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ADDRESS TO SECTION ON ORAL SURGERY.
By D. H. GOODWILLIE, M. D.,
The organization of the Section on Dental and Oral Surgery in the American Medical Association foreshadows such a changed relation between dentistry and medicine as will, it is to be hoped, in a few years, in some respects greatly modify the teaching and practice of both. And at this, our first meeting after the organization of the Section, it may be proper to indicate to what this mode of teaching naturally tends, and what the new relation should be.
In foreshadowing the future we can hardly avoid taking a glance at the past, and noting the probable fact that in their beginning, dental surgery and medicine diverged from a common centre. After many a hundred years of separation, it is to be hoped that in the near future they will become reunited and their natural relation restored. While not a step can be taken either in what is known as mechanical dentistry (the making of artificial teeth, or in dental surgery, the treatment of the natural teeth), without mechanical manipulation-skill in the former rests upon a basis of mechanics combined with art; while an intelligent practice of the latter is based upon medical knowledge.
For no disease can be intelligently treated without a knowledge of the histology, the anatomy, and the physiology of the organ or organs diseased, as well as the pathology, prognosis, and rationale of the treatment employed to restore the parts to a healthy condition ; and this—whether applied to any single organ or any number of organs of the body, or to the entire system-is medical science. And to comprehend these conditions, either singly or collectively, in any organ of the body,
involves a most comprehensive knowledge of medicine,-principles underlying the whole system. And, although good results have been reached in the treatment of certain diseases of the teeth without medical knowledge—as in other diseasessuch practice is empirical and insufficient as a guide for those who would become thoroughly skilled as dental surgeons.
From the best information we can gather, diseases of the teeth, like general surgery and the treatment of the eye, was to some extent practiced in its earliest history, in connection with medicine. The Arabian school is responsible as the separating wedge which divorced medicine and surgery—a complete division taking place about the middle of the twelfth century. All medical knowledge at that time being in the hands of the priesthood,—the Council of Tours regarding the practice of surgery as unworthy the dignity of their sacred office, and beneath the attention of all men of learning,—surgery was relegated to barbers and bathers, and dentistry (requiring mechanical skill in the use of metals) naturally fell into the hands of the blacksmith, the barber, and the watchmaker.
In those times surgeons were not considered worthy of consultation by medical men.
They were simply employed to work under the direction of the physician, and when their work was done they were dismissed. But in time these surgeons acquired such a knowledge of anatomy, surgical pathology, and medicine that they began to consider themselves qualified to prescribe the treatment of those requiring their services, and to assume the responsibility of after treatment and cure of these cases. This claim, at first stoutly contested by the general practitioner, was ultimately conceded, and as philosophy and science shed their light upon the subject, surgery, once rejected as unworthy, has become one of the most important supporting pillars in the temple of medicine.
But—in our country, at least—as a pre-requisite to this position, a general medical education is exacted of the surgeon. He is simply a doctor of medicine practicing surgery from choice. But in surgery, as in other departments of medicine, the most uniformly good results are achieved by the specialist, for the simple reason that, after being well grounded in PRINCIPLES, subdivision of labor tends to the best results.
While dentistry, in the Middle Ages, was practiced almost
exclusively by barbers and jewellers, dental literature—though meagre—was the product of medical writers.
But as the most successful treatment of surgical diseases required a better medical education than had been previously possessed by those who practiced surgery, so, too, time and experience taught that the mechanical manipulation essential in the treatment of dental diseases was most successful when directed by medical knowledge, and gradually medical men were found engaged in the practice of dental surgery.
But as good results may in some cases be reached by mechanical skill only-as might occur in some cases in surgery—the medical profession have been slow to recognize the importance of a medical education on the part of those who practice dental surgery, and the public equally slow in demanding it.
The struggle for supremacy between the properly educated and uneducated has been tedious and too long continued. But physicians, as well as the public, are beginning to appreciate the fact that, while a medical education is not essential in the manufacture of artificial teeth, it is as essential in the treatment of the natural teeth and their associate parts as it is in the treatment of any other class of diseases. But this general medical education should be supplemented by special instruction in dental surgery, as the ophthalmologist, oraurist, or surgeon should supplement his general medical knowledge with such special instruction in his department as would tend to develop the highest degree of skill, and render him an authority in all matters relating to his specialty.
