The contributions of Milo Hellman to physical anthropology

TPI E (IONTRIBVTIONS

Oh’ MILO HELLMAN ANTHROPOLOGY

TC) PHYSICA

Ii

M

IL0 HELL~IAN’S great contribution to the science of physical anthropology can be summarized in one’ short. sentence: He took a technique that was dead and static and vit,alized it into one that was alive and dynamic. By this I mean that he adapted a series of measurements originally designed for adult skulls, and applied them to the heads and faces of living individuals----nay. more than living, growing individuals ! Dr. Hellman was literally a pioneer In his bands anin the pmctical appkxtion of anthropometric techniques. thropometry (more precisely craniometry) ,juxtified it.s birthright as a precise science. It is in keeping with his use of precise measurement that T)r. Hellmau brought to orthodontia a rigorous, uncompromising attitude of scientific ol)jectivity : classification, diagnosis, and procedure were all subservient 1.0 ;I thorough study and analysis of each case under observation and/or treatment. If Dr. Hellman’s attitude could be reduced to a single phrase, it would bc: Know your patient-which reall,v means know the grolr*th @tern of you I’ patient. Tn analyzing Dr. Hellman’s research, it is important to note that his basic work was done on crania, largely from the American Museum of Natural Hist*ory (where he was R’esearch Associate in Physical Anthropology). Obviously, on such material it was impossible to use age-classes in terms of chronological years. He accordingly postulated a series of seven “ stages of dental develoll merit.” as I’ollows (see 1927a, p. 478; 1929, p. 183; and 1940a, pp. 430-431’) : Stage I designates that period of early the deciduous dentition.

infancy

lwt‘orr

the completion

of

Stage II

designates the period of late infancy at the completion of tlrc deciduous dentition. Stage III designates the period of childhood, when the pernmnent first molars are erupting or have taken their positions, in addition 1~1 which some or all of the deciduous incisors have been lost ant1 are being replaced by their permanent. suc~:esnors. Stage IT’ designates the period of pubeswwe. when the second permanent molars are erupting or have taken their positions in addition to which some or all of the deciduous canines and molars are 10~1 and are being replaced by their permanrnt successors. Stage V designates the period of adulthood mhrn the third molars are erupt. ing or have taken their position.

62

WILTON

Stag-o VI

MARIOK

designates the period of molars are worn off to grooves. Stage VII designates the period crowns of the teeth are or all of the teeth have

KROGMAN

old age when the occlusal surfaces of tlLe the extent of obliterating the pattern of of senility, when at least half of the worn off, in addition to which some, most, been lost.”

2

I

3 A.

B.

Fig.

L--A

and

B, Photographs

of type

skulls

in Dental

Stages

I to VII

(1926.

PP.

69-70).

What Dr. Hellrnan was actually doing hem was one of his truly significant contributions. (It, was literally fo~~rd ulml him, for he did not and could not know the ages of his cranial series.) lie cniancipated the thought of growth *In

practice. Dr. Hellman used subdivisions within each stage, especially in mixed of III and IV (See 1940a,, p. 431). In 1926. he published typical photos of each (See pp. 69-70; also see 1929, Figs. 1 to 7, pp. 134-135). (Fig. 1, A and B.)

der.titions

stage

HELLMAN’S

CONTRIBUTIONS TO PHYSICAL

ii2

.2NTfIROPOI,OOY

STANDAKL~

S’TAGE I 11

III

males and fem:lles males

females I\’ males females v l’emales

NUMBER Tone 13 X5

.\vl?l:AGEAGE ----- ----ti.llo year? 9.98 years

89 7-i 121 II

U.fHJ years 11.98 pears l-L.44 years 22.43 yc:a rs

I~FXlh’rll~N I .13 yc‘arn 1.76 1.M I .7ti “.oo 1.x3

bars tears ;Y?w L $ms VP:,I’,

These were New York patients of Dr. ITellman. In 1929 (see Fig. 13, p. 19.5, Fig. 2 of this paper), I)r. Hellman ~,resrn~.~tl a diagrammatic. profile of fa,cial size, proportions. and positions in each of thkn seven stages. For this purpose he llsed prchistoric~ American Indians (Arizona 01’hot11 scxcs.

Fig. Z.-Typical

facial proAles in Dental Stages I to VII (1929, Fig. 13, p. 19.;).

Dr. Hellman showed initiative and imagination in his use and adaptation of craniometric measurements. From t.he very beginning, he accepted the fat% t,hat the growth of the face and its general craniofacial relationship must 1~ measured in three dimensions : height, breadth, and depth (or len@h). The measuremen& he employed are set forth in scvtlral of his papers.’ I have chosen his 1927a and 39271) papers as tyyica1.f *See: 1927a, PP. 481-483; IL 136, Fig. 20, p. 137. Fig. 21, t1 am taking the liberty clarity and / 01‘precision. This theses ( ) are his.

192i’b. p. 922: 1929. Fig. 8. p. 186. Fig. 10, p. 191 : lRSi;1. p. 138; 1933a, pp. 1121-1122. of editing the definitions a bit, in the interests uf great~~r will be shown by the us’ of brackets, thus: I 1. ‘rtw ,,arc.!r-

64

WILTON

A.-Measurements

of Height

MARIOS

KROGMAiS

of Face:

(a)

