1
1168 ANNOTATIONS DENTISTS’ CIRCULARS Sir Francis Acland’s opening speech on Nov. 9th at the twenty-third session of the Dental Board of the United Kingdom contained the consoling information that his parliamentary duties are not to stand in the way of effective occupation of the Board’s chair. " I have adopted," he said, " regular hours for public work-week-days 9 A.M. to 12 midnight-and I believe that the Registrar and other officers of the Board have found that they can now discharge their duties with greater promptitude, owing to my receiving and answering their letters on the same day that they are written and posted." He went on to welcome Mr. Bishop Harman as a member of the Board appointed by the General Medical Council, and noted Dr. R. H. Crowley’s consent to serve on the Dental Health Education Committee. Apart from such domestic matters, the most interesting part of his address dealt with the evergreen problem of the proper means for a "Dentist, 1921 " to make himself known to pro- spective clients. We have been consulted, said Sir Francis, by dentists about circulars which they propose to issue themselves, or which have been issued by other dentists. This, he said, is the type of thing :- (i) A teeth institute sends circulars to its patients asking them to look in and inspect dentures made of a wonderful substance which has been newly discovered ; (ii) another dentist proposes to send his patients, not with his account but as a separate document, a circular letter saying that in view of the present hard times he proposes to allow a discount on all accounts which are paid promptly ; (iii) cards headed " Please take one," announcing a reduction of fees " to meet present financial conditions," are placed in a dentist’s waiting-room. The question raised is whether this sort of thing constitutes an advertisement, and whether the Board would make any objection if circulars or notices of this sort became habitual. I can only advise, Sir Francis said, any dentists who may have done things of this kind, or may contemplate doing so, in the favourite phrase of a well-known private secretary to a member of the Royal Family- "Perhaps better not." It may be done by some with the most innocent intention, but others will then follow and will go a little further, and their intention will not be so innocent. Intention cannot be proved ; like paternity it is a matter of opinion. But suspicion may be aroused, and if there seems sufficient ground for it, it may lead a dentist to pay us an involuntary visit. Dentists should be above suspicion. ____ A NOVEL DIET FOR LIPOID NEPHROSIS WITHOUT entering into controversy Prof. E. Schiff 1 puts forward some novel suggestions for the treat- ment of lipoid nephrosis in children, based on his experience in the university children’s clinic in Berlin during the past three years. He discusses briefly the symptoms and signs of the disease, emphasising that an " oedema-tendency" rather than obvious oedema is a necessary feature, and proceeds to an analysis of the cause of death in various series. From this it appears that secondary infection is the principal factor, and he argues that treatment should be directed in the first place to improving the child’s resistance, rather than to getting rid of the oedema, which after all will only go when the underlying œdema-tendency 1 Jahrb. f. Kinderh., October, 1932, p. 1. -the still mysterious feature of lipoid nephrosis- disappears, as it often does spontaneously. The usually accepted type of diet, poor in fat and high in protein, Schiff regards as unsatisfactory. A child deprived of fat, he argues, is a very likely subject for infection, and the higher lipoid content of the blood in lipoid nephrosis cases cannot be altered to any great extent, if at all, by the lipoid content of the diet. Indeed, he is inclined to think that the high lipoid content of the blood may be a response to a " lipoid- want " of the organism as a whole, and he therefore gives the children a diet very rich in lipoid material, especially the yolk of eggs. Liver is also advised as a useful form of protein and fat in the diet, while meat is allowed although it is not regarded as essential. The best diuretic, Schiff believes, is urea ; but huge doses are required, such as 30 to 60 g. daily, and as this is unpleasant to take, even with honey, fruit-juice, or jam, he finds it easier to get the same effect by giving large quantities of vegetable food. These dietetic principles are applied as follows. On admission, usually in an oedematous state, the children are given on the first day fresh fruit and vegetables such as tomatoes and raw carrots. An increase in urinary output and decrease of the oedema follows in a few days, and then egg yolks are intro- duced into the diet. Schiff recommends two to three daily at first, aiming at five daily after a few days, given with sugar and orange-juice. A day or two later meat is introduced, including liver. The raw vegetables and fruit are continued and if oedema and ascites have altogether cleared up the child receives salt-free boiled vegetables and carrots with the meat, a few weeks later being allowed two to three salt-free bread rolls daily with salt-free butter. On this diet the child can be discharged without any further alteration. The fluid intake is restricted to the 60 to 100 c.cm. of fruit-juice taken each day, but with a raw fruit and vegetable diet extra water is considered almost unnecessary. As soon as the oedema has disappeared the children are allowed to get up and spend as much time as possible in the fresh air. Schiff urges the importance of finding and dealing with any possible sources of infection in such cases, but he does not support the teaching of some American workers that infection of the paranasal sinuses plays a large part in the causation of lipoid nephrosis. Nine patients have received his diet with good results. Three of them caught a hæmolytic streptococcal infection in the ward while under treat- ment, and despite very severe tonsillitis none had any recurrence of oedema. Schiff thinks this is a severe test of the validity of his theories and it should certainly encourage others to try his method. THE NATURE OF HALLUCINATION A PAINSTAKING research by Dr. Raoul Mourgue into the nature of hallucination deserves attention from psychiatrists. The now famous views of the philosopher Bergson formed the background of Dr. Mourgue’s inquiry. The thesis of his work is that hallucinosis springs from a breakdown of intel- lectual synthesis resulting in the emergence into consciousness of elements that belong to the uncon- scious life of the individual. This unconscious is not viewed in the light of the psycho-analytic concept, 1 Neurobiologie de l’hallucination. By Raoul Mourgue. Preface by Prof. Henri Bergson. Bruxelles : Maurice Lamartin. 1932. Pp. 416. Fr.91.

