It would be impossible in the time to which this paper is limited to cover all the various diseases to which the mouth and lips are heir. For that reason I will limit myself to the infective tumors of the mouth and their relations to the dentist, principal among which we find that of syphilis. The syphilitic lesions of the mouth may range from. those of slight inflam mation to deep ulceration. It is not uncommon to meet with the primary chancre on the lips, this takes the form of a tumor oftentimes prominent, and has in many cases been taken for epithelioma, of which I will speak later. By microscopic examination the tumor is found to consist of an immense number of round cells. It is well known that the virus from a syphilitic ulcer is infectious. In the first stage of the disease we should be the most guarded. It is believed by many that in the secondary stage the blood, and even the milk, from a nursing mother are infectious. There is less danger of infection in the third stage. Be it conceded that all do not operate on those so morally corrupt as is usually thought of those who become victims of the loathed disease; unfortunately it attacks others. I know of a well known professional man of this city, married, with as bright children and as happy a home up to that time as any of us would pray to have. When he sat in my chair for an examination a little over year ago, he ventured to make the remark, "Be careful; I have consulted you because I know you will be." Not an unusual thing for a patient to say, but it set me to thinking; it may have been the reason for the preparation of this paper. I had not ventured far with the examination when I stopped and asked, "What is the history of this case?" "I will tell you," he said. And he told me how, in the practice of gynecology, he had been infected on the finger. It is not necessarily a venereal disease. It may occur from the contact of buccal mucous membrane of a nursing child with the nipple of a syphilitic nurse, or it may occur from the common use of drinking glasses, etc. An entire family have been known to become infected through the use of towels, napkins, etc., that have passed through the hands of a syphilitic servant. The disease is caused by the entrance of a specific microbe into the system. As I said in opening this paper, the conditions of which I spoke may not come under the treatment of dentistry, but the diagnosis does. From two weeks to two months after the lips or tongue are brought in contact with syphilitic dig

charges, we find the commencement of the chancre, much the appearance of an ordinary lesion; thus upon the lips, the chap or crack oftentimes found on the median line, the herpetic ulceration and cigar or cigarette burns very closely resemble the initial lesions. At the end of the first week, however, the specific characteristics of a labial chancre are usually so distinct as to make diagnosis easy. Upon the tongue ulcerations produced by continual contact of that organ with the ragged edge of carious teeth are not unlike those of syphilitic origin. Watch it; if after five or six days the inflamed papule enlarges and extends, becomes enlarged above the surrounding part, the epithelial covering drops off, and if the application of silver nitrate, which so quickly cures the common and painful papule of the tongue, has no effect on it, look out for syphilis. Later there will be an induration of the sore. Certain cancerous conditions, principally that of epithelioma, will not respond to silver nitrate, but be increased if anything. You may differentiate between the two by the following, compiled partially from the American Text-Book of Surgery.

Occupies only a few weeks in growth. May be months in growing.

Slight odor.

History.

Heals under mercurial treatment.

Odor offensive.

No history.

No difference.

Microscopic examination of either is uncertain. In secondary syphilis we find the mucous patches, the secretions from which are highly infectious. These are found wherever the continuous influence of warmth, moisture and friction exists, consequently often found in the mouth. It commences in small papule, and enlarges very rapidly. Superficially grayish if found on mucous tissue; red, smooth and polished if on the skin. On the lips, tongue and membrane of the mouth the epithelium is whitish, having the appearance of having been touched with silver nitrate. Of the tertiary stage little need be said, only remember that syphilis in any stage, first, second, or third, or that of the hereditary stage, is infectious. The lesions

of hereditary syphilis are often found, because in the deposition of gummata the constitutional effects are more often seen, terminating in apoplexy, diseases of the ear, eye, and so forth.

Syphilis of the teeth has chief interest to us from its important bearing on diagnosis. First dentition displays little evidence of syphilis otherwise than that which may be occasioned by the interference of nutrition, and consequently there is an irregular development, chalky enamel, deficient in quantity, unevenly distributed, with 'promise of decay. As I have said, that may depend on various causes. In the permanent teeth the same may be true. Stomatitis produced by mercurial or gastro-intestinal derangement, by local irritation of any kind, is apt to produce imperfectly organized dental structure; mer. curial teeth, for instance, are usually deficient in enamel, irregularly aligned and honey-combed, scraggy, and of an unhealthy dirty color, and widely separated. None of these conditions are specially characteristic of syphilis. The permanent upper central incisors are the best guide. When stunted like so many pegs stuck in the gums, abnormally narrow at the cutting edge, widely separated but converging toward the lower edge, they are suggestive of hereditary syphilis. This condition is known as Hutchingson's teeth. These abnormalities sometimes affect the adjoining teeth or the entire denture. Do not confound these with the serrations of recently erupted normal incisors.