Total face height, from the [midsagittal] point where the nasal bones [internasal suture] articulate [intersect] with the frontal bone [nasofrontal suture] [nasion] to the lower border of the mandible [in the midsagittal plane] (menton) [ gnathion]. (b) Upper face height, from nasion [in the midsagittal plane] to the lowest interalveolar point of the bony septum between the upper central incisors (upper alveolar point). (c) Lower face height (symphysial heiglrt) [in the midsagittal plane] from highest point of interalveolar septum between the lower central incisors (lower alveolar point) to the mcnton [gnathion]. (d) Dental height or interalveolar distance [the midsagittal distance] from the lowest point of interalveolar septum between the upper central incisors to highest point of interalveolar septum between lower central incisors. (e) Anterior nasal height [midsagittal distance] from nasion to the lowest point of the anterior margin of the floor [lower margin] of the nose [nasal aperture] [nasospinale]. (f) Posterior nares height [midsagittal distance] from base of vomer to the posterior margin of the palatal process of the palate bone. (g) Subnasal height [midsagittal distance], from anterior margin of the floor of the nose [nasal aperture] [nasospinale] to the upper interalveolar point. (11) Palate height, from a line at the top of the interalveolar septum between second and third molars on both sides to the highest point (For this of the palate [traverse palatal arch] in the median line. measurement a special instrument had to be devised because this point had to be ascertained from three planes-anteroposteriorly, transversely, and vertically.) (i) Mandibular height, from the point of the interalveolar septum between first and second molars to the lower border of body of mandible held in a horizontal plane. (j) Ramus height (measured with a Reserve goniometer)(1) Condylar height, from the angle of the jaw (gonion) to highest point of condyle. (2) Coronoid height, from the gonion to the tip of the coronoid process. (k) Sigmoid notch depth, from a line touching the highest points of the eondyle and coronoid process to the deepest point in the curve of the notch.

h’.-Measurements (a)

of Width

of Face:

Interorbital, between the points of articulation of frontal, maxillary, and lacrymal bones [dacryon]. (b) Bimalar, between the maxi110 malar suture at the lowest point [ zygomaxillare inf erius] . (c) Bizygomatic, between the zygomata at their widest spread [zygion]. (d) Nasal width, between the lateral margins of the nasal aperture at their widest points. (e) Posterior nares, between the posterior margins of the internal pterygoid plates about one-third above the palate. (f) Bicanine (minimum alveolar arch width), (1) between the most prominent facial points of the canine alveoli, in the maxilla, and (2) at the most prominent point between the canine and first premolar in the mandible.

HELL&IAN’S

CONTRIEWTIOES

.., t 1st

AE;THROPOLOGT

TO PIITSICAI.

tl1eorist.s from a slavish adherence to birthday-age, and focused upon the rc>trl oGginnlljII ncccssify bccamc 1W a,vtb,the biologic (dental) age. What mrndously important concept. CVlUiVillt~llt S. In his l!Ei;r paper (1,. 479), he otiercxl the followill g \\'ilS

il

StllgWl$?
1W1 IW

f0lloWd

illVill~iill~l~

liis stag0

S’PAGE

NUAfBER Sow 13 83 89

1

II males and femdes III males IV

elassifimtiol~

female9 males

74 I”1 II

females V femalrs

: .\VEKAGE ACE _____--_

ti.00 year* 9.98 9.80 l1.!J8 14.44 os’43 --.

years years years years pwrr

STAN bAllI, I~P.\rI.\TlWl _------_--

1.13 yw r?l 1.76 jx=ars 1.M years 1.7G years !!.OO years I xi yc’* r*

These were New York patients of Dr. IIellnnn~. In 1929 (see Fig. 13, p. 195, Fig. 2 of this paper), I)r. Hellman presented a diagrammatic profile of facial size, proportions, and positions in each of tht* seven stages. For this purpose he used prehistoric American Indians (.4rizona i of lx-d11 scxcs.

Fig. Z.-Typical

facial

profiles

In Dental

Stases I to VII

(1929, Fig. 13, p. 1%).

Dr. Hellman showed initiative and imagination in his use and adaptation of craniometric measurements. From the very beginning, he accepted the facet that the growth of the face and its general craniofacial relationship must 1~ measured in three dimensions : height, breadth, and depth (or length). The measurements he employed are set forth in sc~ral of his papers.* I have chosen his 192i’a and 392% papers as typica1.t *See : 1927a. PP. 481-483: IL 136. Fig. 20. P. 137. Fig. 21. t1 am taking the liberty clarity and / or preclslon. Tbls theses ( ) rare his.

1927b. p. 922: P. 138; 1933a. of cdlting the WI1 be shown

1929. &‘I$. 8. p. 186. Fig. 10. p. 191: 1931:1. py. 1121-1122. deflnltlons n bit, In the interests of greatvr by the use of brackets, thus: [ ]. ‘l’lw pnww

66

WILTON

MARION

KROGMAN

MEASUREMENTS

I

HEIQHT

WIDTH

DEPTH

I

Total palate Ant. Palate Post. Palate Alveolo-Ramus Pre. Ramus

Total face Upper face Lower face Dental Nasal

Bizggomatic Rimalar Bicanine iuuDeri Bicanine (lower) Max. alv. arch

Subnasal

MrL~p~~~ers! . . arch, (lower) Nasal Post. nares Interorbital

Ramus

Palate Maximum Palate Minimum Bicondylar Bigonial

Cond. Cor. Dist.

\I&

Palate Post. nares M. region (of mandible) Condvlar Coroioid Sig. notch

z

Basal (Mandible) illv. Arch (upper) illv. Arch (lower)

