BY S. H. GUILFORD, A.M., D.D.S.,

knowledge and skill to enable us to serve them well, and after that we must use that

the Philadelphia Dental College.

The relation between a dentist and his patient involves a double obligation, which, though tacit, is just as binding as though legally drawn, signed and witnessed.

On the one hand, it requires that the patient shall submit to such treatment as the circumstances of the case require, and shall afterward properly remunerate the

dentist for his services. On the other

hand, it requires the dentist to give to his patient his best, most thorough and

most conscientious services.

If the pa

tient should not be willing to perform his part of the contract, we would either not receive or not continue him as a patient. So, too, if we do not fulfil our obligation in the premises, the patient should and would leave us and seek the services of one more skillful or more conscientious. Patients come to us because they believe that we are possessed of skill of a high order, and will serve them in a satisfactory manner. If they did not have confidence in us, they would not seek our services. Having shown their confidence by preferring us, it behooves us not to violate that confidence, but to serve them in a way that shall tend to strengthen and increase it. To do this, all our operations for them must be well done and satisfactory. We must, in the first place,

knowledge, to bring about the satisfactory results that they expect.

Thoroughness should be a cardinal principle with every dentist. What is not thoroughly done, cannot be well done. No matter what amount of knowledge and skill is brought into the case, lack of thoroughness will ruin the result. Knowledge is most important and so is skill, for without either we cannot be entirely successful, but with them both we still need thoroughness. Dental work lacking thoroughness, is like the play of Hamlet with Hamlet left out.

Few occupations call for the same amount of pains-taking care that ours does, and nowhere, scarcely, is failure atIn the outside tended with as bad results. world a piece of work improperly done involves at most, in its re-doing, only the loss of money; but work upon the dental organism involves the expenditure of time, money and nerve force, so that when it has to be done over it becomes a serious matter. In view of this it becomes our duty to do what we have to do as thoroughly as we can.

The question of charges or expense does not enter into the case at all, for if we served the patient gratuitously he would certainly expect the work to be well done. Neither can lack of time be urged as an

excuse for want of thoroughness, for we can decline a case if we choose; but, having once accepted it, we are bound to do our best by it. The amount of careless and indifferent work that one is constantly obliged to see is simply amazing, and is really hard to account for.

We, of all others, cannot afford to be careless in our work, for, with occasional failures staring us in the face when we have put forth our best efforts, what would become of us or our patients were we to do less than our best? Our work calls for the strongest knowledge, the highest skill and the most exact care, and we cannot overlook the matter. Success is what we all strive after, and real, true success cannot be obtained in any department of life without being thorough in what we do. Our profession is no exception. The successful men are the thorough men. Men who throw the weight of their knowledge, and skill and thoroughness into each operation they perform, be it ever so trivial, are the ones who now, as in times past, lead in the professional race. Men like Varney, Webb and others would never have gained the reputation their work gave them had it not been for the thoroughness and conscientiousness with which they performed every operation they undertook. Had they been satisfied with the "well enough" idea, they would probably have never been heard of. Let not the young men starting out in professional life commit the too common error of confounding apparent with real success. They are widely different. The one "goes up like a rocket but comes down like a stick," and is heard of no more. The other builds more slowly but more surely, and leaves behind an enduring monument to help and encourage those who come after. The quiet but conscientious worker, struggling to build up a practice that will support him, is often discouraged and disheartened by the apparent success of some worthless fellow who,

by speaking well of himself in public print, and by dishonest practices, quickly succeeds in filling his office with patients and his pockets with money. But let him not be discouraged; honesty has never yet been distanced by dishonesty, and competency has always come out ahead of incompetency in the long run. Apparent success, brought about by improper practices, is short-lived and should not deceive. It may allure, but, like the "Will-o'-the wisp," if followed, will as certainly end in disappointment and disaster. There are many elements that go to make up what is known as success, but of them all, none is more important than the single one, thoroughness.

ABSORPTION OF MERCURY FROM RUBBER PLATES.

In No. 5 of the Dental Practitioner is a criticism by W. E. Driscoll, on my article on rubber plates, contained in the fourth number of the journal; but the language is so indefinite, or my comprehension so dull, I fail to understand fully the meaning of his first question—viz. : "I wish to ask him, or any one who can answer, how can you demonstrate the truth of the assertion that mercury is absorbed from rubber plates?"

