4. The cultivation of a generous professional spirit amongst
practitioners throughout the district.
With respect to the first object, I think the purport of the Act is so
clear that it requires but few remarks from me. It is impossible to draw
any definite line where the help of an unqualified person must cease and
that of the duly qualified practitioner commence. Any one who dresses a
wound or a bruise, or reduces a dislocation, practises surgery, and no
one could for a moment imagine that a law would ever be passed to
prevent his doing so; and in like manner, we could not expect that the
legislature would ever allow the drawing of a tooth or any other similar
operation to be made a penal action, although the person so doing may be
said to be practising Dentistry; but as soon as any one endeavours to
make the public believe he is a qualified practitioner, by assuming the
title of Dentist or any other name implying the possession of the Dental
diploma, so soon he becomes amenable to the law; the act thus
guaranteeing to the public, that _for the future_, any one who claims
the professional title shall of necessity have obtained the necessary
qualification. Any person, or any number of persons, who may wish to put
the act in force in any particular case can do so, but before taking
action it will be necessary to obtain the sanction of the Medical
Council. This at first sight may seem to be an unnecessary precaution,
yet I think on further consideration you will admit that it is a very
wise provision, as it entirely prevents the possibility of any one being
proceeded against from personal pique or any other improper motive; and
if in any case it is thought desirable that a person’s name should be
removed from the register, all that is necessary is to collect
sufficient _reliable_ evidence, and transmit it to the central board in
London, who will bring the matter before the Medical Council, the only
body by whom such action can be taken. And in cases where these
proceedings may be necessary, I am sure they can be carried out without
earning for ourselves the opprobrium of acting as spies or professional
police, which some have already been willing to assign to us.
With regard to the second object of the Society, we must all feel that
the interests of the profession will at times require the careful
consideration of its members, and necessitate the existence of some
organised body which shall be able to act with the authority of the bulk
of its members, and for this, no better scheme can be devised than the
one we are now so much interested in—the formation of a central society,
with recognised branches in the more distant parts of the country,
constituting an organisation by which the feeling of the majority of the
profession may at any time be ascertained on any question that may arise
bearing on the well being of the profession.
In the third object, “The reading and discussion of papers on Dental
Surgery and Mechanics,” the surgery you will notice is placed first, and
justly so, as the higher branch; though in early times, and I fear even
to a more recent date, the order in importance was more frequently
reversed in practice. The mere mechanical calling of former times—for in
its infancy Dentistry was little else—has now been developed into a
profession and gained admission within the sacred portals of the College
in Lincoln’s Inn Fields, and it is for the present and future
generations to prove by the exercise of their highest mental as well as
mechanical faculties, that the profession is worthy of the position
which has been accorded to it.
It has been noticed by those who most frequently attend the meetings of
our speciality, that papers on mechanical subjects are more easily
procured, and often prove more attractive than those on surgical
subjects, but this will no doubt become less as the educational
facilities of the present day are brought to bear more and more on the
whole body of the profession. Surely the preservation of the natural
organs is of far more importance and value to the patient than the
substitution of others, however efficiently supplied.
What should we think of the surgeon who allowed himself to be deterred
from directing all his energies to the preservation and restoration to
health, of a diseased or injured limb, by the thought that an artificial
substitute could be provided for it. No! No! Whatever our politics may
be let our surgery be conservative. Far be it from me to appear to
undervalue any branch of my profession, for no one can have been long in
practice without having experienced the well earned gratification
derived from noticing the relief from pain, and in many instances the
perfect restoration to health, that follows the substitution of
efficient members in the place of useless and diseased ones; but far
greater is the credit and higher the appreciation of the patient, when
the diseased natural organs themselves can be preserved and restored to
a state of efficiency; and how great are the facilities for so doing in
the present day, compared with the early reminiscences of many of our
older brethren. All of us who were fortunate enough to hear the
interesting paper read before the General Meeting of the Society in
August last, must have been forcibly struck with the contrast between
the paucity and quality of the instruments there mentioned, and the
appliances of the present day. What would have been the feelings—I might
almost say the bewilderment of the practitioner therein described, could
he have been transported into one of the large depôts with which we are
so familiar. The numerous and beautifully adapted instruments for the
variety of operations unknown in those days. The admirably adjusted
forces for each form of tooth, the endless variety of excavators and
pluggers, the wonderfully delicate nerve extractors, the rubber dam and
its adjustments, the saliva pump, the electric mallet, the improvement
in our chairs, and that greatest of all boons, both to patient and
operator, the Morrison engine, the name of the inventor of which
valuable instrument, ought to be indelibly inscribed in letters of gold
in the Archives of Dentistry, to say nothing of the application of
vulcanite and celluloid, and the many ingenious appliances for the
workshop. Surely these should lead us to value the benefits we enjoy,
and teach us to strive to use them to the best of our ability, not
influenced by the thought of self-glorification in attempting to surpass
all others, in the performance of this or that brilliant operation, but
ever remembering that the ultimate aim of all our efforts should be the
increased amount of good which we are thereby enabled to accomplish for
the benefit of our suffering fellow-creatures.