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Page 1: DENTISTS' CIRCULARS

1168

ANNOTATIONS

DENTISTS’ CIRCULARS

Sir Francis Acland’s opening speech on Nov. 9that the twenty-third session of the Dental Boardof the United Kingdom contained the consolinginformation that his parliamentary duties are notto stand in the way of effective occupation of theBoard’s chair. " I have adopted," he said, " regularhours for public work-week-days 9 A.M. to 12

midnight-and I believe that the Registrar and otherofficers of the Board have found that they can nowdischarge their duties with greater promptitude,owing to my receiving and answering their letterson the same day that they are written and posted."He went on to welcome Mr. Bishop Harman as amember of the Board appointed by the GeneralMedical Council, and noted Dr. R. H. Crowley’sconsent to serve on the Dental Health EducationCommittee. Apart from such domestic matters,the most interesting part of his address dealt withthe evergreen problem of the proper means fora "Dentist, 1921

" to make himself known to pro-spective clients. We have been consulted, said SirFrancis, by dentists about circulars which they proposeto issue themselves, or which have been issued byother dentists. This, he said, is the type of thing :-

(i) A teeth institute sends circulars to its patients askingthem to look in and inspect dentures made of a wonderfulsubstance which has been newly discovered ; (ii) anotherdentist proposes to send his patients, not with his accountbut as a separate document, a circular letter saying that inview of the present hard times he proposes to allow a discounton all accounts which are paid promptly ; (iii) cardsheaded " Please take one," announcing a reduction of fees" to meet present financial conditions," are placed in adentist’s waiting-room.

