2111. tnr . ColumWa (HnitJersittp intiieCitpofBfttJgork College of ^ijpfificiaitj; anb ^urgeoitjf Hifararp THE PRACTICE BUILDER A Confidential Book Digitized by tine Internet Arciiive in 2010 witii funding from Open Knowledge Commons http://www.archive.org/details/practicebuildertOOhamb THE PRACTICE BUILDER A Treatise on the Conduct and Enlargement of a Dental Practice A MANUAL OF THE BUSINESS SIDE OF MODERN DENTISTRY TREATING OF EVERYTHING THAT AFFECTS THE PROFESSIONAL REPUTATION AND FINANCIAL SUCCESS OF A DENTIST ::::::: BY CHARLES R. HAMBLY, D.D.S. Author of "The American Dental Instructor," "The British Dental Instructor," "The Dominion Dental Instructor," " The Australian Dental Instructor," " Artificial Teeth," "Interesting Facts About Crown Work and Bridge Work in Dentistry," "Irregularities of the Teeth ; How They Are Corrected," "The Children's Dental instructor," Etc., Etc. Siitb BMtion CINCINNATI AND NEW YORK AMERICAN DENTAL PUBLISHING CO. 1897 Printed in the United States Copyright, 1897, by AMERICAN DENTAL PUBLISHING CO. All rights reserved Entered at Stationers' Hall, London, Eng. Special Coated Paper manufactured expressly for this book by Perkins, Goodwin & Co. Composition, Electrotyping, A rtistic Typography, Press-work and Binding by The Trow Directory, Printing and Bookbinding Co. NEW YORK Press Clippings by Romeike's Press Clipmng Bureau new york, london, paris, berlin and sydney Chicago Press Clipping Bureau CHICAGO TO THE READER To get the greatest good from this book it will be necessary to begin at the very beginning and read it from cover to cover. Do not open it here and there, nor glance at detached paragraphs. Begin at the very beginning, and read to the end, and you will be in possession of all the principles that underlie the growth of a dental practice* Study it. Observe, think, read. Question and record, and by so doing qualify yourself to judge of the soundness of its teachings. ^0 ALL THOSE MEMBERS OF THE DENTAL PROFESSION WHOSE SUCCESS HAS BEEN ONLY AVERAGE OR LESS THAN AVERAGE THIS BOOK IS CORDIALLY DEDICATED TRUSTING THAT ITS PAGES MAY BE STUDIED WITH PLEASURE AND PROFIT BY ALL WHO OWN IT PREFACE JHIS book is written because it is needed. It fills a want long felt, a want definitely understood, yet which has been difficult to express in words. Many practitioners have felt the need for just such information as it conveys — whether effectually or not must be judged by the owner. For some years the author has been impressed with the belief that a book devoted to the business side of dentistry would be of decided benefit to the members of the dental profession ; not alone to the younger members and the large number who an nually enter the ranks, but to manj^ who have been in practice for years, but who have, by neglect or other causes, failed to advance the financial interests of their practices in accordance with their terms of service. All of the statements made are founded on actual experience the aim has been to make a practical book, a useful book, and to present answers to the problems which confront dentists every da3^ There is in the book the best that the author knows about the subject, and the best that he has been able to learn from other people. Every statement made is thoroughly honest and thor- oughly earnest. CHARLES R. HAMBLY, D.D.S. Advice is invaluable in business, it stirs one up so. Bad advice is better tfi?n none, it makes one think for himself ; the best use of good advice is to thus make one think for himself, for that is where wisdom comes from. It never comes from anywhere else. If good advice does it, good; if bad advice does it, that also is good. So advice is good, whether bad or good. Build today, then, strong and sure, With a firm and ample base ; And ascending and secure Shall to-morrow find its place. —Longfellow. REMARKS RELEVANT In the production of this work its editors have availed themselves of every source from which helpful information might be had. The points herein discussed being recognized as unusual and of such intan- gible nature, it will be readily understood that much labor has been in- volved in garnering the thousands of points between the covers of this book. The deductions made and observations propounded are the result of careful observation by practical men. No theories are ad- vanced. The projectors have no hobbies to exhibit. The practical application of business factors toward professional success has been noted by men of thorough training, and it has been the attempt of the editors to present them clearly and exhaustively in order to unfold definite information upon the perplexing questions that present them- selves to young and old alike — to the young graduate, flushed with pride upon the acquisition of the much-desired sheep-skin, filled with a laudable ambition to excel in his chosen vocation, hopeful of an ability to open and conduct his office upon professional principles without the employment of doubtful expedients to advance his interests ; and to the practitioner of years and experience it is hoped the book will prove no less helpful, because it is realized that no matter how long he may have been in practice, he will admit that he does not know all that is to be known about the manner in which a dental practice should be con- ducted. No dozen men know all that is to be known on the subject. It is too complex for any one man or any dozen men to know. Hence, if but one idea is of value to any man, it cannot fail to pay him for his investment ; because, if it is applicable at all, it is applicable for all time — for as long as he remains in practice. INTRODUCTORY The history of dentistry is replete with interesting incident. This is true of both ancient and modern dental history. In modern dental history — that which is of most interest to we of to-day — is witnessed the evolution of a distinct science within the limits of a single generation. Away back in the dim mists of ages gone — ages musty with the mildew of antiquity — we read of the dentistry of the time. We trace its dissemination and progress through China, Egypt, Rome, Greece, Etruria, Palestine, and Arabia, and wonder at its ups and downs; we read of the skill of the Etrurians, or Etruscans, whose operations in ornamental dental gold work and bridge work are admired to-day. For centuries it suffered the same fate of other callings, and during the dark ages fared no better nor worse than any other science. After the dark clouds of ignorance and superstition had cleared away, and science and invention again became factors in the world's progress, dentistry advanced in common with other arts. Men became interested in the study of the dental tissues, and several treatises were produced dealing with the facts then known concerning the dental apparatus. After its introduction into the United States, dentistry — dental knowledge and dental skill — grew rapidly, and attained for itself a world-wide recognition, culminating in its acceptance by the medical profession as a sister profession worthy of proper recognition. THE CODE OF DENTAL ETHICS Adopted by the American Dental Association, August, 1866 ARTICLE I. THE DUTIES OF THE PROFESSION TO THEIR PATIENTS. Section i. — The dentist should be ever ready to respond to the wants of his patrons, and should fully recognize the obligations involved in the discharge of his duties toward them. As they are, in most cases, unable to correctly estimate the character of his operations, his own sense of right must guarantee faithfulness in their performance. His manner should be firm, yet kuid and sympathizing, so as to gain the respect and confidence of his patients; and even the simplest case committed to his care should receive that attention which is due to any operation performed on living, sensitive tissue. Sec. 2. — It is not to be expected that the patient will possess a very extended or a very accurate knowledge of professional matters. The dentist should make due allowance for this, patiently explaining many things which may seem quite clear to himself, thus endeavoring to educate the public mind so that it will properly appreciate the beneficent efforts of our profession. He should encourage no false hopes by promising success where, in the nature of the case, there is uncertainty. Sec. 3. — The dentist should be temperate in all things, keeping both mind and body in the best possible health, that his patients may have the benefit of that clearness of judgment and skill which is their right. ARTICLE II. MAINTAINING PROFESSIONAL CHARACTER. Section i. — A member of the dental profession is bound to maintain its honor and to labor earnestly to extend its sphere of usefulness. He should avoid anything in language or conduct calculated to discredit or dishonor his profession, and should ever manifest a due respect for his brethren. The young should show special respect to their seniors; the aged, special encouragement to their juniors. Sec. 2. — The person and office arrangements of the dentist should indicate that he is a gentleman; and he should sustain a high-toned moral character. 14 THE CODE OP' DENTAL ETHICS Sec. 3. — It is unprofessional to resort to public advertisements, such as cards, hand-bills, posters or signs calling attention to peculiar styles of work, prices for services, special modes of operating, or to claim superiority over neighboring practitioners; to publish reports of cases, or certificates in the pvblic prints; to go from house to house soliciting or performing operations; to circulate or recommend nostrums, or to perform any similar acts. But nothing in this section shall be so construed as to imply that it is un- professional for dentists to announce in the public prints or by cards simply their names, occupation, and place of business; or in the same -manner to an- nounce their removal, absence from, or return to business; or to issue, to their patients, appointment cards having a fee bill for professional services thereon. Sec. 4. — When consulted by the patient of another practitioner, the dentist should guard against inquiries or hints disparaging to the family dentist, or calculated to weaken the patient's confidence in him; and if the interests of the patient will not be endangered thereby, the case should be temporarily treated and referred back to the family dentist. Sec. 5. — When general rules shall have been adopted by members of the profession practising in the same localities, in relation to fees, it is unprofes- sional and dishonorable to depart from these rules, except when variation of circumstances requires it. And it is ever to be regarded as unprofessional to warrant operations or work as an inducement to patronage. ARTICLE III. THE RELATIVE DUTIES OF DENTISTS AND PHYSICIANS. Dental surgery is a specialty in medical science. Physicians and dentists should both bear this in mind. The dentist is professionally limited to dis- eases of the dental organs and the mouth; with these he should be more familiar than the general practitioner is expected to be; and while he recognizes the superiority of the physician in regard to disease of the general system, the latter is under equal obligations to respect the dentist's higher attainments in his specialty. Where this principle governs, there can be no conflict, or even diversity of professional interests. ARTICLE IV. Dentists are frequent witnesses, and at the same time the best judges, of the imposition perpetrated by quacks, and it is their duty to enlighten and warn the public in regard to them. For this and the many other benefits conferred by the competent and honorable dentist, the profession is entitled to the con- fidence and respect of the public, who should always discriminate in favor of the true man of science and integrity and against the empiric and impostor. The public has no right to tax the time and talents of the profession in examinations, prescriptions, or in any way, without proper remuneration. TABLE OF CONTENTS PAGE Preface 5 Remarks Relevant 9 Introductory 11 The Code of Dental Ethics 13 CHAPTER I Dental Education 23 CHAPTER n Dental Legislation 39 CHAPTER HI Location 45 CHAPTER IV Selection of Outfit 58 CHAPTER V Furnishing the Office 61 CHAPTER VI The Elements of Success 68 CHAPTER VII The Causes of Failure 84 15 l6 TABLE OF CONTENTS CHAPTER VIII I'Ai;e The Dentist Himself 90 CHAPTER IX Personal Appearance 99 CHAPTER X Introduction to the Public no CHAPTER XI Partnerships, Associations, Etc 135 CHAPTER XII Mode of Living 137 CHAPTER XIII Social Diversion 140 CHAPTER XIV The Church 147 CHAPTER XV Marriage 153 CHAPTER XVI Banking 161 CHAPTER XVII The Grades of Material 169 CHAPTER XVIII The Grades of Work 173 CHAPTER XIX The Laboratory 179 TABLE OF CONTENTS 17 CHAPTER XX PAGE The Operating Room 181 CHAPTER XXI Children's Teeth 184 CHAPTER XXH Gold Work 187 CHAPTER XXni Plastics ^9° CHAPTER XXIV Pl.\te Work ^93 CHAPTER XXV Crown and Bridge Work 200 CHAPTER XXVI ^Esthetic Operations 204 CHAPTER XXVII The Medicine Chest . . 208 CHAPTER XXVIII Antiseptic Dentistry 214 CHAPTER XXIX Local Anaesthetics 217 CHAPTER XXX General Anaesthetics 219 CHAPTER XXXI Office Business Fittings 222 1 8 TABLE OF CONTENTS CHAPTER XXXII page The Typewriter and its Usts in Ueni istrv 228 CHAPTER XXXIII The Dental Journals 231 CHAPTER XXXIV The Dental Society 254 CHAPTER XXXV Books 262 CHAPTER XXXVI Lady Assistants 270 CHAPTER XXXVII Boy Assistants „ 274 CHAPTER XXXVIIl The Dentist's Home 277 CHAPTER XXXIX His Person 279 CHAPTER XL Ideas 283 CHAPTER XL! Classifying Information 287 Ci;.\PTER XLII Purchasing 290 CHAPTER XLIIl Conduct at the Chair = 293 TABLE OF CONTENTS 19 CHAPTER XLIV page Treatment of Other Den 1 ists 298 CHAPTER XLV Paying Bills 303 CHAPTER XLVI Honesty 305 CHAPTER XLVn Policy 307 CHAPTER XLVni Tact 309 CHAPTER XLTX Ambition 311 CHAPTER L Confidence 314 CHAPTER LI Economy 316 CHAPTER LH Emergencies 319 CHAPTER LHI Accidents IN the Office 321 CHAPTER LIV Recreation . , 325 CHAPTER LV Making Money Outside of Dentistry 327 20 TABLE OF CONTENTS CHAPTER LVI page Conservatism 33' CHAPTER LVH Impractical Ideas 334 CHAPTER LVni Patience 337 CHAPTER LIX Standing by Work 339 CHAPTER LX Influence and How to Get It 342 CHAPTER LXI Reputation 345 CHAPTER LXII Wine and Women 347 CHAPTER LXHI How TO Become a Specialist 351 CHAPTER LXIV Book-keeping 35^ CHAPTER LXV Handling Patients 374 CHAPTER LXVI Popular Dental Education 385 CHAPTER LXVII Dental Instructors 391 TABLE OF CONTENTS 21 CHAPTER LXVIII page The Question of Saving Teeth 403 CHAPTER LXIX Points for Special Study 407 CHAPTER LXX Duty of Young Men to the Profession 412 CHAPTER LXXI R KCORDS 415 CHAPTER LXXH Advertising 422 CHAPTER LXXni The Other Side of Advertising 469 CHAPTER LXXIV Printing 473 CHAPTER LXXV Type 499 CHAPTER LXXVI Borders 503 CHAPTER LXXVn Quotations 507 CHAPTER LXXVHI Compensation , . . . 514 CHAPTER LXXIX The Development of Ability 532 22 TABLE OF CONTENTS CHAPTER LXXX page Post-Graduate Study 538 CHAPTER LXXXI The Dental Protective Association 541 CHAPTER LXXXII Fire, Life and Accident Insurance 543 CHAPTER LXXXni Fakirs 546 CHAPTER LXXXIV The Use and Abuse of Credit 562 CHAPTER LXXXV How to Get Patronage 591 CHAPTER LXXXVI How to Hold Patronage 599 CHAPTER LXXXVH How to Get New Patrons 636 CHAPTER LXXXVni Short Sixes 651 CHAPTER LXXXIX Pellets of Gold 653 CHAPTER XC Extracts 655 Dental Education " Men of polite learning and a libei-al education " Prior to the establishment of dental schools, in 1839, dental educa- tion was an unknown quantity. .It comprehended nothing more than a short term with a preceptor, at the expiration of which the pupil re- ceived a certificate of qualification and recommendation. Armed with this, he entered upon his field of duty. At this time — 1800 to 1839 — every dentist was a law unto himself ; what he learned he kept to himself, and .profited by such exclusive knowledge, methods of operating, etc. Many of the hints which now are to be had at every society meeting were treasured as most valuable knowledge— practitioners frequently disposing of these secrets for $50 and $100; prominent among them was the manner of protecting the pulp by use of quill and ivory, an idea con- sidered of great importance, since it was sold time and again for the figures quoted. With the establishment, of the Dental College, the Dental Journal, and the Dental Society, this condition became impossible. Those who had ideas exchanged with others, to the benefit of all concerned— the practitioners, and through them to their patients. A more extended dissertation upon the history of dentistry than can be given here will be found in Lennmalm's " Review and History of Dentistry," by Dr. Hermann Lennmalm: H. D. Justi & Son. Dental history did not, in reality, begin until 1839. Before that time it was frag- mentary and unsatisfactory. The period following is one of the bright- est pages in our progress; new life was instilled, new enthusiasm, new hopes and aspirations were awakened. An epoch was marked. Contemporaneous with the establishment of the Baltimore College of Dental Surgery, the American Jonriial of Dental Science and the New York Society of Dental Surgeons sprang into being. The course of instruction in the schools was at first one term of five months ; and this was not strange when we consider that physicians and surgeons 23 24 THE PRACTICE BUILDER were made out of the raw material in two winter courses of five months each, and in thousands of instances in one course of five months. This was a good beginning of the grand scheme of dental education, which is still in its infancy. The attendance at the dental schools at this time was limited, by reason of the lack of an established demand for men of ability, especially in rural communities and in the far West and South; by the fact that the general public did not care whether a man was a graduate or not; by the lack of necessary funds to prosecute study on the part of intending students; by thp fact that practitioners were not required to perform operations of anything like the scope expected of dentists to-day. The recruits were from every rank of life, and of every degree of intelligence; what wonder is it then that hundreds of men incapable of any appreciation of the requirements for practice, and totally unadapted to our vocation, should have been turned loose upon a confiding pub- lic? And yet, what an array of talent resulted! many names that are to-day prominent, and that were in the past bright, shining stars of learning devoted to the advancement of the profession — veritable jiatri- archs! Many of them still lend the glory of their presence to our soci- eties and our literature. The requirements for entrance were not rigid — not more so than were demanded of candidates for admission into the schools of medi- cine. These could only be regulated with the development of the sci- ence, and the larger educational facilities af^'orded by the increasing- number of institutions. Many applicants were already past the time when most men have settled down in their vocations. Many applied without either previous instruction under practising dentists, or any particular adaptibility for the work, having sviddenly determined to be- come dentists because of their belief that thus vast wealth, or at least an easy livelihood, might be gained. They came from the ranks of practising physicians, many of whom had performed the minor duties of the dentist; from the ministry, from law, and from every line of business. There were drug clerks, shoe clerks, grocery clerks, tailors, farm hands, blacksmiths — all without previous training for the work; yet some of these men applied themselves to their new field with such vigor, such assiduity, that they rapidly forged to the front, became the THE PRACTICE BUILDER 25 possessors of lucrative practices, and held the good-will and esteem of their patrons and fellow-dentists as long as they lived — and some have seen the gradual growth and development of their chosen profession on ideal lines — on lines of such liberal thought and action that it stands to-day without a parallel in the history of educational institutions. With the broadening of dentistry as a whole and in cooperation with its advance as a science, dental education took on a more scientific aspect by the adoption of more rigid requirements for admission and more extensive training as a basis. The course of study became more exhaustive and the examinations more stringent, resulting in the grad- uating of men better prepared for practice ; thus gaining for dentistry a more wide-spread confidence on the part of the public, and winning from the medical profession its favor and support, as evidenced by its invitation to the dental profession to take part in- the international med- ical congresses on the footing of professional equality, and to take part in the transactions of the American Medical Association, providing therefor a special department in dentistry. The cooperation of dental faculties, finding expression in the Na- tional Association of Dental Faculties, has largely increased the fellow- ship and good-will of dental institutions, lessened the competitive spirit, and broadened the horizon of dental training. The adoption by the National Association of Dental Faculties of resolutions tending to the establishment of equitable requirements for the admission of candi- dates; for the adoption of certain conditions, standards of fees for in- struction, terms of pupilage, courses of instruction, and requirements for graduation, and conferring of degrees, has had a healthy and invig- orating effect on dental education, and toward the protection of the public against the establishment of questionable institutions for the training of questionable individuals. To-day we are not aware of the existence of any such institutions; but in years past several were in operation, both in medicine and den- tistry, chiefly in the central States. The course of instruction in dental colleges at present comprises a three years' graded course, of eight months each year, with auxiliary and supplementary courses to those who have not had previous office, training. 26 THE PRACTICE BUILDER The requirements for admission are about the same in all the insti- tutions which comply with the regulations of the National Association of Dental Faculties. Recently resolutions tending to the establishment of a protective system against undesirable students have been inaugu- rated, whereby a student dismissed from one school for misconduct, or for inability to pass preliminary or final examinations, may not be ac- cepted by any other college of the association until a satisfactory cer- tificate is received from the school from which he was expelled. A gradual enlargement of the requirements for admission to the schools has been noticed, and is a gratifying evidence of professional development. This nmst be gradual, notwithstanding some extrem- ists, not connected with the dental schools, and who know little of the difficulties encountered in the application of radical changes. Not a month goes by in wdiich someone does not attack the colleges through the journals or in the societies. Many w-ho are loudest for the adoption of hobbies, or for reform, have never had any connection with dental colleges, but they know all about how these institutions should be operated. They would be so strict in their entrance examinations that no one could get in; consequently no one could get out. This is perhaps as good a way of saying it as any other. However, we should like to see some of these gentlemen use some of their own capital in an effort to establish a school on the lines of the ideal dental college which they have mapped out, and upon which they claim a school should be conducted. From the most simple requirements in the early history of the col- leges, more stringent qualifications have been demanded from time to time, until at present (with those in contemplation for the near future) it may be said that the requirements for admission in the majority of dental schools far exceed in severity those in operation in most medical schools. The National Association of Dental Faculties and the National As- sociation of Dental Examiners, together with the State Boards of Den- tal Examiners, may be said to be intimately associated in an harmonious effort to raise the standard of dental education, to protect each other against unscrupulous practices, preferences, and favoritism; to compel all colleges to adopt uniform courses of instruction, according to the THE PRACTICE BUILDER 2^ needs of dentistry, and in accordance with the accepted importance of special studies. For several years the dental colleges have been endeavoring to work with the State boards by inviting the members of the latter to attend the examinations for degrees held in the schools; the boards have accepted these invitations, and have expressed themselves as highly pleased. There is not and should not be ill-feeling between the colleges and the boards; the purpose of both is the protection of the public and the pro- fession against incompetents. It may be said that anyone competent to pass the college examinations need have no fear of the State boards. We do not say, however, that anyone who can pass the State board can pass the college examinations. We know of some dangerously incompetent men practising to-day under the license of the State, a disgrace to dentistry and a menace to the people. Men so grossly incompetent that it is a wonder they can make a living. Instead of having attained a scientific knowledge of that which they claim loudly to possess, they derive an empirical knowl- edge through their continued mistakes, where they have a chance to correct them, which is not always the case, the patient generally being able to go to someone else for relief. The simple operations do not require extensive knowledge, and to these the incompetent usually confines himself, occasionally telling of difficult operations which he has performed — in his mind. The gradual establishment in practice of properly trained men will have its effect on the grossly incompetent, and they will eventually be compelled to go to the rear. It is interesting to note the growth of the country, and the number of dentists in practice, from 1850 to the present time. The subjoined tables may be relied upon, having been prepared Avith great care. They were presented at a meeting of the American Dental Association. Census. Population. 1850 23.191,876 i860 31,443,322 1870 38,558,371 1880 50,155.783 iP-^o 62,622,250 189s 70,500,000 Number of Dentists. Average Population to each Dentist. 2.923 5,606 7.839 7,934 5,607 4,918 12,314 17,498 4,154 3,579 25,000 3,134 28 THE PRACTICE BUILDER It was stated at the time this paper was read that the number of den- tists given might appear too large ; but the compiler advanced the opin- ion that it was too small, and we are inclined to agree that this is the case. In an attempt to get the number of dentists for directories, great diffi- culties are experienced in the small towns and the country districts West and South. A great many names which should be there are not to be found in city directories, and hundreds of names in every State are not reported because no directories are published from which they can be taken. The dealers should be able to help out, but it is a ques- tion whether a complete list of the dentists in the country can be gained without an expense too great to be practical. Another table is also in- troduced, as being of interest to young graduates and those wishing information concerning the number of dentists in the cities: Qily, Population. New York 2,000,000 Chicago 1,700,000 PhiLidelphia 1,200.000 Brooklyn 1,000,000 St. Louis 600.000 Baltimore 600.000 Boston 500,000 Cincinnati 350,ooo Cleveland 350,000 Pittsburgh and Alleghany 350,ooo San Francisco 350.000 New Orleans 300,000 Milwaukee 270,000 Washington 270,000 Detroit 260,000 Minneapolis 225,000 Newark 215.000 St. Paul 190.000 Jersey City 180,000 Louisville 180,000 Kansas City, Mo 160.000 Rochester 150.000 Indianapolis 150.000 Omaha 140.000 Troy and suburbs 140.000 Worcester 130.000 Providence, R. 1 130.000 Toledo 120.000 Denver 120.000 Columbus 120.000 Syracuse 1 16.000 Atlanta 100.000 New Haven 100.000 Albany 100.000 Number Average Population of Dentists. to each Dentist. 1,200 1,666 704 2,414 526 2,280 528 1,852 160 3.750 185 2.767 325 1,538 ISO 2,000 114 3,070 140 2,500 241 ' 1,452 88 3,409 90 3,000 226 1,194 125 2,080 80 2,812 86 2,500 70 2.714 40 4,50a S3 3,396 8S 1,882 70 2.142 70 2,142 25 5,600 30 4.666 53 2,452 75 1.733 35 3,428 85 1.411 40 3.055 50 2,320 38 2,631 43 2.32s 30 3<33:i THE PRACTICE BUILDER 29 City. Population. Grand Rapids 85,000 Richmond 85,000 Nashville 85,000 Paterson 80,000 Wilmington 70.000 Seattle 60,000 Hartford 60,000 Camden 60,000 Springfield, Mass 52,000 Chattanooga 50,000 Sioux Falls, S. D 50.000 Tacoma 45.000 Portland, Me 38,000 Akron, 30,000 Salem, Ore iS,ooo Total 14,081,000 Number of Dentists. Average Popu to Each Den 46 60 38 1,804 1,416 2,236 20 3.500 20 33 3.500 1,818 40 1,500 20 3,000 32 1,625 20 2,500 15 25 26 3-333 1.800 1. 46 1 20 1.500 12 1,250 6,427 2,190 A table showing the number of graduates from 1886 to 1895, inclu- sive, and the number of schools, is here appended as affording an in- teresting study to those for and against the establishment of dental schools — a subject which we shall shortly consider — as well as to those contemplating establishing themselves in any of the cities mentioned, giving, as it does, condensed facts regarding the number of persons composing the dentists' constituency: Year. 1886. 1887. 1888. 1889. 1890. Number of Number of Schools. Graduates. 24 28 29 31 33 503 597 746 796 963 Year. 1891 1892 1893 1894 1895 Number of Number of Schools. Graduates. 33 39 35 47 1,241 1,483 379 905 1,208 Observe that in 1886 we had 24 schools, which graduated 503 men; in 1892, 39 schools, which graduated 1,483 men; while in 1895 we have 48 schools, w^hich graduated 1,208 men. From 1892 to 1893 a decrease in the number of graduates is shown, due to the fact that in 1892 the three-year course was inaugurated. This brings us to the consideration of an important subject — the es- tablishment of dental schools. Every observing reader of our journals has noted the large number of schools established in the last few years, and finds himself asking: " Are we really in need of so many schools of dentistry?" 30 THE PRACTICE BUILDER They are being established not in large centres of population alone, but in the smaller inland cities, and as special departments of some schools of medicine. In 1895 the number of dentists in this country was estimated at 25,000, and there were 48 colleges, or one college to every 520 practi- tioners. In medicine there are in this country 120,000 practitioners and 150 schools, or one school to every 800 physicians. If there were as many dental schools proportionately as there are medical schools, we would have 30; and no well-informed man could say that that number is not sufficient to meet the present needs, and the needs for several years to come. Allowing 1,200 graduates per year, would average 40 to each of the 30 schools. At present some of the schools graduate less than ten men, while four or five turn out from fifty to eighty per cent, of all graduated. We do not say that the schools having the smallest attendance do not turn out as good men as the larger ones, but we note that most of the former are the more recently established, and that they are generally in the smaller cities. Those having large attendance arc old-established colleges and are in the large cities; their attendance is large because they deserve it ; they have wou reputation by methods time-tried and true. Institutions lo- cated in the large cities have facilities so much more favorable to the intending student that it would seem a waste of time to enumerate them. Take, for instance, a dental college in New York, Philadelphia, Bal- timore, Chicago, or Boston, and we find that it has been in operation for years, and that its professors have grown gray in their life-work of train- ing young men for their professional duties; we find that they have kept pace, nay, made the pace, in dental progress; we find them devoted heart and soul to the uplifting of their beloved profession. We note the names of these instructors foremost in the dental societies, and their voices arc heard in the discussion of the many intricate probhins that confront us. Their pens have produced the articles of interest to the world of dentistry through decades of research and investigation ; and all that is foremost in the book literature of dentistry — the various text- books, works of investigation, and results of experience — is largely the work of professors in our American colleges. These men have always THE PRACTICE BUILDER 31 had the welfare of dentistry at heart, and through them the most needful advances have found expression and adoption. Again, schools in large cities have clinical facilities that are impos- sible elsewhere; a large population is necessary for clinical service, which is one of the most important, if not the most important, factor in dental education. While in many instances the operations required are of the simplest nature, they afford the student ample opportunity to acquaint himself with the elementary principles of practical operating, and for the application of the theory at the time he is learning it. He is thus prepared to advance to more difficult operations as he is found fit to undertake them. In many instances a student finds opportunity to perform operations under the direction of an appropriate instructor, such as he will not have for several years after starting in practice. It can be said of the dentist, as it cannot be said of a lawyer or physician, that a graduate of a good school is prepared to perform any of the duties that may be required of him. The dentist, from the beginning of his training, is taught to perform the operations, and does perform them, just as he is required to do them when he starts into practice ; he is taught to do all the complicated and difficult operations which his professors perform, so that when he starts out for himself he is prepared for any call which may be made upon him. Physicians and lawyers, on the contrary, are taught theory from the beginning of their careers as students, and without opportunity for its practical application while they are learning it. Thus, when they enter practice, they are confronted with difficulties, having for the first time opportunity for putting into use all that has been learned, and must often wait until gray before being called upon to do the work that is almost daily performed by their older professional brethren. Of late, however, a gradual change has been evident, so far as the physician is concerned, and the younger element seems to have come more into popular favor. Not so with the lawyer; age is necessary to attain to the handling of the most difficult classes of practice ; few young lawyers are found in the possession of practices calling for a high de- gree of legal ability. With reference to the instructors in dental colleges, it may be said 32 THE PRACTICE BUILDER that only those in the large cities can have eminent dentists as profess- ors or permanent instructors, because the foremost practitioners are always found in those centres; only there can their talents receive proper ])rofessional and tinancial appreciation. Men of marked ability do not hide their light under a bushel, and they must live where they will receive a commensurate recompense. Thus a school in a small city cannot have as its permanent faculty the very best ability, and it cannot have the large clinics essential to the performance of the practical work. The (juestion of payment for services in dental college clinics has come up frequently in societies, and, as it bears upon education, we give it consideration here. It is said by many that service in clinics should be entirely free. The colleges, in their advertisements, sometimes use the words " small charge to cover cost of material," and many of those who criticise the business methods of the colleges state that no charge should be made, as the fees paid by the students should make it possible to do work without charge, claiming that the infirmaries are operated at a large profit in most of the schools having large clinics. This may be true, but we know that no charge is made except where mate- rial is used by the student, and that the charges made are in most in- stances reasonable and satisfactory to those who apply. The cost of advertising service is sometimes quite heavy, and the charge for mate- rial makes it possible for the schools to pay these expenses from the infirmary receipts. Then, if the work w^ere performed absolutely free, many of those who come would not have confidence to apply for service; people know that when they pay for anything they are likely to get an equivalent; they think that anything given away is not so very good, or it would not be given; then, too, the fact that material is paid for will prevent the student from slurring his work. Every student is, of course, anxious to do his best, but when he knows that the work or material is paid for, he know's also that the patient expects him to do the work properly, and feels it more his duty to do it, just as if he had received the money himself. If no charge were made for gold and silver fillings, or for plate work, the schools would have such a run of this work that they would be compelled to close their doors. Much has been written