1

ANGLES

Facial Alveolar, Gonial Mental Canine

I

POSITION

SW. Nasion Upper Aur. Pros. Sup. Aur. Pros. Inf. Aur. Menton

. ,,

were, in reality, a series of radial projections in the midline from a biporionic plane or axis. As time went on, he added more points and measurements of ‘‘position ” : from what he called auriculo to nasion, subnasal, prosthion, upper alveolar point, incision (the edge of upper central incisors), infradental, pogonion, menton or gnathion, and gonion. It is not quite clear just what Dr. Hellman meant by auriculo. It is certain that he did not use either auriculare or porion, although, strictly speaking, the use of a headspanner presupposes porion as the meatal focal point. From Fig. 12, C, p. 702, (1941b), it seems that he quite arbitrarily used the center of t.he bony external auditory meatus as t,he point from which he measured auriculo-nasion, auriculo-menton, and so on. In Figs. 12, A and B, p. 702 (1941b), he illustrated the facial height and width measurements on the skull.” (Fig. 3.) Dr. Hellman used his measurements not only to get an arithmetic idea of size and proportion, but, much more important to him, to achieve a ,graphic portrayal of the face and its size-proportion relationships. In Fig. 26, p. 143 (1931a) (Fig. 4 of this paper), there is shown a modified “profile.” Here the face is shown as a rough triangle, with radial dimensions from auriculo to nasion, the upper alveolar point, the lower alveolar point, and menton. In this illustration, the facial profiles are those of girls with Class I malocclusion, in Stages III (A, B, and C) and IV (,I). The ‘’profiles ’’ made graphic the csscntial faciodental relationships in the several classy and divisions of malocclusion. In Fig. 6, p. 934, Fig. 7, p. 934, and Fig. 9, p. 937 (1927b), the face is shown as a quadrilateral, with dimensions from auriculo to the anterior profile and to gonion, and condylar relationships in addition. Fig. 6 shows a normal profile compared with one in Class II, Division 1, and one in Class III. Fig. 7 shows varying types of Class II, Division 1, malocclusion, while Fig. 9 does the same for Class III. (Figs. 5, 6, and 7 of this paper.) The graphic use of measurements served Dr. Hellman four major purposes : (1) The profiles served to contrast the faciodental relationships of a *See

also

Fig.

24,

B,

and

C, p. 935

(1939).

rnaloccluded dentit,ion with the ~zornd; (2) the profiles served to t~mphasizc~ variable faciodental relationships withk a single class (and its division) : (3 1 the profiles served to delineate the growth crchir>Llecx’ rl~r&~,q frenhend !ot’ OIIservation ) : (1) the profiles served to differcul ialr hct,wccu the CIIUV
fy- &&qal-

-- - - - - . -

6 -#&9ion- inasrbnit-t!ppt-r fa@e- - - ;-~ta~a&?e-- - $7/) ^-----7-pmLL9------5-Cower face--

- --

@ -md-----------

by growth and those possibly due to orthodontic therapy. Contrast with Q norm, variability, growth, the effects of treatment,-all bhese were at his disposal as he plotted and analyzed the profiles. It is obvious, from the above statement, that Dr. Hellman readily transferred his cranial studies to the living patient. What he at first observed and learned from the skull, he verv

68

WILTOX

MARION

RROGMAN

logically transferred to the head. The measurements of the dead were of use Dr. Hellman’s long hours in the American onZy as they told of the living. Museum of Natural History, his countless thousands of precise measurements, The bones told their story, and he translated came to fruition in his practice. the story into the treatment of living tissue. It, is an epitome of 11-r. Hellman that he grew in orthodontic knowledge and insight with his own researches into growth.

Fig. Fig. malocclusion Fig. Class III Fig. Fig. 7. p. Fig.

Fig.

6.

4.-Facial proflle (triangular) (1931a, Fig. 26, P. 143). B.-Facial profile (quadrilateral) (1927b, Fig. 6, p. 934). B.-Facial profile (quadrilateral) 934). 7.-Facial profile (quadrilateral)

or

girls

in

; normal ; varying ; varying

Stage

III

(A,

compared types types

to of

B,

Class

Class

of Class

7. and

III

II,

C) II,

with division

division

(1927b,

Class

Fig.

II

1, and 1

(1927b,

9, p. 937).

TIEI,I,M.\S

k

In his orthodontic a record of progress in height, and minimum facial dimensions were

CONTRIBI-‘ITONS

TO

l’H\‘SI(“.\I,

(i!)

.\?;‘~HR01’01,O(iY

practice, he routinely took a complete health history and height and weight. On the head he took length? breadth. frontal diameter (forehead diamctcr). The following taken : BREADT,

,-LZ

~----

:z ~~~~------------

HIIGHT

DEPTH

Total (na-gn j l:pper cna-alv., x-k., m-in fra ) Lower (,inv-gn., infra-gn.) lkntal ( xk:infra.) Nasal Mouth (or lip)

Ricondyla~ Bizygomatic

.-..

--~

---.-._

Aurie.-nasion Auk-subnasal A~uric.-prostl~ion huric:alv. point .\uric.-incision Auric.-infradent hurie:gnathion Auric:gonion Condylo-nasion (londylo-gnathion Gonion-gmathion

Bigonial Interpalpebral Nasal

Mouth !or lip)

____---

(Wherever gnathiov, is stated, it is to bo noted that Dr. Hcllman used tht~ h‘rench. menton.) Dr. Hellman was not content to let the profiles serve as the only evidence of variability. He very early used statistical tools for this purpose--he was especially fond of the standard deviation (S.D., sigma,a). In 1921 (pp. 17-1s of reprint), he studied the relat,ive disease rcsist~ance of breast- and bottle-Cc(l babies.

Bottle-fed &east-fed He then tested for significance following

with t,he formula

~,rz

and arrived

at thca

results : ‘Error

2.22 first av. -= qx

1.83 Error second av. = = g 70 Error

of the diff.

2.22 = -__ 9.27 -=1.83 8.36

v --.--(.a3)2 .i (,21)2

.23 .21 =

.3

The difference of the averages is 1.55 (5.59 - 4.04), which is about five times as great as the error of the difference (.3). “A difference to be real must be at least four times as great as the error. It is, therefore, quite safe in saying t’hat t,here is a real difference in the incidence of diseases between the breast-fed and bottle-fed.” In his paper, “ VariaGon in Occlusion ” (1921), he based his entire discussion upon the standard deviation and error of the difference. In this pa.peper, Dr. Hellman made a very cogent conclusion: **. . . We must use Johnson’s newly proposed term ‘Individual Normal’ reservedly. . . . I would prefer the phrase ‘individual variation. ’ ”

