DR. KEEP'S ADDRESS BEFOKE TUB assar^tts^tts itantal JUcutg, MAY 18, 1865. j J_i J.. 1> Jl v. . ^ j. v i AUG 2± \ THE AIMS AND DUTIES DENTAL PROFESSION. BY N. C. KEEP, M. D. Addkess before the Massachusetts Dental Society, at its First Annual Meeting, May 18, 1865. | LIB?f BOSTON: PRESS OF T. R. MARVIN & SON, 42^3NP1tBS8--B?itl I L. u .....__J 1865 At the Annual Meeting of the Massachusetts Dental Society, held May 18, 1865, on motion of Dr. L. D. Shepard, it was " Voted, That the thanks of the Society be tendered to our honored President, for the kind words of advice and encouragement he has given us, and that a copy of his Address be requested for preservation in our Archives and for Printing." On motion of Dr. Lawrence, of Lowell, it was also " Voted, That the Annual Address be published in pamphlet form, for the benefit of the members of this Society." THOMAS H. CHANDLER, Secretary. 74 Boylston Street, May 25, 1865. To the Massachusetts Dental Society : Thanking you for the vote of thanks you tender me, please be assured that I am happy to place the accompanying Address at your disposal. , Very Respectfully Yours, N. C. KEEP. ADDRESS. With gratitude to Almighty God, that peace has dawned upon our nation, we meet to-day to celebrate this, our first anniversary. The first thoughts which arise, regard the formation of our little band, the mutual acquaintances which we have made, and the pleasure and profit which we have derived from the interchange of ideas, and professional and social civilities. We feel that we are thereby better prepared to discharge our duties to our patients. We find confidence and friendship taking the place of that distrust and alienation which might have existed, and which would have prevented the highest usefulness of our profession. Our first obligation as dentists is to our patients; we are in honor bound to seek their interests before our own. In my own experience not more than one in three of those who apply for relief from toothache can tell which is the painful tooth. How imperative careful diagnosis, that grave mis- takes may be avoided. The customs of trade may 4 have sanctioned sale and purchase, where only one party could be benefitted; but no one regards it honorable in a dentist even to extract a tooth, without first assuring himself that the comfort and welfare of the patient require its removal. But if he persuades patients to have good and useful teeth extracted to make way for artificial ones, or if he allows a patient to persuade him to remove living and useful teeth that more comely ones may be introduced, he dishonors his calling, and deserves the indignant reprobation of both the profession and the public. The liberal charter which has been granted us by the Commonwealth, and which we have this day accepted, gives us a legal existence as an institution for raising the standard of professional education, and enables us to cultivate harmony and good fellowship among ourselves ; and, if we are faithful to our trust, will secure to us a position among the educational and beneficent institutions of America. We, therefore, invite those of our brethren who have enjoyed the confidence of the community ; who have shared both the exhausting labors of a most wearying profession, and the honors and emoluments which crown success, to lend their aid in the present undertaking. It is our purpose to establish a museum. In this, rare and curious specimens are to be collected, 5 and can be preserved far better than in private cabinets; and the museum will be accessible to all who wish to study its contents. It would be, in- deed, laudable in those who possess cabinets crowded with preparations, casts, models, records of cases, and other material, to make this Society the deposi- tory of their treasures. Otherwise, these accumu- lations are liable in a few years to be scattered and lost, when their present owners may no longer have control over them. If this suggestion should be adopted by the proprietors, they would make a substantial contribution to public science, save their valuable specimens, and lend important aid to the advancement of dentistry. We are, moreover, to have a library; and we hope to receive sufficient donations to make this also a useful department. We owe it to ourselves to make ours a liberal profession. Without enumerating all that such a profession comprises, we may safely say that it < requires those of its members who have, through their own efforts, or the teachings of those who have preceded them, made improvements in dental science, to perpetuate these improvements for the benefit of succeeding generations; and under no circumstances whatever, to desire or even to con- sent that their discoveries shall live and die with themselves. In what way these shall be communi- cated to others, is, no doubt, an important and * 6 difficult point to be decided. It is, perhaps, equally difficult to decide what shall be the compensation for valuable contributions to knowledge. In my opinion, the very best mode of communication is by personal instruction. Let those who would be taught, form classes, and engage gentlemen of the highest talent and acquirements to impart to them, for a liberal compensation, by lectures, and demon- stration in the laboratory, and by the chair, their discoveries and improvements. Although some special point, or novelty, may be best introduced by individuals, this mode of instruc- tion has its limits. It cannot be a complete substi- tute for a college for training dentists, of which I propose to speak presently. But it has this advan- tage, that it recognizes the right of property acquired by one's own research. It is an honorable way in which such knowledge may be given and received without the intervention of patents, so universally disliked by the profession. A limited course of clinical lectures, as above alluded to, would be of great advantage to the younger practi- tioners, who may have