To emphasize its Christian philosophy that the human body is the temple of God, Loma Linda University has chosen as its motto, "To Make Man Whole." It seeks to restore man to wholeness, that he may more fully enjoy relationships with his fellowman and communion with God.
"To Make Man Whole" must be more than a motto. It must be transformed into practical reality by continually developing new medical, surgical, and mental health services. One such contribution to the physical and emotional needs of patients is being made by W. James Nethery, D.D.S. (Class of 1965), a member of the Medical Center's radiation oncology team. He works closely with cancer treatment specialists and plastic surgeons in making maxillofacial prosthetics (artificial replacements for missing parts of the face). A maxillofacial prosthesis not only restores a person's normal appearance, but it also restores him to society. Nethery is one of the few dentists in the United States who has specialized in making maxillofacial prostheses and who works full time in this field. His patients come from as far away as Seattle and Chicago. They may have been born with physical deformities or they may be suffering from the effects of cancer or an accident.
Nethery makes eyes, ears, noses, once even the whole side of the face. He first makes a rough clay model of the part, carving and then checking it with the patient for fit. An ear must line up with the other ear. The nose must be just right. A close relative of the patient is encouraged to comment. When the prosthesis is acceptable to the patient, Nethery smoothes it, makes a mold from Linotype metal, then paints a layer of clear syrupy polyvinyl chloride into the mold and embeds tiny red and blue fibers to simulate the capillaries and veins of normal skin. When the prosthesis hardens, it is painted with colored polyvinyl chloride to match the patient's skin. The prosthesis is attached to the patient with a special tape that has adhesive on both sides, so that it can be removed every night and replaced every morning.
Nethery believes that those who have suffered misfortune should be helped to live with dignity. One of his patients was a grandmother concerned about her grandchildren's response to her. Another was an elderly gentleman whose nose and upper lip had been removed by cancer surgery. By making a plaster impression of the surgery scar and studying a presurgery photograph, Nethery was able to fashion a prosthesis that restored the patient to his former appearance.
Contributions Through Research
Although Loma Linda University is perhaps best known as an educational center for Christian physicians and dentists, it is also known internationally in scientific and governmental circles for its contributions to medical and dental research. Much of this research, presented around the world in papers and scientific exhibits, deals with the basic sciences. Such research forms building blocks for future scientific breakthroughs. Most of the research is too technical to discuss here, but the contributions of Drs. Jorgensen, Hon, and Judkins will illustrate the quality of research conducted by the University staff and alumni.
The fetal monitor is an instrument that significantly reduces the dangers associated with childbirth. It is also used before birth to assess the condition of the fetus. The pioneer work in fetal monitoring was done by Edward H. Hon, M.D. (Class of 1950). With an extensive background in electronics engineering, he started his research in 1955 as a member of the faculty at Yale University. He continued his research at Loma Linda University School of Medicine during 1960-64 and again at Yale, where in 1969 he developed the world's first fetal intensive care unit.
With the monitor Hon developed, monitoring the heart rate of the unborn infant is a simple procedure. Obstetricians can now hear fetal heart rates continuously, even during labor contractions. Previously, this was not possible. In addition, the monitor enables obstetricians to measure the strength and frequency of uterine contractions. The evaluation of fetal heart rate and uterine contractions together provides information about the condition of the unborn infant and how well it is tolerating labor. This information helps prevent complications during labor and delivery which otherwise could lead to fetal damage and death.
In 1969, while still at Yale University, Hon was featured in Life magazine. Between 1956 and the Life report, he had monitored over 3,000 births, including that of his own son. Explaining monitoring and why it was such an important procedure, Life magazine stated: "The fetus must struggle to survive the strains and pressures being put upon it. For years attending doctors have had no reliable way--nothing better than a stethoscope--to tell precisely when the fetus was in trouble. Consequently, some five to seven infants per thousand die unexpectedly each year.
"The instant a baby gets into trouble--a squeezed umbilical cord, a compressed head or a shortage of oxygen--its heart reflects a precipitous fall on the machine's graph. Fortunately, 90 percent of all fetal distress is caused by umbilical cord compression. Once spotted, it can usually be relieved by simply changing the mother's position.
"When the unit...was tried on four hundred mothers with histories of difficult labor, the results were impressive. None of the babies died, the number of caesarean sections for fetal distress was reduced by 75 percent, and the number of injured babies was cut by 50 percent. Hopefully, Dr. Hon's new system could save as many as 20,000 babies a year.''1
Fetal monitoring has become a part of good obstetrical care in hospitals and clinics around the world. Where monitors are being used, fetal death during labor has dropped dramatically.
Newborns have been in better condition, and the likelihood of brain damage is lessened.
Much of the clinical research that formed the basis of the design of present-day fetal monitors was done at the LLU Los Angeles facility, the White Memorial Hospital, from 1960 to 1964. The data compiled during this period are of fundamental importance and laid the ground work for subsequent research in fetal monitoring.2
Dental Pain Control
Loma Linda University School of Dentistry owes much of its international reputation to a technique of pain control developed by Professor Niels Bjorn Jorgensen, D.D.S., a specialist in local anesthesia and sedation, who taught in the School of Dentistry from 1954 to 1974. The technique, which can be used in any branch of dentistry, involves intravenous sedation in conjunction with a local anesthetic to reduce patient apprehension and fear. This sedation technique allows the patient to hear and respond rationally. While general anesthesia puts the patient to sleep, the "Loma Linda University Technique" maintains the patient's protective cough reflex and allows him to cooperate with the dentist. The technique is unique in that the dosage of the medication is individualized, administered in small increments according to the patient's response. Jorgensen promoted the designation "Loma Linda University Technique" (rather than the "Jorgensen Technique" as it is known by many of his peers). He was "incalculably aided" by Forrest E. Leffingwell, M.D. (Class of 1933), who was professor and chairman of the Department of Anesthesiology at Loma Linda University School of Medicine from 1956 to 1968.
