THE HISTORICAL SIGNIFICANCE OF PROFESSOR GIES' 1927 STUDY IN THE STOMATOLOGIC MOVEMENT

¹ Chairman of the Committee on Stomatologic Education and Legislation, American Society of Stomatologists, New York, N. Y.

To evaluate the study, it is not sufficient to express satisfaction or dissatisfaction with it. Such judgments are not necessarily healthy judgments, for they are motivated by subjective factors more than by an historical insight. One must, therefore, take account of more than the immediate and directly related events to estimate the "historical value" of the study. As an illustration of the need of a broad historical outlook on these questions, I may point out the "D.F.A.A.U." episode to which I called your attention elsewhere in this discussion. What may have been considered a false move at the time (in 1923-24) has apparently proved to be (in 1929), in my estimation at least, a most important and progressive step in our educational development.

In this brief comment on the study a number of important issues had to be left untouched, for this discussion was not intended to be an exhaustive analysis of the vast field covered in the Bulletin. My major object was to present a method of approach to the study, by which method I hope others will be able to guide themselves in future discussions. In these discussions, I consider it essential to take cognizance of several fundamental ideas in order to assign the study the commanding place it deserves in the history of the stomatologic movement in America.

The science of stomatology (dentistry) must be differentiated from what has generally been termed "dental science." The object of the science of stomatology is essentially to serve as a foundation for its application to the methods of prevention as well as curing oral disease. It has thus fundamentally a utilitarian objective. But there are certain phases of investigation pertaining to stomatology which must be pursued quite independently of application and immediate usefulness. Methods of investigation of the nature of disease (oral disease), employed in the broad field of medicine, should evidently not be excluded from our equipment of research and practice. It is also well to bear in mind that the laboratory method is not the only avenue of approach to a study of stomatologic problems. Accumulated experience from practice, the empirical method, furnishes us with valuable and indispensable information. To derive the full benefit from the scientific method in the study of oral health and disease, laboratory investigation should be synchronized with the scientific data obtained from clinical research. The stomatologist (dentist) of today who is essentially a clinician (practitioner) approaches his problems through the gateway of science. If there is no science of stomatology, one must be created. But one mode of therapy—reconstructive therapy (often confused with bridges, crowns, fillings, etc.)—can never serve as a foundation on which to build the science of stomatology. Oral reconstruction can no longer be designated as the outstanding characteristic of that which in some quarters has been accepted as "dental." Dental practice calls for more freedom in the science of stomatology. Scientific freedom, in the sense here indicated, may most easily be obtained through the presence of such a spirit among teachers and practitioners. Dental education should be the embodiment of this spirit. Dental education has so far not been motivated in its activities by this ideal.

The needs of dental practice adjustable to the needs of the public and the public health are not reflected in the dental curriculum. The dental curriculum has not been adjusted to the ultimate needs of clinical stomatology. Such deficiencies are compensated by a small minority of practitioners through unsystematized after-training in fundamentals and special subjects. The theory of dental education, based on the "autonomous" view of dental practice, is not guided nor modified by the progressive tendencies and the modifications of dental practice in accord with the bio-medical theory.

We are led to deduce, from an analysis of the study, further evidence of the broad applicability of the "vested interests hypothesis" in dental education. It further establishes the fact that the dental-autonomous educational system permits of no "evolution" of the present mode of dental practice, as an independent form of health service, to that of a health service of an "oral specialty of the practice of medicine." The dental autonomous doctrine is inherently antithetical to the stomatologic doctrine. Stomatology (dentistry) is a branch of medical practice today, and it should be made so in every respect in the future.

The dental educational problem is so big and broad in its scientific, educational, and socio-economic aspects, that it deserves a thorough investigation representative of all interests concerned. On an earlier occasion, I proposed to Dr. Kirk and Prof. Gies that such a survey be inaugurated, to represent stomatologists, dental autonomists, dental and medical schools, and to include the public. Dr. Perry again proposed such a survey in his 1928 report (55).

Prof. Gies' study lends further convinction to the belief that the stomatologic movement in America must continue under the leadership of practising stomatologists, organized independently of all other existing professional societies, but in coöperation with them to further its objectives. The American Society of Stomatologists must continue to champion, uncompromisingly, the cause of "dentistry a specialty of medicine" in every respect, and must under no circumstances surrender any of its rights and privileges bestowed upon it by virtue of its position as a defender of the welfare of the rank and file of the dental profession.⁷

Education is a field probably as complex as that of history. In their application to our specialty what is true of one is probably true of the other. In reading the Bulletin, and before judgment is passed, let us recall the words of Prof. Karl Sudhoff:

"The medal indeed, has its reverse side. The historian of general medicine is, on his part, in no sense competent to give intelligent and exhaustive instruction in the histories of the several specialties, if he relies upon his fund of general knowledge alone. That requires first and foremost, a thoroughgoing course of self-instruction, such as could only be obtained in connection with long continued practice of the specialty itself. Only an ophthalmologist could write a history of his specialty that would be really worthy of the name. Only a surgeon could write a history of surgery that could be taken seriously. A suggestive and stimulating history of a disease can only be written by a practitioner who is thoroughly familiar with the manifestations at the bedside, and so on" (56).