to be hoped that a measure so one-sided, and prejudicial may, upon due reflection, be speedily repealed. There are numerous graduates from our Dental Colleges now practicing in England, who reflect honor upon their native land and professional confrères, as well as upon their American Alma Mater. The writer was pleased to meet a number of his old pupilsgraduates of the "Philadelphia Dental College," who have been eminently successful, and are enjoying enviable positions in their profession. American dentists, I am sure, fully appreciate the distinguished position, labors and merit of their professional brethren in the mother country, and are disposed to award to them their full mead of praise and honor. The cordial and most generous manner in which the American representatives to the late "Medical and Dental Congress," held in London, were received and entertained, fully demonstrated the fraternal sympathy existing between members of the same profession, though separated by three thousand miles of stormy seas. Are not our obligations mutual? We owe much as a profession to English dentists, and England in return owes much to American Dentistry. There are certain peculiar modes of practice, of which I would be glad to write at some length, but the limit of this paper forbids. In the operative department much work of a high type of excellence is being done at the present time. In gold fillings much more than formerly. There is, among a certain class, a marked emulation of the thorough and finished style of first-class American operators. Although amalgam and plastic, or white fillings predominate to a great extent, gold as a filling material, in the estimation of those who rank highest in the profession is the "ne plus ultra." For artificial dentures, teeth of American manufacture are largely used; also dental instruments, appliances, and various

materials supplied by American manufacturers.

The number of dentists in London is "legion," and yet they all seem to live. Some of them live in opulence. For some operations the fees are higher than with us; for others lower.

The trip of a few hours takes you from the great, bustling, smoky city of London to Paris, the gay metropolis of France. To most tourists the change is a pleasant one. Fourteen years had elapsed since the writer was there. The Empire was, at that time, at the zenith of its power and glory. The Worlds Exposition was in session, and strangers, pleasure-seekers, and industrial representatives from all parts of the globe, poured within the walls of the city and crowded it to overflowing. Napoleon III., was the proud Emperor of France. His imperial popularity and power, together with the pride, energy and wealth of the Empire, were taxed to the utmost to make the occasion a dazzling pageant for the entertainment of all Nations, and the gay and brilliant Metropolis the wonder of the world. Subsequently came the FrancoGerman war with its disastrous results. The emperor is defeated and made a prisoner of war. Paris is besieged and captured by the victorious Germans. What a change! From the throne of

a mighty Empire, to the cell of a gloomy prison ! Such oft is the fortune of wars; and the fate of those who rashly wage them for purposes of self-exaltation! What a lesson on the uncertainity of human events, and the delusive and transient nature of Earthly power and glory! But this vein of thought so natural at the time of my visit these reflections suggested by great events that had transpired during the lapse of a few years, changing the destiny of the nation-must be no longer indulged. I was glad to find that Paris, instead of being demolished, exhibited on every side

evidences of the greatest prosperity; and in its improvements, splendor, and gayety, seemed to fully equal if not surpass imperial Paris of former years.

During my short stay my time was fully occupied, and I will record a few things that may possibly interest some one in the profession.

There are few countries in the world where more dentists may be found than in France, and Paris is a regular dental bee-hive. Not only do French dentists in great numbers practice here, but American, English, Gern.an, and Italian members of the profession, have come to this populous, prosperous, and gay metropolis, as a promising field for enterprise and success in business. The natural effect of so much competition is, that the remuneration for the dental practitioner is, as a rule, small indeed. Many dentists consider one dollar (5 francs) a sufficient fee for filling and treating a tooth.

But

Ten francs is the average fee, and 20 francs, ($4) is taken by most of the leading men. I am talking of the average respectable dentist. Several eminent French, and foreign dentists receive five, ten, and sometimes fifteen dollars. I have been told that they obtain these fees rarely, and may see a patient six or seven times, treat a tooth, and fill with gold for four dollars. This statement does not include a few men who enjoy a European, and even a cosmopolitan reputation, and who receive exceptional fees sometimes fabulous. These are, on an average, as well paid in France as the best dentists are in this country for operating, and perhaps better for mechanical work. I can say but little touching dentistry in France, that may be new, as our art is tending to become cosmopolitan. I have noticed that soft gold is used to a large extent in the form of eylinders by the best operators. Amalgam and the white fillings (Gutta Percha

and Osteo Plastic) are more used than with us.

