SADISM AND MASOCHISM-SEXUAL CRIMINALITY

SADISM AND MASOCHISM

 Sadists derive sexual pleasure from inflicting pain, usually on their sexual partners. They want to prove their strength or virility by being aggressive or, for example, by emulating domineering fathers who used to punish them. Sadism may be expressed in forms other than sexual deviation. Teasing may be one. Children may be sadistic in their drive to assert themselves, though some seemingly sadistic actions by children are due to curiosity and lack of understanding. Thus, a child who pulls the wings off insects may have no idea that he is being cruel, since he may be acting from the same impulses that make him examine rocks and other inanimate objects. Masochists derive sexual pleasure from being treated cruelly, from being hurt physically or emotionally, or from hurting themselves. They may unconsciously wish to be punished for some "sin." Sadism has been called neurotic aggressiveness; masochism, neurotic submissiveness. Both spring from similar maladjustments and both may exist in the same individual. Masochism actually appears as a character attitude more frequently than it does as a sexual deviation.

SEXUAL CRIMINALITY

 The term sex maniac is an unscientific one used to describe people who commit violent sex crimes such as rape. These are people with serious emotional disorders; however concealed they may have been before a crime was committed. The fact is that many of us have peculiar sex impulses; they are usually fleeting and we do not actually consider acting upon them any more than we do acting upon other transient notions that pop into mind, such as jumping from the top of a tall building. In some sex criminals, however, the control mechanisms that normal people possess are defective or break down. In others, deep-rooted feelings of guilt, inferiority, or insecurity may divert sexual instincts in abnormal directions that are socially dangerous.

Psychoses People who suffer from the neuroses and other emotional illnesses previously described usually have a grasp on reality. They live in the real world and usually are able to get along in it, even if in awkward, suffering fashion. Psychotics-those who suffer from any of the several illnesses called psychoses-are farthest removed from rational behavior. They can no longer cope with reality or can do so only intermittently. They make up the greatest portion of the more than half-million persons in state, federal, and private mental institutions. Their actions often are absurd or grotesque, occasionally dangerous. 

Neurotics and care for it

Among neurotics are fanatically neat people, inveterate worriers al- ways dwelling on the worst that can possibly happen, uncontrollable overeaters. Most neurotics get along; they earn their livelihood, frequently a handsome one, but at the cost of great effort and pain; have a home life (often dismal); and seem normal in some activities while markedly abnormal in others. While a full-blown neurosis can be painful and make life miserable,still it may protect some people from things they unconsciously feel would make them even more miserable. A mother who is overly concerned about her children, constantly worrying over them, may in fact resent them but hides this feeling, which she cannot tolerate, by being overattentive. Neuroses can be broken down into more than half a dozen types.

1. ANXIETY NEUROSIS. In this type, the person experiences episodes of anxiety which may range from mild uneasiness to panic. Sometimes physical signs develop: sweating, dizziness, diarrhea, breathing difficulty, chest pain. The victim may feel tense and irritable, may awaken in the night in a state of terror. A characteristic feeling is one of U anxious expectation," the way one normally feels when something dreadful is about to happen, except that the victim of an anxiety neurosis may have no idea as to what the dreadful thing might be. This state often is linked with a fear of losing love-for example, when there is a conflict in the unconscious mind between a desire to hate the loved one (perhaps to get even for having been hurt) and a desire to win that person's love. Sometimes, the anxiety is shunted off by linking it with the situation in which it was experienced. If it occurred first in an elevator, the individual may blame the elevator, which he then fears and avoids in the hope of a voiding the anxiety.

2. PHOBIAS. These can be divided into two types: common phobias, or exaggerated fears of things most people have some fear of, such as death; and specific phobias, or exaggerated fears of things that aren't in themselves ordinarily frightening, such as open fields. Psychiatrists usually exclude more realistic fears stemming from forgotten experiences, such as an adult fear of touching an electric cord because of a forgotten experience in childhood of receiving a severe shock from a defective cord. Phobias usually are rooted in guilt feelings, in fears that, having been "bad," something is bound to "get you." The list of phobias is almost endless. Among them: acrophobia, the fear of high places; agoraphobia, of open spaces; aichmophobia, of sharp and pointed objects; anthropophobia, of people; claustrophobia, of en- closed spaces; climacophobia, of falling downstairs; dromophobia, of crossing the street; hypnophobia, of sleep; kleptophobia, of stealing; mechanophobia, of machinery; monophobia, of being alone; mysophobia, of dirt and contamination; necrophobia, of the dead; nyctophobia, of the dark; pantophobia, of everything; phagophobia, of swallowing; syphilo- phobia, of syphilis; topophobia, of situations (stage fright); zoophobia, of animals.

3. HYPOCHONDRIA

 In this condition, the mind's illness is manifested through abnormal preoccupation with body organs or functions. Afraid of, or convinced he suffers from, physical disease, the patient notices many body sensations, even those of normal fatigue, which do not con- cern other people. There is no physical cause for the condition, but merely assuring the patient that he is all right physically does not eliminate the hypochondriacal attitude.

4. CONVERSION HYSTERIA. This differs from hypochondria in that it produces a physical manifestation which, although not real in one sense, is certainly real to the individual. One example is hysterical paralysis, which may develop in a soldier undergoing severe conflict between a desire to be brave and a desire not to be killed. Suddenly he feels his legs paralyzed. He is not faking. Pins can be stuck in his legs and he has no feeling. Yet, when the conflict is resolved, either by circumstances or by the soldier himself, the paralysis vanishes.

