u g h perpetuation m a y become inherited. F o r diagnosis reliance is placed on blood examination considered in association with the clinical picture. Agglutination b e i n g an expression of the change of dispersion, an increased s e d i m e n t a t i o n rate indicates over-contraction of protein. T h e refractive index rate of s e r u m falls as protein expands, while a rise in the percentage of blood calcium indicates aberrant dispersion. T h e ratio of viscosity/ refractive index or the viscosity/percentage of protein index indicates w h e t h e r t h e protein is m o r e over-expanded t h a n over-contracted. O t h e r examinations include blood sugar, blood urea and the dark g r o u n d picture. T h e aims of t r e a t m e n t of disease are to prevent t h e change in the protein b e i n g rendered aberrant and to restore the r h y t h m to its n o r m a l course. Being in t h e n a t u r e of an invader, t r e a t m e n t is a possible aggravator of the d a m a g e already suffered by t h e protein. T h e theory embraces m u c h m o r e t h a n consideration of these c h a n g e s in disease. T h e a u t h o r visualises evolution in some six cycles, f r o m the sub-atomic products in t h e first to m a n in the sixth. He claims his work is c o m p l e m e n t a r y to Sir Albert H o w a r d ' s e m p h a s i s on the need for the " good heart " of the soil and the importance of natural m a n u r e s with their micro-organisms. T h e theory offers an explanation of the success of h o m o e o p a t h y , the epidemicity of influenza, intestinal toxaemia and shock, while it accounts for births and d e a t h s occurring m o r e c o m m o n l y d u r i n g t h e n i g h t t h a n d u r i n g t h e day. O n t h e other h a n d the author does n o t agree with to-day's views o n h o r m o n e s or of t h e importance of vitamins. H e holds that viruses are t h e p r o d u c t s n o t the causes of disease, while he classes s u c h diseases as measles and smallpox as c u t a n e o u s forms, and poliomyelitis a n d encephalitis lethargica as n e r v o u s types of so-called influenza. It would s e e m t h e theory is in accord with and is based on definite laboratory findings of changes in blood and on the bacteriology of excreta, and is t h e n elaborated on. purely theoretical considerations to offer in t u r n an explanation of various occurrences. T h i s d e v e l o p m e n t does not, of course, m e a n that t h e theory is n o t necessarily f u n d a m e n t a l l y sound, a n y m o r e t h a n t h e fact that it is n o t generally accepted or has n o t been accepted m o r e ral~idly cannot be taken.as an a r g u m e n t against its validity. T h e a u t h o r challenges, or p e r h a p s chides, u s by his p r e f a c e - - " T h e advance of medicine h a s at all times been i m p e d e d by two factors ; by t h e existence of so-called authorities, a n d by the existence of fashionable medical theories." (Virchow.) Pulmonary Tuberculosis : A H a n d b o o k for S t u d e n t s and Practitioners. By R. Y. KEERS, M.D. (EDIN.), F.R.F.P.S., and B. G. RIGDEN, M.R.C.S., L.R.C.P. 2nd edition. (Pp. 272. 124 illustrations and plates. Price 17s. 6d.) E d i n b u r g h : E. & S. Livingstone. 1946. Messrs. Livingstone are to be c o m p l i m e n t e d on yet a n o t h e r excellent addition to c u r r e n t medical literature. T h e a u t h o r s have been confronted with the difficult task of writing for medical s t u d e n t s a n d general practitioners. T h e y have successfully avoided the dual pitfalls of over-simplification and excessive detail. T h e chapters on epidemiology, pathology a n d prognosis deserve especial praise. M u c h of the epidemiological material on allergy and i m m u n i t y is still in the " N o M a n ' s L a n d " o f controversy b u t a fair and reasonable s t a t e m e n t of c u r r e n t theories has been presented. Perhaps the m o s t profitable chapters for the s t u d e n t are those devoted to Prognosis and T r e a t m e n t . T h e f o r m e r is a f u n d of s o u n d j u d g m e n t w h i c h should prove of inestimable value as .a guide for the clinically perplexed a n d inexperienced. Despite t h e i m m e n s e strides in the recent d e v e l o p m e n t s of phthisis, s u c h as streptomycin in the therapeutic field, and the Disabled Persons .Act in the sphere of rehabilitation, the a u t h o r s have f o u n d time to discuss t h e merits and limitations of these advances. T h e x - r a y plates, t h o u g h very representative, reveal in s o m e instances an indifferent quality of reproduction w h i c h the a u t h o r s and p u b l i s h ers would be well advised to rectify if a f u r t h e r edition is c o n t e m plated. Again, the chapter on Differential Diagnosis is too brief a n d patchy either to bear authority or convey a ~!ear clinical picture to the reader. T h i s second edition is written in a fluent, u n d o g m a t i c and m o s t readable form, a n d should readily find a place on the bookshelf of t h e keen s t u d e n t or intelligent practitioner w h o desires to keep abreast with recent advances. B.M.

