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MEDICATION-RESIDENT CHAPLAINS.

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citement or convulsions. This was not observed at the Bicêtre, where instruction of these unfortunate creatures is pursued on a large scale; and Dr. Ray attributes it to the fact of only the dangerous and diseased idiots being sent to the English asylums, while those of all kinds are sent to the Bicêtre.

14. Medication. As the wonderful effect of enlightened moral treatment became exhibited in the English asylums, the active medical means, heretofore so much in vogue, lost their reputation. A great proportion of the cases in England too are chronic, and very often occur in persons whose supply of food has been defective and innutritious. In such, a supporting treatment is curative which would prove destructive in America; and a far more abundant use of malt liquors is allowable in the one country than in the other. In England, these are often found to subdue excitement, impart a healthy tone to the system, and prepare the way for convalescence beyond any other of the medicinal or dietetic substances more commonly used in America. Narcotics are given in Europe to some extent in order to procure sleep, but not, as in America, for the specific purpose of subduing mental and nervous excitement. For this purpose, the prolonged use of the warm bath or the cold douche is much relied upon in France; and, at Rouen, M. Parchappe employs the warm bath, with cold sponge lying on the forehead, in about sixty patients per diem. On account of its entire proscription in America, the author was much surprised to observe the frequency with which the use of tobacco is allowed to the patients in Europe; but he is disposed to believe it, under restrictions, a very proper indulgence.

15. Religious Exercises.-This is one of the most delicate of all the points in the moral management of the insane, and one in which wellintending officiousness may do an immensity of mischief.

"That part of the British public which takes any interest in asylums for the insane, is disposed to attach an undue importance to religious exercises in the moral treatment of the insane. They make the common mistake of supposing that, in mental as well as bodily disorder, the patient is equally able and willing to profit by the consolations of religion, while the truth is, that, generally speaking, the insane manifest far less docility than either those who are bound down with bodily infirmity, or those who are sound both in mind and body. But the insane are sick, and the sick stand in need of religious advice and consolation, and this logic has led, among other results, to the appointment of resident chaplains.

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The practice of having a resident chaplain, however, was condemned by the medical officers, without any exception at all. It was thought that to render any essential service in their clerical character-to avoid doing harm indeed there was required more practical knowledge of insanity, more knowledge of mankind in their sound as well as unsound condition, than the education and habits of clergy men enable them to obtain. There is another objection to resident chaplains which ought to be conclusive, even were the others much lighter than they really are. It is so difficult to define their exact province in the work of restoring the disordered mind, that collision with the medical officers is not unlikely, nor has it in England been an unfrequent result. The latter may see all their efforts frustrated by what they deem the injudicious course pursued by the chaplain, who, however, cannot be

made to regard it in that light: and the consequence is that much ill-feeling is engendered, and a system of unpleasant relations established, productive of incalculable evil. When it so happens that the chaplain is a man of yielding nature, ready always to surrender his own views when conflicting with those of the medical officer, and always willing to make himself useful in any way that can be suggested, then he proves to him a valuable adjunct. But why risk the peace and harmony of an institution upon so uncertain a contingency as the chance of obtaining a person of this description-especially for an object of doubtful utility? It may be said that, if the Superintendent believes the course of the Chaplain to be injudicious, the latter can be replaced by a more suitable person. This is more easily said than done. Every one must be aware that the removal of an officer, however unsuitable, is, at best, a difficult and an unpleasant affair, and consequently, that much is usually suffered before it is undertaken. But leaving all speculative considerations, the success of the arrangement in Great Britain, where it has given rise to much ill-feeling and some scandalous scenes, has not been such as to recommend it very strongly to our favour."

The paper contains some interesting observations upon the disposal of Criminal Lunatics, and upon the Size of Asylums (Dr. Ray not approving of the very large ones in America), but our want of space prevents our adverting to them. As it is, we have noticed the Essay at greater length than we intended; but it is written in so fair and candid a spirit, that we thought it desirable to present our readers with a pretty full account of its contents as a pendant to the article on Insanity in our last Number.

THE SURGICAL, MECHANICAL, AND MEDICAL TREATMENT OF THE TEETH, &c. By James Robinson. Pp. xx. 320. London, 1846.