The doctor either means the coloring matter in the dental gum we use is so pure that it is entirely destitute of mercury, or that the mucus membrane refused to

absorb it if it be there. I suppose, from the context, he means the former.

Now, it is very easy for the doctor to demonstrate that there is free mercury in vermillion, by taking some of the very best "Chinese" and rubbing it on a bright copper plate; he will find enough mercury there to satisfy him on that point. Or he may ignite a piece of vulcanized rubber, and catch the smoke on a piece of bright copper, and again find the mer

cury.

I do not believe that mercury (per se)

absorbed into the system through the mucus membrane does the gums any harm; but the trouble comes from the mercuric sulphide being acted on or altered in some way by the acids or alkalies it meets with in the mouth, and held there in contact with the gum by the plate, causing the irritation and consequent swelling we sometimes see.

In the next paragraph of his criticism, he says: "I advise vulcanizing rubber at 340°." I begin to think that the doctor reads very quickly-with a sort of a hop, skip and a jump. If he will take a little more time and read my article all through, he will find that I stated that my method was to divide the time of vulcanizing into two portions: the first portion at a low heat, to cure it and to allow time for the sulphurous gases to escape, thus preventing a porous plate; the second heat for a shorter time, to harden the rubber. I have vulcanized in this way ever since I was the agent for the Old Vulcanite Company-some twenty or more years ago— and during all that time have seen no good reason to alter my plan.

As the third paragraph of his criticism admits the possibility of the mercuric sulphide injuring the mouth, it requires no remarks from me.

In my own experience I am able to recall but two cases where rubber caused any serious trouble. One, in which I was called in consultation, the mucus membrane of the patient's mouth was considerably inflamed, with numerous small purulent ulcers, discharging a small amount of white pus on pressure. The treatment consisted of a chlorate of potash mouth wash and an abandonment of the rubber plate; with substitution of a gold one, there was no trouble afterwards. The other case was in my own practice-a young lady of sanguo-lymphatic temperament, who by a fall had lost a central incisor in the upper jaw. The dentist she employed to replace it inserted a rubber.

It is noted by Southey, in his common place book, "The Doctor," that "Progers, who had been about the person of Charles the Second, died at ninety-six, in cutting his teeth. He had four, and many others were coming, which so inflamed his gums that it proved fatal." Poor old Progers! "Cutting of the teeth" is, rightly or wrongly, credited popularly with the destruction of many lives, and it would seem from this case that it is liable to be accused of being at work even in the terminal stage of existence. In the nursery it has always, perhaps, been regarded as a very serious matter. Nevertheless, this common belief, like many another, may not be well founded. Cumulative tradition has possibly served to at least excessively emphasize the balefulness of the process. It may, however, be taken for granted, I believe, that the amount of suffering experienced by children in general while getting their primary teeth is very considerable. It causes decided uneasiness in almost all, and decided danger in some. If it rarely or never destroys life directly, it certainly not unfrequently does indirectly. But I am not sure that it is entirely wrong to give it as the actual cause of death in not a few cases. This

is at any rate done. In Philadelphia, about thirty deaths are attributed to it, on the average, yearly, in the bills of mortality. During the census year ending June 30th, 1870, there were three thousand two hundred and forty-seven deaths attributed to it in the United States. There is assuredly some ground for the prevailing belief that dentition is the direct or indirect source from which flow many of the ills and a large share of the mortality of babies.

It would appear, however, that there are some physicians who seriously regard the coming of the teeth as an extremely innocent matter, being, as they say, a purely physiological process. I would advise such that it is assuming a great deal to take it for granted that dentition is in all cases a purely physiological process. Perhaps in no child is it absolutely physiological; it is at best only approximately physiological. In a recent address, Dr. B. W. Richardson went so far as to declare that he had never seen a healthy child," never one "that had not in it either some actual or latent constitutional disease." At any rate, there is good reason for believing that in a large proportion of children, especially in large cities, dentition is of decidedly pathological import. As is true of many other troubles, it generally tends to be more marked in proportion to the degree of unhealthiness of the child. And let it be borne in mind that the sensibility of all infants is great, and of some sickly ones such that even a trifling irritation may be followed by serious constitutional and other effects.

But it is not my purpose to speak of the subject of dentition. This has been done very well in a lecture published in this journal recently. It may be well, however, to say, in the words of John Hunter in his admirable treatise on the natural history and diseases of the teeth, "the symptoms are so various in different chil

dren, and often in the same child, that it is difficult to conceive them to be from the same origin, and the varieties are such as seem to be beyond our knowledge."