in the journals, and still more spoken in the THE PRACTICE BUILDER 33 societies, concerning the dental graduate; complaint varies from in- competency to overcrowding the ranks, and the latter subject seems ever present in the minds of many agitators. The phase which treats of his incompetency may be set down as devoid of truth; never were men so well fitted for their duties, when turned out; better fitted, by far, than the croakers who spend their time in belittling the graduate and the dental college from which he came; never were the schools so well prepared to train men for the proper performance of their duties. If these complainants could look back and see themselves as they were at the time of starting in practice, and would consider how infinitely superior are the graduates of to-day, they would, we believe, have little to say. It is rare for a man now to enter practice without having first completed his entire college course, while formerly it was not unusual ; in fact, it was the more usual thing to start right out after the first course and attempt to perform operations upon which clinical instruction had not yet been received. When we consider that the first course was usually devoted to anatomy, physiology, chemistry, and a very little mechanical dentistry, the impropriety of entering prac- tice with such slight qualifications is manifest. These spasmodic at- tacks upon the graduate are productive of no good, and place the younger members of the profession in an embarrassing position. We have met very few young men who have shown arrogance or disrespect to their more experienced brethren ; we have found them ready to learn, and glad of an opportunity to exchange the store of their knowledge for the advice and counsel of their elders. The dental colleges turn out the best that can be done with the mate- rial sent them. They cannot make a brilliant dentist of a man when the man himself is at fault ; he may pass the entrance examinations suc- cessfully, and yet be incapable of evoluting into a skilful dentist. Many men miss their calling; they are just as likely to miss it in dentistry as in anything else, and if the colleges properly perform their part of the contract, we see no reason why they should be held to blame. While much has been written regarding the requirements for entrance, a great deal has been said that is not possible of practical application under existing conditions; the ideas set forth by most writers, if put into application, would prevent many really good men from entering 34 THE PRACTICE BUILDER dentistry — many who would grace the profession, advance its interests, and by their abiHty develop the still latent public confidence in the true standing of dentistry. To apply many of these theories would be to protect both the com- petent and the incompetent practitioners already established, and to pre- vent anyone else entering practice. This is a most unhealthy view of the matter, and one which cannot be too early corrected. We should not expect men entering colleges of dentistry to present credentials indicating a higher mental training than do those entering medicine or the ministry, but we should expect them to give evidence of training equal to that possessed by candidates for either of these; and we are of the opinion that, taken on an average, the students of dentistry will make quite as good a showing as the students of the older professions. Of late years we are more and more receiving into the ranks men qualified by education of a superior character — men who have had the advantages of extended preparation in the college and university. Such advantages cannot be overestimated ; bringing, as they do, to dentistry a trained mind, fitted by years of study for close application and under- standing of the dry and at times uninteresting facts of scientific investi- gation, they are enabled to progress logically, untrammelled by a lack of familiarity with those things which are a source of continual trouble to the student less fortunate in preliminary education. In anatomy, physiology, etc., a knowledge of Latin and Greek is of very great advantage, for in these the derivatives are used in con- nection with every important part of study. To the man with a pre- liminary education, embracing a knowledge of these languages, these studies are greatly simplified, because he does not need to memorize a long list of unintelligible names that have no meaning to him, and which he often readily forgets. The broader a man's preliminary education has been, the broader, it may be accepted, will his chances for professional preference become, because he is on an equality with the best educated men in any com- munity in which he may locate, and is capable of attracting to himself, by reason of his superior preliminary and professional training, the representative individuals of his locality. THE PRACTICE BUILDER 35 Another matter often spoken of is that which relates to a term of pupilage under a preceptor, by young men intending to study dentistry, to enable them to be more familiar with the routine of work, and to ap- preciate more understandingly the lectures and clinics of the schools. It is the opinion of many practicing dentists that such preliminary training is of very great advantage, but we think that under present conditions such advantage is very greatly overestimated. In the ma- jority of cases the time spent by the pupil in a dental office was from one to five years, and the greater portion of this time was employed in the performance of minor duties, with very little opportunity for per- forming operations in filling teeth, or any of the mechanical work in the laboratory that called for any degree of skill ; while, at the same time, it was not convenient for the preceptor to instruct him in the various processes involved in their performance; and it is not right to permit a student to perform operations of any kind upon the teeth without hav- ing received the appropriate training in anatomy, physiology, etc. We think it is usually a waste of time on the part of a young man to enter the office of a dentist with a view of staying a year or more, and learning little beyond the simplest duties of a routine practice. If the dentist were paid $ioo or $200 for a year of instruction, he could afford to give the young man some of his time in preparing him for college, and the student could be made more valuable to his preceptor for the outlay of time and money; and when he entered college he could take hold of all that work which may require manipulative dexterity, with hands and fingers trained by familiarity with the work to be done. So far as the colleges are concerned, it is probable that they find a man just as acceptable when he has not been with a preceptor as when he has, with some exceptions. If the preceptor was a graduate of the school to which the student applies, it would be an advantage, because he would use the methods of operating, etc., which he had received from his professors; but, if the student applies to another college, he would have been better ofif without the preceptor, because he will have to unlearn a great deal, and begin with the modes of operating which are in vogue in that institution. It is the business of the dental college to train men for dentistry, • and thousands to-day who never had the advantage of a preceptor have 36 THE PRACTICE BUILDER become skilful operators. The professors find it easier to instruct a man who has not become confirmed to one idea, or to one particular mode of doing this or that. Dentists frequently receive inquiries from men for advice concern- ing the adoption of dentistry as a profession, many of whom have no appreciation of the requirements and no knowledge of the dilBculties. Some of these have good educations and would be a credit to den- tistry, but most of them labor under the impression that dentistry is a nice, easy business, and that the dentists are all making money rapidly and taking life easily. Many of them have tried a half dozen vocations with more or less success (generally less), and finally have come to the conclusion that dentistry would be just the thing for them ; they think they could learn it in a short time, because they don't have to know about anything but the teeth; and, as they admire a nice operation in filling, or a finely constructed piece of bridge work, they think only of the large fee paid and the short time in which the operation was done, and the compara- tive ease with which it was performed, ignorant of the preceding patient study and labor in the various departments of training, extending over far greater territory than that which embraces a knowledge of the teeth alone. They do not consider the various studies, but may ask about how much it costs to become a dentist, or how long it takes to graduate. If, perchance, one of these young men enters a college, the three years of constant study and application necessary before he is consid- ered capable of entering upon his duties and performing even the simple operations which he has admired, are discouraging to him; and many and many a man has dropped out of the schools, admitting his unfitness for the life. Considering the time and money spent in acquiring a knowledge of our profession, it should not be wondered at that many prefer another vocation ; for the same amount of money, and the same time applied, would have sufificed to thoroughly establish them in other pursuits wherein far greater returns could be received for the outlay. The concentration upon one subject, the devotion necessary to the attainment of distinction, and the life of habitual confinement, are not repaid in financial appreciation in dentistry as in other callings. But, to one possessed of requisite qualifications, endowed by nature THE PRACTICE BUILDER 37 and education with the abihty to surmount its difficuhies, dentistry offers inducements of professional success and financial appreciation that will well repay him, and waits with open arms to receive him. The man whose early education has been neglected, or who has been brought up in surroundings mentally and morally opposite to those in force in the sphere of life in which he will exist as a professional man, will find the lack of teaching in his youth and the habits formed in his early associations to have become so much a part of him that he can with difficulty eradicate them. Such habits are likely to become so firmly fixed that they continually remind those with whom he may be thrown of the unfortunate training of his youth; these things, of course, act against his professional standing, and the opinion of his patrons is likely to be affected by their knowledge of his unfortunate lack of early advantages. It is written that " A faithful man shall abound with blessings, but he that maketh haste to be rich shall not be innocent." The faithful student of dentistry will surely find his reward; if not in material pros- perity, it will come in the acquisition of culture, the consciousness of duty well performed, and in the final approbation and " Well done! " of the great JNIaster when his work shall be ended. There are some very important facts which have a direct bearing upon the responsibilities of the student, and which may properly be considered in this connection, since the sooner they are realized the better. Life at its longest is short. What is to be done should be done in earnest. Time is precious. Opportunities are limited. Money is val- uable. No one is justified in squandering money, or neglecting his opportunities or wasting his time. If a student has no settled plans for the future, it would be well, at least, to give the matter careful consideration, and, if possible, decide upon a course of action which will be congenial and worthy of his best endeavors; and it should be remembered that the better he is qualified for it, the more likely will he be to succeed. Those who are best edu- cated for their calling (other things being equal) invariably take the highest positions. The acquisition of knowledge, although requiring close application and often laborious study, seldom fails to afford the 38 THE PRACTICE BUILDER student real pleasure and substantial profit. Knowledge is varied, and is not to be obtained wholly from books. Much benefit may be derived from the study of human nature. Much of our success in life depends upon the faculty of pleasing and being pleased. A person of gloomy, sullen disposition not only renders himself miserable, but makes all with whom he associates uncomfortable; while, in the case of a person who is genial and frank, his good nature becomes infectious and secures for him the warmest admiration and afifection. The amenities of life should be cultivated. Politeness is a cheap accomplishment which pos- sesses a magic power. Gentlemanly conduct is always in place, and never more so than in the professional man. Vulgar language and bad manners are always out of place. They are the result of ignorance and ill-breeding, and should be abandoned at once. " Diligence is the mother of good fortune." Patient, persevering efforts surmount diffi- culties, and fit the student for surmounting obstacles in his profes- sional life. Dental Legislation " The law, which is the perfection of reason " In this book we are concerned with the subject of dental legislation only so far as it treats of the enactment of measures for the protection of the dental profession against incompetent men, the protection of the public in a similar respect, and legal safeguards for the dentist as to compensation for his labor. The history of modern dentistry, as practiced in the United States and England, shows that in its beginning it was a science of which the elements were little known. Each dentist evolved ideas suitable to his individual needs, because at that time no authoritative system of practice was in vogue; dentistry was followed largely as a secret art; each dentist kept to himself what he knew, carefully hiding from his contemporaries the various means by which he attained success in his operations, and by which he secured an exclusive clientele. Learning, as they did, by experience rather than by scientific inves- tigation; being without the aid of colleges, societies, or journals, they were empirics, and objected to legislative measures prohibitive of em- piricism. Their disapproval was based, in many instances, upon the fact that they would have to divulge the processes by which they had attained prominence, and thus give to other dentists the opportunity of adopting them, and of gaining an equally wide reputation. Those possessed of superior manipulative dexterity, who had in their keeping the potent methods which had attracted to them a high-class practice, had all the work to which they could possibly attend ; and they contin- ually railed at those practitioners less fortunate than themselves in abil- ity and prestige. The first law in the United States to regulate the practice of den- tistry was enacted in Alabama in 1841. Although there were probably more inefficient dentists in Alabama than in any other State, it was the 39 40 THE PRACTICE BUILDER first to put into effect an ordinance for the suppression of irregular prac- titioners; and this was done more to extirpate the latter than to elevate the standard of dental education. After this time dentistry, by reason of the establishment of colleges of dentistry, enjoyed a period of prosperity and advancement which had not been dreamed of, and it was accorded a standing among the pro- fessions to which its rapid progress and development justly entitled it. The number of schools multiplied as the demand for them was evidenced by an increasing number of students, and much more acceptable men were noticeable among those entering the ranks. State after State secured legislation for the protection of the public and the profession, until at present nearly all have laws requiring prac- ticing dentists to have diplomas from reputable dental colleges, or to have passed examinations before a board of examiners appointed by the Governor; or both conditions may be exacted in some States, and failure to comply with these is punishable by imprisonment or fine, or both. One of the laws most recently put into effect is that of the State of New York. This law has several features which have met with serious objections from many prominent men all over the countrv-, as well as in New York. It is conceded by all that dental education and legislation are factors of the greatest interest to all practitioners, and those con- cerned in the development of dentistry upon a broad plane. The sub- jects are mutual in the interests involved, and where one possesses feat- ures which are not in accord with the other, a lack of harmony results which affects the interests of both and impedes the progress for which both are putting forth their best efforts. So long as legislative measures are for the benefit of the public they cannot fail of hearty acceptance; but when they become operative for the benefit of the few, or when sections indicate a tendency to protect those who are already established and to prevent others from establish- ing themselves, they become dangerous. So long as they aim at higher qualifications for practitioners, they are beneficial to dentistry and to the community; but when they grant to the Board of Regents the powers which have been vested in that body in New York State, they become obnoxious and questionable. THE PRACTICE BUILDER 41 One clause of this law gives to the Board of Regents power to sus- pend for a limited season from practice, or to revoke license uncondi- tionally, for unprofessional or immoral conduct, gross ignorance, or in- efficiency. When laws deprive a person of the means of livelihood, except where it is proved that the pursuit of a calling by an individual is a menace to public health, life, or morals, such legal enactments be- come subjects for most serious consideration; in accordance with our free institutions such a procedure cannot be permitted without a trial by jury, because the common law gives this right. A clause in this law reads : " The Board, in connection with the Regents, shall frame rules from time to time for the regulation of their own proceedings, and for the examination of candidates for license to practice dentistry." It is believed by editors of dental journals occupying the highest place, that to put such power into the hands of men, even of the highest integrity, is an innovation so radical that a question of its legality may well be raised. Says the Cosmos : " Let us by all means throw every possible safe- guard around our professional fabric and exclude from it the incom- petent, the inefficient, and the immoral ; but, in doing this, see to it that no injustice is done by excluding the worthy. To vest a board of den- tal examiners with absolute power to make law ; to fix the destiny of men without let or hindrance; to establish their rules of government and their own standards of education ; a law that directs that they shall sat- isfy themselves, without providing for appeal, is, in our opinion, not only improper legislation, inequitable and unjust, but it implies a degree of infallibility upon the part of the board which, in the present stage of human weakness and frailty, is hardly warrantable. Such laws should be replaced by legislative enactments more in harmony with the fairness and equity which characterize our American institutions." We refer the reader to the Dental Cosmos of July, 1895, wherein the law is given in full. We also call attention to the short term of notice which is given to practitioners of the intention of those in authority to put into effect measures of this character. Many students were attend- ing the dental schools at the time of this enactment, who had intended practicing in their native State; but, by reason of the sudden notice 42 THE PRACTICE BUILDER ami inability to comply with its financial requirements, these were de- prived of a right to practice in that State ; while many men, protected by this law, who are already in practice, could not give such evidence of ability as those men who were barred out. A greater interval should be allowed from the time such a law is formulated before it is put in force, because undue haste is unfair to all who may be concerned. The protection of health and life require far more vigorous efforts on the part of framers of dental laws than those which they expend in attempting to restrict practice. We refer to the need for more stringent legislation in the matter of nostrums and their use in the extraction of teeth. The frequency w'ith which fatalities have occurred in the past would seem to demonstrate the necessity for such laws. The wide- spread administration of cocaine for this minor operation, by those who have no knowledge of its properties as a drug, should cause a halt as to its employment, inasmuch as the records show that the conditions which limit its safe use are by no means clearly defined. It is certain cocaine has a narrow limit of safety, even when the drug is accurately com- pounded and given in proper doses; and the use of secret preparations in which the proportion is not definitely known, or in which the pres- ence of the drug is denied, should, we believe, be considered nothing less than criminal, and should call for the enactment of measures cov- ering the case. Those familiar with this subject are aware that this drug is used al- most as freely as so much water would be, if the latter were efifective for the same purpose in the extraction of teeth, and that it is used by men totally ignorant of its properties or action; and these stragglers serve to hold up the entire profession to disgrace. Those practitioners who do not employ cocaine should aid in suppressing the tendency for the wholesale extraction of teeth, by favoring the passing of such laws as would take from unworthy individuals the right to the use of a drug which they do not even understand. The use of cocaine is in many cases the chief mode of attracting patronage, because the work of the larger number of these men is con- fined chiefly to the extraction of teeth and the insertion of artificial ones. When it is used by competent practitioners, with full knowledge of its properties, we believe that it has never been abused; but when in the THE PRACTICE BUILDER 43 hands of incompetent men accidental death ensues, those who are re- sponsible are deprived usually of the support of their confreres and are treated without mercy by a jury. The dentist is not given the same protection against the public that the public is given against the dentist; especially is this true in the mat- ter of contentions arising over the settlement of book accounts. Thou- sands of dollars are yearly turned over to the profit and loss account that should be paid; probably no other profession loses so much, except the medical fraternity. The physician, however, loses only his time and energy, while the dentist loses not only his time and energy, but most expensive materials — the precious metals, gold and silver; while the cost of maintaining his office is much larger than that of the phy- sician. In many cases he makes appointments for the performance of work, which are not kept; and he cannot always charge for his loss of time, especially in the smaller towns, because of danger of giving offence, and many of those who apply to him come several miles from the country. However, the law gives to the dentist the right to charge for lost time, because he relies upon his office hours for support, and he cannot always fill the time by an appointment with another patient. No one will care to make a claim where only a small amount is involved; but when persons make arrangements to have work done requring the use of expensive materials and methods, the dentist is protected and can collect the full amount. For complete information on these points we refer the reader to " Dental Jurisprudence " (Rehfuss). More trouble is experienced by dentists in regard to accounts against those who are wearing artificial teeth than for any other opera- tion; after the person once gets the teeth there is a tendency to take all the time he wishes before settling the bill; and when one expresses dissatisfaction, he is inclined not to pay at all. When work is paid for promptly, on completion, no complaint is likely to be heard; but, if the bill remains unsettled, the dentist may be sure that there will be some complaint, and he will find that the best thing to do is to obtain part payment at the start, and try to get the teeth into his possession, presumably for some alteration in the plate; then he will discover that the patient will manage to obtain the money in order to regain the 44 THE PRACTICE BUILDER teeth, and he may rest assured that he will hear no further about pain or a poor fit. When a person wears a denture for a reasonable length of time without paying, the dentist is warranted in taking measures to force payment, because the law recognizes that retaining the work is pre- sumptive evidence of its being all right, and it is so ruled. The fees recoverable by dentists are in proportion to the services rendered; when a certain fee is stipulated, he can recover it in full; when no price is agreed upon, he can recover a reasonable compensation, de- termined by the charges usually made by other dentists for similar ser- vices. Eminent practitioners may charge more than less prominent ones can, because it is taken for granted that the patient employs him with a knowledge of the diflfercnce in ability. It is required by law that dentists keep an accurate record of their operations and the fees charged for the same, to be entered at the time they are performed, or they cannot be accepted in evidence. Location " A local habitation and a name " It is remarkable how few young men, when in college, have any idea where they will locate for practice. This matter seems usually to be left for consideration until after they have been graduated, and many have arrived at no deiinite decision after having been out of school for several months. This is better than being in a hurry and getting in the wrong place. It is the most important step in a young man's life, after he has been graduated, and it is well for him to study the situation carefully. Dentists are not in the habit of changing frequently, and, if a man succeeds in building a large practice, he would be foolish to leave it, because he has, when established, a source of revenue which is his as long as he is worthy of it, something that is the equivalent of an established business in any other vocation, with the added advantage of always being his own master; the dentist is in his own domain a czar; his will is law ; no one can dictate to him in any way ; he is answerable to no one on any point concerned in the conduct of his business. In selecting a location, one should be governed by the kind of com- munity — manufacturing, agricultural, mining, etc. — as well as by cli- mate, geographical position, and its peculiarities as to general health, not forgetting one most important point: " Does the community need another dentist? " " Is it supplied with good dentists? " " Are those already in practice capable of performing operations in accordance with the most recent modes? " By referring to the table of statistics, we find that the distribution of dentists is pretty nearly even throughout the country ; and that where some cities show a greater number of people than others in the average of population to each dentist, the explanation may be that these cities have a large population which is not acceptable to dentists for patron- age. Take, for instance, Omaha, Neb., with a population of 140,000, 45 46 THE PRACTICE BUILDER and 25 dentists, makings an average of 5,600 to each, while Washington, D. C, with a population of 270,000, and 226 dentists, has an average population to each dentist of 1,194, and we will find that the patronage of the 1,194 to the Washington dentist is as profitable as the 5,600 to the Omaha dentist. This is explained by the fact that in Omaha there are thousands of foreigners, for whom the dentist is not called upon to render services, except for the removal of ofYending teeth; but in Washington the population is composed more of the cultivated class; it becomes a case of ciuality, not quantity. Most young men with whom the writer has been thrown in associ- ation at the time they were thinking of establishing themselves in prac- tice, were anxious to start out in life either in a very large city like New York, Philadelphia, or Chicago, or else to go West. But if the young man will stop to consider, he will see that if he starts in a large city it will take him a great many years to make any headway; he cannot make his salt for the first two years; he will be in competition with hundreds of men of established reputation ; he cannot hope to attract a clientele of a character worthy of his training in a year or two; without occupation for two or more years his time will be lost; and, with no receipts and many disbursements, the outlook will be cold and dreary. Even if he has friends, he must remember they have inter- ests of their own. and however anxious they may be to see him suc- ceed, they cannot give their time toward aiding him to an acquaintance with their friends. If he does become acquainted with a large circle of people, these persons are not anxious to intrust their teeth to the care of an untried man, who has given no evidence, so far as they know, that he has ever done good work. He must take what he can get, and in most instances this is very little. At present the work of dentists in the larger cities is becoming spe- cialized, and the people are aware of it : so that, when one is in need of an operation for the correction of irregular teeth, he goes to a specialist, and a skilful worker in bridge work is sought by another in the need of service of this class. The tendency to specialism robs a young man of opportunity to become familiar, by daily contact, with the more un- usual work expected of the dentist. His rent is higher than in smaller cities, his living expenses are more, and the hundreds of ways that pre- THE PRACTICE BUILDER 47 sent themselves for spending money, with the thousand and one things that in city hfe continually divert a man's mind from his work — all contribute, so far as mental expansion and professional growth are con- cerned, to make the beginning of a man's career in a large city exceed- ingly undesirable. If the young men of the present day would combat the tendency to go to the great centres of population, and cast their lines in the smaller cities, it would be better for the people they serve and better for themselves. The young man who possesses energy and ability, and the wisdom to locate in a small city and remain there, is to be envied; in so doing he shows a clear-sightedness which is lacking in many; it makes no difference how well qualified he may be, nor how well he could serve the best element in a large city, it would avail him naught if he went thither and could not apply what he knew. It must be remembered that a man must work right from the start, after having finished his college training, to enable him to get the full value of his own abilities, to test them, and to make his mistakes; for he will blunder, and, if he does this in a large city, it will hurt him far more than it will in a smaller one, because, if he makes mistakes on the very persons who are the foundation of his practice, his prospects are affected right from the beginning by undesirable influences. In the smaller cities the happiest kind of a life is before him. With a more limited field than in a vaster, and, to him, more meaningless, city, he can concentrate his efforts and cement his connections in a way that would be impossible elsewhere ; with honest dealing as his watch- word, every step he takes is noticed. Every advance counts just so much for him. He is in direct touch with the people who make up the life of the town; he grows with the community, and in time becomes part of its best life, and the degree of his success depends only upon his own efforts and opportunities. In a few years he is in possession of a paying practice, whereas, if he had located in a large city, he would have neither a practice of much account nor the chance of advance- ment. The best chances for success and happy living lie in the smaller cities, and not in the greater ones, where the successes of the few are constantly being heard of, but the failures of thousands are not told. 4S THE PRACTICE BUILDER It is always so in life; we hear much of success, and the failures are care- fully hidden from observation. The quality of intellectual life in the smaller cities astonishes one who finds it for the first time. And the secret of it lies in the fact that people in these have more time for the cultivation of the mind, and for the gratification of mental tastes. People come closer to each other, and their amusements are more satisfying, more harmonious. Some- thing more than material instinct enters into their lives. A social gath- ering in these places is as pleasant in its naturalness and freedom from conventionalities, as a similar entertainment in a large city is obnoxious on account of its superficiality and formality. A majority of those dentists now in possession of the most lucrative practices began their professional lives in small towns, because they realized that there was the best chance for mental growth, for profes- sional expansion, and the acquisition of an income. No more prominent instance of the wisdom of beginning profes- sional life in a small city can be given than that of Thomas W. Evans, now of Paris, France. Dr. Evans, in the beginning of his career, lo- cated in a small lumbering town in Wisconsin. He possessed superior training for his life work, and could undoubtedly have taken his place among the better class of dentists in any city. However, he chose to locate in the Wisconsin town, where he attracted no particular atten- tion as a dentist, and spent a good ])art of his time with dog, gun, and rod, hunting and angling in the neighborhood. All this time he was preparing himself for his opportunity when it should present itself. We next hear of him in Paris, whither he had gone at a time when few, if any, American dentists had established themselves abroad. Shortly after making his residence there a royal wedding was to take place between a crown prince and a princess ; the crown prince became afifected with a maddening pain that drove him nearly frantic, and caused fears to be expressed as to whether the marriage could take place at the appointed date. Dr. Evans being sent for, after the court physician had failed to afford relief, went to the residence of the prince, and, upon entering the room where he was walking about with pain, was met by a horrible odor emanating from the mouth and nose of the patient; the latter begged the doctor to do everything in his power to THE PRACTICE BUILDER ^g Stop his sufferings. Doctor Evans ordered the unfortunate young man to go into the corner and stand on his head; such an order to the prince caused his attendant to look with amazement upon the doctor; but the prince, crazed with pain, did as he was directed, and, upon standing on his head, a flow of pus came from the nostrils, fiUing the room with an unspeakable odor. With the outlet of the offending matter, the prince experienced great relief, and, after appropriate treatment of the Antrum of Highmore (for, as we have already recognized, this was the seat of difficulty), the prince was restored to health, and the marriage took place. The man who locates in the small city will become a better all- around dentist in less time than the man who locates in the large one, because lie will get the work to do; the man in the large city, at the start, finds that the desirable class has already been in charge of dentists of repute for many years ; people will not change to an untried man with- out cause; if they decide to change, it will not be to go to an unknown man, but to one who has been established for years. If he should decide to locate in a rural community, that is to say, in a town having a population of i,ooo to 3,000, he will find that, if he is possessed of proper ability, he can make just as much money in such a town, with its tributary population — provided there be not more than one other dentist there — as he could in a town of 8,000 to 12,000 people, having seven or eight dentists. He will be known to the community in less time than he could be in a town of larger size. He will have op- portunity to perform a wider range of work than he could expect in a larger town, w^hile at the same time he can keep as closely in touch with all that concerns the advance of dentistry through his journals. Nor must he think that all the plugs are in the country practices, for they are not ; there are as many, if not more, poor workmen in the large cities as in the small cities and towns. If a man is poorly qualified for his work and does not give satis- faction, the fact wnll become known more quickly than it will in a large city; the people communicate such things more rapidly in a small town; they consider that they have a right to discuss and dissect one whom they employ in a professional capacity, whether it be min- ister, physician, lawyer, or dentist, and those who know anything 50 THE PRACTICE BUILDER at all about it know that the dentist sometimes gets more than his share. In the larger