THERE is not, we fearlessly assert, in the whole range of medical practice, no, not even including all the absurdities, and still more, the wilful falsehoods, of Homœopathy, of Hydropathy, of quackery in all its forms, from the last edition of the advertising and puffing book of the regular physician, to the last advertisement of Morrison's pills, or Holloway's ointment, any one branch or element which offers more startling anomalies or more atrocious examples of lying empiricism than the present practice of Dental Surgery. Let any one who takes umbrage at this assertion, or who feels a consciousness, although even himself a Dentist, that he does not deserve to be included in this disgraceful category, and there are many such, look at the advertising colums of the Times or the Chronicle, the Satirist or the Age, or let him order from across the Atlantic the last or any other number of Stockton's Dental Intelligencer (we believe this is the title of the work), and we ask for no further apology for our unhesitating and contemptuous sentence. The present state of the profession (the trade we had better say) of the Dentist, is one of the foulest blots in the page of medical history. In a branch of medical and surgical practice, which ought to be associated with a good general knowledge of the principles of physiology and of pathology, which can only be successfully and

1846.]

ROBINSON ON THE TEETH.

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honorably followed by one whose professional education has been that of a physician and surgeon, whose information is only limited by the extent of the present improved teaching of our schools, and the general practice of our hospitals, we find that every Jew mechanic who, from want of character, or other not less disgraceful cause, fails in his trade-every charlatan who makes up for want of real knowledge of the profession by the most impudent pretension-every unhappy student who is plucked at the College or the Hall, considers himself fully competent to fleece the public in the character of a Dentist, and to practise, without knowledge sufficient to treat safely a whitlow or a cholic, a branch of the profession which includes as numerous and important a class of obscure sympathies and severe and even dangerous consequences, as those which are associated with any organ or system of organs in the human body.

Whence arises this shameful opprobrium? What is there essential to the practice of Dental Surgery that involves an anomaly so disgraceful, and so universal? Is there any one circumstance necessarily associated with this branch of the healing art, to which can in any way be traced this blight that hangs over it, and taints every one belonging to it with a portion of its evil? We believe that it is not difficult to discover its cause, in the universal association of the art of "Dentistry" (we rejoice in this vulgar Americanism as so appropriate to the case) with Dental Surgery. It is, we feel convinced, this and this alone, that has reduced Dental Surgery to the level of a mechanical trade, and never can it rise to take its legitimate rank with other branches of the profession of medicine and surgery, until this ill-sorted union is dissolved. It may perhaps be urged that it is impossible to sever the two. That there is not sufficient discrimination in the public mind to enable the mass of society to distinguish between the mere Dentist and the Dental Surgeon-that the association of the two has now become so universal that it would be a mere act of Quixotism in any individual to attempt the practice of one without the other. We have only to answer to this, that it has never yet been fairly tried, and, at all events, we feel that, until it is tried, no one has a right to complain of the position to which the professional dentist has reduced himself in the ranks of the profession.

We believe, however, that it may be done. An individual, perhaps, could do but little; and it would probably be ruinous to his practice, or at least temporarily injurious, for him to attempt it alone. But surely, if the educated members of the profession, those who have become recognized and authorized practitioners of surgery, by the acquisition of a diploma from either of the Colleges of Surgeons, or other similar body-the graduates, so to speak, in the profession-if these would but unite to throw off from themselves, as by one act, an opprobrium under which, we doubt not, many of them feel oppressed and degraded, the voice of the intelligent public would sanction the effort, and their confidence would reward an act of courage and honour so creditable to those who effected it, and so unspeakably beneficial to the public themselves.

This is not, however, the place, nor have we room, to enter at large into the details of any feasible plan for effecting so great an object. The hint may be of use and heartily do we wish that any representation of ours could so rouse the respectable portion of this degraded branch of their

profession, to a sense of the degradation which they are themselves perpetuating by every act of tooth-making, as should make their disgrace too heavy for them to bear, and force them to cast it off as an unworthy appendage to the legitimate and honourable practice of their profession.

The above remarks will at once evince to our readers, that the book before us will find but little favour at our hands, considered as a professional work. Its whole plan and scope involves the very union which we have been deprecating; and the very title has the anomalous arrangement of the mechanical interposed between the surgical and the medical treatment of the teeth; and, as if this were not a sufficient indication of the prominence given to the manufacturing department, we find in addition the words, including dental mechanics."

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Our duty as honest reviewers will not allow of our taking a partial view of any professional work which comes before us in our official capacity. Private respect for persons may sometimes render that duty very painful; but in proportion to the difficulty of being impartial is its necessity increased. We proceed, therefore, to examine what is the situation which this work ought to occupy in the estimation of the profession, with the determination to "nothing extenuate nor set down aught in malice."