PUBLIC H E A L T H , April, 1947 No. 1 of the new quarterly British Journal of Social Medicine, edited by Profs. F. A. E. Crew a n d Lancelot Hogben, with t h e assistance of, a m o n g s t others, Drs. W. G. Clark a n d Fraser Brockington, a n d p u b l i s h e d by the B.M.A., appeared in January. It comprised papers on " Incompatibility of Mother a n d Foetus with respect to the Iso-Agglutinogen A a n d its Antibody," by J. A. H. Waterho~ase, M.A., rn.n., a n d Lancelot Hogben, v.a.s. ; " A Docum e n t a r y Study of Jaundice, associated with Syphilis T r e a t m e n t a n d Blood Transfusion," by Sidney C. Truelove, M.A., M.D., a n d Lancelot Hogben, F.R.S. ; " Epidemiology of Infective Hepatitis a m o n g Allied Troops in Italy," by P. L. McKinlay, M.O., D.P.D., O.P.m, a n d Sidney C. Truelove, M.A., M.D., a n d " A Study of the H a e m a t o l o g y of 663 Substandard Recruits u n d e r training at an A r m y Physical Developm e n t Centre," by R. A. M. Case, M.B., CH.B., vn.9. T h e a n n u a l subscription (for four numbers) is 25s. a n d a single n u m b e r costs 7s. 6d. PSYCHOLOGY AND THE DENTIST Dr. Lois Munro, a m e m b e r of the staff of the Tavistock Clinic, recently addressed t h e Dental Officers' Group of the Society. Dr. M u n r o referred to file fact t h a t dentists often appeared as figures of f u n in cartoons a n d caricatures; psychiatrists were also sometimes the subjects of comic sketches, b u t with this difference. There recently appeared i n Punch a caricature of a patient outside a psychiatric consultant's rooms a n d the patient was wearing a halo and two horns. In the case of the dentist it was he who was t h e m e n a c i n g figure b u t with the psychiatrist it was the patient who was in fear a n d t r e m b l i n g at his own guilt. To return to, the caricatures of t h e dentist: w h y was the dentist pictured as the inflicter of pain and not as the preserver of teeth ? There was no doubt t h a t this was a f a n t a s y t h a t was retained quite irrationally in m a n y people's minds. In so far as the dentist dealt with the m o u t h he was related to a part of the body t h a t was of enormous significance to the individual, i.e., if the m o u t h were not functional, starvation occurred. T h e cutting of teeth b e g a n at a critical period in a child's life, say from the fifth to seventh m o n t h , when the age of weaning was approaching. Eruption of teeth, sometimes painful, was coupled with an u p r u s h of aggressive impulses. Before this loving tendencies were in t h e ascendant, b u t with teeth came the desire to b i t e ; the impulse to bite a n d hurt. A child's world was one of feeling, if he were angry, the world was a n g r y with him. If he wanted to hurt, t h e world wanted to h u r t him. T h e speaker t h e n told a tale of a child of some 18 m o n t h s , whose m o t h e r came into t h e room carrying a shoe with the sole broken away from the upper, a n d the nails protruding. T h e child went into a p a r o x y s m of fear a n d was only comforted with difficulty. For a while the m o t h e r could only wear soft bedroom slippers in the child's presence. Gradually the fear subsided a n d some two to three years later the child said: " M u m m y , do volt r e m e m b e r when I was frightened by an old shoe ? It m i g h t have bitten me ! " T h o s e who have to deal with m o u t h s a n d teeth come within the scope of these early feelings a n d memories, and so dentists m a y become acquainted with early fears related to oral aggression. T h e speaker t h e n referred to certain traditions regarding teeth, such as t h e wearing of a necklace of lion's teeth to give the wearer a lion's strength. T h e dentist, she said, m u s t recognise the part he played in relation to the patient. He became a peg on which to h a n g archaic images a n d it needed a great deal of reality a n d assurance for the dentist to put over his real personality. Familiarity was a great point of achievement, such as when he b e c a m e Mr. So-and-So a n d not just " t h e dentist." He h a d to deal with t h e fallacy t h a t he h u r t a n d was potentially very stro'qg a n d powerful. H e h a d to p u t over t h e idea t h a t his strength was being used for his patient's good a n d t h a t it was u n d e r complete control. Dr. M u n r o t h e n compared the outlook on dentistry, in this country a n d in t h e U n i t e d States. Here dentistry was looked u p o n as a necessary evil a n d was accepted with a great feeling of rectitude a n d afterwards of relief. In the United States t h e need for beautiful teeth a n d what went with t h e m wSs m u c h more stressed, t h e people were more tooth conscious, their teeth were good t h i n g s a n d the dentist was there to help t h e m to keep them. A n o t h e r t h o u g h t was the part anaesthetics played in dentistry. O n the Continent there was a greater fear of s u b m i t t i n g to general anaesthesia. In this country there was more willingness tt~ s u b m i t to general a n a e s t h e s i a coupled with a suspicion of local anaesthesia. General anaesthesia m a d e t h e patient helpless a n d so more involved in those deep archaic fears often expressed in the form of strange dreams. Finally, Dr. M u n r o wondered how these feelings in regard to dentists would affect their a t t a i n i n g what they wanted in this world, a n d t h e proper recognition of their s t a t u s If such fears were held b y Ministers, Parliament a n d the general public to a n y extent, t h e n t h e y m i g h t not be given the full recognition they deserved, or perhaps only a g r u d g i n g acknowledgment.