5. OBSESSIVE-COMPULSIVE NEUROSIS. This leads people to do things without knowing why or without wanting to do them. The impulse stems from ideas that have no relationship in the individual's conscious mind. For example, a person always puts on a certain garment inside out. It is a kind of ritual, an appeal to magic powers, much like the knock on wood some people use. But the normal person who knocks on wood does so as a kind of joke because he has been told it is a lucky thing to do; a victim of neurosis sees no joke in his rituals, performing them because he is extremely insecure. As a child, he may have turned to his own "magic" rituals in a desperate attempt to cope with problems too great for him to handle.

6. NEURASTHENIA. The word means, literally, nerve weakness. It was once supposed that nerves in the brain could actually tire and that brain fatigue would result. Now it's known that neurasthenia, like hypochondria and conversion hysteria, is a product of emotional conflict. The patient honestly feels too weak or tired to get out of bed or even to think coherently. He can sleep for extended periods impossible for a well per- son, or can lie for hours doing nothing. Yet he is not physically ill; resting will not cure him; only solving his problems can lead to cure.

7. NEUROTIC DEPRESSION. It is not neurotic to experience unhappiness or depression on occasion-for example, when a loved one dies. It is normal to experience grief and to mourn; in fact, as we have seen earlier, this is an essential process. Normal people do not grieve almost endlessly and to the point of melancholia, not because they are insensitive or superficial; their grief other Problems,may be even more profound than that of badly adjusted people. But when the latter suffer from neurotic depression, they feel helpless; their low self-esteem convinces them they can never cope. These neurotic depressions are so closely bound up with feelings of insecurity and inadequacy that they can be triggered by events that well-adjusted people accept matter-of-factly. Such depressions cause great suffering.

5.       DISSOCIATIVE NEUROSIS. Anxiety may cause a person to forget for a time who he is and what he is doing. When he regains awareness, he has forgotten what took place during the forgetful period. An extreme example of this neurosis is amnesia. Character Disorders A character disorder, also called behavior disorder, involves a lack of conscience or a pattern of conduct that violates the standards of social responsibility. People with the disorder do, indeed, behave as if they did not respect standards important to most people. A character disorder may be harmful to society as well as to the individual.

Stress- Frustration treatment

COPING EFFECTIVELY MENTAL AND emotional stress cannot be eliminated from life. 

Nor does it have to be. In itself it is not harmful. It is not a disease but a normal part of life. It is not so much the amount of stress an individual is subjected to that determines whether he or she will suffer from acute anxiety or depression or psychosomatic illness as it is how the stress is perceived, understood, and handled. And there are measures we can make use of to handle stressful situations in our lives more effectively.

There can, of course, be situations that seem so overwhelming that we may need medical or other professional help if we are to cope with them. Such help, as the next chapter will show, is available. But for most situations we have resources of our own that we can learn to use successfully.

HANDLING FEELINGS OF FRUSTRATION

When we have worries and cannot do anything about them, we have feelings of frustration. Long continued, frustration can take serious physical toll. In a classic experiment demonstrating the physical effects of frustration, rats were strapped to a board-for them, a most frustrating situation. As they struggled uselessly to get out of the situation, large areas of their heart muscles disintegrated and the animals died. Obviously, the one way to have saved the rats would have been to release them. Medication might conceivably have dulled the frustration for them but not released them. Man's frustrating situations are not so obvious. 

But they can be no less exacting. And while there is often a temptation to regard them as insoluble and to dull the feelings they arouse by such means as drugs and alcohol, man's frustrating situations quite often can be solved.

There is usually something that can be done to adapt to the circumstance or to change the seeming circumstance. If, say, your job is a particularly frustrating one, must it remain so? Is the frustration irremovable? There are many cases like that of a man, a successful young executive, or so he had been, who became a victim of painful headaches and insomnia and began to have trouble with associates on the job and with family at home. 

He had recently been assigned to a responsible new position in a division of the company that was in trouble. He worked hard and yet couldn't make as much of a dent in the many problems the division faced as he thought desirable. Increasingly anxious and tense, he put pressure on the people working with him as well as on himself, to the point where he no longer had their cooperation.

He had a gnawing, ever growing fear that his superiors were dissatisfied with his work. Only when he faced up to the fact that it was this fear which was driving him and, at the same time, was frustrating him, making him act in a self-defeating fashion, could he nerve himself for a showdown with the company president. It was a productive showdown. 

Was the president dissatisfied with his work, he wanted to know. On the contrary, the president told him, he thought he had done remarkably well in a difficult situation. And, in fact, so concerned was the president over the possible loss of the young man that he insisted he take an immediate vacation and promised to assign additional personnel to help him in his work. If you feel you are faltering in your job, that you are out of your depth, it mayor may not be true. It's healthy to find out where you stand, to take action rather than suffer along. 

You may not be out of your depth at all but may have created frustration for yourself by demanding more of yourself than anybody could reasonably expect. If you are out of your depth, the chances are that this will be discovered by others sooner or later; and if you own up to it sooner, there may be something of an immediate wrench but you will save yourself much grief and may well find yourself a happier situation much sooner. 

Myths about Foot care - Early Problems

 EARLY PROBLEMS on Feet

About 99 percent of us are born with perfect feet and manage to quickly acquire trouble. One study carried out not long ago in seven cities found that 74 percent of children in elementary schools had foot problems; by high school, 88 percent.

There are several reasons for this. Throughout life the feet are subjected to the stress of standing on hard surfaces. Man doesn't do enough walking, which is good for the feet. Standing is an enemy of the feet in the sense that it involves 100 percent use of them; walking involves only 50 percent use since one foot rests while the other supports weight. 

