should be looked for; diabetes and Bright's disease may cause a sluggish condition, anæmia, as well as other things too numerous to mention, may be present. Therefore, a complete clinical examination should be made of the urine, foeces and blood.

The local irritation may be mechanical, chemical or bacteriocidal and should be removed before the systematic treatment is applied. But one is dependent upon the other for absolute success.

Among the mechanical irritants we may have, ill-fitting dentures, ragged teeth, fillings not properly polished and calcarious deposits. These irritants should be removed.

The chemical condition is regulated by magnesium hydroxide and diet; the elimination of tobacco in all its forms, no stimulants of any kind should be taken and a diet prescribed to help the local and systemic condition.

Bacteriocidal causes may be removed by removing all badly broken down roots, crowning and filling others that can be saved, all tartar removed and autogenous vaccines employed. Elimination should be most thoro in all its channels. The process of elimination should be watched by the blood pressure. Besides the treatment already prescribed locally, nitrate of silver should never be used, as we already have an irritated condition, and all chemical irritants would increase the epithelial infiltration.

In my experience, I have noted that half the cases referred were over-treated and when the irritation was all removed the lesions disappeared.

Locally I employ copper galvanism with excellent results. This requires two, at the most three treatments, each treatment one week apart. The tissues are thoroly infiltrated with copper salts and given a full week's time to recover. If after three weeks it fails to respond to this treatment the parts are removed with the electrical cautery, provided there are no metastises. When

these are established an extensive surgical interference is necessary and all lymphatics involved must be removed.

A word regarding radium. Radium offers us a new hope in all forms of neoplasm, especially about the face and mouth. It has been my privilege to see this work for some years in Europe and this last year has proven to me the merits of this newly discovered element. In fact, to such an extent that I have, at the present time, 500 milligrams of radium salts and will open an institution next week.

Tobacco, as an exciting cause, contains Phrual. 316 cases; 267 were males, 44 females. All males were smokers and some of the women also smoked. plause.)

(Ap

William B. Jones, M. D., Rochester, N. Y.

To such a paper as we have heard, little can be added. We can only emphasize the points that seem most important to the listener.

The Dentist first sees nearly all of these cases and sees them early.

Almost every one comes to us with a history of observation by one or several dentists. A large number have disfiguring or malignant disease.

These operations are horribly mutilating, and too often unavailing. I believe that no one who does not retain interest or familiarity with the patient, realizes how some apparently small lesions grow into such terrible afflictions. If it were possible for a dentist who has seen one of these in the beginning to spare time to attend an operation when the disease had become extensive, the memory would quicken his mind to the necessity of early radical treatment of every one. And that is needed. The great opportunity of cure, the most hope for these sufferers is early, very early radical removal of the disease. Should it be done immediately when first recognized? It

should be before that, when only suspected. Our ambition should be not only to cure, far better to prevent. Let us have firmly in mind that the most important thing is to prevent a cancer or other disease, and only when too late for that content ourselves with trying to cure at the earliest possible moment, and realize that even then, it is for some, entirely too late.

Of all ways that the dental and medical professions can co-operate, no other is more vital.

You have brought us to understand how much you can help us in many general diseases, if we insist upon our patients getting and maintaining healthful conditions within the mouth. We would urge you to be on the alert for warnings easily overlooked, but of tremendous importance to your patients, of impending local diseases.

If properly considered, they should be grateful to you, and there should result increased regard and respect for what can be done by both branches of our profession, and for their individual members.

Dr. Bloodgood has told us plainly that the early treatment of precancerous lesion is not the cure of cancer. It is the prevention of cancer. Let us have firmly in mind that the most important thing is to prevent cancer or every malignancy, and only when too late for that, content ourselves with trying to cure at the earliest possible moment, and realize that even then, for some it is entirely too late. (Applause).

Dr. B. Holly Smith, Baltimore, Md.

I feel somewhat responsible for this paper this evening, and as I have been referred to, I want to confess to the audience that I am rather sorry I got Dr. Bloodgood up here, because he beat me

playing golf today (Laughter). He said something about mutilation, and it reminded me of the Union soldier sitting on the steps of a building, with both legs off and one arm, begging alms. A man came along and put a five dollar bill in his hand, and the beggar thought he had made a mistake and called him back, and asked why he gave him so much. And the man said: "You're the only Yankee ever I saw trimmed to my notion." If Dr. Bloodgood finds cancer present, he certainly does trim it out (Laughter). I have had to put in some artificial jaws and so on for the people he operated on. If this were a case of a thousand legged worm, who loses one leg, and still has 999 to go on, it would be different. if you take a man's jaw out, or especially a woman's (Laughter), and she is badly crippled, and I think it is encumbent upon us as dentists to take the warning that has been given us by good authority, and when we find these small lesions in the mouth to ask for consultation. Only by our appreciation of the method of procedure which has prevailed among the medical and the surgical fraternity can we expect to take standing with them in the treatment of disease. We should, as dentists, grow into the larger practises of the older callings, and I welcome the day, and it is today, when we shall pursue the same procedure that is customary among those who practise

But

the older professions of medicine and surgery, and that is when we need advice to ask for it. We often say to our patients "An X-ray will cost $10." "I am very sorry. I would like to know whether that is an erupted tooth but I don't like to go to the expense." What does Dr. Bloodgood care for that? He says to his secretary: "Send around and have this X-ray taken." He doesn't consult the patient. We should have the same right to know exactly what the condition of the mouth is. (Applause).

Dr. J. C. Bloodgood, M. D., Baltimore, Md.