Although the _Transactions_ of the Odontological Society contain a very
voluminous and valuable collection of papers bearing on one speciality,
there still remain numerous subjects and modes of operating which may be
made productive of profitable discussion. Such are the replantation of
teeth now attracting so much attention, the erosion of the surfaces of
the teeth of which so little is known in the present day. The various
improvements in the materials for filling, and amongst a variety of
subjects, far too numerous to be mentioned here, the startling
announcement of the so-called New Departure Creed.
As this last is a subject which I think we all feel greatly interested
in, and also bears on the branch of Dentistry which we are now
considering, I will venture a few remarks on some of the articles of the
accepted and new departure creeds as tabulated in the _Dental Cosmos_.
I am not aware that the so-called accepted creed has been the recognised
standard of practice in this country. The doctrine that gold, and
nothing but gold, should be used for permanent fillings, has certainly
been extensively promulgated by those of our Transatlantic brethren who
have settled in this country; and I cannot but look upon this new
departure, as the natural reaction which might be expected to follow the
over anxiety to build up large adhesive gold fillings, on fragments of
weak and often disorganized teeth, totally unsuited for such an
operation; but until I can see some stronger reason than has been
hitherto adduced by the advocates of this new departure, I must, in any
case suitable for a good gold filling, confess my unwillingness to
abandon for any other of the fillings now in use, a material that we
know from past experience is capable, when judiciously applied, of
preserving and restoring to a state of efficiency, in some cases for a
period of twenty years or even for a much longer time, teeth which
otherwise would have been lost in about the same number of months. For
the efficient use of this material much must of course depend on the
manipulative ability of the operator, but it has often seemed to me a
matter of doubt, whether, in the case of those large adhesive gold
fillings, the patient has received an equivalent for the tedious and
necessarily expensive operation that has been undergone.
The choice between contour fillings and separation of the teeth in the
case of approximal cavities, must, I think, depend in a measure on the
aptitude and judgment of the operator, since the two plans when
successfully performed, may be made equally efficient. The latter
however—separation—seems to afford greater facilities for operating, and
also for cleanliness in those patients who are unable or unwilling to
devote the time and attention necessary for that object.
The professed incompatibility of gold as a filling material with tooth
bone, seems to me to be at variance with the frequent success which we
all must have experienced, in the use of that filling in cavities on the
labial surface of the roots of the upper incisors. I mention this
particular position as being easy of access for operating, and also as
being one where the enamel, tooth bone, gold, and saliva, are in
constant contact with each other. In those cases where the success of
the operation has not equalled our expectations, in endeavouring to
estimate the probable incompatibility of the filling material as a cause
of failure, it is, I think, necessary to consider whether in the
ordinary operation for filling, the whole of the diseased dentine has
been so thoroughly removed, as to admit of its proving a satisfactory
test case, for the microscope reveals to us a change in the dentine in
the sides of a decayed cavity, even when it appears sound to the eye,
and also to the feel of the instrument; and in those portions of the
margin of the cavity which we undercut for the retention of the filling,
we have the dentine not only denuded of its nutrient covering, the
periosteum, but also deprived of its nutrition from the pulp by the
severance of the tubes of the dentine, and the intervention of the
filling material, and in this deteriorated condition, in all probability
still exposed to the continuous action of the same deleterious
influences (whatever they may have been) which first caused the decay;
and I cannot but think that the failure when it occurs, is in a greater
measure due to the above named causes, rather than to the
incompatibility of the gold with the tooth bone; but with all the
success that has attended the use of gold for so many years, we must
still, I am sure, be willing to admit the want of a perfect plastic
filling, which shall be able to withstand the friction of mastication,
and also the deleterious action of the fluids of the mouth.
The dictum that, “a tooth that can be so treated as to be satisfactorily
filled with anything, is worth filling,” is one, I think, that all who
value conservative surgery must readily agree with.