And shoes-poorly fitted and often designed for the eyes rather than the feet -deserve a major share of the blame. Foot specialists who have examined many thousands of feet lament over what they call "man's insistence on forcing a square into a triangle." If you take off a shoe and look straight down at your foot, you will note that the sides make roughly parallel straight lines, and even the front can be described more or less as a straight line running from big to little toe. But look at your shoes and more than likely the toes are shaped like triangles.

Only when man started enclosing his feet in shoes did he have to start worrying about corns, calluses, hammer toes, bunions, and other foot ailments.

MYTHS 

We are surrounded by foot myths. They range from the notion that many foot troubles stem from wearing sneakers in childhood to wearing loafers, which are supposed to be bad because they let the feet spread. 

As one authority on the feet notes, undoubtedly the feet will grow somewhat larger and wider if not restricted by ill-shaped shoes, but this is healthy. The biggest misconceptions center on flat feet and fallen arches. Because the Army once rejected thousands of men with flat feet, the idea that there's something inevitably wrong with flat feet persists. 

 One of the nation's outstanding investigators of the foot, has reported that many people with arches "as flat as pancakes" never have experienced foot pain, while some of the most painful and obstinate cases involve feet with well-formed arches.

According to some authorities, only one out of 1,000 people with flat feet experiences pain because the feet are flat. The best practice for the flat-footed person-and anyone else with a painful foot problem for which there is no clear-cut, obvious cause-is to get advice and treatment from a physician or podiatrist rather than to keep buying arch supports. 

TEETH AS FOCI (CENTERS) OF INFECTION

TEETH AS FOCI (CENTERS) OF INFECTION

Some years ago, infected teeth got the blame for many diseases, especially arthritis, and "bad" teeth were extracted wholesale in the hope that once these "foci" of infection were removed, health would be restored. Now infected teeth are regarded as important in disturbing general health and as accessory rather than prime factors in some disease states. 

The decision to have teeth pulled is a major one; and as in the case of any operation, you should feel free to tell your dentist that you wish a consultation with your physician or a specialist before proceeding. Be sure to consult with your physician before having even a single tooth pulled if you suffer from such problems as chronic heart trouble, rheumatic fever, high blood pressure, diabetes, or nephritis.

 REMOTE SYMPTOMS RELATED TO FAULTY BITE 

The way your teeth come together as you chew food may cause or aggravate symptoms far from the teeth. A faulty bite can displace the joints just in front of your ears where the jaws meet (the temporomandibular joints). Their displacement may account for face or head pains, noise or blocking of the ears, and dizziness with or without nausea and vomiting. Patients usually seek their physician's advice for such conditions, but your physician may advise that your bite may be the cause of such distress and needs investigation.

ARTIFICIAL TEETH 

With proper preventive dental care, including the use of effective home methods of keeping the mouth healthy, artificial teeth should become much less commonplace than they are now. If you must use dentures, they should be removed and cleaned, and the mouth rinsed, after every meal if possible. Don't use hot water which may warp or crack them.

Keeping the artificial teeth overnight in a glass of water has helps to maintain their cleanliness. Artificial teeth should be checked regularly to make certain that they have not warped out of shape and that a change in your mouth or gums has not made them fit badly. 

Filling Teeth- Reimplanting Teeth

 FILLING TEETH

Once tooth enamel has been destroyed by acid, it will not be replaced; neither will the dentin of the tooth when it has been destroyed. But if the decay has not gone too far, the dentist can save the tooth by removing the diseased portion and filling the cavity. For this, he drills out the decayed area, applies an antiseptic, then inserts a well-fitted filling. When decay has penetrated to the pulp and root canal, the tooth may ache. 

The nerve dies and infection spreads around the ends of the roots in the jawbone. This may lead to infections elsewhere even when the tooth itself does not hurt.

The dentist tries to save most of the tooth by cleaning out the decay and the residue of pulp and nerve. He sterilizes the root canals, then fills them and the cavity to seal them and keep them sterile. Thereafter, such a tooth is examined at intervals by x-ray. If the infection continues or recurs, the tooth may have to be extracted, but there is a good chance that it can remain in place.

REIMPLANTING TEETH

Techniques of re-implanting dislodged teeth and of inducing damaged tissue to regrow are new and still not matters of routine dental practice, but they are advancing beyond the merely experimental stage. Re-implantation means that, under some circumstances, a permanent tooth that has been knocked out may be reinserted into its socket, reinforced, and encouraged to grow back into the jaw. In regeneration, the tissues and bone around teeth, after being destroyed by disease, may be induced to grow back. 

ALIGNMENT OF TEETH- CORRECTING IRREGULAR TEETH

ALIGNMENT OF TEETH

 Teeth that are irregular, that overlap or stick out in odd directions, can present problems. Sometimes there is malocclusion-failure of upper and lower teeth to meet (occlude) properly. Heredity may account for this. Irregularity also may stem from early loss of baby teeth because of decay or accident or from failure of the baby teeth to fall out at the right time. 

When there are regular visits to the dentist, he can, in the case of a pre- maturely lost baby tooth, insert a "spacer" to help maintain the space so that permanent teeth will have the opportunity to grow in properly. And if a baby tooth is being retained too long, he can, with the help of x-ray examination, determine the presence and developmental state of the permanent tooth that is to replace it and can take appropriate measures. Some dentists believe that irregular teeth may be the result of excessive thumb and finger sucking at the time the second teeth are coming in.

Since a healthy, happy child usually has given up sucking his thumb by the time he is six, it is advisable to discuss this habit with your doctor if it persists. Another factor in irregular tooth alignment and faulty bite is insufficient chewing because the diet is overloaded with soft foods.