already been instructed in the theory of the dental art. But we need more than mere lectures ; we need facilities for acquiring a thorough professional education. I am most happy to say that much which is required for ele- mentary and adjunctive education, is already within 7 our reach. I refer to the advantages offered by the Institute of Technology, recently established in this city by the munificence of large-hearted and public- spirited members of our community. This Institute has already become the rallying point for those who would learn the laws which govern matter. My own predilections would favor a thorough and united dental and medical education. I should hope, in such a case, that the degree of M. D. would be the lawful and merited appendage to the names * of those young men who enter our specialty. If this, however, is not yet attainable, it may not be out of place to inquire whether Harvard University might not appoint professors of dentistry, and confer upon proper candidates the degree of " Doctor of Dental Surgery." We are admonished, also, by the accidents to the teeth and jaws which have be- come so frequent since the establishment of rail- roads, and during the progress of the rebellion, » now so happily closed, that the time has come for a Chair of Dentistry in our Hospitals. We have no doubt that the peculiar fitness of a practical dentist to take care of shattered teeth and jaws, would be acknowledged and appreciated by the surgeons and patients of these institutions. The late Dr. George Hayward, in his report of hospital cases in the year 1837-8, speaking of accidents to the jaw bone, says, " It requires some mechanical dexterity to apply 8 the thread neatly; but in large cities we can avail ourselves of the skill of dentists for this purpose; and I have in this way been frequently indebted to the ingenuity of my friend, Dr. Solomon Keep." Our Society should recognize the mutual obliga- tions of the members of the profession. All must admit that a profession, as a whole, should be sup- ported, or it cannot be respected. It would not be right for a dentist who is rich to give his services gratuitously to all who might call upon him. It would be far better that he should charge fair com- pensation, and present the amount to some charita- ble object. No member of the profession ought to feel himself injured, if some one who has obtained the confidence of the community by years of toil, which may have well-nigh destroyed his health, can, and does command large fees, which are be- yond his own reach. Let it be remembered that the number of those who can give large fees is rela- tively small, even in cities, and that their confidence has not been secured without heavy cost. The habit which has existed in some places, of enticing a brother dentist's patients away, under the pretence that they can be served for less money, is very pernicious to the profession and to the com- munity. Does not every dentist feel that he has a property in the good will of the patients whom he has watched over for years 1 Does not every young 9 man hope to see the day when his labor shall also be rewarded by such patients \ And is he willing to sanction a course which must, at no distant day, militate directly against himself? The man who sends a patient away with imper- fect treatment, because he is not fully conversant with the best methods, ought to stop and qualify himself, or retire from the profession. The man who values his services at a low rate, because he himself is a learner, inflicts a heavy tax on his patients. The man who contents himself with in- ferior operations, because he can only command small pay, will probably find that his patients will come to the conclusion, that ,they have paid for more than they have received. No one ought to complain, or be dissatisfied, be- cause confidence commands a high price. Financial men and capitalists understand this. Undoubted securities always bring much higher prices than those which are uncertain, though the latter may have intrinsic value. How shall this confidence be secured by the young practitioner'? Assuming that he is well qualified for his business, it is only necessary for him to be diligent and faithful in his calling, correct in his deportment, and honorable in his transactions, and time will do the rest. I feel, also, that our Society is called upon to make known, in all legitimate modes, the abuses 2 10 which exist among us, and are apparently on the increase, through the malpractice and deception of persons falsely claiming, and even advertising themselves, to be dentists. We may do much to enlighten the public. Physicians, and those who have the welfare of all at heart, will do well to warn the community against the evils which are so rife at this time, and which have become a fashion, and even a mania. The use of anaesthetics has introduced a new era in surgery; and, as is well known, ether was first * employed in Boston for preventing pain in the extraction of teeth. It fell to my lot to have much to do with its introduction and early use. I soon observed that the freedom from pain was not secured, at least in many cases, without some counterbal- ancing inconveniences and undesirable results, when only a single tooth was to be extracted. But the great evil which has grown up through the use of anaesthetics is this: that ignorant patients, believ- ing that artificial teeth would be better than their natural ones, have been persuaded in some cases to have them extracted, with the assurance that, by the use of ether or nitrous oxide, they will not suffer pain in the operation. Such are thereby maimed and made to incur irreparable loss, when, had the natural safeguard of the fear of pain remained, 11 common sense would have triumphed, and the natural teeth would have been preserved. Each one of us has listened to expressions of gratitude from persons of every class in society, assuring us that our