Such

Now, when to the discerning senses of the observing, sensible physician, a child. is suffering severely from the eruption of one or more teeth, relief should, of course, be procured as soon as possible How is this end to be attained? The advice given by many amounts to little more than to use a soothing syrup-a la Winslow-of some sort. Meeting the various indications is, in truth, in numerous cases, far from being an easy matter. measures as serve to favor the general health are particularly indicated in every Careful regulation of the diet, daily bathing and a fair amount of exercise, especially in the open air, are among the items of great significance. Make the process as little pathological as possible by making the condition of the child as physiological as possible. Anodynes, antacids, febrifuges and other remedies, including local applications, may or may not be called for. But I believe the remedy most imperiously called for, in at least bad cases, lies in the use of the lancet.

case.

Of the use of the lancet in dentition it is curious to observe how different are the.

opinions entertained.

opinions entertained. Some do not hes

itate to say that it is of no value. Thus, in a recent widely circulated work on the diseases of children, by Dr. Henoch, a Berlin practitioner of seemingly large experience, it is said: "It is now generally held that every attempt to facilitate the eruption of the teeth, and thus remove the symptoms due to difficult dentition, is absolutely useless. I have in earlier years performed scarification with sufficient frequency to convince myself of its entire inutility; and it even appears to me that the cicatrix formed may increase the difficulties connected with the penetration of the teeth." Here is what Dr. J. Lewis

Smith says on the subject, in his work on the diseases of infancy and childhood : "The gum-lancet is now much less frequently employed than formerly. It is used more by the ignorant practitioner who is deficient in the ability to diagnosticate obscure diseases, than by one of intelligence, who can discern more clearly the true pathological state. Its use is more frequent in some countries, as in England, under the teaching of great names, than in others, as in France, where the highest authorities, as Rilliet and Barthez, discountenance it.

I know no accidents of dentition which require prompt scarification, except suppurative inflammation of the gums, convulsions, and paralysis. In other cases the operation may be safely postponed till other measures have been employed." In Drs. Meigs' and Pepper's treaties on the diseases of children it is said: "Lancing of the gums is undoubtedly a most important point in this (laryngismus stridulus) and other diseases of childhood connected with dentition. We have long been convinced, however, from personal observation, that a resort to this operation merely because the child is passing through the period of dentition is at least useless. We have never found it to do any good unless the teeth are near enough to the surface to produce manifest swelling, attended with heat and soreness of the gums. So long as the gum is hard,. insensible, not turgid, and of its natural color, and the mouth not hot, cutting has done no good." That wise old master of the healing art, John Hunter, after speaking of symptoms arising from dentition, says: "So far as my experience has taught me, to cut the gum down to the teeth appears to be the only method of

Dr. Henoch speaks very rashly, to say the least, in declaring that "it is generally held that every attempt to facilitate the eruption of the teeth is absolutely useless." The idea was not formed from an extensive acquaintance with the literature of the subject. Again, the statement of the doctor as to his experience with the use of the lancet may well lead one to infer that he has had hardly any experience with it. He is like those who, although having no knowledge of the use of the lancet in general medicine, yet unhesitatingly venture to condemn it. What he has to say about "the cicatrix" may rightly produce the impression that he has not made himself master of the subject. If the lancing is properly done, there need be no cicatrix; and if there be one it will not serve to retard the " penetration" of the tooth. As Hunter long ago said, at the point of cicatrix the gum offers the least resistance to the appearance of the tooth.

Dr. Smith is doubtless right in holding that ignorant practitioners are very apt to use the lancet when not required, and in his intimation that the use of it is largely a matter of fashion. But I am also quite sure that too many practitioners who are usually regarded as intelligent do not use it as often as they should. His statement that he knows no accidents of dentition which require prompt scarification, except suppurative inflammation of the gums, convulsions and paralysis," is a trifle extraordinary. What of cases of, say, laryngismus stridulus and of cholera infantum, in which dentition bears largely a causative relation? Except in the diseases he mentions, the doctor would. postpone the operation till other measures have been employed." It scarcely follows from this that he is acquainted with the cardinal principle of sound medical practice. In treating of the same subject Hunter correctly remarks: would be better at once to remove the

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