CORRECTING IRREGULAR TEETH 

Poorly aligned teeth are likely to do more than detract from appearance. Often, food tends to collect behind them and the gums may become irritated. When only a few teeth meet properly in chewing, the force of the bite falls entirely upon them and may loosen them. Your dentist can check to determine whether a child's bite is poor. He can detect the first signs of serious malocclusion and advise whether and when orthodontic treatment to correct it should be undertaken. 

The earlier a potentially serious case of malocclusion is detected and treated, the less time may be needed for its correction. o An irregular tooth or two does not necessarily mean malocclusion and may not really be disfiguring. Your dentist can tell you whether it is advisable to have treatment. Orthodontic treatment takes time, patience, skill. It can be expensive. If your child really needs orthodontic care and you cannot afford it, discuss the matter with your dentist and investigate dental clinics. 

ABOUT BABY TEETH - Dentistry

ABOUT BABY TEETH 

Nature provides two sets of teeth in a lifetime: the 20 deciduous (baby) teeth, and the 32 permanent (second) teeth. This is no extravagance, for the jaws of an infant are hardly large enough to accommodate the teeth needed later. Make no mistake about the importance of proper care of the first teeth. Even though they are to be replaced, if they become badly diseased and fall out, the permanent teeth may not come into place properly.

A child's first set of teeth begins to form before birth, and their proper formation and structure are influenced by the diet of the mother. She need follow no special diet for her baby to have good teeth; the balanced, nutritious diet prescribed by her physician for her general health will provide for good teeth in her child. Usually, by the age of two and a half years, the child's complete set of baby teeth will have erupted. Shedding will usually begin when the child is six or seven years old. At that age, the first permanent teeth, the first molars, also appear. 

 Proper nourishment is required for healthy development of both the first and second teeth; important, too, are cleanliness and dental super- vision and, when necessary, dental treatment. 

PICKING THE PREVENTIVE DENTIST

 As we have indicated, dentistry today is in a new era-of prevention rather than mere mechanical repair. As in medicine, there are tremendous differences among men in the dental profession. They differ in personality, and your family needs a dentist whose personality is attractive to you and with whom you feel compatible.

You need a skilled dentist, of course. But you also need one, in our opinion, whose interests are along the lines of prevention rather than merely of good treatment. There are still some otherwise excellent dentists-men capable of remarkable repair work-who have not quite caught up with the modern trend of dentistry. But increasingly there are men dedicated to the idea that total mouth care is vital, that what has to be corrected must be corrected and, going beyond, patients must be helped to avoid need for correction. 

There may well be such a man available to you even if you live in a small community. Your family doctor or your pediatrician will help you find him. It is important in terms of dental health-and, in the end, it is economic in terms of family budget-to make regular visits to a dentist practicing prevention.

And it is important to introduce your child to him at an early age, even as young as two years. 

At that point, he can check the child's dental development; he can, if necessary, make corrections to prevent trouble; he can provide detailed instructions for you in the care of the child's mouth and in how to introduce the child gradually to caring properly for his mouth. Chances are that no treatment will be needed and the child's first-and very important-experience with the dentist will be a pleasant one, which will stand him in good stead all his life. 

HOW CAN YOU USE PREVENTIVE TECHNIQUES for Dental care?

HOW CAN YOU USE PREVENTIVE TECHNIQUES?

A cardinal rule is to see your dentist for regular checkups. Get your children to him early, even at age two. Encourage your dentist to use preventive measures in the office-fluoride topical applications once or twice a year, or oftener if needed, and not only for children but for adults in the family. 

If your dentist is too busy or not interested, you can find one who will be interested, happy to take the time for the applications and for instruction.

Make use of the following guide for mouth care which details, step by step, the home oral hygiene measures advocated by many dentists who are leaders in the preventive approach. You can check the guide with your dentist for any special suggestions he may have that could make it even more valuable for you.

A GUIDE FOR EFFECTIVE MOUTH CARE

This is a guide to thorough cleaning of the mouth, not just brushing of the teeth, as a means of helping to prevent both decay and gum disease. It is important to remember that decay occurs when bacteria attack food particles and produce acid which eats away at the tooth structure. The bacteria cluster on teeth in a film called plaque. 

Plaque also fosters tartar formation and, in turn, gum inflammation and infection. Whenever possible, brush after eating to remove food particles.

But remember: one complete cleaning of the mouth, preferably at night before retiring when you can take time to be thorough, is essential. Because it takes 24 hours for plaque to form anew, one such cleaning daily can help eliminate this prime factor in both gum disease and decay.

Dental care

Dentists take the time to show patients exactly how to break up and clean away plaque with toothbrushing methods not the same as those most of us use; and they demonstrate the use of dental floss, not as most of us use it to merely dislodge food particles from between the teeth, but also to get plaque off the sides of the teeth. 

They send patients home with a supply of wafers and a little dental mirror to be used for self-checking on home cleaning. They take the time to recheck with wafers in the office on subsequent visits to make certain home care is effective. Ideally, the mouth should be cleansed immediately after a meal or snack. Practically, that is a difficult goal for many people. But these dentists emphasize that, because it takes 24 hours or more for plaque to reform, even a single thorough cleansing of the mouth at night before retiring can go a long way to minimize decay and gum disease.

And these dentists can point to patients, children andadults, with long histories of severe decay brought under control by educated home care. Among these dentists are periodontitis, specialists in gum diseases, who get only the worst cases referred to them-so far advanced that surgery to eliminate the deep gum pockets is necessary. But, typically, they will not operate until the patient is shown how to care for his mouth at home and goes on a prevention program for several weeks or even months. In virtually every case, these periodontitis report, they are able to demonstrate that the patient himself, with proper home care, can bring even the most advanced periodontal disease under control so that, once surgical repairs are made, there will be no recurrence.