The question raised is whether this sort of thingconstitutes an advertisement, and whether the Boardwould make any objection if circulars or noticesof this sort became habitual. I can only advise,Sir Francis said, any dentists who may have donethings of this kind, or may contemplate doing so,in the favourite phrase of a well-known privatesecretary to a member of the Royal Family-"Perhaps better not." It may be done by somewith the most innocent intention, but others willthen follow and will go a little further, and theirintention will not be so innocent. Intention cannotbe proved ; like paternity it is a matter of opinion.But suspicion may be aroused, and if there seemssufficient ground for it, it may lead a dentist to payus an involuntary visit. Dentists should be above

suspicion. ____

A NOVEL DIET FOR LIPOID NEPHROSIS

WITHOUT entering into controversy Prof. E. Schiff 1puts forward some novel suggestions for the treat-ment of lipoid nephrosis in children, based on his

experience in the university children’s clinic in Berlinduring the past three years. He discusses brieflythe symptoms and signs of the disease, emphasisingthat an

"

oedema-tendency" rather than obviousoedema is a necessary feature, and proceeds to ananalysis of the cause of death in various series. Fromthis it appears that secondary infection is the principalfactor, and he argues that treatment should be directedin the first place to improving the child’s resistance,rather than to getting rid of the oedema, which afterall will only go when the underlying œdema-tendency

1 Jahrb. f. Kinderh., October, 1932, p. 1.

-the still mysterious feature of lipoid nephrosis-disappears, as it often does spontaneously. Theusually accepted type of diet, poor in fat and highin protein, Schiff regards as unsatisfactory. A childdeprived of fat, he argues, is a very likely subjectfor infection, and the higher lipoid content of the bloodin lipoid nephrosis cases cannot be altered to any greatextent, if at all, by the lipoid content of the diet.Indeed, he is inclined to think that the high lipoidcontent of the blood may be a response to a " lipoid-want " of the organism as a whole, and he thereforegives the children a diet very rich in lipoid material,especially the yolk of eggs. Liver is also advisedas a useful form of protein and fat in the diet, whilemeat is allowed although it is not regarded as

essential. The best diuretic, Schiff believes, isurea ; but huge doses are required, such as 30 to 60 g.daily, and as this is unpleasant to take, even withhoney, fruit-juice, or jam, he finds it easier to getthe same effect by giving large quantities of vegetablefood. These dietetic principles are applied as follows.On admission, usually in an oedematous state, thechildren are given on the first day fresh fruit andvegetables such as tomatoes and raw carrots. Anincrease in urinary output and decrease of the oedemafollows in a few days, and then egg yolks are intro-duced into the diet. Schiff recommends two tothree daily at first, aiming at five daily after a fewdays, given with sugar and orange-juice. A day ortwo later meat is introduced, including liver. Theraw vegetables and fruit are continued and if oedemaand ascites have altogether cleared up the childreceives salt-free boiled vegetables and carrots withthe meat, a few weeks later being allowed two to threesalt-free bread rolls daily with salt-free butter. Onthis diet the child can be discharged without anyfurther alteration. The fluid intake is restricted tothe 60 to 100 c.cm. of fruit-juice taken each day,but with a raw fruit and vegetable diet extra wateris considered almost unnecessary. As soon as theoedema has disappeared the children are allowed toget up and spend as much time as possible in thefresh air. Schiff urges the importance of finding anddealing with any possible sources of infection in suchcases, but he does not support the teaching of someAmerican workers that infection of the paranasalsinuses plays a large part in the causation of lipoidnephrosis. Nine patients have received his diet withgood results. Three of them caught a hæmolyticstreptococcal infection in the ward while under treat-ment, and despite very severe tonsillitis none had anyrecurrence of oedema. Schiff thinks this is a severe testof the validity of his theories and it should certainlyencourage others to try his method.

THE NATURE OF HALLUCINATION

A PAINSTAKING research by Dr. Raoul Mourgueinto the nature of hallucination deserves attentionfrom psychiatrists. The now famous views of thephilosopher Bergson formed the background ofDr. Mourgue’s inquiry. The thesis of his work isthat hallucinosis springs from a breakdown of intel-lectual synthesis resulting in the emergence intoconsciousness of elements that belong to the uncon-scious life of the individual. This unconscious isnot viewed in the light of the psycho-analytic concept,

1 Neurobiologie de l’hallucination. By Raoul Mourgue.Preface by Prof. Henri Bergson. Bruxelles : Maurice Lamartin.1932. Pp. 416. Fr.91.