munity from contagious diseases so frequently observed. It may presently be suspected in medical science that there is but one disease, not many, and that the seeming many are but the varied and classified manifestations of the one. A move in this direction was made more than a dozen years ago, when it was suggested that disease-producing germs came from innocent ones by feeding upon unsanitary pabulum. Two eggs whose physical structure and chemical analysis are identical develop into different species. The seeds of the Rocky Ford when planted in Colorado and New York produce in each locality a very different quality of melon. Vice and virtue are conditions of latitude and longitude. Microbes, like men, change their habits and their skins, becoming like the osteoclasts, builders o. destroyers, according to the soil upon which they feed and the guiding principle under which they work. Dr. Snow of the London Cancer Hospital has recently stated that a very large percentage of cancer cases, especially in women, have a distinctly traceable mental origin. A year ago your essayist had the honor to present to this Association a paper bearing directly upon this very point; and I now rejoice to find that men eminent in the domain of bacteriology, biology and science-Professors Lehmann, Loeb, Elmer Gates of the Smithsonian Institute, and a host of others-furthering the ideas at that time expressed. The more we gather in the lines of heterogeneity in all the various fields of nature, the more we find them circling about a common center to which they are all attached, from which they derive their origin and by which they are controlled. A physiological relationship existing between the tooth and the jaw, all the rest of dentistry is purely the work of the artisan and the mechanic, requiring the highest type of human skill, ingenuity and artistic taste. The liberal professions are never the producers-they are the thinkers of the world, and we should master the one before we commence the other. The artist alone is the doer. When we have crossed the borders of a liberal profession, we may then pass out into the great sunlight of life among the harvesters and the reapers who are intelligently working for the benefit of the race. I have no desire to belittle any calling-every man is working in the field to which he is best fitted—but rather to raise the mechanical and physical to the dignity to which these sciences are entitled. Let us try and rise above the narrow confines of our own little niche and recognize with Emerson "There is no great, no small To the soul that seeth all; . And it cometh everywhere." So long as the bread and butter question enters into professional work, just so long as we are compelled to fall back upon the few talents that we have developed in ourselves in our evolution from the tadpole, it is not to be wondered at that professional excellence takes the form of the groove in which it is rusting, and by which it is supported. We are inclined to do that which we can do well. We seem so helpless in other directions that our sight rarely gets above the narrow wall to which we cling. Do you wonder then that some of our teachers cling so desperately to these antiquated methods? It is not with any great wish or expectation of converting any member of this Association to my individual views, but as a protest against some of the slovenly and inefficient methods still in vogue, that I have presented this paper. To the majority of the members of this Association, to those men among them whose attainments I honor and whose friendship honors me, I know my strictures are uncalled for; but it is to them also that I speak, for it is from them that I look for vindication and help, that the profession we follow may become a unit in practice and an honor among men. Discussion. Dr. J. Y. Crawford, Nashville: This is an excellent paper, but there are two points upon which I cannot agree with the essayist. In the first place, he ignores one of the fundamental principles upon which successful dental prosthesis rests, namely, the ability of the gum to assume the function originally performed by the tooth and roots. In the second place, his statement about the devitalization of all pulps under crowns and bridges is radically. wrong. The pulp presides over the welfare of the entire tooth structure and should be preserved whenever possible. Dr. Thos. Fillebrown, Boston: I wish to say amen to Dr. Hungerford's statement with regard to the preparation of teeth for the band. Whenever a considerable portion of the enamel is removed and the greater part of the crown is covered the pulp will die in a short time, so in all such cases it should be devitalized and removed. I wish also to agree with the statement that a tooth should be trimmed down until the circumference is largest at the margin of the gum. Occasionally a patient will present who is unable to bear the necessary grinding. In such cases a pure gold cap, reaching about half way to the gum, may be burnished on the crown so as to fit closely. The pulp of a tooth treated in this way will remain healthy. Dr. J. N. Crouse, Chicago: In teeth which are not bell-shaped, but which grow larger toward the gum, I should trim but little, and I should not destroy the pulp unless it were absolutely necessary. If rightly treated I do not think so many of them will die as we imagine. I should rather take chances on its living than to cut the tooth down and have the root lost sooner or later, and usually sooner than later. In my scrap heap I have a large number of bridges, where the wisdom tooth, roots and all, is cemented fast in the cap, and where the whole business was easily taken out by hand, although the bridge had been well made and well fitted. have never been able to quite decide what makes the pulp die in a tooth which has been cut down, but believe the acid in the cement has considerable to