 Under way today is a vast amount of research seeking additional preventive measures. Before long, anti-decay agents may be going into foods. Recent studies with children suggest that a chemical, sodium dihydrogen phosphate, added to breakfast cereals, can help reduce decay. Other work indicates that adding phosphate to chewing gum can be similarly helpful. In a dozen laboratories, scientists are busy trying to develop a vaccine that may immunize against decay-causing bacteria. Much other research is going on. But the preventive measures available right now can drastically reduce dental disease. 

Gum disease progresses in stages-pyorrhea-Plaque

Gum disease progresses in stages

 It starts with gingivitis, in which the gums become inflamed, swollen, and tender. Left uncontrolled, the inflammation advances and the gums begin to stand away from the teeth so that pockets are formed which harbor bacteria and pus. 

This ispyorrhea. As pyorrhea progresses, fibers holding the teeth in their sockets weaken and gradually the bone supporting the teeth is destroyed, and the teeth become loose and are lost. What starts the process?.There is now evidence-thanks to the brilliant work of many investigators, notably Dr. Sumter Arnim of the University of Texas, Houston- that, just as in tooth decay, bacteria are involved.

Clinging to the teeth and working on food particles to produce acid, bacteria also produce a material-a film called plaque-that covers them over, allowing them to work undisturbed. Plaque not only furthers decay; it triggers the formation of tartar, or calculus. 

And it is calculus that, spreading down below the gum line, irritates the gums, starts up inflammation and gingivitis, and opens the way for pyorrhea and gum disease progression. "Calculus cannot form unless plaque is present," says Dr. Irving Glick- man, Chairman of the Department of Periodontology at Tufts University School of Dental Medicine. "It's important for a dentist to remove calculus once formed; but it's also vital for the individual to minimize formation. In no other field of medicine can the patient so effectively assist in preventing and reducing the severity of disease.

Other factors may enter into decay and gum disease. In some caries- rampant individuals-those with far more even than the bad-enough average of decay-poor nutrition or faulty saliva flow may play a role; dentists can correct both. Faulty bite may help foster gum trouble; this can be corrected. But it is now clear that against both decay and periodontal disease, effective home care to prevent plaque formation is a prime weapon of prevention.

And more and more dentists are taking time to educate patients in proper home care methods. Recently, one of us spent two and a half months visiting such men in and around more than a dozen cities and in small communities. It was gratifying to see them lift bits of plaque from patients' teeth and place them under special microscopes so the patients could see for themselves the teeming colonies of bacteria in the plaque. 

Plaque on the teeth is invisible, but these dentists reveal it to patients graphically with a simple tool, a disclosing wafer. It's a small tablet containing a harmless vegetable dye. Chewed up, it stains the teeth temporarily, but only where the plaque is. 

PREVENTION OF DECAY

 MOVING TOWARD PREVENTION OF DECAY

The first glimmer of hope for avoidance came with the discovery some 30 years ago of the value of fluoridated drinking water. Ingested regularly during childhood while the teeth were being formed, fluoride could combine with the developing enamel to make it more acid-resistant. It could halve the incidence of decay in children. Currently, some 3,000 communities serving about one third of the total population have fluoridated water. 

Many dentists in no fluoridated areas now prescribe fluoride tablets, or vitamins with fluoride added, for children. Another advance came about 20 years ago with the discovery that painting a sodium fluoride solution directly on the enamel could cut decay 25 to 40 percent. This, however, was true only for children up to about age 15. And the applications, which took quite some time, did not add extra protection for children in fluoridated water communities. 

After some searching, scientists next turned up stannous fluoride, a combination of tin and fluorine. One application a year of stannous fluoride proved far more effective than sodium fluoride applications. It added to the protective effect of ingested fluoride. And it worked for adults as well as children.

There followed incorporation of fluoride in toothpastes-to provide, in effect, a daily topical fluoride application that could supplement periodic applications by the dentist. In 1960, for the first time, the American Dental Association established a therapeutic category for dentifrices. 

Where before toothpastes had been considered aids to cleaning and no more, now, with fluoride added, they could also reduce decay by one third or more. At that point, the picture was this: Ingested fluoride could help endow youngsters with teeth better able to resist decay. Topical applications by a dentist and use offluoridated toothpaste could increase protection. Combined, the measures could reduce decay by as much as 90 percent in children. 

Another important development was to come when work of the Armed Forces demonstrated dramatically that adults, too, could benefit. These very same methods provide for even further improvement in reducing decay. 

Dental diseases

The Navy has experimented further-with a "self-preparation" program. Before they go to the dental clinic, servicemen get a cup of pumice paste containing fluoride and are shown in groups how to brush it on their teeth for 10 minutes to achieve a thorough cleaning and burnishing. 

After that, a dentist has only to apply a fluoride solution for 15 seconds and the treatment is completed. The self-preparation technique has been extended to children of naval personnel, and Admiral Kyes is convinced it has broad implications for the civilian community. 

As Navy children scrub their teeth at home under their mothers' supervision and go todental clinics for brief and inexpensive treatment, so schoolchildren can scrub at home and receive their topical application at home. Self-preparation is a dental Pandora's box because it breaks through dentistry's two restraining bonds-time and lack of manpower.

 The Armed Forces' work has provided a clear-cut demonstration on a massive scale that decay prevention techniques are highly effective for adults as well as children and that they may be widely and inexpensively applied.

Dental diseases are directly responsible for general poor health, affecting patients of all ages. Rampant dental cavities in children not only result in facial deformities in adulthood but contribute significantly to bacterial contamination of the blood and may be quite important in the development of certain forms of heart disease. 