That “unskilful and unscrupulous Dentists fill with tin covered with
gold, thereby causing galvanic action, pulpitis, death of the pulp,
abscess, and loss of the tooth,” has certainly not been an accepted
creed in this country, for I was early taught the use of this material
both alone, and in combination with gold, when I first commenced the
study of my profession with Mr. Sheffield, of Exeter, and long
experience, and the retention of a tin filling in my own mouth, in a
perfect condition for over five-and-twenty years, has fully proved to me
the value of this metal. When used in combination with gold, and exposed
to contact with the fluids of the mouth, it certainly undergoes a
chemical change, becoming nearly black in colour, but without staining
the tooth as some amalgams do; it also becomes harder, and cuts harsh
like an amalgam filling, but the change does not appear to cause any
alteration in its bulk, or in any respect to interfere with its
efficiency as a filling, nor have I ever found it produce any of the
evils suggested in the creed, and I cannot but think that it would be
more used, were it not for the universal prejudice that exists in the
mind of the public in favour of gold, partly arising from the magical
charm which resides in the word gold, and partly from the nothing but
gold theory (if I may so call it), which has been so largely spread by
our American brethren.
That “a filling may be the best known for a tooth and yet leak badly,”
seems a simple admission that in some cases bad is the best that we can
do for them. If experience has taught us anything, it certainly has
proved that it is the leak which does the mischief; and as in warfare no
fortress is considered stronger than its weakest part, so is it with a
tooth that is filled. A small leaking point will soon undermine the
filling, and prove its ruin.
The statement that “gutta-percha _properly used_ is the _most permanent_
filling material we possess,” must make us wish to know the meaning of
the words, “properly used,” for the rapidity with which it wears away,
in any position in which it is subjected to friction in mastication,
seems to me to prevent the possibility of its ever being permanent.
The force of the article which says that “a poor gutta-percha filling,
_in its proper place_, is better than a _good_ gold one,” seems to
depend on the question as to what is the proper place for a gutta-percha
filling: surely not the place where we can insert a good gold plug, if
by “good,” is meant one that is not only solid, but also sufficiently
tight to exclude all moisture from the cavity.
It certainly is rather startling to hear from the country from which
have come the severest criticisms on the use and the users of amalgam
fillings, the admission that “amalgam per se, is an excellent filling
material.” With amalgams, as with the other plastic materials, a
_perfect_ filling of its kind has yet to be discovered, for a measure of
uncertainty seems to exist in all of them; but as a proof that an
amalgam _may_ make a good useful filling, I can say that I have seen
more than one apparently in a perfect condition after thirty years’
wear, and I cannot but think that much of the discredit attaching to its
use, arises from its being the filling we naturally have recourse to in
all cases of doubt and difficulty.
That “the use of plastic filling material tends to lower the standard of
Dentistry, thereby diminishing its sphere of usefulness,” is scarcely a
fair way of stating the matter. The indiscriminate use of them would
certainly do so, but the judicious selection of them in cases unsuited
for the use of gold, need not necessarily interfere with the acquirement
of the manipulative ability necessary for making good gold fillings, nor
is it desirable that it should do so, as the power of manipulation
required for the successful use of gold, must tend to perfect the powers
of the operator in the use of all plastic materials, and must thus
extend the sphere of usefulness of that Dentistry which has for its
standard of excellency, ability to save teeth.
Time has only permitted me very briefly to notice some portions of this
new creed, to show that it contains much that might be productive of
profitable discussion, but I think from what has been said, we may
reasonably conclude that each material has its own particular
advantages, and that until we are in possession of a filling suitable
for universal application, a judicious selection is necessary on the
part of the operator in each particular case.
The fourth, and not the least important object of the society is “the
cultivation of a generous professional spirit amongst practitioners
throughout the district,” and to this I hope may be added throughout the
whole body of the profession; for the knowledge that we are branches of
one central society, should lead to a feeling of fellowship not only
with the members of the parent society, but also with the members of the
other branches, and surely it is not too much to hope, that with the
extension of the Society and its branches, and the feeling of
professional brotherhood thereby engendered, we may see the gradual
increase of that Christian charity which “thinketh no evil,” and which
would scorn all attempts at self-exaltation, by the disparagement of the
efforts and qualifications of a fellow practitioner, which I fear has
been greatly encouraged by the isolation that has so long existed in our
speciality.
Nor must we omit to notice the great benefit to be derived from the
friendly discussion of subjects in which we are all mutually interested,
not only to the profession at large, but also to each one individually,
for which of us in his early days has not felt the wish that he had
thought of this or that other mode of treatment in some particular case;
and what more likely to impress new ideas on the memory, or, to use a
familiar expression, make us “have them at our fingers’ ends” (the place
where surely they are wanted when operating), than the friendly
discussion of them which it is one of the objects of our Society to
encourage?
