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APR 13 1914




BY BENJAMIN W. RICHARDSON, M.D., Licentiate of the Royal College of Physicians ; Physician to the Royal Infirmary

for Diseases of the Chest, and Lecturer on Physiology at the Grosvenor Place School of Medicine.



[Delivered November 9th, 1858.] MR PRESIDENT AND GENTLEMEN, BEFORE entering on the subject proper of the present lecture, I cannot omit the pleasure of expressing to yourself, Sir, the Council, and Members of this College, the gratification I feel at the honour of having been invited in my capacity as a teacher of medical science, to the exercise of my calling in this place.

Nor would it be grateful in me to forget an act of great kindness, in connexion with the honour of the invitation. Feeling, doubtless, that your lecturer, engaged as he is, not in the special field of dental science, but in collateral pursuits, could not be expected to treat on those special subjects which constitute what may be called the direct science of dentistry, the Council of the College, with quick delicacy of feeling and of action, gave to him the selection of each subject of discourse ; intimating to him, through you, Sir, that subjects of a collateral kind would be acceptable to the members, and that a physician speaking to them as a physician, and taking a physician's view of dental diseases, would be heard with satisfaction.

But for this extension of privilege I could not, however gratifying the invitation, have accepted these duties. As it is, I enter upon them not merely freed from much embarrassment, but with pleasure, since I am enabled to take for my discourses such texts as, to an observer of the general phenomena of diseases, offer the means of describing the history of the relationships which exist between the local phenomena of a special order of diseases, and of diseases as a whole; such texts, in

short, as will allow me to hold up to those who are engaged in dentistry proper the medical aspects of their science.

Nor do I fail to anticipate that some benefit may accrue to us all in this attempt at blending the general and the particular. One half the world knows not how the other half lives, says the old proverb. One half the science-world knows not what the other half thinks, would be another allowable version of the same maxim. So I hope that, from a representation of what the medical half of the science-world thinks on the matter of dental diseases and their treatment, the other half-brothers in science—may gather some fruitful suggestions, and even from the errors of medicine borrow wisdom

“For there is a soul of truth in things false,

Could men observingly distil it out." The general title of this course stands as follows :-"The Medical History and Treatment of certain Diseases of the Teeth and their adjacent Structures.” In the divisions of the course no attempt will be made towards classifying or systematising the subjects. Taking up each text given in the syllabus, I shall make each lecture an independent essay.

On the present occasion there are before us for discussion,

“ The Constitutional and General Causes of certain Diseases of the Teeth and their adjacent Structures."

In this lecture we shall review in a general sense, much which in after lectures will form the subject of particular study, Without design, therefore, this is naturally and in reality a lecture introductory to the whole course.

It may be well at the onset of our labours to consider the meaning of the terms “local disease,” and “constitutional disease,” in their relations to each other.

Our common phraseology supplies us with this division of diseases into local and constitutional ; long custom sanctions it -practice clenches it. Since the days when the Father of History, travelling through Egypt, wrote some two thousand years ago, " that one Physician is confined to the study and management of one disease; that some attend to disorders of the eyes, others to disorders of the head; some take care of the teeth, others are conversant with intestinal disease, whilst many attend to the cure of maladies which are less conspicuous ;" from then till now, I say, in the division of labour necessary for the treatment of diseases, classifications of diseases have been taken as the bases of the divisions of labour, and in a social sense at least, this arrangement, when not over-driven, has worked well. Practically, therefore, it were better to let it alone.

But if we take this matter into consideration on a higher ground; on philosophical argument, we shall find that the division of diseases into “ local” and “ constitutional” forms is arbitrary, and does not rest on close observation of nature. We shall find that the most local type of disease, local as regards place, position, and origin, lapses always into constitutional derangement, more or less severe ; while in the majority of cases the origin of local disease is due to a preceding systemic disorder; in other words, to a constitutional cause.