The elimination of decay ... is most urgent in the treatment of bacterial endocarditis [a heart infection] and rheumatic fever. Elimination of dental disease is essential in preventing certain forms of kidney disease in children and adults.

The Teeth and how to care about it?

 THE TEETH

THE most exciting news in dentistry today is not any new drill, anesthetic, denture material, or other fix-it device or procedure. Just the opposite: It's a whole new concept which puts the emphasis on stopping dental disease before it can happen rather than treating it after it does. It is based on the development of simple, practical tools for calling a halt to tooth decay and gum disease. It promises, if you use it, to cut your dental pains and dental bills and could do much for your appearance and general health as well, no matter how old you are or even how much you have been ravaged by dental disease up to now. It is high time we had it. 

Good teeth contribute not only to appearance but to good digestion. They are necessary, too, for good and clear speech. And teeth that are free of disease provide no portal of entry for infections that may spread to affect other areas of the body. And yet tooth and gum troubles, which have plagued man through all recorded history, do so even now.

Even though American dentistry has been the best in the world from a reparative standpoint, the American mouth is a disaster area, getting worse, not better. Right now, more than 20 million Americans have lost all their teeth; 90 million have at least 18 missing, decayed, or filled teeth; and there are more than a billion unfilled cavities in the country. By age 35, one of every five of us needs dentures; by 55, one of every two. 'Fifty percent of all two-year-olds have decaying teeth; by the teens, five of every six youngsters do. 

On top of this, gum disease takes a huge toll, affecting not only older people-90 percent of those over 65 and 80 percent of the middle-aged -but also two thirds of young adults. Even among 12-year-olds, four out of five have gingivitis, the precursor of most gum disease. Dentists have been kept so busy fixing and patching that, according to a recent survey, 40.3 percent of the 90,000 dentists in the country are unable to take on any new patients. This, despite the fact that 40 per- cent of the population, practicing complete neglect, have never once visited a dentist. 

So bad is our dental health that, according to the American Council on Education, if all the dentists in the country were lined up on the East Coast and moved westward, taking care of the needs of the population as they went along, they would get only as far as Harrisburg, Pennsylvania, before having to turn around and go back and start over again. Such facts, coupled with insights into the why of both decay and gum disease, are galvanizing the dental profession. Its leaders and the best dental schools now are working to turn dentistry into a new kind of profession-no longer mechanical and reparative in major emphasis but rather primarily devoted to making dental disease as avoidable, in effect, as measles or smallpox.

Already, the Armed Forces dental corps has developed pioneering programs which are producing dramatic results. At the U.s. Naval Academy, Rear Admiral Frank M. Kyes, Chief of the Navy's Dental Division, has reported, "Dental decay has virtually be- come a thing of the past." In a recent cross-country trip to visit dentists leading in introducing the new preventive dentistry into private practice, one of us found them reporting enthusiastically that decay can be reduced by as much as 90 percent and even more in both children and adults; that gum disease also can be checked; and that the required measures are to a very great extent simply new, more effective methods of home care. 

PREVENTIVE CARE OF THE ENDOCRINE SYSTEM

PREVENTIVE CARE OF THE ENDOCRINE SYSTEM 

It has been said that we are what our glands make us. That, of course, is an oversimplification. Other factors enter the picture-but the glands do, indeed, have a vital role, influencing structure, function, and personality. What everyday care is required to prevent disease of the endocrine system? Everything that contributes to good general health contributes to good health of the endocrine glands. 

That includes sound nutrition; it includes proper exercise and other physical activity, which have a stimulating effect on many of the glands; it includes the avoidance as much as possible of excessive stress and strain, which may debilitate glandular functioning. If you suspect at any time that you may have a glandular problem, don't toy with the idea or attempt self-treatment. 

Let your physician consider the problem, make any necessary tests, arrive at an informed diagnosis-and then, using the constantly growing knowledge of endocrinology and growing stockpile of therapeutic aids, provide treatment.

 The sooner any endocrine disorder is discovered and properly treated, the more likely the prevention of debilitating conditions and complications. Some specific things to do : To protect the islets of Langerhans so they will secrete insulin normally, two items are important. First, keep your weight normal; obesity promotes diabetes. 

Second, use as little refined sugar as possible. We urge, too, that you read our section on diabetes and make certain that at your periodic medical checkups tests for diabetes are included. To protect the thyroid gland, use iodized salt, especially if you live away from the seacoasts. To protect the ovaries and testes against venereal disease, see our discussion of gonorrhea (page 580). 

To help assure the health of the adrenals, get reasonable amounts 'of physical activity which can provide normal stimulation for these glands. There is no primary protection for the pituitary, parathyroids, and other endocrine glands. See the Index for listing of diseases of these glands and what can be done for secondary prevention. 

Female Sex Glands and Mensturation - Ovulation

THE FEMALE SEX GLANDS

 Like the testes, the two ovaries have more than one function. They produce the ova, or eggs; they also secrete hormones needed for both reproduction and feminine characteristics. The ovaries lie in the front part of the abdomen, below the navel, and each is connected with the uterus by a fallopian tube. 

The ovarian hormones are estrogen and progesterone. They are produced in small amounts before puberty and after menopause, and in abundance during the childbearing years, the period when a woman has her regular monthly cycles.

MENSTRUATION AND OVULATION

 Menstruation involves the discharge of the extra blood and tissue built up in preparation for conception but not used. Cycles vary among women and even in the same woman, but generally the time from one menstrual period to the next averages about 28 days. Doctors customarily count the first day of menstruation as day 1 in a cycle. During the first 14 days of the cycle, the ovary contains a follicle, a small hollow ball about the size of a pinhead. Within the follicle is an egg. The follicle grows during the two weeks until it becomes about as large as a pea. 

