« SebelumnyaLanjutkan »
be questioned, I think, that the conditions preceding and following obstetorix play a most important part—perhaps the most important part—in the structure and formation of the teeth. For it is during the periods of gestation and lactation that the teeth are formed. If, during this time, proper bone-making material is supplied, and assimilation is so conducted that the structure of the teeth is so dense and firm that they are capable of warding off the agents of decay and disease, there will be little need of the services of the dental surgeon in after life; but if, on the contrary, there is a lack of this supply and assimilation, the teeth will fall an easy prey to these destructive agents, and often cannot be saved at all, in spite of the constant care of the dental surgeon. And as children do not usually fall into the hands of the dental surgeon until after this formative period has gone by, and disease has begun its ravages, from the nature of things he can have but little influence over the mother, or, to any great extent, control these conditions.
But the dental surgeon, if properly educated, can, above all others, most forcibly impress upon the minds of students in medical colleges the importance of proper care to be exercised in the cases of expectant and nursing mothers, in supplying their system with such bone-making material as will tend to develop the most perfect teeth.
Preventive sanitary principles will apply with as much force in dental as in other diseases, and the old and trite maxim that “ an ounce of prevention is worth a pound of cure,” is never more true than when applied to diseases of the teeth. In fact, in regard to the diseases of the teeth it may be said, an ounce of prevention is worth a ton of cure. Operative skill has reached great excellence in arresting dental diseases, but the greatest skill in dental science will be attained when the family physician, who is the earliest confidante and adviser of the expectant mother, will learn so to instruct her in dental hygiene that when the teeth of her child are formed they will be so dense in structure, and so capable of resisting the agents of decay, that the services of the dental surgeon will be but seldom required. But as, since dental colleges came into existence, all matters relating to the teeth have been practically ignored in medical text-books and colleges, the present generation of physicians are in almost total ignorance in regard to these matters. A large majority of them cannot tell the number of teeth contained in the temporary or permanent sets—when they are formed or when the time they cut, or should be or are shed; and with such a lack of knowledge on their part in regard to these most important organs, it cannot be expected that they will bestow even a passing thought upon the subject of their formation; but its importance is so great that it should no longer be ignored, and it is to be hoped that the organization of the Section in Dental and Oral Surgery in the American Medical Association will be soon followed by the establishment of chairs for the teaching of this department of medical science in all of our medical colleges. And it gives me the greatest pleasure to state that such chairs have been established in the leading medical colleges of Chicago, which are to be filled by practicing dental surgeons. In these colleges all matriculants are to enter as medical students, no matter whether they intend to engage in general practice or any of its specialties, and, when qualified, they graduate as doctors of medicine, with the same knowledge of diseases of the teeth and their treatment as of any other department of medical science.
Could such chairs be established in all our medical colleges, so that all who hereafter engage in the practice of medicine would be better informed in regard to dental diseases, the family physician would find his knowledge in this respect of great service to him in his practice. With the foundation principles underlying every department of the science securely laid, in a regular medical education, the graduate would be prepared to enter upon an intelligent study of dental and oral surgery, or of any other medical specialty. With this preparation could our present dental colleges be converted into dental infirmaries, and similar institutions be established at all our medical centres, where medical graduates who desire so to do could receive the didactic and clinical instruction essential to qualify medical men to engage in the practice of dental and oral surgery, our practice would become far more scientific and successful than it now is, and our patients would be greatly benefited by the change.
ADDRESS ON ORAL SURGERY.
By D. H. GOODWILLIE, M, D.,
NEW YORK CITY.
Mr. President and Fellows of the American Medical Association :
Having been honored by you as the first presiding officer over the new section created by your action last year at Richmond, Va., I am before you, to answer to the duty put upon
It is another indication of progress in the healing art that this representative body of the profession in this country should include in its deliberations everything that goes to secure health and happiness to mankind.
There are two natural divisions in the subject of this Section, namely:
First.— Dental Art, which is nearly all of a mechanical nature; and,
Second.—Special Surgery, which includes the treatment of all diseases connected with the mouth.
To the proper practice of the latter it is necessary that there be added the experience of the former, with a practical knowledge of medicine and surgery.
There are few who may possess the ability to acquire the requisite theoretical knowledge, and to put it into full practice in both divisions above referred to, as they both have become so intricate.
Every properly qualified general practitioner should have at least a theoretical knowledge of all diseases of the mouth, so as to be able to make a proper diagnosis, or, by his timely advice, prevent disease. For this purpose I would have established, in every medical collego, a chair of oral surgery, that would at least give a theoretical knowledge, and require it of every graduate—the practical instruction to be obtained in a hospital and dispensary devoted to this specialty.
All medical officers appointed in the army and navy should have practical experience in all diseases of the mouth.
In the period of more than a score of years of professional life, the first part of which was spent in the treatment of diseases of the teeth, and latterly has been exclusively given to diseases of the mouth and associate parts, pardon me for trespassing on your time in giving you an outline of such experience as, I hope, may be most interesting to you. I desire briefly to call your attention to some of the diseases of this part by illustrative cases, and to exhibit some by means of wax models, diagrams, etc.
A simple interference with mastication, for instance, in the child, interferes with the proper nourishment of the body, so necessary for not only supplying the waste of the tissues, but for the growth and development of every organ and tissue. At this stage alimentation is of vital importance, and mastication is the very first act in the process.
The process of development of the deciduous teeth, commencing in utero and completed early in the life of the child, escapes, to a great extent, from the effects of many diseases incident to childhood, but they often produce sad results on second dentition. Many disturbances of the vital processes interfere with development, and produce characteristic marks upon the permanent teeth, so that in adult life you may be able to tell what was the kind of disease, and the period at which it occurred in the process of development.
Dentition is a physiological process, and seldom takes on pathological changes, except as influenced by some disturbance of the general system. During the first two years of life first dentition takes place; and in this period also the child is subject to numerous diseases, often of a dangerous kind.
The teeth and the liver are often made the scapegoats for a good deal of ignorance, both professional and lay. For if no ready cause can be found for ailments, these poor organs get more than the lion's share of the blame.
How many thousands of children have fallen victims to the fallacy of the laity that teething is a disease,-a necessary consequence,—and that little or nothing can be done. So it comes that the ever-watchful vender of marvelous drugs and babyfoods finds in this a fruitful field for cultivation, to turn an honest penny in, and so comes to the rescue with his able assis