70

WILTOS

M.kRION

KROGMAS

Here Dr. Hellman was warning against the idea that there might be as many growth patterns as there are individuals. Certain it is that he recognized individuality, per se, but always within a predictable framework of mcasurablo and assessable variability, determined statisticall,v. Individuality run rampant is veritable growth anarchy; individuality predicted is growth under control. It was quite natural for I)r. Hellman to ostend the idea of the standard deviation to his profiles. An example may bc taken from his Fig. 6, p. 431 (1931d) (Fig. 8 of this paper), study of “open-bite.” On either side of the average profile there is a shaded area corresponding to - 1 (T and -C 1 U. Within this range are the bounds of the “normal variation, ” as conceived by him. Upon this framework there is superimposed a case of (-“lass I open-bite malocclusion to show not only deviation from an average (norm), but from normal variation (+ 1 U) as well.* In his 1939 and 1941 papers! Dr. Hellman carried his use of the standard deviation still further. He erected a vertical line which served as the average base line for each mcasuremcnt taken (for each sex and each ‘dental age-proup) Then, on horizontal lines, again for each measurement, the limits of I 1 SD. and - 1 S.D. were delineated. The ends of each horizontal (t 1 SD.) were then connected to give a vertical, symmetrical configuration which Dr. Hellman called his ‘(wiggles. ” Fig. 3, p. 688 (1941b) (see also E’ig. 4, 1). 939, 1939) shows the general outline of such a “standard deviation diagram. ’’ (Fig. 9 of this paper.) The idea is to plot individual dirnensions (ix., the dimensions taken on an individual) upon such a diagram. Dr. Hellman felt that “normal” dimensions would fall within the diagram, while “abnormal ” dimensions wo~~lcl fall without its bounds. Fig. 4, p. 689 (19411)) (xc also Fig. 5, p. 939, 1939) shows two “normal faces” (both in Ytagc V, A), plotted on the basis of standard deviation diagrams (Fig. 10 of this paper) . Devicrs such as thcsc demonstrate Dr. Hellman’s flair for graphic presentation and analysis of data. that 1)r. Hcllman’s stutlics in ontogeny wcrc relaied It is not surprising II is as I bough hc were stimulated to caonsider to his early studies in phylogeny. ontogenetic growt,h by a very intensive preoccupation with what might bc termed evolutionary growth.t In his studies (1918, 1919b, 192Ob, and 1942a), Dr. Hellman proved himself a competent, comparative odontologist. While hr focused his at,tention primarily upon the l’rimat,c%, cspecial1.v the great Anthropoids (orang, chimpanzee, hvorilla), he studied also (via pl~blished reports) the> placental mammals generally and the n~ammallilrc reptiles. In this summary, I venture to quote several conclusions from his 1919b study- (p. 27 of reprint) : That, evolutional processes influencing surll modifications as numhrr, form, position al:tl occlusion of teeth, constitute a noteworthy factor in the c~stablishment of form in the dental arches not only of the rarious placental mammals in general, hut also of the apes and man.

z;;t~;n

*In

“Normal Variation the study of the

his paper emphasized

t&his phase Sregory, p. 53.

of

Dr.

Hellman’s

of Teeth bounds of

researches

and. Jaws and Orthodopty” varlatlon in the analysis

is presented

in

greater

detail

of by

(1935c), cases Dr.

to W.

Dr. be I<.

Fig.

8.

WILTON

72

MARION

KR~GMAN

That this difference may be due to a fundamental difference in the pat,tern of the teeth in the two jaws, as well as to the adherence to the primitive position of the molar teeth in the upper jaw. The extreme diversity in form of the human dental arch fails to obscure Thus, the difference in tooth pattern in similar conditions as in the anthropoids. t,he two jaws, primitive position and occlusion, also produces in man a difference in the form of the two dental arches constituting one denture.

With the knowledge gained from his comparative craniological and odontological studies, Dr. Hellman was the better prepared to analyze the complex adjustments in human crania-facie-dental growth and development. It has already been pointed out that he considered growth in three dimensions (or “planes,” as he called them). We may now note his conclusions with respect to the interplay of growth in these dimensions. For this purpose, we may refer to his papers of 1927a, 192713,1927c, 1931b, 1933a, and 1935a. From his 1927a paper (pp. 512-513), we may quote as follows: 1. Growth

2.

3.

4.

5.

in height of face is attained

by:

a. Moderate increase in dimension of the upper and lower face. b. Greater increase in the subnasal area and lower molar region, really the alveolar process. c. Development of the dentition, pushing, as it wvrre, the upper and lower face apart. Growth in width is attained b-: a. Moderate increase in width in the median plane anteriorly. b. Greatest increase in width in the lateral halves posteriorly, espec,ially at the gonion. c. Intermediat,e amount of growth posteriorly, ascending from the gonion and laterally between gonion and canine. Growth in depth is attained by: a. Increase in dimensions of facial structures in anteroposterior direction. b. The incremevts taking place at the posterior end of the structures concerned, palate and alveolar process of the maxilla above, and alveolar process, ramus, and body of mandible below. c. The lower in position the structures are, the more rapidly they grow. Adjustment of Facial Position: This is determined by measurements taken: from a point in the cranium (external auditory meati) to certain anterior points of the face in the median line (nasion, prosthion, and menton). These dimensions hitherto thought to measure growth are shown to measure position. Modification of the Different Angles: The angles are shown to change in an opposite direction to the other measurements, i.e., the other dimensions grow larger during development while the idea of the modification of the angles grow smaller in degrees. The traditional mandibular angle cannot be upheld.

Emergent from a contemplation of the foregoing, Dr. Hellman came to dichotomize growth (“increase in size”) and differentiation (“change in proportion and adjustment in position”) (1933a, p. 1145). Furthermore, he was greatly impressed hp diflering growth mtes and their effect upon variability. In his 1927b paper (p. 942), he observed as follows : Different parts of the same face grow at different rates of speed at a given period of time. The same part grows at different rates of speed at different periods of time. This gives rise to variability in structure.

Variability in structure gives rise to variability in part:: rornposed of w(‘!I *tl.UCtlll.eS. The face, consequently, varies in the same individual at llifkreut periods 01 life. It varies in different individuals at the wme I”:riocf o L’ tirnc. i.e., at tLr> same age. It varies in different racial groups. There is conhidcrable variability 8imilarly the face varies in occlusal types. in types of face, though helouging to the same r:~w anal pw*ewing ricntitions ill normal occlusion.