As it grows, it produces estrogen. Follicle growth as well as the menstrual cycle in general is under pituitary gland control. On about day 14, stimulated by the pituitary, the follicle bursts and the egg is discharged from the ovary to enter the fallopian tube on its way to the uterus. If sperm are present in the tube at this time, fertilization may take place in the tube. The fertilized egg then continues its journey to the uterus where it implants itself on the wall of the uterus.

Meanwhile, the ruptured follicle from which the egg carne is transformed into a yellowish, solid ball, now called the corpus lute urn, or yellow body. The corpus luteum produces a second hormone, progesterone. Scientists now know how to make synthetic hormones to control ovulation. Contraceptive pills imitate the natural body processes in preventing ovulation, as discussed elsewhere in this book. 

Estrogen and progesterone help build up the lining of uterus, making it thicker and providing it with a rich blood supply to feed the unborn baby. During the last 14 days of the cycle, the two hormones are produced by the corpus luteum. The fertilized egg secretes a hormone that causes the corpus luteum to persist in producing estrogen and progesterone from the fertilized egg is necessary because at the end.Pregnancy has not occurred, the corpus luteum degenerates and its retions stop. 

With cessation of hormone production, the rich blood supply built up in the uterine lining sloughs off and menstruation occurs. Menstruation and menstrual difficulties are discussed in detail elsewhere in this book.

MENOPAUSE

 Menopause, or change of life, is as natural for women as menstruation is. There should be no dread of it: nothing more disastrous occurs than the tapering off and cessation of the monthly cycle. True, some changes, natural ones, occur. Estrogen secretion is reduced. The follicles no longer release eggs. Menstruation stops, suddenly or gradually. 

After menopause is well established, in about a year, there should be no more bleeding. Be certain to consult a physician immediately if bleeding or spotting occurs, since this may signal cancer or an- other disorder requiring prompt treatment. Actually, unfounded fears are to a large extent responsible for the emotional disturbances some women experience during menopause. 

Certain physical symptoms may occur because of the glandular changes taking place. If they become troublesome, they may be relieved by hormone treatment. We discuss menopausal symptoms more fully elsewhere. 

Male Impotence

MALE IMPOTENCE

 Inability to have sexual relations is a complex problem. It may result from a disease of the testes or of the pituitary. Some nervous .system disorders cause impotence. In most cases, however, the testes and entire endocrine system are normal and the problem is trace- able to emotional disturbances or psychoneuroses. Such men may be helped by a family physician who understands emotional disorders. 

If necessary, the family physician may suggest help from a specialist in psychotherapy. Sterility, the inability to beget children, occurs in some men who are not impotent. It may be due to failure, for many possible reasons, to produce enough sperm or sperm active enough to reach and fertilize the female cell. 

While only one healthy sperm is needed for fertilization, and 300 million or more are usually released in an ejaculation, the journey to reach the female cell is so hazardous that many lively ones are required to ensure that a survivor gets to the right place at the right time. Ways have been found to help many men with sterility problems, as discussed elsewhere in this book. 

Male Sex Glands and Impotence

THE MALE SEX GLANDS

The two testes, which lie enclosed in the scrotal sac of skin just below the penis, secrete semen containing the male reproductive element, the sperm. They also produce the important male sex hormone, testosterone. One of the first known hormones, testosterone's activity was deduced from the events that followed removal of the testes.

 It has been known for centuries that if the testes of a boy are removed or destroyed before puberty, he does not develop typical masculine characteristics. Instead, his personality is gentle, his voice high-pitched, his chest narrow and flat, hismuscles underdeveloped. He lacks facial hair and pubic hair, his penis is small and underdeveloped, and he is impotent. In addition to affecting male sex organs and secondary sexual characteristics, testosterone stimulates muscular and bone development and helps maintain muscle strength. 

If testosterone is injected into a female animal, certain masculine characteristics develop and female hormonal function is inhibited as long as the testosterone injections continue. If testosterone is injected into a eunuch or a man with underactive secretion, the size of the sexual organ increases, secondary sexual characteristics develop, and there is an in- crease in sexual desire and potency.

The effect is transitory. 

People who benefit from testosterone require treatment for their entire lives. It is important to note here that while testosterone administration may be helpful in cases of hormone deficiency; injections of the hormone are ineffective for "rejuvenation" and may in fact be dangerous, sometimes leading to tumor or cancer of the prostate. 

The aging process is not con- fined to sexual function and cannot be halted by a single hormone or any combination of hormones yet discovered. Actually, many men can reproduce at age 70 and beyond. The feeling of decline experienced by some men is more likely to be due to factors other than sex gland inadequacy-either other physical problems or psychological difficulties. A thorough medicalcheckup is advisable rather than costly and potentially dangerous testosterone injections. 

Adrenal and Pituitary glands Symptems and causes

 The Adrenal Glands Each of the adrenal glands, one atop each kidney, has a cortex, or outer portion, and medulla, or central section. The cortex secretes about 30 hormones and regulates many metabolic processes. The medulla produces the hormone epinephrine, more commonly called adrenaline. Adrenaline output is stepped up when you become fearful, angry, or excited-leading to a speed-up of heartbeat and many chemical changes that prepare the body for action. 

Among the major functions of the adrenal cortex and its hormones are the control of salt and water content of the body, and the control of sugar and protein metabolism. The cortex also secretes a hormone similar to that put out by the testes. In some tumors of the cortex, women develop masculine characteristics such as a deep voice and facial hair, and menstruation may slow or cease. In men with such tumors, the masculine secondary sex characteristics become more pronounced.