Norman Trieger, D.M.D., M.D. (editor of the Journal of Anesthesia Progress, the official publication of the American Dental Society of Anesthesiology), referred to Jorgensen as "one of the giants in anesthesiology in dentistry, and in particular, in the education of the undergraduate student...[in the technique of] sedation."3
In March 1965, Jorgensen's teaching film, "Inferior Alveolar, Lingual and Buccal Nerve Block," won the "1st Grand Prix" award out of 70 films judged in the International Dental Film competition in Paris. In all, Jorgensen made nine films. These classics have been used by schools of dentistry around the world. Jorgensen's textbook, Sedation, Local and General Anesthesia in Dentistry (published in 1966), was distributed throughout the United States, western Europe, Italy, and South America.
Jorgensen's teaching program at Loma Linda University anticipated by at least 15 years most of the recommendations in the "Guidelines for Teaching the Comprehensive Control of Pain and Anxiety in Dentistry," published by the American Dental Association in 1971. In 1960 Jorgensen won the prestigious Heidbrink Award, presented by the American Dental Society of Anesthesiology. And in 1966 he was awarded the John Mordaunt Prize, the highest honor of the British Society for the Advancement of Anesthesiology in Dentistry, being its sole recipient until his death in 1974.4
Selective Coronary Arteriography
In 1966 Melvin P. Judkins, M.D. (CME Class of 1947), introduced the Judkins Technique of Coronary Arteriography, which creates Xray pictures of the blood vessels of the heart. While he did not originate coronary arteriography, his technique and ingenious catheter designs greatly simplified the procedure. Instead of obtaining patents for his inventions, which would have made him extremely wealthy, he gave them to the world of medical science.
During the procedure, a radiologist eases a tiny hollow plastic tube (about the diameter of the lead in a large pencil) up the large artery of one of the legs, first to the aorta and then, in turn, to the left and right coronary arteries. In each location of study, colorless liquid called "contrast," is injected through the tube (vascular catheter) into the coronary arteries that supply blood to the heart muscle, making them visible on Xray film. The patient's physician is thus able to see the exact location and extent of any disease. These pictures then make it possible for cardiologists and heart surgeons to select the preferred method of treatment, which brings relief of pain and extended life to many coronary arteriosclerosis victims.
Dr. Judkins was a perfectionist and, according to former students, an excellent teacher. He played an important role in the training of the next generation of physicians in the management of his technique. He also created state-of-the-art cardiovascular laboratories at LLUMC.
Until his death in 1985, Dr. Judkins was recognized internationally as an authority on radiologic equipment and on the diagnosis of coronary artery disease. He would be delighted to see the advances that have been made in recent years in the treatment of coronary disease and new catheters based on his designs which are used to introduce balloons and stints into coronary arteries to indirectly relieve blockages.
The Judkins Technique of Coronary Arteriography is recognized internationally as a major contribution to world medicine.
A Fluid Transport System and the Prevention of Tooth Decay
In 1971 discoveries by Ralph R. Steinman, DDS, MS, professor of oral medicine, School of Dentistry, and John Leonora, Ph.D., professor of physiology and biophysics, School of Medicine, demonstrated a change in fluid dynamics within teeth: a transport system flowing from the pulp through the dentinal tubules.
Dr. Steinman had studied the dental literature back to the 1880s and had discovered an interesting minority view based on research indicating that teeth might possess a defensive mechanism against cavities. This information motivated Dr. Steinman to explore the theory. He developed a rapid technique to visualize dentinal fluid flow using a fluorescent dye as a marker. By tracking the dye, Dr. Steinman was able to document an astounding observation: that teeth are internally active. In the absence of sugar, the dentinal fluid flowed within the tooth from the dentin-pulp interface through the dentin. In contrast, no significant flow occurred in the presence of a high sugar intake. The fact that sugar in the diet could affect an internal process in teeth had not been documented before.
The discovery had important implications regarding the eventual prevention of dental decay. The significance of the outward dentinal fluid flow is: (1) It prevents the penetration of bacterial acids into the tooth structure, and (2) It neutralizes the bacterial acids on the surface of the teeth.
To answer the question of how this mechanism was controlled, Dr. Steinman consulted with Dr. Leonora who suggested that a hormonal mechanism would be most appropriate for controlling dentinal fluid flow. Their collaborative studies led to the discovery of a new endocrine system: the hypothalamic-parotid gland endocrine axis. They isolated the parotid hormone in a pure form, and showed that it stimulates dentinal fluid flow. They demonstrated that a high sugar diet suppresses the function of this endocrine axis and consequently dentinal fluid flow. They went on to demonstrate in rats that they could physiologically prevent the suppressive effect of the high sugar diet on dentinal fluid flow and prevent dental decay 80 to 100 percent of the time.
Subsequent research by others has concluded that dentinal fluid flow also exists in human teeth. As in rats, dentinal fluid flow may be an important defensive mechanism for preventing dental decay in humans.5