cities, as we have said, an incompetent man is safer than in a small city, and we have seen poorer work from the ordinary men there than we have from the ordinary men in the small town. At the same time, the finest dental work, and the possessors of the highest degree of skill, are to be found in the large cities; and this is but natural, for here only can a really skilful man receive the financial appreciation which is the stimulus of his endeavors, and it is only natural that the best men should be found where they are most appreciated. Here only can they have a large number of really desirable patrons. ]\Iany young men enter practice in a community where it is neces- sary for them to travel from one small place to another at frequent intervals; these localities are usually so small that they are not able to support a dentist unless he takes in a territory extensive enough to give him as many patrons as would make a constituency in a town of or- dinary size. While he has the same opportunity to gain a wide acquaint- ance w'ith unusual operations, he secures fees usually above those which obtain in towns. So far as actual profit is concerned, we believe that these men are in receipt of better cash returns than those which reward the man who practices exclusively in his ofBce. The work is more dif- ficult because of the lack of facilities for reaching his patients; and the undesirable feature of having to drive from place to place is not specially inviting to many, but when the remuneration is sufHcient to compensate for these things most men are willing to overlook them. Another field which seems most alluring to young men is found in foreign countries; almost every place on the globe being considered good for dentists — England. France, Germany, Russia, Spain, Italy, Austria, Turkey, India, Egypt, China, Japan, and South America — all these offer to young men, as they think, unusual attractions. In the first place, a young man should consider what a residence in any of these countries means to him : what is the character of the population ; what it would avail him if a country had a population of four hundred millions, and the people did not have their dental outfits cared for. What good would it do a man, for instance, to go to China, if the people had no use for him or did not propose to make use of him? Then, there is the Ian- THE PRACTICE BUILDER 51 guage of the people ; while a dentist can ordinarily perform almost any dental work without speaking a word to the patient, he could not do so in a foreign country, by reason of the people having no knowledge of dentistry, w'ith the exception of the Caucasian residents and the higher class natives; then the climate may be such that he would not care to adapt himself to it, or he might not even have the opportunity to do so before his demise. The isolation from his usual mode of life, and the fact that he can have little or no opportunity for social intercourse, are rea- sons which are sufficient to prevent most men from going to distant countries. But the fact remains, however, that nearly all that has been done in the interest of dentistry and in the enlightenment of the people of foreign countries has been done by American dentists resident in those lands ; men who went there and opened the way when the art com- prehended nothing more than the extraction of aching teeth, and the employment of such remedies and primitive methods as came within the ken of the native dentists or artisans. The amount of money which practicing dentists are said to make in foreign countries, if reports are true, would bewilder the most pessi- mistic individual who ever lived ; the charges that are said to be made for work are enormous. The writer numbers among his acquaintances men who have practiced in Hong Kong, China; Rio Janeiro, Brazil, and capital cities of many other lands; and his talks with them have led him to understand that the statements which find their way into the dental journals are wide of the mark. A great many men living in this country are anxious to create the impression that they are making a great deal more money than they really are, and do not hesitate to add from 50 per cent, to 100 per cent, to the figures which represent their yearly incomes; and so it is that these reports of foreign success become exaggerated, with this difference, i. e., we can generally verify or dis- prove the statements of those who misrepresent thiftgs here, while it is difficult or impossible to do so with those who live abroad. One thing that is noticeable, though, with those who go abroad, is that so many of them come back; this is surprising in the face of the statements that dentistry is so profitable in these foreign countries. Most of us can call to mind one or more instances where men have spent several years abroad, to finally return to their native land and begin over again in 52 THE PRACTICE BUILDER practice, no better off, apparently, in finances, by their long sojourn in other countries. This should serve as a warning to those thinking of going abroad. The loss of income incident to a failure to establish one's self in a foreign country is nothing compared to the loss of time. To a man without capital and without practical experience, one of the best things to do, if he can, is to secure a position with an estab- lished practitioner. Here, without expense, he can apply his theory, can use all that he has learned in college, without having the running expenses of an office to pay for, while at the same time he receives suit- able pay for his work. This alone would well repay him for his time, but the best part is that he is constantly under the eye of his employer, to whose interest it is to see that everything is done according to a proper mode. Thus he is able to make his mistakes where they cannot do him future harm; or better still, he is prevented from making mis- takes at all. After a period of experience of this kind, he is ready to engage in practice for himself, when he can enter it with assurance born of experience — verified experience. He can learn a great deal, even if he enters an office conducted on the advertising plan in one of the large cities, because here he learns to work rapidly, and rapid work is de- sirable, so long as it does not interfere with doing good work. Some of the finest work is done in many of the large advertising offices in the large cities; for, while there is usually not more than one really expert operator in the establishment to supervise the work, this one does such good supervising that the results speak highly for his skill. The pay may not, in many cases, be very alluring, but the chances for gaining experience while doing a great deal of work for somebody else repays better than money. Whether taking advantage of one of the opportunities which fre- quently present themselves for buying out a practitioner is a good plan for a graduate, is a matter which deserves our attention, as it is not settled that the plan is a really good one. In the dental journals of any issue we may find that anywhere from fifteen to twenty practices are offered for sale, with varying inducements, prices, and reasons for sell- ing. There may be instances in which the sale of a practice may be all right, but we incline to a belief born of experience that the procedure is questionable; we have many reasons, some of which we here present. THE PRACTICE BUILDER 53 No man is willing to give something for nothing; and, when buying a dental practice, you must remember that, unless you know all about the history of the office, and know of your own knowledge that the practice is all that is claimed for it, you cannot expect to get a good practice without paying just about what it would cost you to build a practice of your own to the same magnitude. In buying a practice, you must consider the seller's reputation as a dentist and as a private citizen; you must know whether his patients have faith in his ability, and if he is abreast with other dentists in the same place in matters of professional import. You want to know if the practice is getting better or if it is going down ; and, if it is going down, you want to know the reason. Again, can you, in buying a practice, buy the continued patronage of those who constitute its clientele? A man may be able to sell his practice, but he may not be able to sell his patients ; they go where they choose, and, if a new man enters the office, one whom they do not know and of whose abilities they have not heard, they are more likely to go to an- other well-known dentist in the same town than to go to the new man in the old office. In buying an office, a man is often expected to do over again some work which his predecessor had done, and, if the predecessor had a reputation for doing work that was none of the best, the reputation is likely to stick to the establishment. But, on the contrary, if the an- tecedents of the practice prove to be satisfactory and the prospective purchaser believes that the price is reasonable, that the owner can trans- fer to him a share of his patronage, and that he will assist in making him favorably acquainted with his clients, he would be wise to buy; for, when he is installed, he will find that people will come who have been patronizing the office for years, and he will have that much of a start; and, if he does good work for those who come, he already has their influence on his side. Shall a young man enter practice in his native town? This is a very important question to many young men. Hundreds of those who at- tend college have hopes of entering practice in their own towns, but are not just sure as to the propriety of so doing. On this point we have this to say : It depends a great deal on the young man. If through- out his life he has borne a good name, and during his school days was 54 THE PRACTICE BUILDER Studious in his habits and conducted himself properly, and was a clean young man. those who grew up with him, and who will in manhood and womanhood help make up his practice, will remember it and say to themselves that he would in all probability make a good dentist; and they would be right. If, on the contrary, in his youth he was frivolous and changeable, and lacked studious habits, and was an habitue of the billiard-room, or spent his evenings in the back room of a saloon, play- ing cards and idling away the precious hours, the people would come to know of it and think of it when he engaged in practice, and, when in need of the dentist's services, they would be very careful to go to some- one else; then is the time he wishes he had used his opportunities to better advantage. A wide acquaintance and extensive friendship is a most potent element in successful practice, and, provided the man is well (jualified, are aids to advancement which it is very important to have. On general principles, however, we arc of the opinion that most men will do better in the long run by locating almost any place else than at home, except in those instances where the dentist was raised in a large city and he has decided to go back there after a term of practice in a small city. There are many undesirable things about entering practice in one's own town, which are apparent to everyone who in- dulges in the expectation of practicing in the town that knew^ him in his youth. Among them may be mentioned undesirable acquaintances, formed with no intention of continuing them. Partnerships in dentistry, while seen rarely in the large cities, are often found in the small cities. There may be some advantages in this arrangement, but we believe the disadvantages more than counteract them. When two men are associated in a practice partnership, the expense of running the ofifice is lessened by the rent, and other expenses in proportion ; the actual running expense of the ofifice being not more than that which is necessary to operate an ofifice for one man. Some- times a division of the work, by one doing operating and the other the plate w^ork, is conducive to the best results, as each man doing one thing all the time can do that more thafi ordinarily well. The one great ob- jection to a partnership finds expression in the query: Can two men in one ofifice attract the patronage that tw^o men in two ofifices could? We believe not. We never knew a partnership practice to be double THE PRACTICE BUILDER 55 that of one other practice. Another point is that when one of them loses a chent the other loses him, because he will not care to change dentists in the same ofhce, but will seek services elsewhere. Of late years we hear much of professional association in the large cities, and our acquaintance with the plan leads us to favor it most highly. We cannot speak too highly of it as a means of introduction into practice. The usual plan is something as follows : A dentist having a large clientele among the most exclusive class in a large city, having a large demand for his work, accepts into an association with himself a young man for a period of three or five years. The advantages of this procedure can be seen at a glance. The dentist has much of the labor taken from his shoulders without the work being slighted in any way, and without any chance for loss of practice. To the young man the as- sociation is of inestimable value ; it allows him to enter at once upon the duties involved in conducting the highest class practice with a man accustomed to its patronage — one competent to conduct it according to the highest accepted standard of progressive dentistry, with a full knowledge of its present and future requirements, and with a proper appreciation of the code of ethics. The arrangements which are usually made to perfect an associa- tion demand from the younger man his time and talent for a period of years, or so much money for the privilege of the association, and, after the expiration of the stipulated time, he is at liberty to open an ofifice for himself and take with him those patients who have a preference for him. In some cases, where the person with whom he associates himself is advanced in years or is desirous of retiring from active practice, fa- vorable arrangements are made for the continuance of the young man in the practice. Many young men in New York and other large cities have thus stepped into the most desirable practices in the land ; nor is the plan infrequently applied; it is being used in many ifistances in all of the large cities. Given an eminent dentist, with whom a thoroughly educated, ambitious, and industrious dentist may be permitted to asso- ciate himself, the latter by this contact will become polished and his chances for professional preferment be very much enhanced, and his capabilities materially aided in their development. Above all things, do not go into a city of less than 75,000 or 100,000 56 THE PRACTICE BUILDER and open an office to be operated under a style and title similar to that which is used by establishments in the large cities, such as New York Dental Parlors, or one named after some local anaesthetic. People are suspicious of such institutions in small cities, and they are rarely op- erated with profit in cities having a population less than that which we have indicated. Depending for their patronage on a transient class, usually desiring no further service than extracting or plate work, it must be seen that the small cities cannot have a patronage large enough to support these offices. Taking for granted now that the intending practitioner has decided which course he will pursue, we will consider the office location of those who propose entering into their duties independently of partner- ships, associations, and similar affiliations. In the smaller cities, and even in the larger ones, there is always one side of the street which is used much more by the people than the other side. It is often well to have an office on the best side of the street. A corner building is desirable when it is a prominent one, or the office is over a drug store, but it is not desirable when it has an outside en- trance only. The entrance should be always from the inside — that is, from a nice stairway. In the large cities the use of elevators does away with any need for discussion of this point, and it makes no particular difference how high up the office may be. There should be good light, without which it would be almost impossible for one to conduct his business. There should be a good supply of water, and the toilet ar- rangements should be complete. The ventilation should be perfect. For light, the southern and eastern exposures are most preferred. The north light is clear and steady, but not strong, and in the short days of the winter months and in cloudy weather its defects are clearly notice- able. The east is a good morning light, but is, of course, weak toward the close of the day. when one's eyes are tired and when the best light is most to be desired. A west light is the most undesirable, because in the morning it will be weak, and will be bad in the afternoon, unless protected from the sun's rays by a thin white curtain. If possible, the office should have three rooms — an operating-room, a reception-room, and a laboratory — each distinct from either of the other rooms. The plan of having all in one room is very undesirable^ THE PRACTICE BUILDER 57 and, if it can possibly be avoided, it should not be done; where, how- ever, only two rooms are to be had, the operating chair should be properly screened from the reception-room by an artistic screen. And. the laboratory should, when the other room is large enough, be parti- tioned off to permit the use of part of the room as an impression-room,, and for the performance of such work as does not properly come within, the scope of the operating-room. The location to be selected depends upon the size of the town or city. In a town of the smallest size up to one of 80,000, it is usually best, to have an office in the business part of the city, unless one thinks he can command a residence practice in the residence quarter. The latter is not always the best course to pursue unless the city is a very large one, when it is the very best, especially in the great metropolises. We- note that the most prominent dentists in the large cities were in prac- tice for years in the remote sections of the city, the residence section, of those whose business happened to be in the heart of the city; and we also note that, having practised thus for several years, they then re- moved to a wealthy district in the best section of the city, where, by their known ability, they are able to take their already acquired patron- age, and their new location speaks well for their ability, because no one but a man with a large and fashionable class of patrons could afford to^ have an office in such a locality. In selecting an office in an office building, it is well to have the very- best that can be had, because a dentist's practice is altogether a consult- ing practice, and those in need of his services must always go to him;: he should, therefore, see to it that his office is most conveniently lo- cated for ease of access. He should, if possible, see to it that the build- ing in which he proposes to open an office is one of the best, if not the very best, in the town. Even if he does not think he can afford the rent asked, he certainly expects soon to be able to do so, and, unless it is very much in excess of that paid by other dentists in the same locality,, we believe he would be warranted in paying it. Selection of Outfit " Sc'Ar/ xuith care, you'll need it all your life " In the selection of an outfit, much judgment should be exercised. The purchaser should always bear in mind one fact — that he will in all probability never have occasion to buy another outfit, so that he should buy with such good taste that he need never regret his purchase. He should not overdo anything, but in all the essential features of worth he should have the best. The operating chair should be the best that money will buy. It is in constant use, and should afiford the patient a position of ease and comfort; the head-rest should be adjustable to any angle that an oper- ator might reasonably recjuire. The back should be readily changeable, to meet the demands of tall and short persons. The seat should be com- fortably large, and the arm-rests so adjusted as to make the position of the patient one of comfort. The foot-rest ought to be easily changed to suit tall and short persons, and be made to accommodate children as comfortably as grown people. The chair should be easily raised and lowered from a point high enough to enable the operator to work with ease upon distal cavities in the anterior teeth, and in such cavities as present with caries most extensive upon the lingual surface of the an- terior superior teeth. The Wilkerson and Columbia meet these require- ments. The cuspidor should be of the best kind, highly polished and nickel- plated, so as to render it easily cleansed and kept polished; it should be preferably made so that the patient cannot see into it. This does not mean that it can be kept partly filled with disagreeable contents, but that it shall have an opening so arranged that the patient does not need to see into it every time he has occasion to use it. A fountain cuspidor, where it can be had without too expensive plumbing, and where the water is of good quality, is one of the most desirable features 58 THE PRACTICE BUILDER 59 of the operating-room. The cuspidor is always clean, by reason of the running water, and, with the glass and water at hand, the operator is saved much trouble. The bracket should also be the best that can be had; it is used as con- stantly as the chair, and its manufacture should comprise all the features essential to convenience and readiness of access. It should contain all the instruments necessary to the operations in filling teeth, and its top should be large enough to accommodate the alcohol lamp, plug- gers, filling materials, and appliances' used to start the operation and complete it. The cabinet is a most important piece of furniture, and should pos- sess all the desirable qualities. Some of the cabinets manufactured are miserably deficient. The manufacturers seem to be aiming, in man}' cases, to put too much into little. A cabinet should have appropri- ately arranged compartments for the different filling materials ; for the various appliances in use for polishing, etc. ; drawers for such tools as shears, dam punches, rubber-dam holders, mallets, threads, bibulous paper, etc. There should be room for the larger bottles that contain medicines which are not disagreeably odorous ; places for forceps, etc. It is not necessary for it to have compartments to hold the record books, or to serve as a writing desk when not in use as a cabinet, so that those which have this feature should be changed by the purchasers, and these places used to store necessary articles. The gas outfit should be of a good design, should be properly orna- mented, and, unless there must be economy of space, we advise the metal gasometer in preference to the wall outfit. The engine is another appliance in constant use, and in its selection care should be taken to see that only the best be purchased. We advise the cable-arm, duplex spring, and slip-joint attachment. In electrical appliances, dentistry is becoming rich in present worth and future promise. Electricity as a motive power is used to op- erate the engine and laboratory lathe; to operate the electrical mallet; as a means of lighting the oral cavity; to heat water, and for other uses, including Dr. L. E. Custer's continuous gum furnace, electrical cabinet, etc. In fitting the laboratory, a good vulcanizer is important. We prefer 6o THE PRACTICE BUILDER those fitted with time attachment and heat regulator. We commend the Edson as meeting the requirements more fully than others with which we are acquainted, being more easily operated and requiring the least attention. Dentists are in the habit of purchasing large numbers of instru- ments, many of which are either useless or so seldom needed that in a year or so the drawers of the operating cabinet become littered with them. Alany appliances which prove to be mere fads are made and are bought by dentists, only to be laid aside after a short term of use. Many men have pluggers enough for half a dozen dental offices; it is wholly unnecessary to have so many ; a half dozen good points are good enough for almost any good operator; the less points he has the better he will be able to use them ; as soon as he loses one out of a large assort- ment he is at a disadvantage; it is surprising how much a man can da with one point; most operators have a favorite point with which they do a large share of their work. In the purchase of burs many go to extremes; they buy every imag- inable size and shape, or else they buy too few; rapid, sharp, clean- cutting burs are more important than any other instrument; upon them depends the proper preparation of the cavity of decay, and upon the proper making of the cavity depends largely the successful insertion and retention of the filling material. There are too many sizes and shapes, of burs — many more than there is any need for. The two best cavity burs are the dentate fissure bur, of which three sizes are usually neces- sary, and the round bur, the most useful of all ; it is the most economical as well, because it has no angle blades to be broken and can be used so that every surface of every blade is brought into play. In plastic instruments, not more than a dozen are needed. Flagg's set fulfils all requirements as to number and utility. Furnishing the Office " Art and practical titility combined " When a patient enters a dental office for the first time, there is left on the mind an ineffaceable impression of the appearance of the interior; this is especially true if the patient is a woman. If the place has an air of neatness and shows evidence of refined taste, the patient will be glad to have selected such a dentist as its proprietor, provided, of course, the neatness is in harmony with the character of the patient. The ap- pearance should denote the character of the man, and should be indica- tive of success. The furnishings should not only be selected with regard for their use, but also in accordance with his finances. As a rule, a dentist's necessary expenses are out of all proportion to his income. Every dentist is anxious to have a neatly and elegantly appointed office, but at the beginning this is not required. A man should not put himself in debt at the start for the sake of a fine office in- terior; line implements for work are more important than luxurious of- fices; besides this, it would be a waste of money to go to great expense in fitting up an office in the finest style in a community where the dentist must depend on a mixed practice, because many of those applying for service will not appreciate it. Elegance of appointment is lost on such people; besides this, if they go into an office much better than they have seen before, they will become bewildered and suspicious; they will think that they are going to be charged for the furniture as well as for the dental work. In a large city we believe a finely appointed office should be had, where a man is skilful and has an exclusive practice composed of people of the most appreciative sort. Dental offices are often altogether too gloomy and uninviting; too little regard is shown for the comfort of the patient; the surroundings are rarely so arranged as to take his mind from his unpleasant visit. People do not visit a dental office because they like to; and when they 6i 62 THE PRACllCE BUILDER go it is the duty of the dentist to make the call as pleasant as possible. There should be no display of instruments that can be avoided; few real- ize how important this little point is. Nervous, impressionable women are tortured by the mere sight of instruments that are to be used in the performance of the work. They may be beautiful specimens of their maker's skill, they may fairly shine with their plating and ornamenta- tion, and may be very beautiful to look upon as specimens of the manu- facturer's art, but, to a nervous, sensitive woman, they are mere pieces of steel invented to torture her. Keep your forceps, excavators, and pluggers out of sight just as much as you can. In the reception-room one should not have anything displeasing to the sight; especially should he be careful to have nothing that displays the fact that it is a dental oflfice, such as engravings or colored plates of the anatomy of the head, or pictures of enlarged sections of the teeth ; they are unnecessary to the dentist and repulsive to the patient. The walls of the reception and operating rooms should be papered in a light effect, with paper of the best quality, of such a tint as to give a bright air to the rooms, besides aiding to throw the reflected light to good advantage in operating. The windows should be large and ap- propriately curtained, so that a full blaze of light does not strike the eyes, and so that incjuisitive individuals cannot see the persons in your office and what they are having done. The carpet should be of good quality, and of a color that does not soil readily or show the marks of coal when that is used for fuel, or indicate where careless persons have entered the room without having previously removed the mud from their shoes. Outside the office door should be placed mats, which most sensible people will use. The walls should be ornamented with beautiful pict- ures; as it is a trait of human nature to be gratified by the beauties of art, these pictures on the walls of dental offices should be such as to please the eye and appeal to the finer feelings. They may be tender — sentimental, if you will — they may be radiant in color, warm and rich, beautiful w^omen and noble men. They should not be those pictures which are to be found in every home or are on exhibition in every deal- er's window, for such have lost their attractiveness to the beholder by having been seen often before. The pictures ought not to be those of THE PRACTICE BUILDER 63 cows standing lazily in pools of water under broadly arching boughs of grand old trees; if the dentist has come from the country, he need not advertise it in everything he does or owns. It is no disgrace to come from the country, but it is not well to bring the aroma of the farm-yard into your office; patients may think, too, that one is aiming to please their provincial tastes. The frames should be worthy of their pictures, but overframing is not desirable. It is not in good taste for the dentist to have a crayon or portrait of himself in his office. It smacks of egotism and is offensively self-assertive. The patients will probably see enough of the operator to satisfy them, and will pay him for it. He should not, therefore, impose his counterpart upon them. Ornaments, such as a woman's delicate decorative instinct would suggest, are always in good taste. Busts, statuettes, and the like, are pleasing to the eye and add a charming effect. Potted plants, artificial or natural, arranged with regard to artistic effect, always appeal to the ladies, and, when appropriately selected, lend an air to the office or reception-room which makes the patient forget the fact of being in a dental office, but suggests rather a place where it would be pleasant to tarry for awhile. Whenever curtains can be judiciously placed so as to seem to serve a purpose, it is well to use them ; as, for instance, in an archway or alcove, they add richness to the surroundings. Canaries, if they are good singers, make a dental office inviting; springtime and summer are perpetual when the rich, full notes of songsters are heard. Ail these things have their effect not only on the waiting patient, but they make a better man of the dentist ; he is lifted above any tendency to despondency, that dread distemper of men engaged in work that racks the nerves and makes the brain reel. By many it is considered bad taste to display diplomas upon the walls of the reception or operating rooms. In the larger cities, to do this may not be in accord with the strict ethical ideas which prevail among prominent men, but in cities of average size and under many conditions we think it not only right but advisable to hang the diplomas where they can be seen and examined by those to whom they will be interesting evidences of ability. There can be no wrong in giving pa- trons an opportunity to verify their opinion that the dentist is qualified by proper professional training. One should show his colors, stand ^4 THE PRACTICE BUILDER by tlicm, and live up to them. When a man has given the best years of his hfe, the springtime of manhood, rosy with hope and promise, to the attainment of mental worth ; when he has labored long and earn- estly in the acquisition of knowledge; when he has fortified himself against failure by years of preparation for the pursuit of a most exact- ing vocation, why should he not be allowed to ornament the walls of his office with the trophies of his hard-won victories? Hang them up; their presence will ever serve to stimulate to endeavors to emulate those at the head — the ones who conferred the evidence of fitness for this call- ing. Honor them, revere them, treasure them, they are noble emblems of prowess. One should see that he does not disgrace them, and the preceptors who conferred them, by conducting himself in a manner beneath the dignity which their importance merits. Still another reason why a dentist should allow his diplomas to adorn the walls is that, no matter where he goes to practice, he will find, after he has become established, that there is already in his city a veritable horde of pretenders. These men allow their pretensions to take the form of assumed titles. J\Ien who have either never seen the inside of a dental college, or never remained long enough to complete the full course and graduate in proper form, will be found in the enjoyment of every privilege and right that the regularly graduated dentist has earned by hard study and close application, by years of time, by days and nights of ceaseless labor, and by a cost of thousands of dollars. Upon their signs they boldly use the title " Dr.," and some even go so far as to use the " D.D.S." The public is, of course, the great sufiferer by this lack of honor; it has no way of knowing that these individuals are using titles which they have not earned. Not only some of those who began practice after a year or so in the ofifice of another dentist do this, but often men who have passed a State board examination assume titles which do not belong to them. Thus the educated dentist is robbed of an important attribute of his worth. If a man has earned his title, he has a right to expect to reap from its use its distinctive rewards. If a man is a doctor of dental surgery, he should be protected in the use of his title; if he is not a D.D.S.. he should not be allowed to use it, because such use is a deception. Who, when in need of professional advice, would care to seek the service of an impostor in medicine, especially if he were THE PRACTICE BUILDER 65 suffering from a complicated affection of a delicate organ? Who would care to employ an individual possessing" doubtful credentials, to operate upon the delicate muscles of the eye? People who would not allow imperfectly educated physicians or oculists to serve them should be just as careful to select a dentist in whom is afforded every opportunity to discriminate between the competent and the incompetently educated. The office should have a good-sized mirror placed conveniently for ladies to adjust their hair and hats. A hall-tree should be provided, whereon may be placed hats, sacques, and coats, and in rainy weather an umbrella-holder is required. Musical instruments, if they are of fine quality, add much to the attractiveness of the office, but it is ad- visable to get either a good musical box or none at all. The general furniture of the office should be in accord, so far as quality and utility are concerned, with other appointments. Enough chairs should be at hand to readily seat all those who come, but care should be taken not to overcrowd the rooms. A stationary washstand should be placed where it will be handy for the operator, and be readily accessible to the patient. See to it that no disagreeable odor pervades the room. Never let it be said that " it smells like a dentist's office." It is not necessary to have expensive perfumes, but a discreet use of cologne where a ten- dency to malodor is noticed will offset the odors of the medicine bot- tles, which latter should be kept in a special case and tightly closed with ground-glass stoppers. The office door should be set with glass instead of wooden panels, and on the glass should be the occupant's name and profession, together with the words " Entrance," or " Walk in." A wooden panel to a door is uninviting; a person does not know whether it is proper for him to walk in or not, whereas, if a glass door is used, he does not feel that he is intruding upon the privacy of the inmates. At the foot of his stairs the dentist should have a hanging sign of suitable size, not too large. It should be placed so as to be easily seen by those unfamiliar with the locality, but no attempt should be made to have it unduly prominent. Where the dentist has his office in a resi- dence portion of the city it is only proper for him to use a name-plate to announce his profession, but in the smaller cities it is customary to have 66 THE PRACTICE BUILDER a large sign suspended from tlic second story. On this