 Underfunctioning of the adrenal cortex produces a rare disorder, Addison's disease, discussed elsewhere. With cortisone and other preparations, Addison's disease can be controlled and the afflicted person can lead a normal life.

Both cortisone, an adrenal hormone preparation, and various derivatives of it, can replenish the body's supply when the adrenals function improperly. In addition, these medications may bring about favorable results in such diseases as arthritis, asthma, sarcoidosis, and rheumatic fever. The reason is not yet clear, for people with such diseases do not appear to be deficient in adrenal hormones and yet additions to the normal output sometimes produce striking improvement. 

The Pituitary Gland If you think of one line drawn through the head from ear to ear and another drawn backward from between the eyes, the pituitary lays at the spot-at the base of the brain-where the two lines cross. It consists of an anterior or front lobe; an intermediate part; and a posterior or back lobe. The secretions of the pituitary are many and perhaps still more remain to be discovered. From the anterior lobe come powerful agents that influence other endocrine glands as well as various body regions. ACTH, adrenocorticotrophic hormone, stimulates the adrenal cortex.

Thyro-trophic, or thyroid-stimulating hormone, often called TSH, regulates size and activity of the thyroid gland. Also from the anterior pituitary comes a hormone called the growth hormone, which has an important influence on height. During the years when a child is moving toward adulthood, the anterior pituitary secretes gonadotrophic hormone which stimulates the reproductive organs. After childbirth, the anterior lobe secretes lacto- genic hormone which causes milk to flow. One of the posterior pituitary hormones, vasopressin, helps regulate water balance in the body. 

Another, oxytocin, stimulates smooth muscles such as those of the digestive organs and the uterus. Research is constantly revealing new facts about the pituitary and the relationship among the various glands of the endocrine system. Scientists are trying to unravel the mysteries of the thymus and pineal glands. When such problems are solved, it can be expected that many more dis- eases may become not only curable but preventable.

 Pituitary gland diseases are rare. Inadequate pituitary secretion causes some types of dwarfism; excessive secretion stimulates growth to gigantic proportions. Pituitary tumors may press on the optic nerves and produce some loss of vision and headaches. Acromegaly, in which bones increase in size, particularly the bones of face, hands and feet, is caused by an overactive pituitary. Cushing'sdisease also is sometimes caused this way. Underactivity of the anterior lobe of this complex gland leads to a thin, malnourished condition, Simmonds' disease. 

Pituitary insufficiency can cause children to become excessively fat. In some cases, a condition called Frohlich's syndrome develops; children who have it are excessively obese and sexually underdeveloped. If given an extract of pituitary gland in time, they become normal and are spared unhappy lives. If pituitary secretion decreases after puberty, fat may accumulate around certain portions of the body, particularly the hips. When the back lobe of the pituitary fails to function properly, excessive urination results-as much as 30 quarts a day.

This rare malady is diabetes insipidus, not to be confused with" ordinary" diabetes mellitus. While effective replacements for all pituitary hormones are not avail- able, treatment of the organs affected by specific hormones is often possible. Thus, cortisone, thyroid, and sex hormones are often employed for patients suffering from specific pituitary hormone problems. 

For patients affected by dwarfism, human growth hormone has become available; it is effective only in specific cases and only if administered before the normal growth period has ended. The Sex Glands (Gonads) The gonads(derived from the Greek word meaning seed) consist of the testes in men, the ovaries in women. In addition to producing sperm and ova, the glands elaborate hormones that are responsible for the special male and female characteristics. 

Children and Symptems and Causes of Goiter

Children, whose diet lack iodine, may show signs of goiter, when they are reach adolescence. A physician, of course, should check on any suspected case of thyroid disturbance. Tests are not simple; several may be needed, especially when a disturbance is relatively mild. One frequently employed test is the basal metabolism, which records the amount of oxygen used. In hyperthyroidism, the amount is increased; in hypothyroidism, it is decreased. 

Another test uses radioactive iodine as a tracer. Severity of thedisease can be established by the amount of the iodine taken up by the thyroid; an underactive gland will take up less, an overactive one more. The protein-bound iodine (PBI) test involves an examination of the blood taken from a vein to determine whether the amount of PBI normally produced in the body is elevated as in hyperthyroidism or low as in the opposite condition.

Thyroid tumors occur. Most are benign, or harmless; some are malignant. Surgery is the usual procedure in cases of thyroid cancer but radiation is sometimes used, particularly if the malignancy has begun to spread. The Parathyroid Glands These tiny glands, usually found in clusters of four, are embedded near the thyroid base. They are so much smaller than the thyroid that before surgeons were certain of their presence they were sometimes re- moved with the thyroid when excision of the latter was necessary. The location and significance of the parathyroid are well known today, and there is little danger of accidental removal. 

The hormone of the parathyroid, called parathormone, has much to do with the balance in the body, and the excretion in the urine, of calcium and phosphorus which are derived from milk and other foods and are necessary for bone growth and maintenance. If the parathyroids become underactive, the calcium level in the blood falls and muscles develop painful spasms, called tetany. In severe cases, convulsion and death may result.

 Administration of parathyroid hormone, or certain synthetic compounds with similar actions, or a potent vitamin 0 preparation, will usually keep calcium output normal and stop the spasms. Feeding calcium is helpful in such cases. Hyperparathyroidism, caused by tumors, can deplete the bones of calcium and may cause kidney stone formation as well. Some patients have duodenal ulcer. A rare disorder, hyperparathyroidism is curable if diagnosed early.