do with it. I should save the pulp wherever possible, but of course there are cases where it must be removed. One of these is where the patient is advanced in life. There is one operation which I am always reluctant to perform, and that is to cut off a sound cuspid tooth, especially for a woman, in order to use the root as the abutment for a bridge, yet it is the proper thing to do. I have made a good many open-faced crowns, but the more I see of them the less I like them. Dr. G. V. Black, Chicago: In addition to what Dr. Crouse has said about putting crowns on teeth with live pulps, I would state that this has been my practice for years, but it has been done with judgment. Right here I must enter an objection to this excellent paper. While it is true that applied physics is a large factor in all dental work, and especially in placing crowns and bridges, we must not use it without exercising judgment as to the present or future conditions of a pathological character due to the application of this work. Our knowledge of pathology, of disease, and of the conditions that are likely to produce it, should precede and control. The paper tends to diminish our faith in well-known bacteriological facts. While there are changes taking place in all living things, the species of microorganisms are as constant as those of almost any other varieties of life, and the essayist's endeavor to show that there is no constancy in the various species of microorganisms seems entirely wrong to me. Dr. D. R. Stubblefield, Nashville: It is an indisputable fact that ali bridgework is against nature, and we should therefore not be surprised when there are compromises on the part of nature under the circumstances under which she labors. Bridgework is in many respects the ideal compromise of the profession with untoward existing conditions, and I heartily approve of it, but when you put four teeth on a foundation which nature used for two, you have overloaded her and must not hope for ideal results. The essayist failed to state that his paper is a Utopian dream, but we should have such things, for there never was a grand practical result that was not preceded by a dream. So long as we hope for universal efforts we dream, and we waste time when we try to force all others into our line of operating rather than to impress upon them the ideals at which they are to aim. Dr. R. H. Hofheinz, Rochester, N. Y.: I should say that a fact was never proven without a fight, especially in dental societies. If Dr. Hungerford stated that he destroyed the pulp under all conditions whenever putting on a bridge, I should say that it was a radical mistake, but I did not so understand him. I thought he stated that he would under all conditions destroy the pulp where it was necessary to secure mechanically correct foundations for his bridgework, rather than endeavor to keep the pulp alive for a short time and have an imperfect foundation. I accord in that statement. However, to my mind the principal idea of this paper is not the destruction of the pulp or the application of the band in bridgework, but something much greater. The essayist speaks of uniformity, and alludes to the broad-mindedness of professional men. Generally speaking, if there were uniformity there would be absolutely no progress, as it is only the difference of opinion that leads to progress and to the acceptance of the best method of doing certain things. The fundamental principles of bridgework which he has laid down so excellently seem as clear as possible, yet we all frequently see cases where these primary laws have been neglected. As to broad-mindedness among our professional men, we must not forget that the very fact of living in this age of specialization means narrow-mindedness to a certain degree. This is largely applicable to dentists, and they more than any other professional men, owing to the long confinement in their offices, ought to do everything possible to exercise their minds beyond their special work. It is largely owing to a smallness of conception that so much of what is said and written at the present time passes away without effect. Dr. J. D. Patterson, Kansas City: If anyone thinks Dr. Hungerford has given us a Utopian idea or that he is a dreamer, I wish to say that there are many in the west dreaming the same dream and carrying out the same idea. I am astonished at Dr. Black's remarks, which seem to indicate that the principles laid down and accepted in the last decade upon bacteriology shall not be improved upon in the next. This is a subject about which we know very little, and opinions are changing from year to year as investigations proceed. There will probably be more change in the future in our ideas as to the biology of bacteria and their action in pathological conditions than in almost any field of science. Every word that Dr. Hungerford has said represents the most advanced ideas upon that subject, and anyone can prove his statements by studying the conclusions of the most eminent biologists and bacteriologists of the present time. ་ Dr. J. E. Wilkinson: Dr. Hungerford makes a valuable point when he says that the outer cusps should not have as much strain put upon them as the inner ones in the articulation, because of the weaker buccal alveolar wall. Of course if we make a greater slope, so as to have more pressure on the inner cusps, then instead of having a pressure at the margin of the alveolus we will have a greater pressure of the apical end against the buccal alveolus. The essayist seems to object strongly to partial plates. Some one stated that all bridgework was against nature, and in like manner all partial dentures are against nature, but there are cases where they do more good and cause less injury than bridges. I do not agree with Dr. Hungerford's statement that swung dummies should not be attached to single roots, as there are cases where this can be done. |