The President of the Western branch has held out to us the hand of
fellowship, which I am sure I need not ask your permission to be allowed
to reciprocate most fully—not only in the wish for their future
prosperity, but also in the assurance that any of their members who may
have an opportunity of attending our meetings, will at all times receive
that cordial welcome which it should be our greatest pleasure to extend
to all the members of our Society and its branches, thus realizing one
of the great objects of our Association, and proving not only by our
words, but also by our actions, that we are anxious to encourage that
professional intercourse which must tend not only to our mutual benefit,
but also to that of the community at large; and if, as their President
remarked, it is a pleasure to them to think that in the formation of our
branch we show “the benefits resulting from the good example they have
set us,” it is no less a subject of congratulation to us to know that
they have at last recognised the good which is likely to accrue, both to
themselves and to the profession generally, by following our example,
and forming themselves into a local branch of the British Dental
Association.
And now, fearing that I have already trespassed too long on your time
and forbearance, it only remains for me to thank you for the kind
reception you have accorded me, and to express the belief that, although
the barque which we have so successfully launched will probably meet
with the usual amount of storms and difficulties, still the old
proverbial “long pull and a strong pull and a pull all together,” in
which you are so able and willing to join, will carry it securely
through the many undercurrents and quicksands which may threaten it on
its course, and secure what we all so ardently hope for—a useful, as
well as a long and prosperous career, for the Midland Branch of the
British Dental Association.
* * * * *
Mr. MAHONIE (Sheffield), moved a vote of thanks to the President for his
able and eloquent address, and in doing so, said that when the
Association was weak, Mr. Campion had come to their aid in a very
courteous manner, and they were now asked to give him their heartiest
thanks for the paper which they had just heard read. The paper was one
which would last more than a year. It was very instructive, and he (Mr.
Mahonie) thought that Mr. Campion was eminently capable of giving them
instructions in the way of Dental Reform. He moved “That the best thanks
of this meeting be given to the President of the Midland Counties Branch
of the British Dental Association, for the able and eloquent paper which
he had just read.”
Mr. W. H. Nicol (Leeds), seconded the motion in suitable terms.
Dr. W. H. Waite in supporting the motion, said that it was a very great
privilege for them to have such a President as they had in Mr. Campion.
His wisdom had been of great service in superintending the efforts which
the Executive have had to put forth. They had been delighted that
morning with the interesting and instructive address which Mr. Campion
had given them, but most of all with the very high and generous tone
that breathed throughout the whole of the address, and he (Dr. Waite)
thought Mr. Campion had struck a key-note which, when the address came
to be printed, would vibrate not only throughout the Midland Counties of
England, but through every country where the Dental profession was
carried on. The motion was carried with much enthusiasm, and the meeting
then adjourned till the afternoon.
* * * * *
The Members assembled in the Memorial Hall at 2.30 p.m., Mr. Campion in
the chair.
The PRESIDENT stated that some idea had been started of bringing
specimens to the meeting, and in order to show what curiosities might be
casually collected, he offered a few specimens to the notice of the
Members.
Mr. ROFF KING, Shrewsbury, then read a paper on “Modelling and Modelling
Composition.”
Mr. J. S. CRAPPER (Hanley) read a paper, entitled “New Ideas in
Mechanical Dentistry,” and exhibited specimens of teeth which had been
manufactured by a new process and sent to him to exhibit.
The SECRETARY read a paper received from Mr. F. Richardson, Derby—“Has
Vaccination any Effect on the Degeneration of the Teeth?”
Mr. H. MARSH (Manchester) read a paper on the “Use of Nitrous Oxide
Gas.”
Mr. MURPHY desired to ask the Chairman whether Licentiates in Dental
Surgery were legally responsible if a patient expired whilst under the
influence of the nitrous oxide gas, or subsequently to the
administration.
In the discussion which followed, there appeared to be a unanimous
opinion amongst those present that Licentiates were not responsible, but
that it would be impossible to define such a position.
The SECRETARY read a letter from Mr. Kyan of Preston, in which that
gentleman expressed his regret at his inability to be present, and hoped
the Members would have a successful meeting.
Mr. RENSHAW moved a vote of thanks to those gentlemen who had furnished
them with such interesting and instructive papers.
Dr. D. A. WORMALD, in seconding the resolution, said they could, with a
little energy and support, make that Society very successful, and as a
representative body on behalf of their profession in the Midland
Counties, they could maintain such a position that it would become an
honour to belong to it.
The CHAIRMAN remarked that it was no light work to prepare such papers
as they had heard read; much time and trouble must have been spent in
the digest of the various subjects. He gave the hearty thanks of the
meeting to the contributors of those papers.
The resolution was carried unanimously.
Mr. Major STEWART proposed a vote of thanks to Mr. Campion for
presiding.
Mr. KING seconded the motion, which was carried unanimously.
The CHAIRMAN (Mr. Campion) returned his best thanks for the kind
reception and assistance the Members had rendered him whilst in the
chair.