Compared with England, dentists use more white fillings; and the dentists in England more amalgam. For mechanical dentistry gold is used to a large extent; also hard rubber by ordinary dentists. Celluloid is very rarely employed. Ivory is still used as a base by some dentists, in rare cases. For instance, patients who have worn hippopotamus dentures for twenty or thirty years, still insist on using them in preference to porcelain teeth. These ivory sets are beautifully carved and are quite artistic; but, as I have stated, are now only used for old patients, and are becoming a lost art, unfortunately; for no branch of mechanical dentistry required so much artistic skill as carving these ivory sets. Spiral springs are still worn in very flat, edentulous mouths. But these are also becoming unfashionable, although some dentists claim that in certain rare cases, for old patients with very sensitive and flat mouths, springs offer an amount of stability which could not be otherwise obtained. Springs when used are adapted to suction plates made on models cast from plaster impressions and carefully articulated dentures. Gum teeth are but little used in France. Healthy roots are filled and allowed to remain in the mouth, particularly when teeth are also standing; the latter are clasped and the dentures are usually in such cases gold plate.

Dental politics in France furnish a somewhat interesting subject for study. The èlite of the profession are striving to obtain dental laws somewhat like the American dental laws. As may be expected whenever a good and wise suggestion is proposed, a warm opposition is made to it. Among those in favor of dental legislation (members of the Odontological Society of France), the names of Drs. Audrieu, Colignon, Brasseur, Gaillard and others, are well-known to us by

reputation. These French dentists have called to their councils and elected members of the society several of our graduates, Victor du Bouchet, Charles Kingsley and Mordaunt Stevens, M.D., D.D.S., who are well-known to us, and some of them are graduates of the "Philadelphia Dental College." Naturally these gentlemen strive in every way to show their desire to help their French confrères; making it a rule, however, to avoid giving advicebut simply information touching the working of dental legislation in America. Being entirely unprejudiced I looked over the names of the opposition society, but none are known to me with the exception of one or two noted adventurers whose staring door-plates, and names in most conspicuous letters on their balconies, force themselves on the notice of every one that walks the streets of Paris. I must say a word or two touching the official organ of the Odontological Society of France. The print is called the "Gazette Odontologique." The editors have thus far kept in the back-ground and have always endeavored to keep up the tone of their journal.

They have been rewarded by a very good circulation, which, although it cannot be compared to some of our dental journals, makes the "Gazette Odontologique" by far the best dental publication on the Continent. Perhaps one of the best evidences of progress which our professional brethern in Paris have made, consists in the institution of monthly meetings of the Odontological Society of France. I regret that I was unable to accept an invitation to attend, but have been told the discussions are of an inter

esting character. The meetings take place on the first Tuesday of each month (August and September excepted), and American graduates are cordially invited to be present; the only formality consisting in sending their cards to the foreign secretary, Dr. Mordaunt Stevens, 42 rue

Cambon, Paris, who will give all information, and introduce them to the president and members of the society.

DENTAL CARIES.

BY DR. C. N. PEIRCE,

Professor of Dental Physiology, Dental Pathology and Operative Dentistry in Pennsylvania College of Dental Surgery.

IN considering the abnormal conditions of the hard tissues of the teeth, we have to do with that which indirectly as well as directly affects the integrity of these structures; also with conditions which produce a modifying influence upon the health and vitality of the more vascular parts.

The theories which have at different periods been advanced respecting the cause of death and molecular decomposition, designated dental caries, have widely varied, and though each has received. enthusiastic support, no one has seemed sufficiently complete in itself to have been accepted as a satisfactory explanation of this pathological phenomenon. The chemical theory, which at one time was held almost to the exclusion of others, was based upon the supposition that the malady was wholly due to chemical agents, acids especially, acting upon the inorganic part of the tooth; from the unsatisfactory explanation of its origin and influence it was found quite inadequate to satisfy appearances and results which were sometimes manifested. Evidence of influences other than local developed the theory, that vital, systemic, or constitutional conditions were prevalent, and modified the integrity of tooth structure by breaking up the continuity which existed between the organic and inorganic parts of the tooth, and that this disorganization was usually preceded by an exalted sensibility of the hard tissues.

Next evolved was the chemico-vital theory-a predisposing and an exciting

cause, vices of conformation, deficiency in the quantity and quality of enamel and dentine, due to imperfect nutrition during the period of development, represented by pits in the enamel and interglobular spaces in the dentine; the sequence of a vital and systemic condition, while vitiated secretions, the result of either local or systemic conditions acting directly upon the external surface of the tooth, were deemed an exciting and local

cause.

Low forms of life found in the oral cavity constitute the parasitic theory. So universal and constant have Leptothrix and other organisms been discovered in the secretions of the mouth, upon the teeth, and in cavities of decay, that their mycelium and minute bodies are supposed by burrowing into the dental tissues to be largely the cause of dental caries. This theory has been earnestly advocated, but not with such perspicuity as to become generally accepted, though favorably regarded by many.

The electrical theory, based upon the assumption that the different tissues of the teeth are at times abnormally charged with negative and positive electricity and hence are broken down by this seeming antagonism, has found numerous and earnest advocates.