In his 19X% paper (p1-,. 1143-45) I)r. ltcllmall is more’ explicit the alternation of rates and times in the three “ l)lan(~s” of grow-t11:

a~~)lll

The transverse dimension of the fave is greatert in its iwrmse in potrti~. the vertical is next in size, and the anteroposterior is smallest. During growvth the largest dimension (xvi&h) increases least, the intwmediate (height) more, and the smallest (clepth I must. .\ll dimc3siou.Q ar( larger in t,he face of the male. When the face increases in width and idepth. ii. does so more below, in 1 iie and auriculonasion regiolls. mandibular region, than above, in the bizygomatic When it incrrasrs in height, it does so more in lowly. at the ramus, than in front. These (lift’erenres are more emphasized in as indicated by the total face height. of the male face. the growtll Iking differrntiation the face changes in pl’oportiou. Ilecaoming longer aili deeper in comparison with its width ; the frm:llv 1’al.e IW~(IIIIC;: relatirctly 10npc~t an11 tlicx male fare relatively deeper.

For a graphic illustration of the rates of ehanpc in Ihe srveral dimc~itsioli~ or plants, rcfcrencc ma>- be made to E’igs. 1, 9, ant1 12 in 1)~. Hellma~l’s .1927a pt1pfT. Fig. I (12. 486) shows percentage addition and reduction in f’acial heights ; Pig. 9 (p. 503) shows percentage additions and reduction in facial depths; Fig. 12 (p. 510) shows percentage atlditions and reductions in kiai heights, widths, depths, positions, and angles. ( Vicx F 11 . 13 , and 13.) Time and t,he researches of other students of Paciodental growth and SC velopment, have elaborated detail, have elucidated complexit,y, but the.v have nor changed in aq- significant manner Dr. Hellman’s fundament,al postulates I growth rate in titnc arl,l growth in a three-dimensional system ; inter])l;\y of inot~~~ilologi~~ in morphologic area; and balanced integration ol’ plant, area to give a normal, individual facr. This was his gro1711d plan: I’o 1,.~1ov~ the normar! fkaf h.e might nsses~ deuiatio?b fTom it in lii)d and dtfJMc. ;I nialocclusion was not necessarily an attained abtJrranc*>----hit was growth proc’c’s~: but /rctrt?rrr~rlf wifir out of balance: out of harmony. r\;ot trcaltnc~llt alwr. was the answer.” powth, Of part,icular interest to physical anthropologists is Dr. Hcllman ‘S tlkxrrssion of sex and race differences in faciodental qowth and in the tcet 11. St,1 differences are discussed’in his 1982 and 1933a I)apers. In genera& growf 11 (iil?ltC.

illltl

it

“Dr. Hellman, in addition to his three-plane ITMX‘F: lacalized and/or specialized phenowen:~, ?.g., rtrle of 313 (1936b. 1938, and 194nb).

growth uxrlysis, tllc! CUSIW of tht?

@(I twtll

w.ttention (Insah,

~1s~) 1./ :rn
tl;C

74

WILTON

MARION

KROGMAS

mensions in size are more marked in the male. The female face is relatively longer, the male face relatively broader and deeper. The female jawbones and dental arches are relatively more prognathous. In Fig. 2 (1). 927) in his 1927b paper, Dr. Hellman presented average male and female profiles (Fig. 14 of this paper). Percentage

Addition

of Total Its

and Reduction

r'*oe Iieieht

crr,:>onrnt

end

pEi11ts

\...*. _..-.*. ._..\ .. 7

co

\

. ..

Lower

f,

\

'yTota1

UPPer

\

\ \ \ ‘\ ‘\ i

Total Pace Height Upper Face Helaht - - - Lower Fete Height ........ Dental Fmce Height -.-.-.-. I

II

IV

III

"

VII

VI

ytsces pig.

Il.--cGrowth

(percentage)

in

facial

height

(192ia,

Fig.

1,

p.

486).

Race differences are discussed in Dr. Hellman’s 1919a, 1919b, 1928a, and 1929 papers. In the 1919b paper (p. 27 of reprint), he said, “The Indians and Eskimos exhibit an edge-to-edge bite, while the Whites and Hindoos, a moderate over-bite, reaching an extreme condition in the Mongolians.” The 1928a study concerns the manifestation of the so-called “Dryopithecus pattern” in the human dentition. He concluded (p. 174) “that as shown by the changes in crown pattern of the lower molar teeth, the most advanced stage is attained by

HF.I,I,MBP\’

‘S CONTRIBUTIONS

TO

l’HPSIt!.\I,

.\ N’l’IlR01’01,O!;S

IF I .I

the modern ffhites; t,he most primitive stage is rctainctl by the West African Xegroes, the Mongols being intermediate. ” His Fig. 7 (1). 165)” shows thta stages in the drift from the “I).-pattern” to tlio ” i-I” ( I-‘ig. 15 of this paper) In his Fig. 14 (1,. 198) (1929) 1)r. 1Iellman l~rcsc~ntrd I’acial l~rofiles of white. Atlstraliatr. ilUCi Hindu, using skulls (Fig. 16 of this ~~il,l)Pl' I.

palate Palsts ps1ate *l"nalar

Fig.

12.--Gron?b

(percentage)

in facial

depth.

(TOtal)
(192ia,

Fig.

9, P. :0:1).

Dr. Hellman was quick to realize that extraneous factors might markedI> influence the pattern and progress of growth. In an article entitled ” Food ant1 Teeth” (1925) he discussed the role of vitamins, sunlight and other light. rays, calories, proteins, carbohydrates, fats, the amino acids, and the internal secr+~tions. He also presented data on food and food habim as a factor in esposuru *See

also

Fig.

4, p. 177

(1940b)

; Fig.

16, p. 16

(1942).

Fig.

13.-Growth

Fig.

14.-&x

(percentagej

differences

in facial

heights, widths, Fig. 12, p. 610).

in facial

proflles

depths,

(quadrilateral)

positions,

192Tb,

and

Fig.

angles

3, P. 9227.)