Great care at the same time requires to be taken in reference to the use of the term “ constitutional origin,” especially in its application to the production of local disease. It were better, in fact, to use the term “ systemic origin” rather than constitutional, and it were better still to say that a local disease is produced through the constitution or through the system, than to say that such diseases are of constitutional or systemic origin. For, when we come to speak of origins truly, we must pass out of the body altogether and look for them in external causes alone. The body, in fact, in itself is perfect as a healthy whole. It cannot by its physiological conformation produce any kind of disorder local or general. It can only be deranged by the medium of external agencies, which affect it by one of three ways-physically, as when it is subjected to accident; chemically, as when it is subjected to the influence of a poison ; physiologically, as when by some abnormal condition in which it is placed, the normal acts are deranged and changed into pathological conditions.

A ladder slips from me, and I am brought to mother earth, with dislocation of my shoulder or cracked head. A physical external cause forsooth happens to me. I take mercury to saturation, and a train of ineradicable eyils follows. A chemical external cause has laid hold of me. I eat and drink too muchI eat and drink too little; I sleep not enough-I sleep too long ; I tax my body over-hard-I tax my brain; and causes acting on me from without, and physiologically, mark me; as a consequence, I contract gout, or marasmus; muscular hypertrophy, or mental imbecility ; the disease according to the cause.

To apply these considerations to the particular subject now before us, we may learn,

1st. That the most local disorder-of the teeth, for example, such as arises from injury, compression, or the action on these organs of a chemical agent-will extend more or less to the body at large.

2ndly. That when a local affection, say of the teeth or their adjacent structures, occurs, as the result of constitutional malcondition, the true origin of such mal-condition is through the system, not of it; that is to say, from some external influence acting constitutionally.

Against the rule here urged as to the external origin of diseases, one exception might be claimed. While it would generally be admitted that the constitutional disorders which arise from accidents, from the effects of poisons, organic or inorganic, from the effects of insufficient or over-sufficient foods or

drinks, from uncleanliness, from atmospheric variations, and from occupations and pursuits, have clearly an origin out of the body, it may be argued that those diseases which pass from parent to offspring, and which are known as hereditary, certainly are derived from simple derangement of the organism itself, and independently of any influence from without. This argument is in part true, and in part false; true as regards present agency-false as regards primary agency. For the fact is, that the child lives in the parent; and the origin of all hereditary diseases and their local consequences, whether of hereditary syphilis or hereditary gout, is in the mysterious chain of generation traceable back to an external beginning. A progenitor received the disease from without, and transmitted it on.

I have introduced these remarks, that I may not be misunderstood in the use of the term “constitutional disease.” At the risk of seeming wearisome, I must repeat that, in what I shall have to say in the sequel on the influence of systemic derangements on the organs of mastication, I shall define diseases of those parts which have their origin from without, through the medium of the body.

We have seen in our previous remarks that local and constitutional disorders hold two relationships—that the local disturbance may take precedence, and act as the indirect cause to the constitutional malady. We have seen that the reverse obtains also. We might therefore, in taking up the diseases which affect the masticatory organs, follow two courses in the way of connecting these special disorders with such disorders as are systemic or general. We might trace those constitutional derangements, which are due to primary affections in the organs of mastication, back to those diseases which are most purely localized in the first instance; to the caries, for example, or the necrosis which occurs in the teeth from the direct effect of chemical or physical agencies exerted on these organs. Or, reversing the study, we might trace out the origin of those diseases of the organs of mastication which arise through the system, and are developed as the simple sequence of constitutional mischief.

In a comprehensive sense, these two points are inseparable ; but on the present occasion our attention is confined particularly to that last named.

Keeping, then, more especially to those diseases of the teeth and their adjacent structures, which have their origin from external causes operating through the body at large, one sees on reflection that while several diseases specially pertaining to the teeth themselves, namely, caries, necrosis, inflammation, and the nervous manifestation which we call ache or pain, may and often do arise from direct local mischief inflicted on the parts them. selves,—these said diseases may also have a constitutional basis, while all other affections of which we shall have to speak, to wit, hæmorrhage, neuralgia, dyspeptic and gouty toothache,

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