sign it is only necessary to have " A. B. Blank, Dentist," the word " Dentist "' being in larger letters than the other words. This conveys all the intelligence that it is necessary to give to the public. The use of the words " dental surgeon," " surgeon dentist," " oral surgeon," or " operative dentist." is most reprehensible. It sounds too bombastic, and, inasmuch as there are no such recognized titles as dental surgeon, surgeon dentist, or operative dentist, their use cannot be encouraged. Some think it necessary to incorporate into their signs a representation of a human tooth, or else a hideous attempt at an imi- tation of an upper denture. This is a most antiquated and repulsive way of calling attention to one's profession. Many make a practice of having a case at the foot of their stairs wherein they exhibit a basket of teeth which they have extracted, or in which specimens of artificial teeth, crowns, bridges, and gold and amal- gam fillings are shown. Sometimes the presiding genius of the es- tablishment will evolve and construct a wonderful contrivance, usually an articulated skull operated by electricity (having fiery eyes at night) so adjusted as to chatter the jaws together and exhibit the perfect ar- ticulation of a full upper and lower denture. Nothing could be more abhorrent to the sensibilities of refined women ; nothing could be con- ceived that would so cause children to look upon the dentist with fear. It is not necessary to have a sample case of work in the office, nor is it professional to do so. The exhibition of dental work is not in good taste. Such means of attracting attention are used by plumbers, hair- dressers, and those in pursuits of a nature that require a variety of styles or designs to enable the prospective purchaser to choose from a collec- tion. The dentist has no merchandise for sale; his skill is his stock. There should not be a clock in the reception or operating room. The patient should not know the time, unless he expresses a wish to that efTect, when the operator may inform him. If a clock stands in the reception-room, and the caller must wait until the dentist finishes work for another patient, he may become impatient at the delay and, looking, at the clock, find that he is a quarter or half hour behind, and say, " Dr. Blank told me to be here at nine o'clock, and here it is half-past nine now." THE PRACTICE BUILDER 67 To make the time hang less heavily upon the hands of those who are waiting, the reception-room should be provided with a small centre table, upon which are kept the most recent numbers of the most popular magazines. A large proportion of those waiting being ladies, it is proper that a copy of The Ladies Home Journal should find a place among the periodicals. A copy of Harper s, Scribners, or TJie Cen- tury should also be kept on the table. It is better, however, to select such publications as make a specialty of illustrations, as, for instance, The Cosmopolitan, Miinseys, McClure's, The Reviezv of Revieius, should be kept to afford one a general view of the field of periodical literature. Bound copies of illustrated books of travel should be added, such as Raymond's books of travel, " America's Wonderlands," and " Ac- tual Photographs of Sights and Scenes." During the Christmas holi- days have the Christmas number of the Dramatic Mirror and the Dramatic News on the table ; pictures of lovely women, especially of actresses, are pleasing to women. A monthly publication called Celeb- rities, containing actual photographs of persons prominent in artistic pursuits, famous actors, actresses, singers, and painters, is of interest and makes an appropriate reception-room book. In advising the use of these aids toward beautifying the dentist's office we have a word of caution. They are not essential to success; beautiful appointments in the office will not do work that is beautiful, scientific, and abidingly satisfactory to the patron. That must come from the brain and hand of the dentist; better far to have good instru- ments and be capable of doing good work, and have a shabby office, than a luxurious office presided over by a man who possesses only or- dinary skill, or one that had placed himself in debt to furnish his office. Debt is a bugbear to a young dentist. It is a bugbear to anyone, but it will do more to lessen a man's chances in a profession than many other things; debts cause worry, and worry kills; whether it kills the body or not, it surely will kill ambition, and without ambition life is a ship without a rudder and without a compass. It would be better to start with a rocking-chair on a soap-box for an operating chair, and gradually fit up an office according to one's financial growth, than to begin with all the fittings of a prominent established practitioner and finally become swamped in debt. The Elements of Success " The secret of success is constancy to purpose " The foundation of success is merit ; merit wins — true merit. While cases come to mind of men who achieve some measure of success with- out professional ability of a high order, depending more upon their business ability than upon skill as dentists, still, we assert that true merit wins — that merit born of fitness for its possessor's calling, merit won by hard study, close application, diligence, and steadfastness of purpose. Hundreds of cases might be cited, too, where men with the very highest skill do not acquire a competency, due to a variety of causes; but chiefiy due to lack of observation and knowledge of success from a financial point of view, a total disregard of the small things wdiich, in their relation to the harmonious whole, are important considerations. It cannot be denied that many of those men with whom we are most familiar through our periodical literature, of the class generally denom- inated successful men, possess no peculiar attributes of superiority over their fellow-practitioners — they lack, in fact, many important elements of character — still they get ahead rapidly, both from a professional and financial point of view. In some cases they started into practice under circumstances of the most unenviable kind; yet, in a few years, the dismal outlook was dispelled and a most inviting hue was assumed; thev seem to have found the combination, the open sesame to success. Reports of their ability spread throughout the community; they are heard of in the societies, among the men that are making history to-day in dentistry. Their articles are noticed in the foremost journals, are copied in esteemed contemporaries, and yet they may be no better den- tists — perhaps not as good as others in their community ; but they have the name, and, when that is once won, it is difficult to deprive them 68 THE PRACTICE BUILDER 69 of their laurels; they have won them, and to the victor belongs the spoils. The business side of dentistry is the neglected side. The dentist is not in practice for pleasure, but for professional distinction and for money; and yet dentists are notoriously poor business men. They throw heart and soul into a continual study of " ologies," and into the technic branches, in a desire to excel in operative procedures; this naturally breeds a neglect of the business side of the question. Why are not all financially and professionally successful? Simply because all do not appreciate the possibilities of a dental practice; for, although opportunities may present themselves at every turn, few know how to take advantage of them. Those who are successful are so because they understand the application of certain principles tending to a logical sequence. Some men have, through the application of certain common-sense rules, achieved success. Success is everyone's mark; but only a few put an arrow in the white. The bull's eye is not hit by accident in dentistry; purpose and persistence train effort upon the difficult mark. A sure way to success is to sight a popular or profes- sional want and proceed to supply it. What is success? Let us consider of what success is made; what success means in the great world of affairs. Said yEschylus, the great Greek tragic writer: "Success is man's god! " Two thousand years and more have not changed the forceful- ness of the line. The desire to succeed is an attribute of all men of sound mind, the one great aim of life, the fulfilment of projected plans, and the reaping of moral and substantial benefit therefrom. Until the true meaning of the word is understood, until a proper appreciation of what success is, is firmly established in a young man's mind, it is idle and useless for him to attempt to speculate on the methods of attaining it. Very few men have a proper comprehension of the matter in its most practical light. We live in an age when his- tory is being made rapidly; when new names are constantly presented to our minds; when new achievements and great successes are being made; when startlingly brilliant things are being done. It is an age of big things, of vast achievements — so much so, that many are fallaciously inclined to look upon success as something that is one 70 THE PRACTICE BUILDER ^vitll the more exalted stations of life and epoch-making events. In the minds of many, success is something which it is given only to the fortunate few to accomplish. Again, many are likely to think tliat because they do not set people to talking about them, because they do not do something which puts them over the heads of their fellows, they are, if not altogether nega- tive, still lacking something of success. The accomplishment of some- thing unusual, out of the ordinary, resulting in becoming known to all people, being exceptional to all other members of the race, seems to be the general idea of success. And yet, if we look over the subject care- fully, we realize that this is a very incorrect idea of success. Statis- tics show that not one person in ten thousand lives a successful life; that but one person of this number on an average is ever heard of out- side of his immediate circle of acquaintances. The greater part of the human race dies as it is born, without hav- ing been heard of b}- the world at large, without having lone anything out of the ordinary. Where we find one leader among men. we find a thousand who prefer to follow, and we find that these people are wise when they always follow; for, when they attempt to lead, they over- whelm themselves with defeat. The instinctive quality of leadership is a rarity even to-day. -If success depended, therefore, upon aggressively constituted temperaments, there w'ould be few to advance. Again, we see many successes that have been attained by quiet meth- ods; many have attained substantial success without the publicity whicli accompanies the dashing successes of the newspapers and of legends. It is probable that many young men are under a wrong impression as to what success is. rather than how success may be achieved. Few seem to appreciate that success in life is as possible in an ob- scure position as it is in one that is prominent. Success is measured by dollars by the average young man, and it is upon this one point that such a view is erroneous. A person making five thousand dollars a year can be as really successful as the one who makes fifty thousand dol- lars a year. It has been said that it is as great an honor to be a success- ful subject, for the subject, as being a successful ruler is creditable to the ruler. Every man has a certain limitation, every man is capable of cer- tain achievements; he is capable of just so much and no more. THE PRACTICE BUILDER 71 There are men who, so long as they are under the direction of someone else, are capable of performing very superior work, but who, if they were allowed to direct the work of others, would be failures of the most complete kind. Then there are men who are not at ease if they are working under the direction of someone else; it is not com- patible with their temperament to be followers — they must be leaders or nothing. It is to be said, however, that it is just as possible to succeed as a follower as it is as a leader. When we speak of anything as successful, we mean that it has eventuated in a manner satisfactory to its projector; it is an agreeable fulfilment of previously laid plans. Thus it is that a dentist may be as successful in the performance of the usual operations of his vocation as in the accom.plishment of the more unusual things. Success may, or it may not, depend upon the prominence or publicity given an in- dividual; many who have attained great publicity are far from being successful as i entists/rr se. If we were to consider those dentists successful whom we know, or whose names are familiar to us, we should narrow success down to a very small number. Successes have been won on the more conserva- tive lines quite as often as upon those which are evidenced by great public approval. To-day a success that has been won on lines of con- servatism, and that has been upheld and maintained by sound judg- ment and business tact, is the success that is most highly commended in professional callings. The success which is the truest success, the soundest, is that which is earned slowly, and which surely strengthens itself. When one has succeeded in eradicating false theories, the proper view of what successful living really is will have a truer meaning to him. Being successful means nothing more or less than doing just the very best we know how, in living as well and doing as well as we possibly can. This is the true basis of success, and it is only through a proper acceptation of it that great wealth, prominent station, or worldly fame is attained. vSome are born to occupy the more exalted stations of life, while others must fill the more humble sphere of existence; both may be successful according to their sphere. When a dentist is thoroughly equipped for the practice of his pro- 72 THE PRACTICE BUILDER fcssion. possessed of mental attributes of a reasonably high order, of manij^ulative dexterity of sufficient merit, let him be alert for every opportunity, and let him embrace it to its fullest possibility ; let him fix his methods on honest principles, and he will be a successful man. It is not necessary for him to make twenty thousand dollars a year; it is not a success of dollars that we are to judge by; it is a success of position. It is the conducting of his business, whether it be great or small, to a satisfactory termination that marks the success. A wise man knows when he has enough — when he has reached his limitations; the reaching of one's limitations is a sign of success; when a man knows that he has done the best that it is possible for him to do he has succeeded. Experience teaches a man w-hen he has reached the greatest depth at which he can safely conduct his enterprises; it is something that should be well learned. The secret of success in life lies in knowing how to make the most of opportunity; those who make the most of opportunity make the most money. There is no theory about this; we see it practically demonstrated every day; the future holds better opportunities than the past has given; people are better prepared to meet these opportunities than they were in the past; those who are best prepared and most likely to succeed. The opportunity to prosper is always present; no matter whether it can be seen or not, it is alwavs present. Those most familiar with professional life are aware that there are more opportunities than there are young men to accept them ; or, more properly speaking, than there are young men properly equipped to embrace them. It is a question of supply and demand, similar to that which regulates the great world of trade. Neither youth nor old age is a bar to professional preference. Den- tistrv is in a transition period when properly qualified men may attain to professional distinction in a shorter time than was formerly the case. Young men are desired in many of the most advanced positions be- cause they are believed to be more progressive, and because of their capacity to endure w^ork ; because they are usually more aggressive, and because they have ideas. Young blood is preferred in most vocations. But the young man must be possessed of creative powers; he must generate ideas and he must put them into use. It is not enough that young men attend strictly to business; they must do more than this. THE PRACTICE BUILDER 73 They are apt to be content to remain in the same professionally success- ful position they started in. A man who can satisfactorily conduct a practice upon a scale pro- jected by himself in the beginning, can, no matter how obscurely lo- cated, rise from his humble condition and fill the requirements of a practice demanding higher attributes than were needed for the duties of his more modest one. But he must be active, observant, ready to grasp every opportunity, ready to use all the good new things, always ahead of his colleagues in his own community. He must not be afraid of the hardest work; he must perform not only his routine labors at the chair and bench, but he must be ready to give his very best thought to planning for the future as well as the present; he must realize that the man who thinks is the man of the hour. The power of concentrating the mind upon one's own affairs is something that is attainable only after continuous application. It is not a gift; it is simply a matter of volition. Any man who has a mind can use it if he so chooses ; that is what it is given to him for. Most men have nothing to thank for their advanced position in life but their brains; few owe it to their hands or to the possession of a large amount of muscle. It is brains only, and the proper use of them. The men who start in to do manual labor without the use of brains to advance their interests will usually be found years after in just the same position in life, and in professional status no higher than when they began. The man who is satisfied with himself, satisfied with his business, content to go on in the same old way from year to year, is on the back- ward track; content to let someone else make the pace, and take the lead, he is out of the race. The world is moving nowadays, and many men are daily becoming back numbers. A man must understand the underlying rudiments of a practice be- fore he attempts to advance the practice itself. The advance of a prac- tice means the advance of the man, but the practice cannot advance until the man has carved the path and produced that which is essential to its advancement. A dental practice may be either a stepping stone to success, or it may be a millstone around the neck of its incumbent. The question is simply one of ability on the part of the man to compre- hend, and to accept the opportunity as it offers. These opportunities 74 THE PRACTICE BUILDER may be likened to a stair or a ladder; for the lowest may be filled so satisfactorily as to enable the climber to attain the next higher position, and to continue thus to develop ability to attain each succeeding posi- tion as the ability to fill it is gained. To be a successful dentist calls for several things. We have enu- merated at some length the qualities of mind and manner which should be possessed by a dentist in the chapter on " The Dentist Himself." We have said that he should be well educated, and have told at some length the advantage which a good education would be to its possessor. He should have good reasoning powers, for these will be called into play Avhen considering any of the work coming under his observation in the treatment of diseased conditions; in considering cause and effect; in all work relating to the insertion of mechanical appliances, and all procedures of a like nature. He should be possessed of keen perceptive faculties, not only in his actual work, but in his dealings with men and women. He should be quick witted for emergencies; his training is never tested to its fullest capacity in anything he does, as it is in the numerous cases of emergency that from time to time come under his notice. He should have a sympathetic and kind disposition, for this is something that has given many a man prominence and substantial pe- cuniary success when he possessed few other recommendations. His exacting position calls more for the exhibition of a sympathetic feeling than perhaps does any other calling, the physician not excepted. He should always be considerate as to his patient's welfare, yet ag- gressive enough to do what he may see demanded. He should listen to no dictation as to how this or that should be done, and should refuse absolutely to do any operation to please the patient when in his own better judgment such would be antagonistic to the patron's interest and not the better course to follow; the interest of the patient should be above every other consideration. He should have great dexterity and a very delicate touch ; bungling manipulations are wholly out of place in dentistry, and roughness of ap- proach or muscular handling of the patient is not only deleterious to his interests, but is simply intolerable to the patient and results in loss of confidence. He should have good morals. An immoral man in a professional THE PRACTICE BUILDER 75 capacity, be he minister, attorney, physician, or dentist, is dangerous to his clients and to his profession; pronounced lapses of morality are not only ruinous to himself, but a reflection on the profession at large. The preservation of clean morals is essential to success; indeed, it is impossible without them. Substantial success calls for concentration. No man can serve two masters. No dentist should attempt to serve two business interests, nor in any way detract from his close application to work. Diversity of thought is as dangerous to a dentist's best interests as is diversity of occupation. Most people are mentally capable of just so much clear thought, and this capability does not usually extend beyond the re- quirements of one vocation in these troublous days of competitive activity. No outside interest of any character should be permitted to come into one's professional hours. The office hours of dentists are usually not so long that they cannot wait till afterw'ard to attend to outside matters. A dentist who fulfils his duties as a dentist with distinction is doing all that one man should do; his hands will be full, and his head too. No young man is wise to attempt to shoulder the responsibilities of superadded interests. Some young men, possessed of more than the usual amount of ambition, attempt to add to their incomes by interest- ing themselves in pursuits foreign to their profession. When a man turns his attention from his duties he turns away from the sure road to success. When a man thinks that one occupation does not offer suffi- cient scope for his peculiar talents, a careful consideration will conclu- sively prove to him that the fault is with himself. To do one thing thor- oughly well is of greater credit than doing two things only indifferently well. We know a physician in a large city, a man who has earned three of the highest titles it is possible to attain, who, outside of his profes- sional knowledge, appears to know little; he is altogether lacking in ability as a conversationalist; is nearly always silent, except upon the subject of his profession; herein he excels; his income is represented in five figures. If young men knew their own work more thoroughly, the necessity for associating themselves with outside interests would not be apparent. A writer of more than ordinary ability, in speaking of evening oc- '^e THE PRACTICE BUILDER cupations, especially mental occupations after ihe regular duties of the day have been performed, advises the ambitious young man to avoid night labor, for the reason that it is likely to be detrimental to success. He compares the human mintl to a machine of iron and steel, which, if operated continuously by night and day, would soon wear out and break down ; and the mental forces, if kept at a high tension for more than a reasonable number of hours, he says, will sooner or later lose their keen perceptive powers. Mental efifort is different from physical labor in that it tires without physical exhaustion. Continual mental effort extending over a long period of application by night, and atten- tion to other duties by day, is undoubtedly unadvisable; and, when per- sisted in for a period of years, will probably be followed by all the ills that usually follow such indiscretions. Upon this subject, however, we have a few words to offer that are slightly at variance with the statements to which we have referred. A man engaged by day in the performance of work that requires mental activity and manipulative effort, such, for instance, as the dentist is called upon to do, cannot formulate plans, suggest ideas, or think con- secutively upon the matters that are of vital interest to his advancement. This necessitates burning the midnight oil. There are few men in this world who have attained to any degree of success without having worked for it; as there is no excellence without great labor, so there can be no success worthy the name that has not cost its votary number- less nights of mental toil. The sooner a young man realizes that if he would succeed in this world he must lose sleep, the better it will be for him. Success means that someone has lost sleep. We believe that at no other time is the mind so capable of keen penetration and subtlety of reasoning as at night, when the various duties of the day are over; that at no other time is mental concentration so possible. This may be due to one of many reasons; but we believe it to be mainly due to the fact that the blood is then more completely at the service of the brain than at any other period of the day. We believe that the late hours of night are better than the early hours of morning, for the reason given. In the morning the blood is kept in circulation, and is not readily respon- sive to the demands of the brain, due to the calls of the stomach and the THE PRACTICE BUILDER n feeling of hunger which is felt most in the morning; after t?he regular meals of the day, the blood, aiding in the process of digestion and as- similation, is needed more in the performance of its offices in these operations, and in consequence thereof is of less aid to the brain than after the later hours of evening, when the last meal has been digested and the blood is not necessary longer to these parts. In professional life there is no such thing as standing still ; a dentist must go forward, or he will go back. A professional man must get ahead of hi.s colleagues, or they will get ahead of him. It is fatal to a man to reach a point where he makes no progress, because stagnation is synonymous with starvation. He must keep abreast of the times, in touch with the best thought and the best activity of his contemporaries ; and, if he fails in this, his success is of the negative kind, for he will surely fall behind, tmconsciously, perhaps, but backward nevertheless. Professional life is a contest of brains, a contest of wits. The contest shows in the amount and quality of the practice. One great secret of progress lies in keeping continually on the lookout for new ideas, new plans, and helpful things generally. This means that a young man must be familiar with the minute details of his work, so that he may clearly conceive and properly carry out whatever ideas and plans he may evolve. It is not enough that a dentist fulfil the routine duties of his office ; he must do more ; he must be capable of viewing a broad horizon of affairs; he must be more liberal-minded than the duties of his pro- fession call for, because it is only for the liberal-minded man that success is sure; the man whose mind is dwarfed by the narrow limita- tions of his craft is not prepared properly to woo the evasive and much- to-be-desired success. To be successful means to be thorough. To disregard the small things means to invite failure; and it matters not how great may be the practice, a complete cognizance of the minor details is essential. Mistakes of judgment are costly ones to dentists, as they are to any- one; it is best to be always on the safe side, but no one should allow the opportunity to succeed pass by for fear of making a mistake on an important case, because there are so many ways of aiming at a proper termination of operations that nothing but an improper understanding of the requirements of the case should deter the operator from the per- 78 THE PRACTICE BUILDER formance of the work in hand. Upon this question of a proper under- stancHng we will say a few words. Without a proper preparation for their life work, few professional men can hope for success. In a profes- sion such as medicine or dentistry, so much depends upon the thorough scientific attainments of its practitioners that without these attainments little hope is to be had of successfully combating the many difficulties that continually beset the path of the aspiring person. We do not be- lieve that a dentist is born and not made; w'e believe that thorough education has made most physicians and most dentists. We do not care to create the impression that success is possible only to those who have had the most thorough education, because we know of many instances where men have attained to some professional fame without having enjoyed the advantages of a complete college training; they made up for it in most instances, however, by the most diligent and painstaking study in those directions wherein they recognized their deficiencies. Professional eminence per sc results from a complete mas- tery of the underlying principles of his art; but a broad professional learning is not enough to enable one to acquire lasting fame or pecuni- ary opulence. This comes from the broad intellectual attainments re- sulting from the most careful preparatory education preliminary to the ttrm of professional training. \\'e realize that no college has ever succeeded in making a profes- sional man if it did not have the material; but we also comprehend that the fully rounded success is not possible without thorough education. A self-made man, provided he be endowed with great ambition, will accomplish more than the man without ambition who has a thorough education. This means that it is more the man than it is the education;, but the self-made man would have been the better man if he had en- joyed the advantages of thorough mental training. Fifty diplomas framed in gold do not mean anything if the possessor is not capable of backing them up with a high order of ability. Ours is a country where the greatest successes are possible, due to the fact that every man is equal to every other; that each can achieve whatever is possible to his ability, with none to hinder and all to praise him; this is peculiar to our democratic government, to our free institutions. THE PRACTICE BUILDER 79 A young man expands mentally at any age between twenty-five and thirty; some may broaden before the first mentioned age, and some may not come into full grasp of their possibilities until after thirty years have been passed; but it is a fair presumption that a man accepts a seri- ous view of life during the periods mentioned. Before this time he is erratic and mercurial, without the settled purposes that after this period possess him. It is a period of preparation for that which is to come when the possibilities of his life present themselves. A man who intends to amount to anything in this world must (to use one of those expressive Americanisms) " get a move on himself " before he reaches thirty ; for it is between the ages of thirty and forty that a man does his best work. After that his judgment is more refined, but his ability to manage de- tails seems to decrease. While a man's most energetic work is done before he attains his thirty-fifth year, his capacity for work does not lessen, because he is thoroughly capable for fifteen or twenty years ; but he must make himself before he is forty. This world is cruel in some respects; notably, that as a man attains an age when he is no longer young, it has no use for him; he is no longer considered in the race with younger, keener, and more alert and aggressive men. It is wise for a man to have something laid aside from his earnings. Every dentist's commercial value decreases with his in- creasing age after he has passed his fiftieth year. Especially will this be true in the future, because younger men are entering the profession, and young men who are just as skilful and as learned as those in the full flush of success. Hundreds of young men who have left college and preceptors, pos- sessed of a superior order of skill and scientific attainments, become impatient because success does not come to them, or, rather, because they do not become successful as rapidly as they had anticipated. They become restless and impatient, and chafe under the wait for results. The actualities of practice are not as they pictured them; the rosy visions become dispelled one after another. But this is experience, and the ex- perience does good by teaching the young man more about his capac- ities and giving him a truer knowledge of himself. Professional life is intricate, multitudinous in its ramifications, and manifold in its demands. To succeed too rapidly is as dangerous to 8o THE PRACTICE BUILDER the man as to succeed too slowly. Patience is a virtue; patience has been called genius. He who would have patients must have patience. There are thousands of avenues to wealth that are tenfold more lucra- tive than dentistry, and infinitely less annoying, so that not merely love of wealth nor worldly ambition could induce a person to spend his life in a profession so poorly compensated. Life at its longest is but short. Time is precious. What is to be done, should be done earnestly. Opportunities do not last always. The acquisition of knowledge, although requiring close application and la- borious study, seldom fails to afford real pleasure and substantial profit. Knowledge is varied, and is not to be obtained wholly from books. ]Much benefit may be gained from a study of human nature. ]\Iuch of the success of life depends upon the faculty of pleasing and of being pleased. A person with a gloomy, sullen disposition not only renders himself miserable, but makes all with whom he is associ- ated uncomfortable; while a person who is genial and frank infects others with his good-nature and secures for himself the warmest ad- miration and aftection. The cultivation of the amenities of life should be sedulously instituted. Politeness is a cheap accomplishment which possesses a magic power. Gentlemanly conduct is always in place, and never more so than in a professional man's office. \'ulgar language and bad manners are always out of place. They are the result of ig- norance and ill-breeding, and should be abandoned at once. The first consideration of the elements of success compels a recog- nition of honesty as a factor, above all others, in the attainment of ambi- tious desires; a deviation from the principles of honesty can give but a temporary success, and will surely reflect against one and prove a permanent loss ; people have a way of forgetting what good a man may have done, and always remembering the one wrong he did. A man cannot wait for something to turn up; he must turn some- thing up. The failure to take advantage of an opportunity, or to make an opportunity, may be the failure to accept the one opening of years. A willingness to learn and a confession to himself that he does not know all there is to be known about his profession, or the manner in which his practice should be conducted, together with ability to judge of the utility of added information for the purposes of his advancement, THE PRACTICE BUILDER bl is necessary. Firmness of conviction is an admirable trait when backed by wisdom. Respectability in a professional man is something which makes him wear well with his clients; respectability of appearance, as well as a re- spectful opinion of women, of other people's opinions, and of things that are sacred. Character is a distinctive quality, either for good or evil. A good character is the richest boon a man can possess, either in a moral or a business sense, and the confidence which may be established in a professional man by a good character is the most valuable capital he can have. Every young professional man has it in his power to estab- hsh for himself just such a character as he may desire. It is a thing of his own making, and, when once thoroughly established, it will bear fruit either for good or evil. Everywhere, the world over, the man who stands firmly for principle against every allurement and all opposition will secure the confidence of his patients and the admiration of all who know him. There can be no grander spectacle than to see a man sacri- fice everything for principle. A noble character not only penetrates the community which surrounds it, but its influences often reach beyond the limits of its own country and is felt on distant continents, inspiring and elevating multitudes. The memories of the great and good men who lived in ages that are passed are still kept fresh in the minds and hearts of the people, and cherished as examples worthy of emu- lation. " Honesty is the best policy," is an adage old and familiar to all; yet no one can wish to be honest because it is the best policy; a man should be honest because it is right; for a man who will be honest for policy will be dishonest for the same reason, if the dishonesty will serve his purpose. A man's character of sterling honesty will establish for him a credit for anything he may