(192’ia.

Fig. It?--Rncial

h;racd on skdls differences in facial mofiles (quadrilateml) Australian Aborigine, and Hindu (192!), Pig. 1 t, p. 198).

of wllitr,.

In all of his discussions of growth pattern and of the operation of cs. traneous factors upon that pattern, Dr. Hellman recognized the role of heredity, though he attempted no real genetic analysis. In his practice he was happ) when he could get siblings for family line comparisons. In his 3.925 paper, in rats. “Food and Teeth,” he mentioned generational studies of malnutrition In his 1936a paper, he wrote as follows (p. 15 of reprint) : Chins, jaws and faces are not products uf ortlwtluntia. Tlley lmve bctw wished on us Iong before anyone thought of them. F’nccr of individuals with

78

WILTON

MARIOX

KROGMAS

dentitions in normal occlusion do not all have uniform chins and jaws. . . . i2s a matter of fact, faces, jaws, chins and dentition are natural features which grow up together. . . . The extent to which each of them may grow is not depended upon, related to, or controlled by the others. They each hare a certain amount of independence. On that account, all faces vary from each other, but each varies in a different way and to a different degree.

If this quotation be strictly interpreted, it seems as though l)r. Hellman in the total pattern were implying a sort of unit-inheritance (i.c., unit-growth) of faciodental relationships. None of his researches bear this out in precise detail, though his earlier work on t,he relationship of form t,o position of teeth (1919a) implies at least an independcncr of arch form and tooth position. Dr. Hellman’s use of dent,al age, in his stages, recorded his emancipation from chronological age. In 1928 (192%) he published what we must regard as a very significant. contribution, not only to orthodontia, but to the field of growth and development as a whole. His “ Ossification of Epiphysial Cartilages in the Hand” is a veritable model of careful precision in observation, and reserved caution in interpretabion and conclusion. He studied sixty girls with an average age, at beginnin g of the study, of 11.48 (a 0.43), over a four-year period. Hc concluded “that ossification of the epiphysial cartilages of the hand occurs in four fundamental ways,” which he designated as Stages A, B, C, and D (pp. 242-43) : A. The cartilage disk narrows. B. The cartilage disk shows precipitation of bone or bud-like processes of ossification. C. The cartilage disk entirely disappears. D. There is differentiation of the bone structure in the ossified area.

Stage A appeared between 12 years, 36 days, and 12 years, 11 months. Stage D is completed between 14 years, 3 months and 15 years. Thus, “the entire process of ossification in the bones of the hand lasts somewhat less than three years. ” Dr. Hellman’s final conclusion is as follows (p. 243) : It may, therefore, be concluded that the period between the ages of 12% and 14 years is replete with significant physiologic processes in this group of girls. The dentition of youth [M2] is completed, the epiphysial cartilages are undergoing the most active transformation and stature is increasing at its greatest rate. Moreover, accompanying these phenomena processes are taking place that subs<,quently bring about pubescence.

It is little wonder that to I)r. Hellman crania-facie-dental relationships ivere one with the entire growing organism. Not chronological age, but, biological age-dental and skeletal-was the North Star by which he set his compass of investigation. With such a course plotted, it is understandable that he so often made the sure voyage of careful diagnosis and achieved the safe harbor of felicitous result. Up to this point, we have noted the tangibles of technique, of measurement, of observation, of interpretation, and of integration of knowledge and fact. This delineates Dr. Hellman, the researcher, the worker with caliper and x-ray. Let us now look at the intangibles, the philosophy, if we may use the term, of

t 11(X ~]~plYXiClt. What, then, of Dr. Hellman, the thinker, the dtwmer--e~~1 If we’vf: noted the way aliti visionary--t he worker with ideas and aspirations? path to the goal, what of the goal itself? Dr. Hellman was profoundly impressed that one of the goals of orthodont,ia was to proceed in compliance with t,he general ground plan of natural design. In his 1919a paper, “The Relationship of Form to Position in Teeth, and Its FSe;iring on Occlusion,” he concluded (p. 54 of reprint) : That, since it is beyond the possibilit,y of ort,hodontia to exert the slight,& influencae toward the modification of a tooth in its form, and since the tooth-form has retained most of its primitive features, it is imperative to base the modification in its position in accordance with these ancestral characters, following the plan as laid down by evolutionary record. For, unless the conditions are fulfilled first, there will modification

always be a tendency on the of all orthodontic procedures

part of Xatnre to assert herself not in accord with her dictatea.

by If

:( WC?

would, therefore work with Nature and have her approval and assistance. we must ~ontino our efforts to a more strenuous endeavor to learn to understand her, accept and appreciate her guidance by the recognition 0 f IW laws as laid down in thtk form of all primitive charncters xniI their vari~lu.~ rn~,(lific~:rlions as found to by associated

with

the

dentition

of man.

E’or T)r. Hellman, Nature presented herself not only in an evolutionar> manner, leaving an imprint of primitive and;‘or generalized characters, hut in the vital dynamics of growth and development as well---perhaps even mow Working witk Xtrtwe meant wm+&q graphically, and certainly more potently. with growbh. He never claimed for therapy what growth had gratuitously hrstowed. In his 1933a paper (p. 1115), he slated iwith italics -for emphasis) I “the ymwth of the fme is nppurenfly nof d~pmdwf rlpon the effect of or-fhodontic tr~cbtment, but that the succe.s.~ of orthodnnfic~ iwtrf~~~rnf ‘mcr?j be dqwntlerrf trpon the elffecf of growth.” In his 1927a ~);lper (1). 171, he warned against “the risk of attempting to do something with orthodontic al)pliancrs tllzt rniplll br accomplished in the course of time b\- natur;ll ctrrclol)lncnt. ” .In his 1931;~ paper (p. 15%). he stated as follows : It must, therefore, be concluded that since the diagnostic. features of rnalo(.<*lilsion of the teeth are inseparably connected with natural process of development, irntl since orthodontic treatment consists of artificial fork exerted by mechanical tlt~ vices upon living structures, it is necessary to be wary of the fact that the procedure must itjations to Iliscarepaneies

be made to conform to those conditions ~vhich general growth phenomena. One should also in growth very often disappear in tllp c9urse

ronatitute natural lirn realize that apparcui of developtient, if un

hindered by artificial encumbrances. It naturally follows that orthodontics. trf’:Llmcut must never 1,~ undertaken until the orthollontirt ii reaeonabl~ rcrtain that the natural growth rhangrs involvetl in the drvelopnlrnt of the f:t(ze and dentit,ioli will

not

romplete

the

task

in their

umn way.