In the tertiary stage there are found the gummata of the tongue; these are of sub-mucous or sub-muscular origin. The sub-mucous are of the size of a pea, are simple or many, beginning as small hard tumors, which soften and discharge through the small openings. Muscular gummata are large and may be found at the edge or base of the tongue, grow to the size of a hazel nut, open in various channels extending in the direction of the muscular fibers. These may be mistaken for tubercular ulcers, or for the epithelioma of which I have previously spoken,

TUBERCULAR ULCERS.

Begin in several small nodules.

On surface.

Little suppuration.

Jagged edges.

Singly.

GUMMATA.

Begin deep down in tissue.
Profuse suppuration.
Sloughing base.

The diagnosis of any disease should not be made upon the local lesions alone, but should depend upon the development of the constitutional symptoms. For that reason, and in closing,

VOL. XLIII.-10.

just a word: I believe the course of dental study should be come so saturated with medicine that a graduate of dentistry, on receiving his diploma, will be thoroughly equipped to treat any form of dental diseases to which the mouth and teeth are heir. This is what I believe the dentistry of the future will be. This will strengthen the bond between the physician and the dentist. In times of consultation there will be no question as to the graduate's ability to treat his patient systematically, as well as locally, when called upon for a treatment of a disease of the mouth wherever any departure from the normal is found.

WHY WE ARE NOT ALL SUCCESSFUL.

By J. C. HENNESSY, D. D. S.,

~Demonstrator of Operative Dentistry, College of Physicians and Surgeons. - It has been authoritatively stated that only 50 per cent of the dentists graduated from our colleges follow the profession or are successful in dentistry. This in a measure is due to the fact that parents are wont to select a vocation for their sons without first ascertaining if they are capable of qualifying for that particular calling. The young man may be bright, and perhaps can learn the contents of a book by merely reading it over. He may make a successful literary man, and may achieve greatness in many other vocations, but, having no mechanical ingenuity, he will be a "glowing failure" as a dentist. Of course, to excel in dentistry one should be theoretical and mechanical, but the mechanical man with a little trying will be successful, where the theoretical man without mechanism must certainly fail. A man to be successful in his chosen profession should be something more than a mere bookworm, he should learn to perform all operations with skill and precision, and should never slight even the most simple part.

A young man attending college is eager to finish; he imagines he has learned everything the first two years, and having built up hopes of success, nothing short of a fortune awaits him. After he has struggled along for a few years and encounters failure upon failure he begins to look at things in a very different light, and finds that he has neglected many very essential things that are required for a successful man. At first he knew it all; now he begins to realize how much he has to learn, and if practicable, after having wasted many years that should have been spent profitably, he now lays the foundation for his suc

cess. He now settles down to study and instils his mind with knowledge on subjects which at first seemed trivial, but which he finds are very essential in everyday practice.

We must expect our patients from among our associates, and if our taste is wanting in respect to our company, we cannot expect a high class of clientele. A young man starting out should identify himself with churches, lodges, private theatricals, etc., etc. All this has a tendency to bring you before the public, that you and your calling may be made known to them in a legitimate manner. Many dentists take offense at trivial matters, and by acquiring an antagonistic disposition repel people instead of attracting them. This is a very bad feature and such men are sure to lose office practice and friends. - We find at college two distinct classes of dentists: one very nicely dressed, smoking fine Havanas, strutting around in a lordly manner and keeping himself aloof from the poor struggling students lest they contaminate him, apparently intent on but one thing-the getting of his diploma. His parents are rich and he has many engagements which cause him to be marked "absent" at many lectures, etc. In the other type we have the poor, half-clad student who lives on a few cents per day and scarcely affords himself the necessaries to sustain life, having to do so that he may make the small sum (which he has gathered together by hard struggling) last to the end of the term. He is attentive at lectures, never missing a single one, and is never without notebooks. He works himself through by hard study, and when the "exs." come he stands high, and having no friends or influence, goes through on his merit. He receives his diploma, selects a location, and by close attention to business, industrious habits, and a desire to ima prove, he gradually works himself to the top. And this is the student writers are trying to keep out of our colleges! Only a short time since an article was written deprecating the prevalent custom of allowing these poor students to matriculate in colleges.

The rich student on the other hand receives his diploma, is installed in luxurious offices on some prominent street, and as long as his parents pay for them he stays there; but as time goes on and they see the folly of such procedure, he either goes out of business, or if he has not been too badly spoiled, he will commence all over again and prepare himself as did the poor struggling student.