need. Every man has a character of some kind, either good or bad, and sooner or later his true character will be known ; often it is known to the world when he little suspects it. Character is made up of the little things of every-day life which, taken separately, might seem unimportant, but, when woven together, make a complete record. Therefore it is that every person may mould his char- acter according to his own design; he may build as he will, since he furnishes all the material out of which his character is formed. He who 82 THE PRACTICE BUILDER builds well in this respect has a richer endowment than money and goods, and a more valuable inheritance to leave to the world. The young professional man should remember the words of Presi- dent Garfield: " Men succeed because they deserve success." Their results are wrought out; they do not come to hand ready made. Many a young man with brilliant prospects has been ruined by hastening to get rich. Emerson says: " Man was born to be rich and inevitably grows rich by the use of his faculties." No country in the world furnishes better opportunity for securing wealth than the United States. Neither honor nor wealth comes to men by luck. They must both be earned before they can be enjoyed, and neither can be earned in a day; it is only by persevering effort and indomitable determination that most men can reach the goal of their ambition. Every young man has within him forces and capabilities which will enable him to work out for himself an honorable position in his profession, and to secure the emoluments of which he may prove himself worthy. Idleness will not produce wealth, and immorality will not produce honor. Money is wasted by the idle and the imbecile, and is accumulated by the indus- trious, the brave, and the persevering. The dentist must be enthusiastic; his enthusiasm must be a part of his thoughts and deeds. " A man with only one idea all aglow with enthusiasm, will accomplish more than a ripe scholar with a thousand grand thoughts stored away in pigeon-holes." He must be so enthusi- astic that he will venture his time, his money, and his hopes on success. The close observation of little things is one of the secrets of success. Human intelligence is nothing more nor less than an accumulation of small facts, carefully treasured, thoroughly sifted, and conscientiously applied. Purpose and persistent industry help far oftener than acci- dents or happy hits. Perseverance will work wonders out of the odds and ends of time that occur daily in every line of endeavor. The mere drudgery undergone by some has been something remarkable, but the drudgery was the price of success. On meeting a great man for the first time, a man the world calls great — it may be a great lawyer, a great surgeon, or a great dentist — we are usually struck by the simplicity of manner and outward appear- THE PRACTICE BUILDER 83 ance of the person; sometimes we are greatly disappointed to find no evidence of greatness. We note in him a simple and unaffected style, a conversation differing in nowise from that of other men, and we do not understand why this man is great ; but he is ; the subtle power is a hidden one, a mental possession, the ability to so marshal the powers of his intellect, so thorough a mastery of the principles of cause and effect, that out of chaotic darkness he produces that which wins him fame or fortune ; or he so improves the thoughts or handicraft of others that a new use is found for the work, or it does better that which others do well. Progress of the best kind is comparatively slow; great results cannot be achieved at once. Waiting patiently is working patiently. To wait patiently it is necessary to work cheerfully, to have one's whole soul in one's business, to never get above one's business by reason of slow progress. An unaltered constancy, a laudable ambition to excel, are necessary. Consistency in conduct, conservatism in practice, honesty of character, neatness of person, and superior education are important elements entering into the requirements for success; these must be backed by a strong will, a patient temper, and the ability to face any difficulty. It is possible for every man to achieve something distinc- tively fine and high. Every man cannot, however, win first rank. The day of raw ability is fast drawing to a close, and native force and sagacity must now submit itself to those educational processes which double its working capacity and convert it into a power of high- est efficiency. The trained man technically educated has the best chance of professional preferment. Those who know anything about success in the professions know that, while native cleverness sometimes secures success early, know, too, that disciplined ability is what wins in the long run; and it is to dis- ciplined ability that the great reputations go. It is on the higher planes and on the last stretches of achievement that technical training becomes indispensable. Superior excellence is a condition necessary to supreme success, and supreme excellence results from high training. Many men for this reason attain to the average degree of success, and few reach the highest pinnacle. The close study of success stimulates success. That which aids the man increases the success. The Causes of Failure " Of all sad words of tongue or pen. The saddest are these : ' // 7night have been ! ' " Failures occur in every walk of life — in trades, in arts, in the profes- sions; they occur in dentistry as in everything else, with one great ad- vantage for the one who fails in dentistry, and a great disadvantage to dentistry itself. The peculiar conditions upon which a dental practice is based ren- der financial failure less frequent than in most other vocations. A dental practice depends upon two elements of patronage, either of which, in many practices, will support the incumbent: these are the transient element and the permanent or family element. The independence of these two elements, one of the other, is a condition that favors the den- tist very greatly, for the loss of one does not necessarily involve a loss of the other. A really incompetent dentist has been known to maintain both elements, even when he did not possess one quality, as a tech- nically educated professional man, that would insure to his patrons the performance of work equal to that of other dentists in the same or other communities. The reason for this is that the patrons of dentists are usually unable to analyze the distinguishing features that mark their abilities as pro- fessional men. The work of some dentists will be considered excellent until the patient finds out that it was not of a high order. Professional failures in dentistry may be due either to errors of omission or com- mission. In preceding chapters we have shown that success is compatible only with the determination to accept certain standards, and to be guided by considerations which we named. We named therein some of the things which a man must be and which a man must do. It is not enough that he should do these things. He should omit to do a great many other 84 THE PRACTICE BUILDER 85 things. A man might be possessed of all the traits that are essential to success, and he might also be possessed of other traits that would mili- tate against his success. wSomeone has said that every failure is a step toward success, but the lives of some men are such a series of failures that they at last think that either the steps are very long or that there are a great many of them. A recountal of failures should not be an interesting topic; they have too many traits in common to afford any great amount of novelty in the recital. Failure in some cases may be due to not selecting a good location, one to which the dentist is adapted or can adapt himself. A dental prac- tice is something that, once gained, will support its owner as long as he cares to give proper attention to his duties, and he cannot be too care- ful in choosing a town or a city that is enough to his liking to enable him to live in it with cheerfulness and contentment. As soon as a man realizes that he is in a place where, if he possesses superior talents, op- portunity cannot be had by reason of environment, he cannot too soon remove to a more congenial locality. But it is ruinous to be of such a roving disposition that a desire is felt to move more than twice, for, if it becomes known that one is always changing, his patrons will become suspicious. Ignorance is a cause of failure, and it is believed to be the chief one; and nothing is plainer than that a man who is not possessed of an intelli- gent knowledge of his profession should fail. It would seem that if he were ignorant, and at the same time showed no disposition to increase his knowledge, failure would be the inevitable result. Failure arises sometimes from neglecting to select some aim in life, some one achievement to strive for, and to bend every energy toward. Without some particular desire to be gratified by patient, painstaking effort, some hope to be realized, some plans to live with, to think of by day and to sleep with by night, to toss about with upon a bed in constant contemplation, there can be no success worthy of the name. Some capital is essential, although not absolutely necessary; but with it much time is saved and the term of professional activity is mate- rially lessened. The professional man's capital is his skill, without which he can never hope for advancement, no matter how much money S6 THE PRACTICE BUILDER he has. There are numerous business procedures that necessitate the use of money by a dentist; the lack of financial aid does nothing more than to prevent him from getting to the front as rapidly as if he had the use of it. With most men entering dentistry, all, or nearly all, of their money has been spent in gaining an education and in fitting up an oftice. For three years prior to establishment in the field of their future endeavor they have been constantly paying out, with nothing coming in. Thus it is that when entering upon work they are com- pelled to husband their resources, to sustain themselves during the period that they are engaged in building up a patronage. Another cause of failure is a too complete reliance or dependence upon one class of patronage. In a practice that is comparatively young this is imadvisable; and, indeed, in cities of the smaller class it is not to be thought of. In these cities, more particularly, a dental practice can- not be conducted with favoritism toward a class, because the best and most desirable class is decidedly in the minority. The peculiar rela- tions of the dentist to his patrons is such that he attracts all classes or none, and in a young practice any attempt at cultivating a class will not prove successful. In a large city and in a long established practice the ability to secure class patronage is sustained by reputation and the absence of fear of competitive activity; because, if a practice is to be renovated and one class of patrons to be removed from the books, no permanent damage can be done. A disregard of the interests of the patients is sure to result in a prac- tice of the most insecure kind. These interests must be the first and only consideration, and under no circumstances should the importance of this fact be overlooked. It is the foundation of a dental practice; it is the only thing that makes the dentist sure of his patrons' support and influence, and influence is one of the strongest elements of financial success. The outlay of too much money for personal expenses is responsible for the failure of many young men to acquire a competency. Penuri- ousness is always contemptible, but its opposite is not wise, and to have a desire to spend money as rapidly as it is earned, and to use it largely for personal expenses, is a hindrance to one's progress. A multiplicity of pursuits, and a desire to engage in other than the THE PRACTICE BUILDER 87 legitimate work of the dentist, is most injudicious; to depart from the regular duties is to slip just so much out of the path that leads to the goal of professional prestige and substantial gain ; for he who does one thing, and does it well, is following by far the safer plan. It takes all of a man's time, conscientiously applied, to become a good dentist, and he whose talents are so manifold and whose employments become so diversified that dentistry is neglected, is treading on dangerous ground if he proposes to remain in dentistry. Politics is something so foreign to the interests of dentistry that one not anxious for political honors will not care to meddle with them; party strife and bitter partisanship, and the rivalry engendered, are hurtful to the professional interests of the dentist. It takes time from the pursuit of his own calling, and many times involves the use of money that is likely to be a de^d loss. Econ- omy of time and economy of money are of the utmost value. Not ap- propriating to one's self the wisdom and experience of those who have gone before, the thousands of things that are not recorded in books and the thousands of items of experience that are in danger of perishing with the men who learned them, invites failure. Much experience in life is gained by men too late to be of any prac- tical benefit to themselves, and he is wise who adapts such experience to his own needs. Wisdom is the applicable knowledge that is worked out betv/cen the lines. Useful information is often worshipped, or fol- lowed blindly, or ridiculed. It should be either digested or used as a stepping-stone. It is not so much what one reads, or hears, or sees, as what the seeing, hearing, or reading makes one think, that proves useful. One thought written means another thought born. Observe, compare, reflect, record. Inability to mix well with one's constituency is a disadvantage ; but there are men who keep themselves unto themselves with the most constant and complete success. This is due to the inherent force of character of the men. Congeniality is an advantage, but it is not a ne- cessity. A certain cause of failure is a tendency to seek the company of persons who are the mental and moral inferiors of one's self. There are men who take a peculiar delight in mixing privately with persons with whom they would not care to be seen in public places ; and to be seen with them would cause them to blush. This fondness for the soci- 88 THE PRACTICE BUILDER ety of inferiors is explained when it is understood that the inferiors pay a certain homage to the individual in whom they recognize a superior. Many men seek the company of these persons as a relaxation from the keen mental strain of working for or with men of equal station; but nothing could be more dangerous to the business interests of a dentist than to be known as a boon companion of the thoughtless and idle mortals who infest every connnunity. If this habit is persisted in, he soon becomes debarred from the privileges of association with his peers and is judged to be one of the class with which he is on terms of famil- iarity; he is also demoralized in his own interests. " W'e cannot handle pitch without being defiled," and no one can be a companion of these individuals without harm to himself. An unfortunate circumstance w'ith many is that of making the ac- quaintance of persons who are not only possessors of dishonest motives, but are also of such a nature that they are not found out for a long time. These persons are usually extremely glib-tongued, and have a knack of insinuating themselves into the good graces of almost anyone, with- out the slightest formality, where a modest man would be months or years in attaining the same familiar footing. Always of a social dispo- sition, they are never satisfied unless they are partaking of the hospital- ities of anyone with whom they may chance to strike up an acquaint- ance. To properly gauge these persons, a good knowledge of human nature is necessary, although even this will sometimes prove at fault. An instance comes to mind of a person who ingratiated himself inta the good graces of a dentist, and, having an ofifice near him, managed to be seen in his company as often as possible. Social invitations were sent to both, the glib one always accepting and the dentist always sending regrets. Complications of every possible nature soon beset the one who w'as all sociability and no business, until finally the dentist was compelled to pay many of the bills of the other to keep his own good name above reproach. The cost was great, but the preservation of a good name was worth the price paid. Even then the dentist suf- fered by being classed with the other, and was in a sense a " Poor Dog Tray," until the evil effects of the unfortunate association were outlived. While little or no loss of patronage may have resulted, the publicity giv- en such matters is most decidedly something to be studiously avoided. THE PRACTICE BUILDER 89 Building castles in the air, a pursuit which is perhaps a pleasant occupation, is one which does not mate well with the practical work of every-day life, and is a habit that most men will do well to rid them- selves of. The stern realities and hard bumps are not nearly so enticing, but they have the merit of actuality and of possibility, merits that are not noticeable in castle building. This habit of wishing and dreaming away the long and valuable hours of early years is to be discouraged; it results in discontent, in getting above one's business, and leads to laziness of mind and body. The abuse of liquor is a prominent cause of disasters in business and professional life. Sobriety is essential to dexterity, and to the exe- cution of details of practice so dependent on the steadiness of the hands. The question of harm from the use of liquor may be an open one. That it does actual good is not. The use of liquor in its relations to the welfare of mankind in general is something that we have no desire to discuss, and it is probable that if we chose to do so, we should find ourselves inadequate to the task. To take a view of the matter just as it is, without the use of the pyrotechnical terms of the peripatetic tem- perance orator, we do not believe that the reasonable use of liquor, the occasional, not the habitual, use, is harmful to any man of sense and judgment. But we do most heartily discountenance the habit of be- coming a fixture at resorts where amber fluid flows. There are now dentists, and there have been dentists in the past, who ruined their practices, disgraced their families, and dashed their hopes to earth, through no other fault than that of drink. Dentists as a class are men who, by reason of their more or less constant employment and close confinement to duty, are likely to be freer from the desire or craving for drink than other men. If a dentist is ambitious for success, anxious for the favorable opinion of his clients, and respectful toward his own health, he will avoid the unwise use of intoxicants. If he would preserve his good looks, he will keep away from bar-rooms. If he would preserve his good name, he will keep away from bar-rooms. If he would preserve his good manners, he will keep away from bar-rooms. The Dentist Himself " There are but three classes of viot : the retrograde, the stationary, and the progressive " We have considered in their order the subjects of dental education, dental legislation, selecting a location, an outfit, and furnishing of office. We have now a few words to say concerning the man at the helm; we shall not say a great deal, because much that could be said has al- ready been told in part in the chapter on dental education, and other matters bearing both directly and indirectly on the subject will be found in special chapters. The old Greeks said that to become an able man in any profession three things are necessary: Nature, study, and practice. So far as this applies to dentistry, we believe that a man adapted by nature, or, more properly speaking, by temperament, for his calling, is more likely to succeed than one who is not so adapted. We do not believe that dentists are born, and not made; in fact, the preponderance of evidence would, in a great majority of instances, show that dentists were made, and not born, dentists. Poets may be born, but dentists have been made. A man who studies dentistry because he likes the scientific in- vestigation the work necessarily implies, and feels that he will be an element in raising its standard in the popular esteem; that he can devote himself assiduously to the practice of this profession ; that he is willing to sink himself for the benefit of his art, devoting himself to uplifting and upholding it as a worthy science; realizing that a lifetime of con- scientious research may be given to it, and that even then one may not attain to any special distinction, even though the highest attainments be exercised, will succeed. The old-fashioned tooth-carpenter has be- come almost extinct, although some localities are still represented by a lingering specimen of the species. In place of such who formerly in- 90 THE PRACTICE BUILDER 91 fested the country, we find modern educated doctors of dental surgery, trained in the theory and practice of the science, coupled with a devo- tion rarely seen in other walks of life. Alen who have spent their early years in pursuits so far removed from dentistry that their entrance upon it would seem presumptuous, have entered into practice, kept pace with the best thought, and in many instances have led the pace. Instances of such achievements are not at all infrecjuent in dentistry. Dr. Allport was, if our memory serves us right, a tailor for a time. Dr. Welsh was a cabinet-maker. Dr. Atkin- son a tailor, and yet all rose to the fullest professional success. In every instance these men showed themselves possessed of the temperamental attributes which are necessary if one would become skilful as a dentist. Dr. Allport, it is said, while serving his apprenticeship, was a source of much concern to his employer, and, becoming disgusted with the tailoring business, said one day that he thought he would quit that and study to become a dentist. The employer said years afterward: " Well, I hear Walter is getting to be a fine dentist; I am glad to hear it, be- cause I don't think he ever would have been a good tailor." Here is a man who was not born a tailor, but made of himself a dentist; he had a good academic education, and he availed himself of the best talent of his time for his dental training, and grew to outstrip his fellows and to become the presiding officer of the most powerful dental association in the vv'orld. A man should know, before he enters upon a profession, whether he has a natural aptitude for it or not; and, if he thinks he has not, he should have the good sense to keep out of it. Only by hard study can one acquire the store of knowledge upon which depends a man's success in a profession. No man was ever born a great surgeon, because surgery is sheer anatomy, and a man was never born with a knowledge of anatomy ; to know anatomy one must study it, bone by bone, muscle by muscle. No man can know all there is to be known of dentistry, even if he applies himself studiously from the very beginning of his adoption of it as a profession; excellence and superior ability are not possible to any one man in dentistry, because the subject is too complex, and it is becoming more complex year by year. Sub- jects become specialized, that a few years since were a part of the gen- 92 THE PRACTICE BUILDER eral dental knowledge; and, while they are still such, they have also become specialties. These specializations are the result of one thing — study — study of the requirements of a special branch ; and it is to study that dentistry will owe its continual broadening. Practice is the means, of course, by which the dentist verifies his stud\ ; and here we find the advance of the science; the theory of yes- terday is the practice of to-day, and the theory of to-day is the practice of to-morrow: this is not only true of dentistry, but of most of the scien- tific work of our time. Some vague theory is advanced here or there, and to-morrow it is practised. Few lines of research afford greater opportunity for the practical application and verification, or repudiation, of the theories promulgated, than dentistry, because of the methodical scientific basis of the profes- sion. Eacli practitioner has modes peculiar to himself, yet these, while differing slightly in then- application, are yet so similar in the ends they attempt that they constitute a generally accepted standard of result. Dentistry has kept pace with the rapid advance of medicine, and has been in many instances more fruitful of good results. This is espe- cially true of anaesthetics, which have received great impetus from the dental profession. So, too, has the study of bacteriology been mate- rially aided by the contributions of dentistry to the general store of knowledge on this important subject. Many dentists of long experience have no special aptitude for den- tistry, while others, possessing little experience, but aided by a natural aptitude and the power of application, rapidly rise head and shoulders above their colleagues. The dentist should have a liberal preliminary and professional edu- cation; the more liberal this has been, the more rapidly will he build a practice and win the favor of his patrons ; the broader his education, the broader will be the foundation of his professional success, and the larger and more imposing will be the structure of professional distinction to which he will attain. There can be no mistake about this; there never was a man yet too well educated to be a good dentist, nor was a man ever too well educated for any calling. From a superior education springs all the good that is to be had in professional life. He must have manipulative skill, or be capable of acquiring that THE PRACTICE BUILDER 93 dexterity which is so essential. Many men have been highly successful, with the possession of no other attribute than that of manipulative skill. He should be possessed of artistic taste, for nowhere is its lack more conspicuous than in the construction of dental apparatus without regard to the appropriateness of the appliance to the temperament of the indi- vidual, or by a lack of familiarity with the requirements of form, color, and harmony, not only so far as relates to the replacement of lost teeth by artificial substitutes in plate work, but in the insertion of modern bridge work, and in filling operations, and in every relation of the rap- idly advancing specialty of regulating teeth and remodelling the features. He must be industrious. He who is industrious shall stand before kings. In this world the man who is industrious is the man who suc- ceeds, while he who believes that all things come to him who waits may be disappointed. To be industrious, therefore, is one of the best attri- butes a dentist can have. A dentist should be of a persevering disposition; perseverance is a trait of character which has made many men succeed, with failure staring them in the face. This trait comes in for exemplification in dentistry with perhaps greater frequency than most men care to admit; its continual application tends, however, to perfection of the art of the individual. Another trait is that of self-control. Alexander could conquer the world, but he could not govern himself. A dentist should possess this most desirable attribute. A man who can control himself can better control others, so far as such control is necessary to inspire confidence and assist toward the more proper performance of the work in hand. Evenness of temper is absolutely essential to obtain and retain the good will of a patient. He must be enthusiastic — optimistic, if you will ; without enthusiasm he lacks a quality that has helped to make dentistry what it is. Enthusi- asm ever has been a most potent factor in the advancement of dentistry as a science and as an art. He should be possessed of business tact; often this is a more power- ful aid to success than the most careful educational preparation. Men possessed of shrewdness and good business ability often succeed when 94 THE TRACTICE BUILDER not possessed of even average education or skill, while many men who have professional attainments above the ordinary, but in whom business tact and foresight are lacking, may fail utterly. It therefore stands a man well in hand to familiarize himself with the business principles wliich obtain in connnercial lines, for he will have ample opportunity to apply them. He should be strictly honest. Honest to his clients and honest to himself. A man who is capable of practices which savor, however slightly, of dishonesty, cannot succeed in dentistry. It makes little dif- ference what form the dishonesty may take; one who is guilty of dis- honesty toward his patients cannot retain their confidence. There is nothing bright about dishonesty ; any fool can be dishonest. A great many have become rich by being dishonest; but the best men, and the most prosperous and prominent ones, are those who are noted for their honesty. It is not a good plan to be honest because " honesty is the best policy," but, if a man is going to be honest, let him be honest because it is right. A man should understand himself. He should know what his am- bition is, what his desires are, what he is capable of doing. A lack of such knowledge of one's self has been the cause of many failures. Be- cause one man has been successful in this or that is no evidence that another could have been equally so under the same circumstances. This lies with the man himself, and with his knowledge of his own possibil- ities. There are hundreds of failures where young men have not gauged themselves properly. They have overreached their own ability. Too many are anxious for meteoric successes. He must know his own instincts — whether they tend to raise him to a higher plane of life, or tempt him to dally with the vacuous and time-killing pursuits of the voung man of the period. The sooner a young man acquires habits of studious application to his profession, the better it will be for him. Mental expansion is the result of such application, and all the pro- fessional growth and personal distinction which it is possible for a man to attain is the result of mental expansion and a broadening of personal culture which cannot be had by frittering away the hours. The great successes in dentistry have been attained by men who worked while others slept or fooled away their time attempting to become society THE PRACTICE BUILDER 95 young men. Every man is the architect of his own fortune, the maker of his own professional success; and, as there is no royal road to learn- ing, there is no short cut to success, and one cannot too early see the truth of this. Every man in dentistry to-day, who has made a name, owes it to no one but himself. His own efforts alone are responsible for his place in the esteem of his colleagues and in the patronage of his clients. After leaving college, young men should come to understand that they are alone, to the extent that they must depend upon themselves. One may seek advice if he chooses, but he must do the work himself. Dentists, as a rule, seek very little advice, performing their work ac- cording to the teachings of their professors, or evolving methods peculiar to themselves; hence they rarely ask advice, except where they can consult a former professor; the literature of the profession performs the duty of giving the advice, without the necessity for applying to other practitioners. This is perhaps as good a place as any to consider the question of professional titles, a subject frequently commented upon, especially in the meetings of the dental societies. Most of these references have application to the question of both medical and dental titles. The use of one or the other of these is sometimes made possible by the practice of conferring the honorary degree upon many men, because of their long service or worthy contributions to the betterment of the profession. Where this has been the case, it would seem that no objection should be made; but, when a degree is conferred without the recipient having given evidence of any especial superiority, the condemnation of the profession is sure to result. It takes three years to acquire the title D.D.S., and the same time, and in some instances four years, to gain the title M.D. The title D.D.S. should be required of every intending practitioner, because the time that has been devoted to acquiring it is an evidence that its holder believes the possession of it is worthy the time, labor, and money so spent; and, if a man acquires an extensive knowledge of dentistry, and intends to follow it as his profession, he will have all he can do to be a good dentist, without scattering his ability by attempting to be both dentist and physician; besides, he has little or no opportunity as a prac- 96 THE PRACTICE BUILDER tising- dentist to apply his medical ability to any greater extent than the general practising dentist who is properly qualified. Instruction in the dental colleges is adequate to all the demands made upon a dentist, so far as these are concerned in the treatment of the systemic effects of local disturbances; in the diagnosis of lung and heart affections; in the manufacture and administration of anaesthetics, and in counteracting the undesirable effects of such administration. If a man proposes to become an oral surgeon, it is proper that he should be a graduate both in medicine and dentistry ; but in dentistry itself, just as scientific work can be done by having merely a thorough knowledge ot dentistry, as though one possesses half a dozen titles. The American Dental Association, at a recent meeting, expressed its disapi)robation of the practice of conferring degrees honorarily upon dentists and physicians. We have no intention of discussing the question as to whether den- tistry is a specialty of medicine. That has been done to the satisfaction of those at least who took part in it, and we have no desire to add any- thing to the matter; but we are quite sure that those in possession of both titles, M.D., D.D.S., have not been repaid, either as to extended knowledge or opportunity, for their application by use or honor. Those in possession of the title D.D.S., without the AI.D., have made records quite as worthy as those who have attained the M.D. degree. People do not care whether a man is an M.D., D.D.S., or whether he is just D.D.S.; neither do they care what school he came from, so long as it was reputable. What the people want to know is, if he is a good dentist; atid they know, too, that they must find this out largely for themselves. They ask of him only that he shall keep pace with all that is good in his profession, maintain a dignity and honor essential to his position, his profession, and his patronage, and they ask for nothing more. Xo man has a right to consider himself a professional man who is not a gentleman; but no man becomes at once, upon the acquisition of his title, a gentleman. Because one is a professional man is no evi- dence that he is a gentleman; but he should be, and usually is. He should never stoop beneath the dignity or gentleness which we expect to see most exemplified in professional men. At first glance we see nothing in a gentleman that attracts the atten- THE PRACTICE BUILDER 97 tion. He may be simple, calm, ingenuous, manly, rather than graceful; sedate rather than animated. His manner is neither reserved nor demonstrative, but attentive, respectful, and guarded; neither obsequi- ous nor imperious, but calm and self-possessed. His politeness appears in acts rather than in protestations ; though he does not despise conven- tion, he is not its slave; he does not allow himself to be hampered by the unimportant, nor does he ever see a heinous offence in a trifling breach of established usage. In him we find that happy faculty which enables one to adapt himself to those vv^ith whom he may be thrown in contact. He believes that everyone has some good points, which, if they are but studied, may be brought out; and that, if a person has weaknesses, he also is possessed or virtues which it is his duty to discover. He does discover these virt- ues, and he makes a friend. In his conversation he shows his versatility and his tact; for, with the pedant he dogmatizes, with the sage he reasons, in the social circle he shines; he consoles the unfortunate; he will contend for the rights of humanity, and swear eternal fidelity to the woman of his choice. He talks trade to the shopkeeper, politics to the ambitious, perspective to the painter, the drama to the actor, playthings to children, house affairs to the matron, and common-sense to all. Honesty with him is an instinct which he exercises without reflection. In his pleasures his prudence appears most prominently; for, what- ever his pleasures may be, he is never seen to overstep the bounds pre- scribed by decency and self-respect. Pleasure that injures no one seems to him innocent, and recreation that follows labor seems to him reasonable. Being discreet in the formation of acquaintances, he studies their characters before he gives them his confidence. In conversation he is neither impatient nor hurried, and he attaches more importance to the matter of his speech than to the selection of words. He takes as much pains to remain unnoticed as many others take to make them- selves seen, and if he appears in a circle where he is not known, the greatest number see in him only a quiet plain man, who, despite his simplicity, has that about him to which