The discussion has brought out some interesting things, as it always does. In the first place, as to the difference between the medical and the dental professions, as a matter of fact, I don't see any difference between them, except, perhaps, the dentists have to be a little more expert in their line; dentistry was a specialty before there was any specialty in medicine. There are things that dentists do not like to do, and things surgeons and doctors don't like to do. If you go to a surgeon with a corn and ask him to treat it, he may feel it is below his dignity, even tho you pay him well for it. I should like to give you a list of the corns I have seen that were treated by the chiropodist first. Take a person with arterial sclerosis or diabetes, the least infection on the toe may mean the match that lights the fire of gangrene. Those people must be educated. The great majority of dentists prefer to do the more expert mechanical work, bridgework and other things that require great skill. They don't like to clean the teeth. The day is coming when more people's lives will be saved by keeping the people's teeth clean than by doing bridgework (Applause). I doubt if most surgeons do not prefer to reset the upper or lower jaw. I remember my first resection of the upper jaw, and I thought it was a great opportunity when the principal surgeon went to New York and told me to do the operation. I performed the miracle, and the patient survived the operation, but died from the disease. That is how most people come to the surgeon today. They say, perform this miracle, with the disease in the last stage. We perform the mirac! they die of the disease later. It is not spectacular to cut a little V-shaped piece out of the lower lip or out of the tongue, or burn a little ulcer on the gum, or take out a mole or a wart, but that is the

nd

real miracle, because the patient lives. The surgery of cancer in the future is major diagnosis and minor surgery, with 100 per cent of cures. Surgery in the past has been minor diagnosis and major surgery. It has reduced the mortality to fifty per cent only in ordinary cancer, usually with mutilation. We must therefore go to the people and tell them. If a person comes to a surgeon today with cancer, and he does not cure it, he can say: "You are among the fifty per cent that no one cures." But if he comes to the surgeon tomorrow with early cancer, and he knows that 100 per cent are cured, and the surgeon does not cure him, he knows that someone has blundered.

Modern surgical results should be so perfect, that the people can tell the difference between training and lack of training in the surgeon. The same it should be with dentistry. The preventive measures in dentistry are tremendous. None of us realize what they are. We do not know whether leukaemia, pernicious anemia, Banti's disease, Hodgkin's disease and many others, do not get in thru the teeth-all incurable diseases. Perhaps many abdominal lesions, such as gastric ulcer, perhaps appendicitis, are traceable to the infection which gets in thru the teeth as well as thru the tonsil. How many cases of Bright's disease, that shortens the lives of many great men and women have their portal of entrance thru the teeth? So this thing you dislike to do, cleaning the teeth, may be the most important and expert thing you can do. I believe it is an expert thing. Bernard Shaw says that we practise medicine as our patients want us to; and that is very true. Take a young man, send him down to Kalamazoo, Michigan, (laughter), with the idea taught by Barker of Baltimore, that the place for pneumonia is out of doors, and the community there believes the place for pneumonia is behind closed windows, and let

him put his first case of pneumonia out of doors, and that patient dies, what will the community say? He will not practise in that community. (Laughter). But if the community is educated by the big medical schools of the country to the fact that pneumonia should be treated that way, whether they die or not, that the chances are best for their getting well, then the doctors would have to treat pneumonia in that way. That is, we as a profession must go before the public with a uniform opinion in regard to the proper treatment of diseases, and then the well trained men will be able to treat his patients properly. At the present time in many communities, a well

trained man cannot treat his patients as he wants to, because that community is educated to the practise of twenty years ago and won't have anything else. We must, as we have educated ourselves better, educate the public to get the benefit of it. The great mass of people do not receive the benefits of modern medicine and dentistry and surgery today, because they know of the surgery of twenty years ago. With the newspapers and the telephone and the telegraph and other methods of education, shall it take twenty years to get the people of this country to know what good dentistry, preventive dentistry and surgery in the early stage means? (Applause).

The illustrations, accompanied by a very brief history, will show plainly the great need and value of Dental Inspection in the public and parochial schools in every city. Dozens of important cases are discovered each month.

It is gratifying to those interested in this work to know that so much can be done for the children. Within the next few months we hope to have considerable important data which to my knowledge has never before been published.— Editor.

'N PRESENTING this paper on Oral Hygiene I am fully aware of the great amount of literature written on this subject. During the last decade mouth hygiene has been brought prominently before the profession and the public, at the same time I believe we are barely entering the portals of this vast domain.

What Oral Hygiene will accomplish in the next decade is a matter of conjecture. The vast territory now open before us presents great opportunities for scientific investigation and practical endeavor. To my mind there is nothing more important in the field of preventive medicine and public health than the proper care of the mouth and teeth.

Little did we realize a few years ago the magnitude of this work. In spite of all that has been done the surface has been barely disturbed. There was no precedent established to guide the pioneers in their efforts, but by their faith

ful work and a firm belief in the benefits derived from this branch of preventive medicine they were enabled to blaze a trail that is being closely followed by every thinking dentist.

Of the pioneers, too much credit cannot be given Dr. W. G. Ebersole and his co-workers. The work done in the Marion School, Cleveland, is known thruout the civilized world. Did it not require great courage and unwavering fortitude for these pioneers to advance and carry on this most important work?

The medical profession has rapidly recognized the importance of Oral Hygiene and a hearty co-operation has been accorded. Many forcible articles have been written by Drs. Osler, Mayo, Evans and Hunter, showing how heartily they are in accord with this hygienic movement. I cannot refrain from mentioning the admirable articles appearing monthly in "Oral Hygiene," edited by Dr. Geo. Edwin Hunt. This little journal contains all that is new and up to date in oral hygiene, and it is eagerly sought and read by dentists and sanitarians.

Many of the pathogenic organisms gain entrance to our bodies thru the mouth and nose. The mouth is, in reality, an incubator for micro-organisms, it having the proper temperature, moisture, nutriment and reaction for their propagation. It is true that all bacteria are not harmful; it is only when the