It was with this object in view that, over forty years ago, Drs. Harris, Hayden, and others sought to establish a department or chair for the teaching of dental surgery in the medical department of the University of Maryland. But when their application was made for this purpose, it was repulsed with the reply that dentistry, being a purely mechanical pursuit (as surgery was considered in former times), a medical education was not necessary-feeling, no doubt, that it would be derogatory to the medical profession to be associated with such an ignoble calling as treating the diseases of the mouth—as in former times it was considered derogatory to be associated with the general surgeons.
Realizing, however, that dental surgery could not be properly practiced without a knowledge of physic, Dr. Harris became instrumental in organizing what was known as the Baltimore College of Dental Surgery, with chairs upon anatomy, dental physiology, pathology, therapeutics, chemistry, operative dentistry, and mechanical dentistry. A limited course of medical instruction was given in this college, and a new degree, known as that of Doctor of Dental Surgery, was created for the graduates.
But it was not pretended that these graduates were qualified to enter upon the general practice of physic. In fact, the instruction was far more mechanical than medical. But, as experience has taught the need of a fuller medical education for the proper practice of developing dental surgery, our dental colleges have, from time to time, increased their curriculum in that department, and several of our universities have been induced to establish dental schools in connection with their medical departments; but, as yet, none of these institutions have required a full medical education of their dental graduates, feeling the need of which many of these graduates have completed their instruction in medical schools, receiving their diplomas as doctors of medicine, which knowledge, being essential as a foundation to correct practice, should have preceded, instead of following, special instruction in dental surgery. Thus educated, the dental surgeon becomes as legitimate a physician as does the special practitioner of ophthalmology, otology, or surgery—a fact which was gracefully advocated by Drs. Gross, Davis, and Sayers, and acknowledged in the organization of the Section on Dentistry at the last meeting of this Association.
Two results to which the establishment of this Section should lead are: First, That all dental surgeons shall receive a medical education, and become legitimate specialists in its practice; and, second, that all medical graduates shall be as fully educated in diseases of the teeth and the science of their treatment as they are in other diseases.
This can only be accomplished by providing for both the dental and medical student the same studies, and exacting of each the same knowledge of medicine. To this end, chairs on dental diseases should be established in medical colleges, and filled by medically educated and practicing dental surgeons.
Although, as previously stated, several of our universities have provided for a fuller medical education for those who pro
pose to practice dental surgery than is supposed to be given in our regular dental colleges, none so far have provided for instruction in dental diseases for those who propose to engage in the general practice of medicine. The result of this is that the medical graduate knows nothing in regard to the teeth beyond what is embraced in about one lecture on their coarser anatomy, which leaves them entirely unqualified to trace cause and effect between diseases of the teeth and associate parts and the local or constitutional causes which play such an important part in these diseases. The importance of a general medical, education, on the part of those who engage in the practice of dental surgery, which I have advocated for so many years, I am glad to see acknowledged in the just issued announcement of the Missouri Dental College as follows.
Many of the diseases of the teeth are dependent upon disturbances of nutrition, which can only be appreciated by one who is familiar not only with anatomy and physiology, but with general as well as special pathology, and they declare that “ the comprehensive knowledge of medicine is indispensable for the successful practice of any specialty,” and state their belief that “the near future will demand of the dental graduate, first, a medical education, to which shall be added the special practical training requisite to fit him to practice the specialty; for we maintain that it is impossible to draw a line separating the many specialties of medicine, or to rigidly circumscribe their duties, without impairing their usefulness.”
And yet with this declaration this college does not exact a full medical education of its graduates.
Those who object to exacting a full medical education as the foundation for the practice of dental surgery, as a clinching argument against it triumphantly ask: “What has obstetrics to do with diseases of the teeth or their treatment ?” They might as well ask What has obstetrics to do with the treatment of the diseases of the eye, or the ear, or the skin ? And yet a regular medical education is demanded as a foundation for practice in these departments of medicine.
But suppose we admit that obstetrics has no direct influence over the teeth, I think that no intelligent person can question that the condition of the teeth sometimes most seriously impairs the health of gestating women and induces premature labor, which demands the service of the obstetrician. Neither can it