The foregoing theories have all in turn found supporters, and by virtue of recognized conditions some of them are more than plausible; but no one of them indicates a well defined cause which satisfactorily explains the malady in all its aberrations.

Important modifying influences there are, and probably, many not yet recognized, which doubtless impress themselves upon the integrity and durability of the hard tissues of the teeth; of such we may mention those resulting from foods, habitat, occupation, mental and physical depreciation or exhaustion, -periods of gestation and lactation, age,

hereditary influence-these all speak in unmistakable language of the multiplicity of conditions which are either continuously or remittingly tending to modify the resisting power of the teeth, rendering them an easy prey to dental caries. These modifying and predisposing causes may all be summed up in the statement—that certain physical, mental, moral, dietetic, hygienic and hereditary conditions are contributing, both directly and indirectly, to the prevalence of this disease. The average student and dental practitioner quite naturally inquires, "Why bother about the causes? The results are patent; let us learn how to treat those-excavate, file and plug to the best of our ability, enough for the life of one man.' True, while the evil goes on unabated and unrestricted there will certainly be work enough for all who do their work well-but is that the aim and end of dentistry? Tooth carpenters indeed!

Dental Caries is characterized by a progressive and often continuous disintegration or softening from the external surface to the interior of the crown, until a larger or smaller portion, or the whole of the organ, has gradually disappeared. In the intelligent and successful treatment of this disease, the practitioner certainly needs to comprehend, as a result of his study and investigation, the anatomical and histological structure of the tooth, as well as a somewhat accurate idea of its chemical composition, and the predispositions of these; that is, how in their morphology, either normal or abnormal, the teeth are subjected to or protected from assaults from without. He needs to study and appreciate, especially the secretions in which they are constantly bathed, their source, or origin, and the modifications to which they are liable, and the influence when either normal or abnormal they are capable of exerting; also the various and numerous

influences tending to modify the progress of caries, or induce its temporary or permanent suspension, the vitality of the tooth, the extent of its recuperative power, and the protection this nutritional effort offers. Upon the principles involved in the prophylactic, manipulative, therapeutic and surgical treatment, the successful practitioner of dentistry needs all the light he can procure --nay, more.

PULP NODULES AND THEIR TREATMENT.

BY H. L. GILMOUR, D. D. S., PHILAD'A.

IN writing upon a subject which seems surrounded with so much obscurity, both as to cause and diagnosis, I feel to shrink more from the possible criticisms of superficial readers and thinkers, than a sense of the magnitude of what is before me. I propose making reference only to cases in practice which it has been my opportunity to treat, leaving microscopy and deeper scientific research for those less accustomed to the ache and cure contact of every-day practice, but infinitely better able to delve into pulp minutiœ and territories still unexplored. The process of pulp calcification has been known for many years, and yet our knowledge with regard to it still remains vague.

My reference, however, is to what is best known as pulp stones or nodules, existing in the pulp tissue, independent of "connection with the walls of the pulp chamber. These nodules, according to my own observation, vary in size from grains as fine as sand-more easily felt by pressure between the finger and thumb than seen by the eye-to large irregular shaped nodes, entirely filling the pulp cavity, and conforming to its shape. The dislodgment of these bodies is frequently attained with considerable difficulty. I have found a spear-shaped point

most effective in breaking up the mosaic, by simply insinuating the point between the nodules and giving it a twist, when they may be easily removed by a stout nerve hook.

In the year just closed I had several cases, all in upper molars, and with the exception of one case, in the teeth of gentlemen ranging from forty to fifty-five years of age, of nervo-sanguine temperaments, grand physical constructions, looking as if sympathy could never be evoked from any source.

The exception mentioned was in the mouth of a lady, and the tooth the first one I can recall where the cavity of decay was deep enough to expose the pulp; this exposure occurred at the mesio-buccal horn, the cavity extending under the gum. I made an arsenical application, seeing her, by appointment, the following day to renew the application; at that time I exposed the pulp over the palatal canal, and there came in contact with as large a nodule as I have in my collection. It was easily removed, with two-thirds of the palatal pulp adhering to it; after picking out four nodules, the patient reminded me of removing five or six nodules three years ago from the corresponding tooth on the other side.

There being no necessity for another arsenical application, I dressed the canals with acetate of morphia paste, filling the outside cavity with pellets of cotton and sandarach varnish as is usual in pulp cavity of operations, and arranged for filling the tooth in a week.

Another class of teeth in which pulp nodules exist, are those without a sign of decay, erosion, or outside manifestation of trouble; neither soreness on percussion, thermal changes, or any of the usual diagnostic signs; but a sensitiveness peculiar to the scratch of the finger-nail on the neck of the tooth, not corresponding in severity to the same kind of scratch above or below the edge of enamel (as the case may