they involuntarily yield their respect. The superficial, the presuming, and the malicious, though 98 THE PRACTICE BUILDER ignorant of the cause, are embarrassed by his steady searching glance; the loyal and the unfortunate, on the contrary, are drawn toward him, feeling that in him they shall find a friend. He avoids what is likely to create discord, seeks to promote kindly feeling among his fellows, and never pleads the faults of others in ex- tenuation of his own. He is slow to take offence, opposes incivility with urbanity, and passion with moderation. Wrong-doing he accounts a weakness, and he pleads weakness as its excuse; the wrong-doer ex- cites his pity rather than his hate. He is guarded in speaking ill of others, which he never does without the best intentions ; as, for instance, to right a wrong, to unmask a hypocrite, to punish the guilty, or to protect the weak. In speaking of his enemies, he never forgets to be just; he is not of those who are blind to the virtues of even the most unworthy, nor is he of those who are so ungenerous as to deny them. He does not soil his conscience with falsehoods; does not wilfully give cause for offence to any ; does not seek to overreach his neighbor ; does not forget the respect due to womanhood nor old age, the feeble nor the poor. His aims are generous, his trust is constant, his word is never broken, his honor is never stained; he is as gentle as brave, and as honest as wise. He wrongs no one by word or deed, and dignifies his life by nobilit} of thought, depth of feeling, and grace of manner. He is a loyal son, a true husband, an honest father. His life is decent. His bills are promptly paid. His tastes are high and elegant; his aims in life are lofty and noble. He is never guilty of that parsimony m little things that disgraces more than display in great ones exalts. He is moderate in his expenditures, and punctual in his payments. He often denies himself the pleasures of luxury to indulge in those of benev- olence. He is modest in prosperity, resigned in adversity, and dignified always. His dress is an index to his character — simple, appropriate, harmonious. The man of the world pronounces it tasteful, the man of the people sees in it nothing unusual, and the man of sense recognizes in it a certain independence of the newest mode. Personal Appearance " Whose gannents wither shall receive faded smiles " Persons are sometimes judged from their appearance, as well as from what they are ; and, as most men realize the advantage of creating a favorable impression, it is well that the dentist should give some attention to the matter of his attire. Every man owes it to himself to be well dressed; and this is partic- ularly true of a young man just entering upon his professional career. The most expensive clothes are not necessary in order to be well dressed, although we certainly do favor the high-priced tailoring rather than the ordinary tailoring at low prices. Nothing is more exasperating to a man accustomed to good clothes than to become the victim of a second-rate tailor. If a man lives in a town where it is impossible to get the better class of tailoring done, he should go to some city where he can select the material and be fitted. Some people have an idea that one should buy everything he requires in the town in which he resides; we are of a different opinion; a man should be guided by his needs, and, if his townsmen cannot supply him with that to which he has been accus- tomed, he should seek elsewhere; he owes it to himself to do so. It is all very well to patronize home trade, but when that home trade cannot supply the grade of work to which one is accustomed, he should not waste his money on it. Most young men have mistaken ideas of dress; for, with their tastes unfixed, they go to extremes; one either dresses in a shabby, cheap-gen- teel way because he cannot afiford, or thinks he cannot afford, to dress better, or he goes to the other extreme and attempts to imitate the styles affected by that class of persons who have the idea that they must live " up to d' limit," as Chimmie Fadden says. Wearing apparel is so moderate in price nowadays that no young 99 lOO THE PRACTICE BUILDER man can afford not to be well dressed, no matter how moderate his in- come may be. Neatness of appearance does not depend upon the pos- session of a large number of suits, but upon how well taken care of one suit may be, and the manner in which it is worn. Where one has a moderate income he will be wise to choose quiet patterns of dark colors. This is not only more economical, but it is in much better taste than the lighter patterns of the more conspicuous cloths. It is a noticeable fact that the most successful men, the men of sense and taste, are always dressed quietly. It will usually be found that only persons of shallow mind endeavor to find notice through their dress. A man's dress is a pretty accurate reflection of his character, and very often he is judged by the taste which he shows in his dress. While a young man may injure himself by his loud and showy dressing, it is equally true that he has no business to dress in a shabby or careless manner. Time was when shabby dress might have been taken as an indication of genius, but this is no longer the case. To a man of more than ordinary genius — one who is established — such eccentricity is pos- sible, but a young man who takes this for a model makes a very serious mistake. Apart from mere appearance, a young man's neatness of dress is without doubt a great inner and outer factor in his success. A neat ex- ternal covering communicates a sense of neatness to the body, and in turn this sense of bodily neatness exerts an influence extending to the work in hand; a man of neat appearance is more likely to be ambitious to perform work that shows the impress of neatness. Neatness of attire conveys a mental impression ; as a man feels so will he work. It is not necessary for a man of moderate means to dress in the immediate fashion, but it is necessary to be neat. Most people have more confidence in one who keeps himself neat and clean than in one who, regardless of good taste, has a shabby and soiled appearance. We have no desire to be understood as making too much of personal appearance as a factor in a dentist's success, but we have faith in it, and have seen evidence time and again to strengthen our opinion that no young man anxious for his personal advancement can afford to slight himself in this matter. THE PRACTICE BUILDER lOi There is no way by which we can arrive at a definite statement con- cerning the amount a young man should spend to maintain a good ap- pearance. It depends largely on circumstances. We do most emphat- ically advise that he should dress as well as his income will allow; it is not necessary for him to dress better than that, nor is it wise to dress below this standard. It should be remembered that money rightly spent to maintain a neat appearance is never money wasted with a profes- sional man, be he young or old, married or unmarried; especially is this true and applicable to a dentist. The chief danger to young men is that they are likely to dress beyond their means. This is not so dan- gerous, how^ever, as dressing shabbily or without regard to the position which professional men must necessarily maintain. Extravagance is wastefulness. Extravagance is unnecessary. Economy of the close kind is altogether inadvisable when directed toward the question of dress. Economy of this kind does not pay. One should make an effort to look neat at all times, and, in a word, to be as presentable as possible. The extreme styles should never be aft'ected by the young man who wishes to gain the confidence of his patients, or the respect of people in social life whose friendship may be of value to him. Among men the best dressed ones are those who dress quietly and well; this is equally true of women. Quiet dressing and good dressing are one, and they are always in good taste. Loud dressing is not good dress- ing, and it is always in poor taste. Good clothes are far from being sufficient to gain one admittance to the better circles of society, but without them admittance is impos- sible. When we go out into the world it is not sufficient to do as others do; we must also dress as others dress, and conform to the prevailing fashion without going the least beyond. It requires something more than a full purse to enable one to dress well; it requires sense, taste, refinement. Indeed, dress may be con- sidered in the light of a fine art. It is a pretty sure index of character, and few dress really well who would not be considered persons of culture. In the replenishment of one's wardrobe, the first thing to be con- sidered is the material. This should always be good. Low-priced I02 THE PRACTICE BUILDER stuffs are rarely, if ever, cheap ; and they are certainly not cheap unless, though low-priced, they are of good quality. As a rule, one suit that costs fifty dollars or seventy-five dollars does more service than two suits that would cost the same amount. If the coat, vest, and trousers of a business suit are not made of the same cloth, the coat and vest should be of the same and be darker than the trousers. Men who cannot or do not choose to spend much money with their tailors should always select dark stuffs. A dark morning suit may be worn on many occasions where the wearing of a light suit would be in singularly bad taste. The wrinkles and knees of trousers should be pressed out about every two weeks. The more close- woven the cloth, the longer a gar- ment keeps its shape. The vest should be buttoned from bottom to top, and the buttons on both coat and vest should be renewed as soon as they begin to show the effect of wear. There is something of the yokel in the appearance of an individual who goes about with his vest half buttoned. Both coat and vest should be made snug around the waist and loose over the chest. A garment that is tight around the waist tends to make the wearer stand straight, while one that is tight over the chest tends to make him stoop. The carriage of men w'ho do not wear suspenders is generally better than that of men that do wear them. Single-breasted overcoats made with a " fly " are most worn, and are, from every point of view, the most desirable. A short-waisted, double-breasted overcoat has been worn a great deal by quite young men of late. It is fashionable, and would perhaps become popular if it did not tend to make the wearer look like a footman. The man of taste always selects for his overcoats dark, quiet colors. It has been said that even the pseudo-gentleman never dresses in bad taste, because such individuals are students of human nature and realize that few are able to read the character beneath the genteel exterior. Said a writer: " If genteel dress, polished manners, and cult- ured address can do so much for fallen specimens of mankind, how much greater influence must appearance, manners, and voice exert for those who are truly gentlemen, and members of an honorable profession." THE PRACTICE BUILDER 103 To a dentist it would seem unnecessary to emphasize the impor- tance of clean linen. There can be no possible excuse for soiled collars and cuffs; few are so poor that soap and water, or the services of the modern laundry, are beyond their reach. There is nothing in a man's dress that invites closer attention than his linen, and, if his clothing is neat and clean, such cleanliness invites an examination of the linen, which, if soiled, mars the entire appearance. Some men are in the habit of changing their collars and cuffs with- out changing the shirt, so that when they stoop they sometimes expose the neck-band; showing a soiled wristband evidences the same lack of care. This shows an improper idea of what constitutes cleanliness. It will not do to practise this sort of economy; we should think most men would appreciate a sense of cleanliness more than the knowledge of a few cents saved. There is but one way to have a good-fitting shirt, and that is to have it made. Nor is this all. It must be tried on and properly fitted to the figure, so that all other orders may be made like the pattern shirt. Nearly everyone has one shoulder lower than the other, especially after several years of operating, and, if this peculiarity is not considered, the bosom of the shirt will never set smoothly; it will bulge out on the lower shoulder side. Let your collars be strictly within the fashion, unless you would look like a rowdy or wish to advertise the fact that you were brought up on a farm, in which case you are at liberty to go to any extreme you please, and to gratify any vulgar caprice. You may, if you choose, wear them so high that you are in danger of cutting your throat, or you may wear pointed collars with points so long that they hang down over your vest. In no matter of dress can a man show his lack of taste more than in selecting unusual forms of collars, immediately they are introduced. In no instance do these collars maintain their fashion for a single season, and those who adopt them as soon as they are introduced make themselves the subject of uncomplimentary comment. The cuffs should be no larger than is necessary to admit of slipping the hand through them when buttoned. There is no need to have them so large that one may see up to the elbow. A cuff so large that it slips I04 THE PRACTICE BUILDER down over the hand has an unaesthetic, slouchy look, besides being in the way and being very uncomfortable in warm weather. Colored shirts may be worn travelling, in the country, and, some say, in the morning in town, but most men prefer white. The pattern of the colored shirt should always be small and the color quiet. There is nothing a man wears in which he shows his sense, or the lack of it, more than in his boots and shoes. Men of sense have their shoes made long, broad in the sole and in the shank, with a big and moderately high heel. The shoe that does not look comfortable never looks well. A dentist may be a ready-made man in anything else, but he should certainly have his shoes made to measure. A man who stands on his feet as much as a dentist should certainly be anxious to avoid the necessity for breaking in a pair of ready-made shoes. Foot ease and foot comfort are essential to an operator, and he should not be reminded that he has feet. The cloth of the tops of the gaiters should always be dark ; third-rate variety performers may suit their own tastes in coloring. Fancy shoe-leather is, if possible, more offensive than flashy neckties. Short, narrow, laced, high-heclcd shoes often cause the big toe-nails to grow into the flesh, a condition it is doubly impor- tant for a dentist to prevent. In large cities it is important not to be among the first to adopt a new fashion in the hat, especially the silk hat; there the new styles in silk hats are first seen, as a rule, on the heads of ward politicians, saloon-keepers, and gamblers. The soft felt hat is the most undesirable for city wear, because it has a slouchy appearance, and it is not easy to get ofif one's head gracefully when saluting an acquaintance in the street. It is usually worn by long-haired persons who affect the picturesque. The jewelry worn should be good and simple. False jewelry is just as vulgar as every other form of falsehood. A woman's jewelry is intended to set off the natural beauty of the wearer; the sparkle of a precious stone or the rich gleam of a chain against a creamy neck serves to bring the beauty of the wearer into greater relief. Unlike a woman's jewelry, a man's should always seem to serve a purpose. A watch, to be in the best taste, should not be large; nor, except it is a presentation watch, should it be elaborately chased. It THE PRACTICE BUILDER 105 should not be very thick, nor, unless one's work interferes or renders the crystal liable to be broken, should it have a hunting case. Very large fancy chased watches always have a common, cheap look; no man of taste chooses one. Watch-chains should be small and the pattern plain. If the links are chased, the chasing should not be elaborate. A man's appearance is vulgarized by w'earing large chains, after the style of log-chains, and having the links elaborately chased. Watch-chains that go around the neck are no longer in fashion. A vest-chain should be attached nearly as high up as it will reach, in the button-hole, and not in a hole specially for the purpose. A young man who wears a large chain elaborately chased, and attaches it in one of the lower button-holes of his vest, has done much to make himself look like a barber's apprentice or a livery- stable assistant. If a locket or a chain be worn, it should be very plain, except in the case of the device worn to distinguish the members of secret societies, when it is right to conform to the usual custom in this regard. A dentist should discard glaring neckties, flashy breastpins, loud watch-seals, brilliant rings, fancy canes, cologne, perfume, and attitu- dinizing. All kinds of rings are worn by men, except cluster rings. These are worn by women only. Scarf rings and collar-buttons with settings are in very bad taste. Diamond studs are not worn by men of the better sort, even when in evening dress ; diamonds are considered vulgar and ostentatious. Three studs in a shirt are to be preferred to one. A single stud is considered inartistic. Fashion changes in jewelry as it does in all things else. Imitation diamonds, or imitation jewelry of any kind, is the extreme of vulgarity, and no man of sense would think of wearing imitation diamonds. Horse-jockeys sometimes wear diamond breastpins. In full evening dress white enamelled studs are to be preferred to diamonds. Scarf-pins are usually worn on Ascot, Claudent, and puiT scarfs; they are also allowable in four-in-hands. Men nowadays, with a few exceptions, wear the hair very short. It is believed that the most artistic cut is that which trims the hair very I06 THE PRACTICE BUILDER short on the sides and back of the head and leaves it comparatively long on the top, for the reason that a high head is always more pleasing than a low, broad one. The part may be as high up as one chooses to have it, but the hair should never be parted down the back of the head. A lock of hair should not be plastered down on the forehead, unless one wishes to use a bartender or waiter as a model. Hair-oils and other like inventions of the barber are no longer in good taste. A full beard properly trimmed and otherwise well cared for is be- coming to most men. A beard reaching down over the chest, or a mustache that is so long as to be in the way, is disgusting to everyone but the owner. If a man shaves a part of the face only, it should be that part that is most prominent; for instance, a man with a prominent chin and sunken cheeks should shave the chin and allow the beard to grow on the sides of his face. A man with a retreating or light chin should, on the contrary, shave his cheeks and allow the beard to grow on his chin, so that regularity of outline to the face is preserved, no matter how the beard is worn. Many men indulge in eccentricities in the matter of trimming their beards — in training the mustache, for instance, after the man- ner of the grenadier. Coloring the beard is in extremely bad taste, and he who does it succeeds only in making himself the subject of vulgar comment. The natural color is always best suited to one's com- plexion. Dentists should be shaven every day; if it is not convenient for them to present themselves at the barber's, they should learn to shave themselves. No one looks at all neat with a two days' growth of beard on the face; a dentist should be especially careful, because he is so continuously in the presence of ladies ; he should take as great care that the face is smoothly shaven as that the hair is brushed. Those men who do not attend to having the hair frequently cut, who do not keep the face clean shaven, and the teeth clean, are not wel- come in the society of ladies, should they happen to know any; and, while they may be received by women of the lower orders, women who are ladies are repelled by men who do not have the appearance of being neat in their persons; ladies may often tolerate such men, and, in fact, THE PRACTICE BUILDER 107 are often compelled to tolerate them, but they usually do so with great reluctance but poorly concealed. There are dentists who do not seem to realize that they should be careful to keep the breath pure. It is surprising to note how many men have an offensive breath. No one should be more readily able to purify the breath and render it free from unpleasant odors. It is simply astonishing to know that some dentists go on day by day the victims of such a distressing condition, and that their patients should be compelled to submit to the same unpleasantness; indeed, a patient sometimes leaves the family dentist for no other, reason than that the breath was so offensive as to be simply intolerable, and ladies find it a matter of such delicacy that they cannot inform the dentist of the matter; yet the latter does not hesitate to have the patient rinse the mouth when the possessor of odorous respiration. In the dentist the condition may arise from a disordered stomach, or from lack of careful attention to the mouth ; with dentists, however, the former is generally the case. Proper attention to the general system will of course remove the cause. The breath should be made the subject of the most careful attention, because it is something which is so instantly noticeable; a few crystals of the permanganate of potassium in half a glass of water will usually be found sufficient to remove any taint which is not caused by a systemic indisposition. The small amount of salivary calculus that is found in the mouths of most people is a frequent cause of the peculiar odor associated with such deposits, and dentists, above all others, should see to it that not the slightest portion is adherent to the teeth. Being present in the office of a prominent dentist in a large city one day, we were dumfounded, on approaching closely to the operator, to become aware of the most sickening odor to his breath; so extremely disagreeable was it that we could not help wondering how he could hold his practice and be so utterly regardless of so personal a matter; but the same condition was noticeable during frequent visits to his office. When so little attention is necessary to be bestowed, it would seem that everyone should study to avoid a condition so disgusting. The nails should be kept moderately long — very short nails have a plebeian look — and be so cut that they are a little more pointed than the I08 THE PRACTICE BUILDER upper end of the nails are. They should not be scraped, and in cutting care should be taken not to encroach too much on the angles. Either of those practices may in time result in injury; the nails cannot be kept in good shape without using a file. Of course, the nails should be kept scrupulously clean. Sometimes men who have to do their own laboratory work, such as polishing plates, crowns, and so forth, and use for such work oil, pumice, or rouge, cannot help a condition of grime or chapped hands, and sometimes a soiled appearance at the finger-tips, under the nails, which it is almost impossible to remove without scraping away the tender skin beneath the nail. When this condition occurs, it is well to remark it before the patient, explaining that it is caused by the materials used in the work referred to, and that it is almost impossible to remove it ; but, when this condition obtains, the hands should be given a thorough washing in soft water, and carbonate of soda should be freely used; the hands should be partially dried, and glycerine and rose-water applied and well rubbed in; then rinse in clear, cold water and wipe dry. This leaves the hand perfectly clean and soft and promotes healing. When a cane is carried, one should be selected that is strong, stiff, plain, light, and small. Ycry large canes are in very bad taste, especially for young men. We close with a few hints concerning men's dress. A full-dress suit consists of a swallow-tailed coat, a low white or black single-breasted vest, black trousers, a white necktie, a standing collar, a high black hat, and a pair of very light kid gloves. This dress should never be w^orn until evening; never previous to the dinner-hour, regardless of the occasion. A white necktie should never be worn except with a full-dress suit, save by clergymen and a few elderly men who never wear any other color. Many men wear these ties every day, with a large expanse of shirt bosom, low-cut vest, and usually select a tie that is ornamented with more or less of fantastic tracing. These persons are usually such as have been brought up in agricultural districts, or are not accustomed to the best usages — men who are not happy unless they make donkeys of themselves in one way or another. Black trousers should not usually be worn except with a dress coat. THE PRACTICE BUILDER IO9 A high hat should not be worn with a sack coat, especially if the color is light. A low hat should not be worn with a long coat — a double- breasted frock, for example. Straw hats should not be worn except with light summer suits. Dark suits are to be preferred for Sundays, especially in the city, and light suits should not be worn to church anywhere. Double-breasted frock coats should always be of black or gray material. Men who have attained to lucrative practice, in both large and small cities, are found to be men who use the best taste in dress, who are well groomed, and have the easy air of one who does not realize that he is well dressed, and who does not notice that he is better dressed than most men. They are men who have used good judgment in the selection of their tailor. It will never do any dentist harm to be known as the best dressed dentist in the city; the best dressed — dressed in the best taste. " Costly thy habit as thy purse can buy, But not expressed in fancy; rich, not gaudy, For the apparel oft proclaims the man." Introduction to the Public " W/iaf began best can''t end worst " The question of a youngs man's introduction to the pubHc is at times one which requires most careful consideration, especially if he enters practice in a large city. In the small cities this is a comparatively easy matter, for in such places it is permissible to insert in the papers among professional cards the announcement of one's having entered the prac- tice of dentistry in the community. In announcing himself as prepared to receive patronage, many a young man makes a serious error in the mediums which he employs. While the code of ethics does not recog- nize advertising, we are convinced that opportunities afforded beginners for introducing themselves are not sufficiently liberal. A man may use the cards in the papers, and yet people may not know at the end of the year that he is in town. This is due to the fact that the space in which professional cards are printed is usually in the least prominent portion of the paper, and the cards are printed in a uniform style. Further, those who use professional cards in the papers are compelled to pay prices which are out of proportion with their power of attracting attention. The plain statement of the situation of the office, and the hours of work of Dr. Blank, is not sufficient for a stranger in a city. He has a right to indicate his distinguishing qualifications, and, if he is engaged in special work, he has a right to state the fact, and to state it in a space and style that will attract attention. Admitting that the purpose of placing a card in the public prints is to gain publicity, there can be no wrong in giving it such publicity as will repay the outlay. In order to distinguish himself from frauds, it behooves the regularly graduated man to indicate in his announcement that he is a graduate and qualified by a college training for his work. In most towns of average size there are from one to three dailies, IIO THE PRACTICE BUILDER III and sometimes these dailies publish weekly editions. Each of these papers has its regular professional columns, its " space " advertising, and its " locals." These last are short squibs of news on the local news page, close to the personal columns, wherein are recorded the doings of the citizens. Advertising leads to the employment, sometimes, of exaggeration of statement and to the presentation of claims that are not strictly in accordance with professional conduct. There is not one dentist in five thousand that advertises that understands how to advertise, when to advertise, what to advertise, and when to stop advertising. This is a bold assertion, but it is one that is warranted by the facts in the case. In proof of the statement, it is only necessary for any interested person to look at the advertisements of dentists as they appear in any of the publications in which they are printed — daily papers, theatrical pro- grams, or other mediums of whatever kind. If this advertising were improved, and the unsightly cuts of plates and other appliances, to- gether with the pictures of the advertisers removed from the ads, and less space used, dental advertisements would not have it said of them as it is said now that " they are the poorest ads in the papers. But first let us consider the space or announcement card. This may or ma}' not be placed among the professional cards, at the discretion of the user. As a rule, the professional cards in the average newspaper are the most battered-looking " ads " imaginable. The type has been used so long in most instances that the small type is read with difficulty. Care should be taken that the notice is not placed next the patent medi- cine " ads," with their eye-catching headlines, such as " Nearly dead; " " Saved from the grave; " " Thirteen doctors gave her up; " " Had con- sumption three times; " " Hood's Sarsaparilla saved my life — loo doses one dollar; " nor next to the liver regulators and patent pills, for the reason that they are set up by experts and are so constructed that they attract the attention of the reader at once, thus detracting from the ordinary " ads " in the neighborhood. The special inducements and the low prices quoted should never form a part of the dental advertisements. The proper size for an introductory " ad " should be about a two or a two-and-a-half-inch single column, and may be worded in any one of half a dozen ways, samples of which we show in the following pages : $ 5 Dentistry I A. B. Blank, D.D.S., a reg- J f ular graduate in dentistry of £ ^ tlie College of Dental £ I Surgery, has established an -^ I office at 202 Main Street | f (over Jones' Drug Store). ^' f^ Dr. Blank is prepared to per- * /. form all operations in den- f 5! tistry according to the most | 9 recent modes that prevail £ 9 among representative dentists 'I of the country. )'^r»5'^»i'fe»;"'yr»i Dr. JI.B. Blank Dentist Late of the American College of Dental Surgery, Chicago, has located in Smithton for the practice of his profession. Dr. Blank is a Q:raduate in Dental Surgery of the above named institution, and is pre- pared to perform all opera- tions relating to dentistry. Office, 72 main Stmt OfRce Hours, g a. m. to 4 p. m. Modern ! Dentistry 1 A. B. BLANK, aas. OmCE, 42 MAIN STREET Opera House Block. A Graduate of the Chicago College of Dental Surgery. I Formerly associated with Dr. I A. B. Smith, 1209 Wabash I Avenue, Chicago. All opera- I tions pertaining to modem I dentistry performed according I to the latest methods used in I the large cities. I Dentist Has established himself at 247 Main 5t., Howe [5lock, where he is prepared to perform dervtal operatioas according to the latest scientific methods. Dr. Blanti mattes a specialty of cor- recting irregularities of the teeth, in which branch he has attained considerable skill. THE PRACTICE BUILDER 115 A. B. BLANK, m. A recent graduate of the Baltimore College of Dental Surgery, IS ESTABLISHED AT 227 Main Street All operations performed accord- ing to the latest methods. Special attention given to the painless extraction of teeth by use of gas and local anaesthetics. Few dentists have an idea how an advertisement should be set. This is because they do not understand type and display. In sending " copy " to the paper, a few words on an extra piece of paper, " To the Printer," explaining to him the effect you desire to get, will aid in hav- ing it prepared properly. In the samples which we have given, it will be noticed that certain words are made more prominent than others. Thus, in the first plate " Dentistry " is the most prominent, because the " ad " is about dentistry. In the second plate " Dentist " is made prominent; in the third " Modern Dentistry "; then " Dr. A. B. Blank, Dentist "; then A. B. Blank, D.D.S.," etc. From one-third to one-half the space should be given to these headings, and for an " ad " of this size the type should be what is known as 24 point, and may be any one of the following styles : Gothic, Ronaldson, Elzevir, Jenson Old Style, De Vinne, Erratick, Virile, Columbus, Rowland, American Old Style, Lippincott. ii6 THE PRACTICE BUILDER The body, or reading matter, should be in ten point or twelve point type, and may be in any of the following styles: Old Style Roman, Elzevir, Gushing. Thus we see that those words which are intended to convey an idea of what the " ad " is about are made to stand out most prominently, occupying, as they do, a large part of the space. It is also advisable, when procurable, to use a border to set off the " ad " to good advantage. Nowadays nearly all printing offices have borders in their type cases, so that a suitable one can be had. But where the general make-up of the paper is behind the times, it is better to use no border at all than one that is inartistic. Where a border is not procur- able at the office, one can be extemporized by the use of brass rules. This is done by using two or three rules all around the " ad." A few words of instruction to the printer will suffice. Sometimes attention may be called to the space " ad " by the use of " locals " for a few days, until it has been seen often enough to let the people know that the new dentist is ready for employment. A few sample "locals," suitable for such cases, are here introduced: Attention is called to the advertise- ment of Dr. A. B. Blank, Dentist, which appears in another column of this issue. An announcement by Dr. Blank, who located here recently for the practice of dentistry, may be seen by reference to our advertising columns. We refer our readers to the announce- ment of Dr. A. B. Blank, which appears elsewhere in this issue. Dr. A. B. Blank, Dentist, addresses himself to the people of Smithton in this issue of our paper. Read tli^ notice. Dentistry has another able represen- tative in Smithton. We refer our readers to the announcement of Dr. A. B. Blank, in this issue. We take pleasure in introducing through our columns, Dr. A. B. Blank, who recently located in our city. His announcement may be seen in another column of this issue. THE PRACTICE BUILDER 117 Dr. A. B. Blank, a young gentleman possessed of superior qualifications as a dentist, announces his name and location in our columns to-day. A new name is added to our list of professional men. It is that of Dr. A. B. Blank, Dentist, whose card may be seen in to-day's paper. Dentistry receives another addition to its ranks in our city, by the arrival of Dr. A. B. Blank, whose announcement may be seen in our professional cards to-day. An introductory advertisement is in- serted in our columns to-day, having reference to Dr. A. B. Blank. Special attention is called to the an- nouncement of Dr. A. B. Blank in this issue. The gentleman makes a specialty of correcting irregular teeth. Dr. A. B. Blank, whose announce- ment may be seen in another column, is specially prepared to perform opera- tions in Crown and Bridge Work ac- cording to the most approved methods. The saving of the natural teeth is an important matter. Dr. A. B. Blank's advertisement in this issue will be read with interest. Painless operations in dentistry are certainly a boon to mankind. Dr. A. B. Blank, whose notice may be seen in this paper, makes a special feature of these operations. Besides the use of these " locals," there is another effective method of gaining the attention of the public. This is by means of a special " write-up," which may be written for the dentist by a reporter, or by the dentist himself. We give a few samples as guides in writing them, or as helps toward instructing the reporter as to the ideas to be con- veyed. These " write-ups " should not be used more than once in the ii8 THE PRACTICE BUILDER same paper, and, if the idea is to be used in another paper, the style of the matter should be so changed that it will appear to come direct from the paper. The "locals," in the same manner, should be dropped just as soon as their purpose is served. A fair sample of the " write-up " is as follows: ANOTHER DENTIST. Dr. A. B. Blank, a gentleinan re- cently located in our city, was visited by a reporter for the Times at his office over Jones' Drug Store. Dr. Blank's office is equipped with all that modern dentistry demands of its practitioners, and the gentleman himself, we learn, is possessed of the highest qualifications for the pursuit of his vocation. Dr. Blank comes well recommended as a careful, painstaking gentleman, and we bespeak for him on behalf of the citi- zens of Smithton, a hearty welcome. We recommend the gentleman to those who are in need of superior dental ser- vice. GROWING. It may surprise many of our readers to know that in the