The first impression made on our mind on opening the book, is that the author, from some cause, not perhaps very difficult to be understood, is deeply enamoured of the American system of dental practice. As he identifies himself in limine with our excellent friends across the Atlantic, as he is an "Honorary Doctor (!) of Dental Surgery of the Baltimore College of Dental Surgeons," (see Title,) as he is, moreover, we believe, the accredited agent of a certain American periodical, before alluded to, we shall perhaps be excused if we consider this close association as some indication of the professional tendencies of our author. Now we are extremely willing to give all due credit to the American Dentists, as mere Dentists, as practitioners of what they so felicitously term "Dentistry"—a term which, by the way, Mr. Robinson has adopted and continually employs. We have been assured by those who know much of these matters, that they are extremely adroit at filling hollow teeth with gold (and, par parenthese, it may be added that these are not the only hollows which they contrive to fill with the same precious metal), that they are clever at managing the arrangement of irregularities in the growth and position of teeth, and that the work which they exhibit in the construction of artificial teeth is something quite extraordinary: but what are their claims to be considered as SURGEONS-what their knowledge of the real principles of the treatment of disease-what their physiology, their pathology, their diagnosis of associated and sympathetic disorders? We intend, on some future occasion, to enter at length into the discussion of these questions, not only with respect to American" Dentistry," but with reference also to the existing state of this branch of the profession generally. At present we shall confine ourselves to such incidental examples as may come before us in our review of the present work; premising, however, that whatever may be our judgment as to the general state of the profession in America, we are willing to grant that there are some striking exceptions to the otherwise universal censure to which we sincerely believe them to be obnoxious, as mere mechanicians.

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ENGLISH AND AMERICAN DENTISTS.

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The title of the very first Chapter of the book before us, sufficiently exemplifies its real scope. It is entitled "The History of the Dental Art; and the first words of this chapter are, "the origin of medicine, like that of many other Arts, is involved," &c. Now here is the fatal mistake which Dentists are very apt to commit. It is all very well for them to look upon their trade as a mere art-they have made it so, as a body, by the very mixture of practice which we have been deprecating :but inasmuch as medicine is to be considered as something more than an art, so ought also dental surgery and dental medicine to be placed on the footing of a science, and its practice to be kept on a professional basis. We will, however, dwell no longer on this matter at present.

In the Chapter in question, we have an amusing digest of the ancient history of the treatment of the teeth, from the earliest ages; and the author has the following pertinent remark on the reasons which would naturally lead the Egyptians to take the lead in the supply of lost teeth by artificial means. The significance of these organs, to say nothing of their ornamental or useful functions, was acknowledged in a remarkable manner by the ancient Egyptians, so that one of their most severe and infamous punishments consisted in the abstraction of a front tooth." "The loss of a front tooth, whether by disease or not, would naturally, under the circumstances of Egyptian law, give rise to unpleasant suspicion, and every exertion might be expected to be made to supply the deficiency. Accordingly, Belzoni and others have discovered artificial teeth in the Sarcophagi of the ancient Egyptians. These, it is true, are rudely made, and, from being of wood, are ill adapted for performing mas- tication, &c." (p. 8.)

This first Chapter closes with a comparison between the merits of English and American Dentists, a comparison no less invidious in its depreciation of the former than it is undeserved, if we exclude the numerous quacks and advertisers of our country from the list. Let us first see what he says of the English authors on this subject.

"About this period, the famous John Hunter turned his attention to the subject, and presented the world with his Natural History of the Teeth;' a production which, while it enlarged the sphere of dental knowledge, piqued the pride and roused the ambition of the English practitioners of the art.

“The inaugural Dissertation on the Structure of the Teeth of man and animals, published in 1798 by Robert Blake, gives evidence of the rapid strides that had been made in the anatomy and physiology of the teeth. This work was soon followed by others, and at the commencement of the nineteenth century, the surgeondentists of this country were fully entitled to rank with the practitioners of the other branches of surgery.

"The most important of the works of our own time are those of Fox, 1803, Bell, 1829, Nasmyth, 1839, Owen, 1840; also those of Snell, Waite, Robertson, Jobson, and Koecker; besides which, we might enumerate several smaller works by Saunders, Clendon, White, and others, and many valuable detached papers in transactions and periodical publications.”—P. 13.

Now for the list of American authors whom Mr. Robinson arrays so triumphantly as evincing so great a superiority over those of his own country.

"Within the last century, dentistry has advanced far more rapidly in the United States than in any other country. Thus we have Gardette in 1821, Parmly