services are appreciated equally with those of other professions. We cer- tainly possess the general confidence of the com- munity. We likewise are aware of a deep personal interest entertained for the educated dentist. We may expect that those who hold us in grateful remembrance, will be prompt to assist by their approval, and, what is more substantial, with their purse, the educational project which we now have in view. Persons who have suffered themselves, or who have witnessed in their near friends the excruciating agony of toothache, are sure to re- member the timely and kindly relief, and hold in grateful recollection the one who administered it. Then we have the hundreds and thousands whose teeth are monuments of the sanitary and hygienic care of dental surgery. We can hardly say too much in favor of preserving the natural teeth. If all who assume to be dentists, were skillful and conscientious, and all patients had a clear idea of their own interest, we should rarely see a set of artificial teeth needed under the age of thirty-five. We have also the honored men and women who, having combattcd disease and accident, have gone 12 through the steps of having one tooth, and in pro- cess of time another, substituted for the teeth which nature gave them, until at fifty, sixty, or seventy years of age they have really experienced a new dentition. To many of this class the possession of new teeth is equivalent to a new lease of life. I have been assured by many persons of unimpeachable veracity, that they have by our art found themselves restored to society, able to masticate food, to speak in public, and almost to forget their presence, while without them they were not only " unpresentable," but in danger of starvation. Cases like these are the basis of a strong bond of friendship between our patients and the profession. If the dentist, however, is not an artist, he will fail to preserve the facial expression. If he does not comprehend the philosophy of his calling, the teeth which he makes will be apt to fail as masticators, and hence become measurably useless to patients. We need the knowl- edge of every science and of every art. How often have We been obliged to extemporize an invention, when an instrument was wanted which could not be purchased. The early education of the hand to execute that which the mind has conceived, has prepared the way for the eminent usefulness and honorable position of many, very many members of the profession. With increased facilities for 13 education, how bright a future would open before the thoroughly capable dentist! But he must be a true man; he must possess more knowledge than he expects to use in the discharge of his immediate duties; he should have a cultivated and logical mind, both for his own satisfaction, and that he may safely advise and counsel those who require professional assistance. The public does not suffi- ciently consider that advice is often of more value than an actual operation. It is quite time for patients and practitioners to feel that when advice is necessary, the best is the safest, and that it is more to be valued when adequately paid for. As individuals, it is incumbent on us to provide for the. education and maintenance of our families and our dependents. It is our duty, as good citi- zens, to bear our share in the support of the Gov- ernment; to be ready at the call of want and misfortune ; to give systematic sympathy and pecu- niary aid; to lend a ready and liberal hand in aid of each department of human progress. We are to remember that there will be destitute families of our own members, who will need our friendly aid in their necessities. We are to remember that our active pr°fessional life is brief at best PreParation for usefulness, and the securing of public confi- dence, are difficult and arduous. When these obstacles have been at last overcome, what do we 14 find our position to be 1 We will assume that the desire for a full list of patients, and for occupation for every working hour, has been realized; the acme of success is then attained, and more patients only hinder and retard dispatch. Professional ambition can go no further. With us the services sought are, to a great extent, personal. The patient wants the experience and judgment of the head of the establishment. After the peculiarities of the case have been care- fully examined, weighed, and a decision reached, ^ we may be greatly aided by skillful assistants. Especially are such available as executives in the laboratory. With pleasure we call to mind those who have had honorable employment for them- selves, and under our guidance have enabled us to ' attend to more patients and produce more elaborate results, than we otherwise could have done. But that our personal attention cannot be dispensed with, seems to me a fixed fact. } In extending our business we soon reach the limit beyond which we cannot safely go; for new temp- tations assail, new dangers await us. It is often difficult to satisfy an importunate patient, that caring for our own health is not in some way injuring him. And we have reason to fear that some of our brightest members have cut short a brilliant professional career by sins of omission. 15 Through a failure to take suitable exercise, rest and amusement, they may have consigned them- selves to an early death or a premature old age, and if we escape these perils, the effect of a lame hand, or of an overtaxed nervous system, or of eyes highly strained—contingencies which happen more frequently in our profession than in most others— will sooner or later admonish us that our profes- sional days are rapidly passing away. These con- siderations, furthermore, teach us that we should make systematic preparation for the support of our families, for carrying forward the benevolent objects of the day, and for the expansion of our own minds and hearts—that, in brief, we should seek to make ours a truly liberal profession.