last three years the gain in the population of Smithton has been nearly three thousand (3,000). This is very gratifying, and our citizens should feel a pride in the fact of our city's attractions to those in other places, for be it known that few cities of its size in the State have such an increase in population to show for the same space of time. When you see professional men enter- ing upon the practice of their vocations in a city already well supplied with talent, it is an evidence of growth and of the need fo'" professional service. Among the most recent additions to our colony of professional gentlemen is Dr. A. B. Blank, a dentist of ability, who comes to us with credentials of the very THE PRACTICE BUILDER 119 best kind. Dr. Blank's office is over Jones' Drug Store, and we need only say that if the gentleman's patronage equals his right to merit it he will have more than he can attend to. ONE MORE. Smithton has for several years en- joyed the reputation of having some of the best dentists in the State. These gentlemen have pursued the even tenor of their way, secure in the confidence of their patients and happy in the posses- sion of lucrative practices. That they are popular men is attested by the re- spect in which they are held by the com- munity at large and by the members of the other professions. Recently a new candidate for popular favor has appeared in the person of Dr. A. B. Blank, a gentleman possessed of high professional attainments and skill. Dr. Blank comes to us from Boston, in which city he secured his professional training. The Doctor is in possession of the highest documentary evidence of his thorough preparation for his life work, and has supplemented this by associating himself with men whose reputation is world-wide and whose prominence in the ranks of dentistry is evidenced by the distinction which they enjoy among the dentists of the world. Dr. Blank is prepared to perform the most difficult operations according to the highest standard of excellence which prevails in the large cities. AN ADDITION. Smithton has recently received a not- able addition to its already well repre- sented corps of competent dentists, in the selection of our city for his profes- sional life by A. B. Blank, D.D.S. Dr. Blank is a regular graduate in dentistry of the American College of Dental I20 THE PRACTICE BUILDER Surgery, and the evidence of his ability is attested by the diplomas and certifi- cates which adorn his walls. His train- ing, it is very evident, nas been of the most thorough character. His office is completely equipped with all the essen- tials for performing the best quality of dental work, and we have no hesitancy in commending the services of the gen- tleman to our best citizens. HE IS WELCOME. It is said that every year there are graduated from the Dental Colleges in this country 1,200 dentists and that there are already in this country over 25,000 in active practice. Where the extra 1,200 go to every year is, it would seem, puzzling; but this is a great country, and it is growing at such a rate that by the time another 1.200 are graduated the population of the country will have in- creased enough to need them. Smith- ton's dentists have always appeared to enjoy large practices, and we hope they will continue to do so. Recently we noticed that a new aspirant for public favor had appeared in our city. The gentleman is Dr. A. B. Blank, a young gentleman lately graduated from the American College of Dental Surgery, and whose credentials are Ai. A re- porter for the Times called at the com- pletely equipped office of Dr. Blank, a few days since, and was impressed by the appliances and instruments which comprise his outfit. If thorough train- ing, perfect appointments, and love for one's work are any evidence of success, then we extend to Dr. Blank our most hearty congratulations, confident of his ability to please the most exacting of our people. His office is conveniently located over Jones' Drug Store, where he may be found from 9 to 4. THE PRACTICE BUILDER I2r These means, it will appear to our readers, can only be employed in the smaller cities, ranging in size from 2,000 to 25,000 or 50,000. In larger cities one would have to employ other means to give the people notice of his entrance into practice. In cities with a population of 50,000 to 100,000 it is usual for dentists to have their offices on the most prominent streets. Where the office is well located a transient patronage will be noticeable from the start, and the individual can use the means suggested further along in this work to extend his connections. Where one is a stranger in a city, he is at very great disadvantage, because of his lack of acquaintance. If he knows several people and is in good favor with them, he has at once their influence and their good-will. He must content himself with the rather unconsoling fact that a dental practice in a large city is a mat- ter of very slow growth. In a very large city, where the offices are usu- ally in the residence district, the dentist cannot expect to attract to himself any but those who reside in his immediate vicinity; and he is supposed to have used good judgment in locating, in the recognition of the need for a dentist in that locality. In the small city the people are aware of all that goes on in the community, and, if a new sign goes up for a physician or a dentist, everyone knows it forthwith. The conditions widely differ, and the means to be employed to introduce a dentist to his community must be adapted to these varying conditions. One of the most effective means in either large or small cities is the invitation form. This is sometimes used by those engaged in mer- cantile pursuits, as well as in professions. For the use of the dentist it cannot be too tastefully arranged. The printing cannot be too good and the style and quality of the paper cannot be too elegant. We do not wish to convey the impression that ornamentation of an expensive kind is necessary, but that plainness and quality are very desirable. Invita- tion forms, which are always printed upon double sheets, are to be had in any printing office; but, when the purchaser sees that the quality is not the very best, he should insist that some be ordered for his special use. The subject matter will, of course, be brief and to the point. It is not intended to convey anything further than the fact that the 122 THE PRACTICE BUILDER person sending it is to be found at an indicated place, and what his business is, and his office hours. We give, in the following pages, a few samples of invitations, which are intended to serve merely as guides, in composing the matter, to those who propose to use this form, and they can change them to suit their own ideas. The dentist should not, however, send these invita- tions to any persons except those of his acquaintance, and he should be careful not to send them to those whom he knows to have a special pref- erence for another dentist, for such things make more trouble than most men recognize. JBgcon : " "Cbfs is tbe flovper tbat smiles on ever^jone, Uo sbow bis teetb as vcbite as vobaU's bone." love's Xaboc Xost : V. 2. (%tthuz SB. EBLank, 3). 3). S. taked pleaMize in Infotming hid fziendd that he marj be found at 14^^ Joocudt (^tteeto whete he id ptepated to petjotm all the opezationd of modezn dentidtty with dhill and pzecidion:^ i^Ql Jjocudt Stzeeto cJUSazch 1, i8q8 Announcement Form. Should be upon double sheet. ANTONY: " When the best hint was given him, he not took't. Or did it from his teeth."' Antony andCleofatra: III.i 4- nrHOPOUGH professional train- ing, practical experience and [)roperlv appointed office and appliances, warrant me in as- seiUng \vn fitness for the per- formance of high-grade dental worh. A. B. BLANK, D.D.5. 1427 Locust Street. narcrv I, 1595. Announcement foirn. Should be upon double sheet Lafen: "Til love a maid the better, whilst I have a tooth in my head," —All's Well, ii., 3- I DO HIGH GRADE DENTAL WORK. I DO NOT DO ANY OTHER KIND. I CANNOT AFFORD TO DO GOOD WORK AT A POOR PRICE. I CANNOT AFFORD TO DO POOR WORK AT ANY PRICE. I HAVE THE BEST OF TRAINING. I HAVE THE BEST OF INSTRUMENTS. I HAVE A COMPLETELY EQUIPPED OFFICE. I AM LOCATED AT 1427 LOCUST STREET. I AM A. B. BLANK, D.D.S. HOURS 9 TO 4 O'CLOCK. MARCH 1, 1898. Invitation Form. Should be upon double sheet. 6aolcrt "Tndced, sir, be tbat sleeps feels not the tootbacfte." — Cymbeline: v., 4. Even $0 small a tbing a$ a tootb 1)d$ caused Generals to lose battles, ministers to lose tbe threads or their discourses, Philosophers to cease philosophizing, and Poets to write drivel instead of elegiacs. flrtbur B. BlanK, d.d.s. 1427 Cocust street. Smitbton, l)Ours, September i, i$9$. 9 to 4 o'clock. Announcement Form. Should be upon double sheet. **A diamond is not so precious as a tooth.** — Don Quixote. A beautiful set of teeth has often been worth more to a lovely woman than a good many diamonds. Dr. A. B. BLANK MAKES A SUCCESSFUL SPECIALTY OF SAVING THE NATURAL TEETH. His office is conveniently located at \427 LOCUST STREET, Over Jones* Drug Store. Office hourst 9 to 4 o*cIock. Smithton, October I, 1898. Announcement Form. Should be upon double sheet. "petbaps Bou'll nceD me During '98" / am a regularly graduated Doctor of Dental Surgery, having gradu- ated from the American College of Dental Surgery. My office is conveniently located at 1427 Locust Street. I am prepared to peiform all the operations required of the most competent dentists. My office hours are from g to 4 o'clock. My fees are reasonable, and my work skilfully performed. ARTHUR B. BLANK, D.D.S. March i, 18^. Announcement Form; Should be upon double sheet. Coriolanus : "'Bid them ■wash their faces. And keep their teeth clean." — Coriolanus, ii., 3. i::Z'-f-ly& dipping a nerve broach into it, a sufficient amount adheres; the broach is then carried into the canals, decomposition takes place at once, the contents of the canals are saponified, and to some extent expelled from the canals. The canals are then simply washed with warm water and dried, when they are ready for filling. Sulphuric acid, for gaining entrance to small canals, in twenty-five to fifty per cent, solution, was introduced by Dr. Callahan. It is also used for discovering canals that cannot be found in the ordinary way. For this purpose seal the acid on a pellet of cotton in the cavity for twenty-four hours, then remove, and the cavity w^ill have a bleached appearance and the small canals present small dark spots. These may then be probed and a little acid worked up into the canal on a small broach; then, with a small broach or a small reamer, the canals may be enlarged. Salol, as a root canal filling and pulp capping, was introduced by Dr. ]\Tascort, of Paris. Salol is a compound of salicylic acid and phenol, containing about forty per cent, of the latter. It is THE PRACTICE BUILDER. 213 a white crystalline substance, somewhat resembling fine common salt. It is an antiseptic, non-irritant, and non-escharotic. Salol has been used as a root filling for several years. It is used by first melting it, and then with a warm hypodermic syringe have a fine needle, inserting the needle as far as possible and injecting the salol, and then slowly with- drawing the needle and at the same time keep injecting the salol; capil- lary force will hold the liquid salol in position until crystallization takes place. In fusing the salol no more heat should be used than just suffi- cient to melt it, else crystallization will be delayed. Trichloracetic acid is used principally in the treatment of Pyorrhoea Alveolaris; after the deposits have been removed and the pockets flooded with a three per cent, solution of Pyrozone, the acid is then introduced into the pockets of the teeth by means of the hypodermic needle, or by the use of a wooded toothpick. The remedies available for our purposes are innumerable. A thor- ough, minute knowledge of all of them is very desirable, but not essen- tial. The principles governing their use are comparatively few, but the thorough mastery of every one of them by him who wishes to be competent is absolutely indispensable. To apply remedies without knowing why is like shooting at a target in the dark — very apt to go wide of the mark and do no good, if, indeed, no harm result. To apply remedies intelligently requires, first, a mastery of the general principles of therapeutics; next, a comprehension of the pathology of the case. A thorough knowledge of a few well-selected remedies is better than. a flippant familiarity with many. Antiseptic Dentistry "New disccn'eries teach new duties'''' The facts established by scientific research in dentistry have com- manded the earnest attention of the profession, especially as these relate to the modes of treatment wherein antiseptics play an important part, and to phases of practice wherein sterilization may be employed. Nothing that a dentist can do can clinch the confidence of his pa- tients more firmly than an eternal vigilance in everything that relates to the cleanliness of himself, his instruments, and the thoroughness of his operations wherein the employment of cleansing agents may be necessary. Among the essential aids to the successful practice of antiseptic den- tistry, the following suggestions are offered as affording a groundwork upon which to begin: If water pressure be available, there should be a fountain cuspidor; if not, then a nickel-plated one, kept partly filled with water, and cleansed after each patient's use, and daily scalded, should be em- ployed. Hot water, always ready for use upon instruments, and for cleansing the hands of the operator, should be convenient. There sliould be at all times an abundant supply of napkins and towels, and these should be used liberally with all patients; no partiality should be practised in ihis matter of cleanliness. There should always be a clean napkin on the bracket upon which are laid the instruments, and this should be changed often. Many dentists use merely the cloth cover of the bracket, which becomes stained and saturated till it is filthy and imfit for use. An indispensable convenience for purposes of cleanliness consists in the use of three- or four- inch squares of bleached muslin. In remov- 214 THE PRACTICE BUILDER 215 ing tartar, or treating a case of Pyorrhoea, one of these squares is held in the left hand, to hold the lip, and when the instrument needs wiping it is used for that purpose, and consigned to the waste basket and fire. Using them for wiping burs and excavators, for stripping soiled cotton from broaches when cleansing pulp-canals, for absorbing blood, etc., laying hold of loose pieces of amalgam or tartar in the mouth, receiving the tooth just extracted, wiping the mouth-mirror or the hand-glass; also use them with a little alcohol or chloroform to cleanse the points of the pliers when gummed with sandarac, for removing dirt from the engine hand-piece, etc. A great convenience consists in a number of small cups or jars for holding burs. One is able to keep them assorted, and to use only those which are clean. As a rule, when a bur has been used once or twice its glory has departed, and it should go at once into the waste box, kept for those which may be worth re-sharpening. On the bracket, too, should be a receptacle for burs which have just been used, and which one may wish to use again after they have been cleansed and disinfected. All burs, when received, either new or re-sharpened, should be given a coat of some disinfectant oil, for insurance against both rust and infection, and the rule applies equally to excavators, scalers, forceps, clamps, etc., which, after cleansing, are put in place to await use. A simple and convenient device for the use of heat to clean instru- ments is the following: Take a small tin or copper tea-kettle having a straight spout. Have a tinner attach to the lid two or three tubes an inch in diameter, and long enough to reach nearly to the bottom. These, closed at the bottom and opening outward, may be used for dry heat or oil, while all the long instruments may be dipped in boiling water through the spout. Any sort of small burner will keep the water at the boiling point, with but little trouble or expense. A special apparatus has been designed for the purpose of steriliza- tion. It is known as the " Sailer Sterilizer," designed by Dr. Z. T. Sailer, of New York, and is for sale by dealers. It is primarily a steril- izer, but also keeps douche-water for the mouth at proper temperature, as well as gutta-percha, mouth mirrors, oil of cajeput, or any medi- cine which mav be desired for use in the mouth or on the teeth. It 2i6 THE PRACTICE BUILDER also has an apartment with hot water for softening modelling com- pound, and an apartment in which to keep instruments for working gutta-percha at an even temperature. An inexpensive apparatus for sterilizing instruments, costing not more than fifty cents, is described as follows: Take dry sand, bake and sift, procure a candy jar (one with a large mouth is best), and fill about two-thirds full of the sand; saturate the sand with a one per cent, solu- tion of Trikresol, and you have your apparatus complete. To disinfect an instrument, plunge it into the sand, letting it remain a few moments, the sand mechanically cleansing it; remove the instrument, wipe off the sand, and it is thoroughly sterilized. The following is a sterilizer for burs: Take one-half drachm of pure Trikresol, and place in a small or glass salve j-^r, filling the balance of the jar with oil. To sterilize a bur, first clean with a bur brush (which should be on every dental engine), then drop it in the jar, letting it remain until you have completed your operation; then remove and wipe off the excess of oil ; the small amount of oil that remains on the bur-shank serving to keep the hand-piece of the engine well oiled. It has been shown by tests and experience that the caustic alkalies, as well as their carbonates, possess marked germicidal properties. One of the most manageable and satisfactory agents is liquor ammon. fort. Instruments soaked for a few minutes in a rather warm aqueous solu- tion of ammonia are most beautifully cleansed thereby without detri- ment to their polish or temper. The advances made in antiseptics, so far as they relate to treatment of diseased conditions of the teeth and jaws, have been so great and rapid, and the journal and book literature treating upon this subject has been so prolific in scientific articles of merit, that we refer our readers to them for the most recent deductions. History is being made so rapidly in this branch of practice that we prefer not to oflfer any observations relating thereto. New remedies are adopted with such frequency that what is new to-day may almost be said to be old to- morrow. Any man engaged in building his practice and extending his reputation cannot fail to see the need for keeping in close touch with all that pertains to the systematic treatment of pathological conditions by employing the most recent preparations for such use. Local Anaesthetics " Dull narcotics, numbing pain " No other article in demand by the dental profession has been sub- jected to the attention of such a horde of fakirs as has the local anaes- thetic. Beginning ten or twelve years ago, these fakirs circularized the entire country with printed matter concerning the virtues of their won- derful preparations. Being an article for which the dentist had constant use, a large amount of money was made by many of these persons. The news soon spread, and shortly the dental journals had more ad- vertisements of local anaesthetics than of any other specialty. At that period the local anaesthetic was prepared very differently from the. present manner. The proper amount of cocaine to be used had not then been clearly established, consequently its introduction was accompanied by many unfortunate circumstances. The large percent- age of cocaine used was out of all proportion to the requirements. The nervous systems of patients were affected, and there were more local manifestations of extreme pain, swelling, and sloughing of the gums. With a more scientific compounding of preparations, successful ex- traction of teeth without pain was accomplished. At the present time less than one per cent, of cocaine, in combination with other appropriate ingredients, is considered an amount sufficient to secure the best results, and to obviate dangerous manifestations. There are several very good anaesthetics on the market in which no cocaine is used. One of the least commendable features in the sale of these prepara- tions was the practice of selling exclusive city licenses, with a certain amount of the anaesthetic, or at a certain price irrespective of the quan- tity of the anaesthetic bought. Following the exclusive right feature, a premium was offered to 217 2i8 THE PRACTICE BUILDER all purchasers of stipulated (|uantitics. Those premiums were of great variety; some offers included au ounce of cement, some a set of teeth, some a hypodermic syringe. But the acme of audacity was reached by the individual who offered to every purchaser of his anaesthetic a cer- tificate so nearly like a regular diploma as to deceive anyone not familiar with the ai)pearance of diplomas. The circular stated that this would be a great advantage to such dentists as had never attended college. Nearly all the circulars issued in behalf of these local anaesthetics made the most positive statements that the anaesthetic contained no cocaine. Analysis by experts revealed the fact that nearly all of them depended wholly upon cocaine for their effect. When such disregard for truth is practiced, it is small wonder that the journals should wage war upon the vendors. It has been suggested from time to time that there should be some legal restriction against the manufacture and sale of these anaesthetics, when it is so well understood that their claims rest upon so poor founda- tions. More than this, laws should be directed against the horde of incompetent men who travel about using medicines whose ingredients are not understood by them, and whose knowledge of physiology, pa- thology, therapeutics, and materia medica is usually of the most rudi- mentary nature. The deceptions practiced upon the public have been both glaring and numerous. Some restrictive measures should be adopted to rid the profession of these pests. All these facts being admitted, it cannot be denied that the local anaesthetic has come to stay. The local anaesthetic, properly com- pounded and properly used, will be productive of good results. Thou- sands who would not take gas are thus handled with satisfaction to themselves and with credit to the dentist. Thousands of people, suffering the tortures of the damned with their decayed and broken- down natural teeth, have been enabled, by use of local anaesthetics, to have them removed and artificial ones inserted. Many other uses besides the extraction of teeth have suggested themselves to prac- titioners, such as obtunding both external and internal parts of the tooth. The local anaesthetic is to-day used in the highest class practices in the largest cities, as well as the smaller ones. General Anaesthetics " Sweet sleep ! whatever form thou takest, thou art fair " The employment of general anaesthesia in the performance of oper- ations in surgical dentistry has, with the advance made in the use of local anaesthetics, been, to a very great extent, abandoned. The use of Chloroform for the extraction of teeth was very general in the early days, and is still used in rural districts. The use of Nitrous Oxide has been responsible for the abandonment of Chloroform as an anaes- thetic in the extraction of teeth. Being safer by far, producing its effects in less time, and with no unpleasant manifestations, it is not strange that it should supplant Chloroform as a safe and reliable aid to the performance of the short operations of dental surgery. Chloroform is the most potent and agreeable anaesthetic, but the most dangerous, and is one at which death may occur at any and every stage of inhalation. Chloroform kills so suddenly that no skill can guard against a fatal result. Another disadvantage of Chloroform is its high boiling point, requiring a great amount of heat and vital force to exterminate it from the body, so that it is probably never entirely eliminated by the lungs, but only with the aid of all excreting organs. Almost all anaesthetics may kill during the first stage by asphyxia; the air may be highly charged, even saturated, with the agents; so much so that, owing to its pungency, it cannot be breathed, and, if forced upon the patient, stifles and sufifocates him in exactly the same manner as would sulphur burned under his nostrils; death would thus occur, without much of the anaesthetic having entered the lungs. Owing to the danger which accompanies its use, Chloroform should not be administered when other anaesthetics are available, or unless the circumstances are such that without it the shock of the operation might 219 220 THE PRACTICE BUILDER kill the patient. Chloroform can cause death at the first inspiration. Ether is less dangerous. It has been found that no anaesthetic is perfectly safe, under all cir- cumstances, in all conditions of health, or in the peculiar environment of all individuals. Children are no exception to this rule; healthy and well-nourished children, in well-ventilated and sanitary homes and hos- pitals, can inhale Chloroform with comparative safety. Those of deli- cate organization, or subject to constitutional diseases in which the lungs, brain, or abdominal organs are impaired, are not fit subjects for any general anaesthetic, but should be treated by means of a local one; or, when this is not possible, it is safer and better to use Nitrous Oxide. Out of twenty-seven cases of death by Chloroform, the cause of death in fourteen cases was given as collapse ; in two cases, shock ; one case, syncope; three cases, asphyxia; five cases, disease or paralysis of the heart, and two cases, chloroform poisoning. The dangers from Chloroform are so great that it would appear un- necessary to discuss the inadvisability of its employment by the dentist in small operations. The responsibility attending the use of anaesthetics is great, as frequently personal and professional reputation is at stake ; it is therefore always better, in the administration of an anaesthetic to a female, to have some reliable person present. This is especially necessary where Ether or Chloroform is employed. Ether, although much safer than Chloroform, finds little more to recommend it for the short operations which occur in an average dental practice. Its record is very much better than that of Chloroform, but the necessity for its use is not apparent in the great majority of cases. The action of Nitrous Oxide is prompt, effective, and is attended with slight discomfort, so that its employment where a general anaes- thetic is needed is to be commended. The training in the colleges of dentistry in anaesthetics and anaes- thesia is systematic and thorough; so far as we are able to learn, more attention is given the subject in schools of dentistry than in the medical colleges; yet it is suggested that a physician be present during the ad- ministration of general anaesthetics by dentists. The dentist's teaching in this direction combines all that relates to the manufacture of anaes- THE PRACTICE BUILDER 221 thetics, together with the diagnosis of such diseases and affections as prohibit their use. Added to this is the fact that the dentist is brought into daily contact with anaesthetics, using them, as he does, with great frequency, especially the Nitrous Oxide in tooth extraction. The dentist cannot afiford to use any anaesthetic, either general or Jocal, if it has a bad record or causes unpleasant effects, either systemic or local. Such things are exceedingly hurtful to a practice, and their occurrence with more than ordinary frequency cannot but be followed by unfavorable comments on the practitioner. Office Business Fittings " Mill of incthod and of system rule the 7uorld " The confusion that prevails in some dental offices in regard to con- venient means of arranging the business side of their work results in continually playing at cross purposes. Disorder is incompatible with any attempt at promptly or systemat- ically putting into execution any of the factors which we have mentioned as having a bearing on the prestige of the practice. These things can- not be effectively done without having a proper office equipment for the work. Few dentists seem to realize this fact. They go on from year to year, blindly self-satisfied to let the office run itself, and allow the little details which might be made powerful aids to personal advance- ment to be neglected or fall into disuse. Systematic men are always in closer touch with every detail than slip-shod, lackadaisical individuals who know little of their business except that on a certain day they are going to perform an operation for Miss Jones, and forget all about it after the work has been done, and know little and care less about the probable need for seeing it again to observe its condition. There are few dentists who have any conveniences in their offices in the way of business fittings, other than those which are afforded by small and poorly arranged cabinets and drop-leaf desks. These are wholly inadequate to the demands of any dental practice large enough to pay the office rent. A desk should be of such size as to accommodate all the books and paraphernalia. A large, well-made and well-finished desk adds a busi- ness-like air to the dental office. When people see an office fitted up 222 THE PRACTICE BUILDER 223 appropriately, it makes them think that the dentist has a good practice, and it looks as if he knew how to attend to his business. A roll-top desk is the most desirable. By merely letting the roll down, everything is out of view, and at the same time safely locked in place. A very desirable size for a roll-top desk is fifty-four inches long, thirty-two inches wide, and fifty inches high, thus allowing for a high roll. This also usually allows for a cupboard at one of the sides or back, wherein may be placed books of record which have been filled, but which must be at hand for reference. Such a desk can be had for from twenty to twenty-five dollars, but we do not believe they are usually for sale at furniture stores. They must be bought direct from the manufacturers. They are usually fitted with sixteen or more pigeon holes, and with several larger spaces where books of record may be kept. In the centre, between the pigeon-holes, are places for such papers, etc., as should be at hand for use, such as bill-heads and note-heads. Pen racks, paper racks, and drawers are usually fitted in the top part of these desks, and extension slides for writing are fitted in the front. Large, commodious drawers are placed in either one of the bases, some of which are fitted with suitable partitions, and here may be placed the cards mentioned in the chapter on " The Use and Abuse of Credit," also those mentioned in " Holding Patronage." The uses for the larger drawers will suggest themselves. There should be some adjunct for filing the invoices and such other papers as it is necessary to keep for reference. This is, of course, best done by use of separate files, keeping kindred matters by themselves. There should be one file for invoices, and in this appropriately indexed file nothing else should be kept but the bills rendered to the dentist. There should also be one file for letters, and in this should be kept the business letters of the practice. One file, labelled " Private," should contain personal matters of interest only to the practitioner himself. Another file containing matters of special interest, such as printed mat- ter, etc., should be labelled either " Special " or " Miscellaneous." One file should be kept for " Unfinished Work " or " Unanswered Letters." By this means, all papers relating to the business, as disinguished from those relating to patients, are kept in one department of the desk, where they are not in danger of becoming mixed with the others. 