In 194% (p. 639)) Dr. Hellman summarixcd his yictw-s on growth :+tl ortlw dontic treatment 1~’ saying, “the most favorable tinw to gain desirable orthodontic results is the period of maximum facial growth. ” Dr. Hellman’s growth philosophy centers upon one word: ?occit!---l~o1, howcve~~, the st,atic quality of observing the status quo. hut the dynamic ap-

80

WILTON

X1RIOh-

KRO(;&lAZ

proach 011 watching while waiti?tg : the establishment of growth stage, the cstimation of growth progress, and the analysis of growth t,rend toward (or possibly away from) remedial balance. This is seen in his 1931d paper (p. 444) : . . . The method of diagnosing cases of malocclusion must rest upon a reeognition of many other factors besides the occlusion of the teeth. These are the stage of development of the patient, and the change in the face, jaws, and dentition yet to take place during further dcvclopmcnt. The fact to be recognized is that, with increase in size, change in proportion and alternation in position of the face, there is also an accompanying effect which tends to modify the occlusion of the teeth. Upon the appraisal of this effect, then, will depend the diagnosis and prognosis of the case. Dr. Hellman felt that his study of growth and development and their relation to malocclusion represented a distinct step forward in making orthodontia a more precise science. In his 1931c paper (p. 2173), he stated: It would seem, then, that, after all, the theoretical aspect. of malocclusion does have a practical value. By the introduction of a scientific method for appraising malocclusion, a means is also furnished for an adequate understanding of the changes brought about by the mechanical procedures employed in orthodontic treatment.

The scientific method meant precision, it nleant adequate statistical analysis, and it meant careful definition of concepts. As early as 1921 (1). 11 of reprint) : cannot be found.” he stated that “the imaginary ideal of the orthodontist There is, however, a workable ideal, “Nature’s i&J, as expressed in the form of type-represented by the average nd its stmdard deviation.” He expounded this theme with the statement that “the aveflcqe . . . represents the ‘xo~MZ, and the range of vnriabilit~y the fype.” This was not merely word playing for Dr. Hellman; he JV::Sfeeling his way towartl a realization that variation, within predictable and measurable bounds, is a natural process of all organic life. In this search for truth and unders1anding, Dr. Hcllman was stern and forthright. “A conglomeration of I’acts. observations, and theories does not constitute a science an;v more than a heap of bricks, lmnbcr, concrete and various other building materials consbitute an edifice. ” (1920a, p. 18 of reprint.) 1%~ went on further to sag “that an accumulatioil of observations, :I collection of appliances, a manifold manner of their ni~uli~~ulation, and a variety of results do not constitute a profession. ” In his 192Oh paper (1q). 6 and 7 of reprint), he warned that mere classification is not to 1~ eonfuscd with diagnosis, which “is essentially a process reyuirin g a separate course of procedure, and has f’ol its object to ascertain the conditions antecedin, 0 the manifested malocclusion in the individual case.” Thcso strictures were dictated by a profound dcsiro to place orthodontia on a sound basis of empirical science. If he were critical generally, it was because he was mor(~ than critical spccificall~--of himself. His paper entitled “Failures in Orthodontic Treatment” (1936r) is an excellent example of Dr. IIellman’s ability to appraise his concepts arid their pragmatic value as revealed by actllal case histories. IIe, like all of us, learned much from failures. i ’Trial and error ’’ are linked as a phrase-but don’t forget that trial comes first! Growt,h and orthodontia were inseparable in Dr/

COSTRIBUTIOSS

IWLI.AI.\?;‘S

‘1

.\sTFIR01’01,0(;Y

TO PRPSI(‘,\L

1. The need of that knowledge which has for its object the diwrimin:rLion rind recognition of those phases of developmf~nt having :i clirrct influencr / a‘~ the eruption and shedding of the tlwi~lutnw twth: (1)) the establirhupon: of tile .r:in ment of the alveolar and dental al~cht~s; aud (0,) tl1r rle\-elr,pruc~Ilr t~c~nri :w wrll as of the entire face. 0. The need of that knowledge which has for its object the application 01’ n:ttur:~l IIIP:~~S (physiologic, or biologic, if you prrfw) to promote the effects which xre f :troral,lt~, and intercept or eliminate those whic*h a w urri’aroral~le to 11cvelu~~ ruent:ll p*ogress. 3. The new1 of that knowledge, abilit,y, and skill \\-hic~h have for their objwt the proper use and expert manipulation of those mec:hauic~al clevires Rhich are maxi in routine practice when actual treatment (~:\ILcspedi~~nt and of greatest lwnefit not bc averted. We

may

anthropology of

Physical

ask ourselves,

1’’’

The

”

scientific,

and

pioneer

answer

Xnthropolo,~

Orthodontia.

And infinit,ely

are

paraphrase

:

put

so doing more

st,udies

proving “The

“What

did

comes

and in

waniomctric

ies--which might

wrll

clearly

he

made

and his

of

simply,

the

long

“He more iut.urc.”

prescwt,-day had

Ii\-e

no

to physical took

to USC, in

profession.

have

is dead.

contrilJute

a successful

analyses,

so fruitful-could skull

Hellman

to vvJ1~1~, and

them

hopeful and

Dr.

the

the

precise, Without

crphalomc+rie s11re -foundation.

the head

tools

service

oi

more his stnd\\‘t>

i”

PF-IYSICAI, .\STFIRO1’OIAJGT ’‘+

--

rr.t Obrervations on the Form of the Dental Xwh of 1111:Orang, 1x17. %I. ()~J~rIll,l~oN’ L 4(Z): .3?-lci (repwit). The Relationship of Form to Po,sition in ‘l’eeth and Its Htaaring on Occlwicm. Thlrit :II Items Tnterest, 55 pp. (reprint). Dimensions vs. Form in Teeth ant1 Their Hearing on the Morphology of the Dental Awh, km. J. ORTIIODONTIA 5(U) : 1-39 (reprint 1. Orthodontia : Origin, Erolution, and Culmination as :I Wpwialty! Dental VosmoY. 19 pp. jrcprint). An Interpretation of Angle ‘8 Classification of Mwloc~c~luxion of ihe ‘I’eeth Supportetl b? Evidence From Comparative Anatomy an11 Erolutiou, I)entnl (‘osmo~, 20 pp. (reprint ) . Mechanics in Orthodontia, From a Modern &pwt, Dental (‘osmos. 24 pp. (reprint /. Variation in Occlusion, Dental Cosmos, 12 pp. irepriut 1. Studiw ou the Etiology of Angle’s Class 11 M:~lot~clur:~l hlanifrstation~, is,r, .I. ORTIUX>O~;TIA 8 (3) : l-20 (reprint). Food and Teeth,,Dental Cosmos 67: 185-195. Some (‘hanges In the Human Face ax Influence~l 11,~ I hex l’relh. Natural TSistor? 26( 11 : 68-i-k. (lllanges in the Human E’ace Brought ~\bout 1)). 1 )<~vrloprncut, 1 ST. .I. (kTJlODOXTL\ 13 (6) : 475-516. The Face and the Occlusion of the Tretll in Man, Ir,r. .I. ORWIOI)OWI~I~~13jll ‘8: DY.L945. One of the Fundamental Factors Concerned in the Rtiology of Derrtofecial Deformities, J. A. D. A. 6 pp. (reprint, Sept.). Racial f’hararters in Human Dentition, I’roc. Am. T’hilosol~hieal SW. 6712 ! : 15; 171. *Dr.

Talgai.,

I-iellman

tz\ll

also contributeed

and the AustraZopithecim% titles :IPZ by Dr. Hellman.

Punin.

to physical These

anthropologv

have

been

his studies of human

discussed

by

Xir’. W.

X.

fossils:

Gregory.

a2

WILTON

MARION

KROGMAN

392813. Ossification of Epiphysial Cartilages in the Hand, Am. ,J. Physical Anthropol. ll(2) : 223-246. lO“9. * -. . The Face and Teeth of Man, J. Dent. Hesearch g(2): 1X-201. 193la. \Vltat About Diagnosis and Treatment of (‘lass Tl Malocclusion oC tile ‘l’eet,h? INT. J ORTHODONTIA 17(s): Il::-15X. 1931b. Ort,hodontia in Itelation to Develop~~~ent ol’ (‘hild Dentition, 1). Survey, 1 pp. (reprint, Sept.). 1931c. Morphology of the Face, Jaws and Denlitiou in (Ilass 1IT Malocclusion of the Teeth, J. A. D. A. 18: 2150-2173. 1931d. Open-bite, INT. J. ORTHODONTIA 17(5): 421-443. An Introduction to Growth of the Human Face From Infant\to Adulthood, INT. 1932. J. ORTHODOFCTIA18(8): 777-801. 1933a. Growth of the Face and Occlusion of the Teeth in Relation to Orthodontic Treatment, INT. J. ORTHODONTIA 19(N): 1116-1148. 1933b. Cusps and Occlusion, Dental Cosmos, 15 pp. (reprint). 1935a. The Face in the Developmental Career, Dental Cosmos 77(7-8), 25 pp. (reprint). 1935b. Growth (discussion of Dr. Boas’ article), INT. J. ORTHOIHNTIA 21(10): 922-928. 193%. Normal Variation of Teeth and Jaws and Orthodonty, TNT. J. ORTHODONTIA 21(12): 1108-1114. (Discussion of paper by Dr. A. H. HrdliEka.) 1936a. Some Problems in Orthodontia a Dentist Should Know, D. Outlook 25(6): 21 pp. (reprint). 1936b. Our Third Molar Teeth, Their Eruption, Presence and Absence, Dental Cosmos, 15 pp. (reprint). 1936c. Failures in Ort,hodontic Treatment, JKT. J. ORTHODONTIA 22: (4) : 343-359. Their Implications and Applications in Orthodontic Some Biologic Aspects: 1937. Practice, INT. J. ORTHODOKTIA 23(8): 761-788. Some Aspects of Wisdom Teeth and Their Impaction, Arch. Clin. Oral Path. 2(2): 1938. 125-I 44. Some Facial Features and Their Orthodoutic Implications, S&f. J. ORTHODONTICS AND 1939. ORAL QURG. 25(10): 927-951. 1940a. Development of Face and Dentition in Its Application to Orthodontic Treatment, dM. J. ORTHODONTICS AND ORAT, SURG. 26(5): 424-447. 1940b. The Wisdom Teeth in Our Lower *Jaw, Arch. Clin. Oral Path. 4(3-4): 171-186. of Occlusion ’‘) Uni. 1941a. Factors Influencing the Occlusion (pp. 49-72 in “Development versity of Pennsylvania Bicentennial Conference, Philadelphia. 1941b. Diagnosis in Orthodontic Practice, AM. J. ORTIIODOXTICS AND ORAL QURG. 27(12): 681.704. 1942a. Factors Influencing Occlusion, Angle Orthodontist 12(l) : 3-27. 1942b. The Optimum Time for Orthodontic Treatment, J. A. D. A. 29: 622-639. The Phase of Development Concerned With Erupting the Permanent Teeth, An{. J. 1943. ORTHODONTICS ASD ORAL SURG. 29(9): 5Oi-526.