224 THE PRACTICE BUILDER In the ilesk which we use there are sixteen pigeon-hole boxes, twelve of which are fitted up with pigeon-holes, and four of which are used for envelopes. The pigeon-hole boxes are labelled with the name of what- ever thev contain. In one we keep the examination cards, which have been made out and placed in envelopes ready to mail the next month. In another the cement cards, made out and inclosed in their addressed envelopes, and ready to mail the following month. In another we keep such documents as insurance policies and the like. Another is used for miscellaneous matters that are too small to place in the desk files. The extracting slips which we record on the smallest examination blanks are also kept in one of the pigeon-hole boxes. As we till up our pocket note-books, we are in the habit of placing the filled book in one of the pigeon-hole boxes until such time as the matter can be separated and put on individual slips, and filed under their appropriate subjects in our portfolio scrap-book, in which are fifty separate envelopes, allowing for keeping several thousand notes on almost as many subjects. This is known as " Breed's Portfolio Scrap Book." and is made by the Bowen-IMerrill Co., Indianapolis, Ind. The price is three dollars. Then we have one pigeon-hole box labelled " Xotes," and in this we place such notes as we have made in the office during the day, on the small desk-pads always at hand. In another pigeon-hole box w-e keep natural teeth extracted from persons who intend to wear artificial teeth. An envelope bearing the person's name and address and the date on which the teeth were extracted, also the number of teeth, is sealed and placed in the pigeon-hole box until such time as the same may be needed for reference in selecting the artificial teeth. Where it can be aflforded, a copying-press and stand are useful ad- juncts to an office having a large correspondence. A large revolving, cushioned office chair is almost a necessity to one who uses an office desk. A pamphlet and catalogue file is a very convenient method of keeping all the catalogues and circulars. The most convenient and useful, and, in fact, the most indispensable adjunct to a desk, or which can be used without the desk, is a desk file; this is a specially constructed file for use on the desk, having its own case. It is of a convenient size, is beautifully finished in polished wood, THE PRACTICE BUILDER 225 and can readily be placed out of the way in one corner of the desk. This file is an essential feature of the system of examinations relating to the general examinations of the teeth of those under regular care, those who have cement fillings, and those who wear bridge work. This desk file is arranged with twelve indexed leaves, each one representing one month of the year. It is also indexed with thirty-one leaves represent- ing the days of the month. Between the days of the month are other leaves indexed with the letters of the alphabet. On all the leaves except those representing the months of the year are ruled lines so that the file may also be used for recording any special information. Thus we see there is in one file a complete compound indexed file in which may be placed all papers of a month, so conveniently as to avoid all confu- sion, and do away with spindles and other contrivances that are un- sightly and unsystematic, and that take up room. The uses to which this desk file can be put are as follows : Suppose, for instance, that March is the current month. We take the mail as it is received in the morning and put the invoices for goods bought, or other accounts which we owe, and place them in the March space. We take the letters from our correspondents, business or otherwise, and place them under the letter indicated by the letter-head. The sheets representing the days of the month are to be used for such matters as relate to the day of a month; thus some business which is to be at- tended to on the loth may be indicated by placing a slip in this date, or by writing on the ruled lines for this purpose. At the end of the month the bills are taken from the INIarch space, entered in the bill-book, checked, and transferred to their appropriate letter in the invoice file. The letters are likewise transferred to their proper letter in the file drawer marked " Letters." All other matters that do not come under the head of letters or invoices are likewise transferred to an appropriate file in the base of the desk. The notes made on the sheets representing the days of the month should be erased as fast as they are attended to, thus making the file ready for the next month. The special and most important use of this desk file is as a means of promptly and methodically sending out the examination cards and re- minder cards, shown in the chapter on " Holding Patronage." We, of 226 THE PRACTICE BUILDER course, get our list of names of those whose teeth we wish to examine from the operating record book, and place them in the examination book described in the chajiter on " Records." From this we fill out the cards with the names of the patients, and the lady assistant fills in the blanks with reference to date on which the last work was performed. The cards are then i)laccd in the index slips, which have the day of the month printed on them, at the proper date, which should be about ten days before the date on which the examination is to be made, so as to give the patient sufficient notice in advance. The reminder card should be placed in the index one day ahead of the date on which the examina- tion is to be made, so that it can be mailed so as to reach the patient the afternoon of the day before the teeth are to be examined. The same operation pertains to the examination of the teeth with reference to the cement fillings, that has been said of the examination cards and reminder cards. The reminder card for cement may be sim- ilar to that for examinations, or it may be different, as may seem best. Bridge work may also be examined at appropriate intervals by use of such cards, and after the same manner as indicated herein. W'hen there is a large amount of plate work done, the record of the extracting may also be written on a small slip, and this slip placed in the month in which the plate is to be made, say for instance, three or four months ahead; and when that month becomes the current one the slip is trans- ferred to the proper date and the patient notified by mail to call and have the mouth examined to see if it is ready to have the plate inserted. A dozen other uses for this file may suggest themselves to our readers. What we here offer has been used by us, and we have found it very convenient, and would not attempt to carry such details in the memory. By this method all worry is avoided. Everything comes be- fore one at just the right time. The desk which wc have mentioned can be bought for twenty-five dollars. The file drawers for the desk can be had at an additional ex- pense of five dollars, and in a special desk fitted for their use. The desk file for use with the record cards enumerated costs three and a half dol- lars, and can be had of the American Dental Publishing Company. The pigeon-hole boxes are furnished with the desk. A revolving chair can be had for about five dollars. When such a complete outfit can be had THE PRACTICE BUILDER 227 for such a very reasonable price, no one who appreciates method and system can wish to go longer without means of thus conducting his business in a business manner. With a desk fitted up as we suggest, a methodical way of thinking will result; or, rather, one will have more time to think and many valuable ideas may result. Try it. The 1 ypewriter and its Uses in Dentistry " A modern 7iecessiiy " At this late day any argument in favor of the typewriter as a labor- saving device is superfluous. It is too well established to need any introduction. Its employment is almost universal. No well-conducted business establishment can be considered up-to-date without it. Among the professions it is in use by ministers, to put their sermons in read- able shape, and by attorneys for all the work done by the hand and pen. By the medical profession its adoption has been less rapid, chiefly for the reason that the busy practitioner has little time for its use, except when an assistant is employed. Among dentists its use is as limited as it is in the medical profession, this being largely due to the fact that dentists do not recognize its helpfulness, rather than that it has no application to their work. The price at which a really good typewriter is sold has made its use by many dentists out of the question, but more recently the liberal terms which the manufacturers offer to responsible persons has made it pos- sible for many to purchase machines who could not otherwise afford them. At present the practice is to pay a portion of the price in cash and the balance in monthly instalments of five or ten dollars. New typewriters are to be had at from $8 to $ioo. First-class type- writers can be rented at from $3.50 to $5 per month. There are in several of the larger cities firms which make a business of buying, selling, exchanging, and renting typewriters, and anyone desirous of getting a good machine cheaply can do so with safety, as the firms are reliable and long established. Machines which are just as good as new are sold at a very great discount from their cost price, 228 THE PRACTICE BUILDER 229 and the highest priced and best makes can be had at from one-half to three-fourths of the price of the new machine. Where satisfactory ref- erences are given, a really good machine can be had at a very low figure, and payment can be made in such sums as will not inconvenience the purchaser. In many instances it is possible to have a typewriter arranged so that the symbols used in writing prescriptions can be attached to some of the keys. This is a decided advantage. In most of the " type-wheel " typewriters a special wheel is furnished upon which these symbols are cast. Where a lady assistant is employed, the typewriter will, of course, be attended to by her. All orders for dental goods should be written on the typewriter, using a copying ribbon, and copied in a letter copying-book. In this way a complete record is kept of every order, and mistakes are often prevented. Half letter-heads should be used to write the orders on, as they are better adapted to the copy-book. The correspondence should also be attended to by use of the type- writer, as it gives tone to the letters and is an indication of business and method. On the first of every month the bills should be filled out on the typewriter. It is much more effective than the hand-written bills, and is neater in appearance. Any articles intended for publication, or that are to be read before a society meeting, should be typewritten, as the clearness of print is an aid to one not thoroughly accustomed to reading from manuscript. Most dentists have a large number of receipts and formulae which are of value, and which should be preserved in better form than pen or pencil notes. The typewriter is of great assistance in printing these in such shape as will keep them permanently in legible style without danger of erasure or fading. In filling out the cards shown in the chapter on " Holding Patron- age," the typewriter is of great utility, and the work is much more effec- tively done than if the dates and names were inserted in handwriting. The lady assistant should be directed to look over the notes taken 230 THE PRACTICE BUILDER at college. Among these are always to be found some valuable pointers that one cannot afford to lose. A typewritten letter should accompany the first cards sent out, as mentioned in the chapter referred to, as well as one which should accom- pany " The American Dental Instructor " when it is sent. The Dental Journals " Mirrors that reflect progress " The establishment of the dental journal was one of the greatest factors in the advance of dentistry, and in giving to it a professional foundation. Prior to it dentistry was a trade, to follow which, in the minds of many, no special training was necessary. The dental journal changed all this, and afforded to the earnest practitioners of the young profession a medium for the interchange of thought and experience. The trade of dentistry was gone, and the profession of dentistry began. During the same year that the dental journal was established — 1839 — the first dental college was opened, and shortly after, the first dental society was organized. Thus the three elements of professional life, professional activity, and professional progress were contemporaneous and cooperative in giving to dentistry and to its practitioners a new standing in the eyes of the world, divorcing it from trade and em- piricism. Few of the dental journals of those early days are still in existence, but it is interesting to note that the first one established is still pub- Hshed — TJie American Joitrnal of Dental Science. There are now in the United States thirteen monthly magazines, three bi-monthlies, and six quarterlies. England has two monthlies and one semi-monthly. France has five monthlies. Germany has three weeklies, two monthlies, on bi-monthly, and one quarterly. Austria has one bi-monthly and one quarterly. Holland has one monthly. Switzerland has one quarterly. Sweden has one quarterly. Italy has one bi-monthly and one quarterly. Denmark has one monthly. Russia has one monthly. Spain has two monthlies. Norway has one monthly. Finland has one quarterly. Cuba has one monthly. Japan has two journals. The United States of 231 232 THE PRACTICE BUILDER Colombia, Soutli America, has one journal. Thus we see that the dentists in all parts of the world are properly represented by dental journals. The books and journals of a profession represent its literature. Books present maturer thought in more concise form. A great deal that is of little value finds its way into the journals. Many articles are mere impressions of the writer, upon some matter comparatively new to him, but which he deems to be of interest to the profession, and which he presents for consideration. Such articles may open up a profitable discussion. Tiic journal article is devoted to some single idea, some certain mode of procedure or manner of treating a certain condition. The books treat these subjects from beginning to end. The journal literature of dentistry is full and complete. Its object is to present, from month to month, the most recent thought and advance, but it requires the possession, on the part of the reader, of experience and judgment. Articles are presented which are either worthless or almost dangerous from the questionable position taken by the writer; experience is demanded of the reader, to prevent him from adopting the individual methods advocated, when such procedure w^ould not be sanctioned by practitioners in general or by the authorities of accepted text-books. It is not unusual to find the same article published simul- taneously in several journals, much to the chagrin of the several editors, who, of course, have not been informed at the time of the acceptance of the manuscript that the writer has forwarded his article all over the United States. It is absolutely necessary for every dentist who has the welfare of his profession, the good of his clients, and his own cultivation at heart, to subscribe liberally to the journals. To keep in close touch with profes- sional progress he should take six of the representative periodicals. It is to the discredit of many practitioners that their journals are received month by month without being carefully read. Not only should the articles be read, but some of them should be read many times. The growing man learns something from everything that he sees, does, or hears. Nothing can touch him which does not teach him. The power to grow is fed by nothing so much as by keeping one's mind open to ever>' possible suggestion from every possible source. Those who THE PRACTICE BUILDER 233 are satisfied with themselves and their attainments, lose a great part of growth because they are stung by criticism instead of being made in- telligent by it, and they shut themselves off from a thousand hints by resting content with their present achievements. The desire to know, and the stimulation which effective reading brings to one's desire, coupled with conscientious practice, is perhaps the most effective impulse to professional reading. The desire to know is the first element, and the conscientious service of our patients is the second, and this should grow in strength as we grow in knowledge, until the two become woven into a common sentiment, as the woof and warp in the fabric, that binds us as a bond of love to professional duty. What journals should a dentist take? He should take those that best represent dentistry. He should subscribe to the journals that keep in touch with every phase of modern dentistry. Each journal has its own distinguishing features. Most of our great journals are broad and national, or perhaps inter- national, in their scope. They reflect the thought of the dentists of America, and so reflect that which is conceded to be best in dentistry. We are of the opinion that the journals most valuable to practition- ers are : The Dental Cosmos, Items of Interest, The Ijtternational Den- tal Journal, The Dental Review, The Dental Digest, and one other, which should be a local journal. The Cosmos is representative of all that is scientific and dignified in dentistry. It is a typical high-class dental journal. With each issue is a subject index, by use of which it is only a mo- ment's work to turn to any point considered in the journal; and a bibli- ography of dental literature, in which are catalogued the titles of the papers printed in all the dental journals of the world, those on dental subjects in the medical and scientific periodicals, and the dental books and pamphlets published throughout the world. Thus the subscriber has in this journal the means of keeping up with every phase of dental literature in all languages. The Cosmos is the best and most liberally illustrated dental journal in the world. Nearly all the leading articles of the most eminent author- ities are published in it. The proceedings of dental societies are pre- sented carefully and thoroughly. The rapidity with which new instru- 234 "^^^ PRACTICE BUILDER mcnts, appliances, modes of operating, books, medicines, etc., are introduced, make it necessary for dentists to be well posted in this direction. The advertising pages of the Cosmos show all the novelties and improvements. The editor is Ur. E. C. Kirk, and his editorials are always forceful and timely. Itnns of Interest, published by the Consolidated Dental Manufact- uring Company, has the largest circulation of any dental journal in the world, and, beginning with 1897, came out with illustrations, and with all that represents in appearance outwardly, and contents inwardly, a thoroughly high-class dental journal. It circulates to every quarter of the globe and has subscribers in every land. Itcjns conducts several departments of great interest. The advertising pages of Itiuis of Interest have always been inter- esting. Because of the wide circulation of this journal and its liberality in the matter of advertising rates, and the fact that all persons and firms who have really worthy, helpful articles to present are always accorded a hearty reception by the publishers, this feature of the magazine has be- come a very interesting one, and it probably presents more advertis- ing, from a greater variety of advertisers, than any other journal pub- lished. To know of the best new things, before anyone else, is one of the secrets of success. It will pay to watch the advertising pages of Items. The editor of Items of Interest is Dr. R. Ottolengui, whose skill as a dentist is of the highest order, and whose ability as a writer is of the most enviable kind. Dr. Ottolengui is one of the most active men in dental society work. Articles from his pen are among the most wel- come features in the pages of our journals, and his book. " Methods of Filling Teeth," is one of the most practical and most useful w^orks in the book literature of dentistry. Dr. Ottolengui is also a writer of fiction, his books. " A Modern Wizard " and " An Artist in Crime," having gained a wide reputation. We may be sure that Items will be a well-edited journal, the editor possessing, as he does, superior al'ility as a dentist, combined with rare gifts as a writer. The International Dental Journal \s published by dentists for den- tists. It is, we believe, the only really independent dental journal in the United States. The International Dental Publication Company is com- THE PRACTICE BUILDER 235 posed of dentists, who are the only stockholders, and its officers serve without salary; the investments of the stockholders merely guarantee the success of the enterprise, all profits being devoted to the enlarge- ment or improvement of the journal. The stockholders are men who are the foremost in the profession, and the best representatives of its progress and position. The leading articles of TJie Internatio7ial always comprise what is best in dentistry. The more recent scientific investigation and the best articles of representative men make up its reading matter. Its reports of society meetings are full and complete. The International x?, very ably edited by Dr. James Truman and Dr. George W, Warren. The Dental Review is one of our liveliest journals. It seems to occupy a field that is all its own. It is the representative of the Middle West, and its contributors are mostly from the Central Western States. It preserves a high standard of contents. Its original contributions are from representative practitioners. The editorials are upon subjects of great interest to the profession, and are noted for clearness and concise- ness of presentation. The editor is Dr. A. W. Harlan, and he is ably assisted by associate editors in the persons of Dr. Thomas E. Weeks and Dr. A. E. Morey. The Dental Digest is the official organ of the Dental Protective As- sociation of the United States. It presents the essence of the leading articles of the month, taken from all the dental journals. It has its departments of " Original Communications," " Digests," and the de- partments usual to other journals. It is under the able editorial direc- tion of Dr. J. N. Crouse, chairman of the Dental Protective Association of the United States. The American Journal of Dental Sciencew2LS the first dental journal established, and, as we have said, it is the only one of those earlier days of modern dentistry that is still published. It is a high-class journal, and has among its contributors the most progressive dentists. It is admirably conducted and ably edited. Its dditors are Dr. F. J. S. Gorgas and Dr. Richard Grady. Welch's Monthly is a bright, sprightly, up-to-date monthly, issued under the editorial guidance of Dr. T. B. Welch, who, for many years and until recently, was the editor of Items of Interest. Welch's Monthly 236 THE PRACTICE BUILDER has its full quota of original communications. In the department of " Current Thoughts," extracts from the interesting matters in profes- sional and scientific journals are shown. In the " Question Box " im- portant problems are presented and answered. " Practical Points " is a department wherein is condensed the ideas, thoughts, and helpful hints garnered from all the other journals, and from society meetings. Other departments are " Items," '* Hints," and a department " For Our Patients," containing matter of interest to those who wait in the dental office. Dr. Welch's editorials have always been one of the most interesting features of his work. His encouraging talks to young men have been very helpful. He preserves a style peculiarly his own, with great clear- ness, and seems to get closer to his subject than any other wTiter we know of. We would not hesitate to take a dental journal that Dr. Welch edited, for the editorials alone. In our extracts we have given some samples of their quality. The Dental Register is one of the older dental journals, and still maintains its position in the affections of its subscribers. Its contents are always fresh and thoroughly in touch with all that is best in den- tistry, and the contributions are of merit and originality. It is edited by Dr. J. Taft, Dr. W. H. Whitslar, and Dr. N. S. HofT. We have said that we believe the dentist should subscribe to one journal that has a local influence, and the interest of which may be said to be of local significance. Thus he keeps in touch with the affairs of his particular section. The typical journal of this class is the Ohio Dental Jotirnal, although we must say in explanation that the progres- sive character of this journal is such as to make it indispensable to many who are in practice hundreds of miles from its home. The local journal for a practitioner in Texas would be the Texas Dental Journal. On the Pacific Coast, The Paeific Stomatological Ga- zette, or The Paeifie Dental Journal. In the South Atlantic Coast States, The Southern Dental Journal, or The Atlanta Dental Journal. New York State is represented by The Dental Praetitioner and Advertiser, and the Odontographic Jotirjial. While yet on this subject, we wish to digress slightly to consider a topic somewhat kindred. In the practice of a profession such as THE PRACTICE BUILDER 237 medicine or dentistry, its practitioners, by continual application, are apt to drift away from the world of affairs ; they become narrowed. The successful physician or the successful dentist of to-day should be famil- iar with what is going on in the great world of affairs. He must know about the political situation, and the diplomatic relations of our own with foreign countries; he must be posted on the war in the Orient, or the latest European intrigues, the gathering war cloud, the latest new book, the latest sensational discovery in science. He must be in touch with current events. A dentist has not time to read any considerable part of the enormous output of periodical literature, and yet one wishes to keep up with the interesting things in literature, art, economics, and science. This he can do by the aid of The Review of Reviews. As its name indicates, it fills exactly the wants of busy professional men. It extracts the best from the other prominent magazines, all over the world, so that its readers may be sure that nothing of extraordinary importance will es- cape them. The peculiar feature of this service is the fact that this mag- azine gives these matters at exactly the same time that they are pub- lished by other magazines, having made arrangements for advance sheets which will allow this. It is the ideal magazine for a professional man. For his patients, he should have on his centre table the latest numbers of The Ladies Home Journal, The Cosmopolitan, McClure's Magazine, The Chap Book, The Black Cat. Returning now to the subject of dental journals, it is necessary to •consider a correlated matter — that of writing articles for publication. Every dentist should pay back from his own experience what he has taken from the great store of professional knowledge so liberally given through the dental journals. As soon as he is justified by his ex- perience, he should cultivate the habit of writing out the results of his observations, for presentation either before the dental society or in the pages of the dental journals. Writers may be grouped roughly as follows : Those with nothing to say, and a poor manner of saying it. Those with nothing to say, and a dexterous manner of saying it. Those with something to say, and a poor manner of saying it. Those with something to say, and a charm of style in saying it. 238 THE PRACTICE BUILDER The first consideration, tlicn, is to have something to say. The author must have some central idea, some distinct informa?tion which he wishes to convey. Having selected the subject upon wiiich one is desirous of writing, each little point that strikes him as being connected therewith should be jotted down in a note-book. Next, get these notes into systematic shape for proper presentation. To get the notes in proper shape, they should be written out on separate slips, and then transferred to a sheet of manuscript paper. Thus, one note that relates to the beginning of the paper is jotted down on the sheet, and farther down the note that expresses the next idea, and so on until all the notes are on the paper in the proper position which they will occupy in the written article. This is called a skeleton. These notes in the skeleton are connected by sentences carrying the subject matter through in a systematic manner and to a proper sequence. Frequently new ideas present themselves while the article is being writ- ten, and these are incorporated. It is a fact that when one writes, he be- comes more familiar with his topic by expressing his thoughts in w^ords. The first copy of a paper is usually disfigured by corrections and eras- ures, so that it is necessary to re-write it. The article should then be placed in the desk until its language is not readily called to memory, and then read. At this time the author can judge of its phraseology, and, if this strikes him as being below the standard, he should make such changes and alterations as will make it read more smoothly. When the paper has been properly worded and punctuated, it should be copied on the typewriter. Attention should be given the heading; this should not be too long, nor should it be indefinite. Be careful to give your name as author and your place of residence. Articles should be based on solid facts, or on analysis of facts, rather than on speculation and theory. Let the diction be pure and simple, and as short and aphoristic as perspicuity will allow, so as not to weaken the effect of the ideas or obscure them with needless verbiage. The title should indicate the contents of the article, and show the general character, purpose, and point of the remarks which are to follow. The following are not good titles, because they are indefinite and hackneyed by long use: " A Curious Case," " A Case in Practice," " Clinical Com- THE PRACTICE BUILDER 239 Plain Facts," " A New Method," " An Interesting Case." The best subjects for beginners are those from their own experi- ence, bearing on conditions which they have met and concerning which they are quahfied to write. The length of an article should depend greatly upon its subject matter; many of our most brilliant writers confine themselves to articles of less than one thousand words, but usually articles, as they appear in the journals, are nearer two thousand words. The writer should not count the words, but should make the words count. Cultivate perspicuity, precision, simplicity, and method; avoid flaws of grammar or logic, and diffuseness, and do not interlard with scraps and patches from the dead or foreign languages. The first articles should always be submitted for publication to the local dental journal, the journal of the section of the country wherein the practitioner lives. He should have an interest in the local journal; the local journal has an interest in him, and he will be likely to be more liberally dealt with by it. His subject may range throughout conditions pathological or modes of treatment, discussions of recently introduced ideas, modes of oper- ating, helpful hints, or anything that relates to crown work, bridge work, plate work, etc. All subjects that lend themselves readily to illustration, where illustrations would be helpful in making the text clearer to the reader, should be illustrated. Therefore, when writing of a particular kind of bridge work, or when writing of a case of regu- lating, be sure to take special models for this purpose, both before and after the completion of the operation, that photographs may be taken of the models, or the models themselves sent with the article. When- ever it is convenient, it is better, in making illustrations, if the engraver can have the models to work from, though good photographs will answer the purpose quite well. In most cases, in the illustrations in the more prominent journals, the models are placed in the hands of the engraver, and, after the draw- ings are made on wood, they are submitted to the author for his criti- cism and suggestion. Most journals favor the use of wood engravings, to half-tone illustrations. For some subjects, half-tones are excellent if a good photograph can be gotten to work from ; but this is frequently 240 THE PRACTICE BUILDER impossible, and a half-tone made from an inferior photograph is an abomination. Illustrations can also be made by the photo-engraving process from drawings submitted by the author, provided the drawing is not complicated. Inexperienced writers are often very liberal users of italics. There is rarelv any actual necessity for these in articles in dental journals. In using them too frequently everything is emphasized, so that a point that should be emphasized is lost in the sea of italics. Many young writers are in the habit, especially if they happen to be possessed of a good vocabulary, of using such stilted phraseology that it becomes dif- ficult to understand. Many think that long words are an indication of superiority. Nothing could be farther from the truth. The best writers in every field are those who write most clearly, and who use the simplest forms of expression. To illustrate, we introduce herewith a portion of an article on Pyorrhoea Alveolaris, that appeared in one of the leading dental jour- nals. Surely no one would care to accept this as a model of style: " The abstrusity of conditions in an atomic aggregation of organic elements wherein automatism is exhibited, too often transcends the finite comprehension of the most intuitively endowed and erudite peda- gogue or scholar, and we are left to grope about in darkness and danger in considering local or apparent pathological manifestations, whose origin occurs in such remote and seeming incongruous ways that the alert diagnostician is astonished at the great remove the object of his direct comprehension bears to the initiatory derangement, and whose insidious progress leads on to vital abnegation or transmutation, be- yond which vicarious intermediation will not retrieve. " Under the above caption of life's functional adversion we qre in- vited to contemplate, to a limited extent, the prevalent expression of vital degeneracy noticeable about the cirvo-gingival margins, and go back with the author to a remote inceptive principle of life to find the original seed of this membranous enemy." This is, of course, unusual, but it serves to emphasize what we have said in reference to this subject. It looks as if the writer had prepared his article and then taken a book of synonyms, and, in every instance where it could possibly be done, substituted a long word for a short one, THE PRACTICE BUILDER 241 or for one that expressed the thought clothed in simplicity of expression. Dental editors have noticed this failing of younger writers from time to time, and their observations should be heeded. The editorial given herewith appeared in one of the foremost journals and states the case thoroughly: " The younger writers of the present period, and perhaps in all epochs of the world's history, have been prone to luxuriate in prolixity of words and superfluity of expression. The art of simplicity in writing seems difficult of attainment, and perhaps few of us have a comprehen- sion how very nearly this lies to clearness of thought. It is a truism to say that in order to think we must clothe the thought in words, but it is equally true that it is possible to think without words, although this may seem impossible to the ordinary observer. Words are the repre- sentatives of pictures, and these were translated originally into root- forms, and through combinations with each advancing wave of civiliza- tion language was established. Science was added to science, and the vocabulary of the learned became more and more specialized, until those only can hope to master it who have engaged in the particular line of work it represents. Technicalities have been added to technicalities, until we are burdened with a multiplicity of tongues among all civilized peoples, known only to the few and a jargon to the many. " That this is true must be evident, and we are constantly threatened with increased additions in the multiplication of new words by the in- troduction of the so-called improved nomenclatures. Fortunately for the world of thought, words are not made to order, or, at least, are not assimilated into the language of a people or in a science in that manner. " The most important consideration in the use of language, in the writer's opinion, is in a direct translation of the idea into the simplest form of words attainable. It is a recognized fact that the best writers of the English tongue to-day, or at any former period, have been those using but few words of many syllables ; and the nearer they have been able to express their ideas in simple forms, the more have they been appreciated and regarded as models of style. " We have been impressed very often in professional reading with the fact that there was a positive need of a better training in this direc- tion. We all have a tendency to a multiplication of ponderous words, as 2^2 THE PRACTICE BUILDER though the nuniljcr of high-sounding syllables increased the force of the idea to be presented. Writings of a scientific character need, above all others, simple language. The difficulties that surround subjects of a recondite character make this imperative, and yet how often is this plain rule violated by writers who load their subject with technicalities, new and old, to an extent that deprives the essay of much of its value. Words are useless if they cloud ideas, and nowhere is clearness of ex- pression more needed than in professional writing. " Akin to this, and of more importance, is the use of simple words in teaching. While it is true that teachers are born, and not made by pedagogic training, there yet remains the possibility of producing a satisfactory teacher out of the ordinary professional man, provided the latter is absorbed with the subject and will avoid the error of over- phrasing, not inaptly expressed by having * digested a dictionary.' " The use of technical terms is necessary within certain well-defined limits, but these may be easily overstepped and the writing or the teaching become a burden to the reader or the auditor. An excellent rule to follow in addressing a class is never to make use of a technical word if another can be found to explain the idea. This given and firmly engrafted on the mind, it may be followed by the proper word. A valued friend and teacher always stops to explain the meaning of a technical term. This, to our comprehension, is not the best course tp pursue. Definitions are rarely of value, as all know who have undertaken the study of a language by the aid of a dictionary. The thought must be absorbed before the word can be comprehended. Hence the folly of showering a class of young men wdth terms beyond their powers to utilize and expect to have them understand the subject matter of the lecture. This is too often the mistake of professional teachers. The rule should never be forgotten to make the subject but a degree above the most ordinary mind present. Complex problems in our specialty, as in all other branches of medicine, are sufficiently difficult without increasing this by a redundancy of technical forms. " The evil is one rapidly growing in our literature, and it seems a proper time to call attention to it, especially to those fresh from college life, who are apt to imagine that learning is best expressed by the use of the longest words, and that, unless their ideas are thus clothed, the THE PRACTICE BUILDER 243 essay will fail of proper recognition. This is a common error not by any means confined to the class mentioned. " The tendency to pedantry in writing is another defect. Use of for- eign words not domesticated in our tongue, or an occasional Latin or Greek phrase, better expressed in English, and which rarely represent in their use solid learning, add nothing to the value of an article, nor is the reader better able to understand, by their presence, the ideas the writer hopes to convey to the mind. " Allied to this is the search of some for style. This has been the bane of many young men and ambitious writers of all ages. It is never to be found by searching, for it is ever elusive. Style is the natural ex- pression of the individual improved by culture. It would be as sensible to expect to acquire a good voice by searching among the singers of the world as to hope to acquire a correct style by reading the masters of word-expression in any age. As the voice can be improved by culti- vation intelligently applied, in like manner the ability to embody thought can be enlarged and improved by cultivated practice. " Technical terms are important and of vital necessity in their proper place, but it is idle to expect that the young mind can absorb them at once, nor would it be desirable that they should. The professional man must learn to think in the terms he uses, and, until this be accomplished, the idea represented cannot be absorbed; and it is just this condition that all first-year students are in to-day, a fact to be remembered by all teachers of dentistry. It is with the object of drawing attention to this subject that these ideas have been brought together, a plea for simplic- ity of language in all our professional relations." Apropos of the general tendency of writers in the dental journals to dififuseness of expression in their articles, we introduce a specimen ar- ticle as it was originally written and as it looked after it had been pruned of its unnecessary verbiage; the article was written for a journal of wide circulation and the editor believing the article could be greatly improved by condensing it did so and sent it to the author for ap- proval. A reply was received that it must be printed as written or not at all. It is rather unmerciful on the part of writers to compel readers to wade through a long article to find an idea that could just as well be conveyed in much less matter. 244 THE PRACTICE BUILDER DARK JOINTS IN VULCANITE PLATES— HOW TO PRE- VENT SAME. There is a great deal of trouble among those who do vulcanite plate work, to avoid dark joints. I submit, herewith, my method of making vulcanite plates, which, if followed out. I think will pre- vent dark joints to a considerable de- gree. Everything should be scrupu- lously clean throughout the entire proc- ess. To commence with, the grinding of the teeth should be done under a mag- nifying glass in order to have a perfect- fitting joint. I use two corundum wheels. The first, a coarse wheel, to knock off the extra gum; the second, a finer wheel, which enables me to make a nice, smooth joint. For waxing up the plates, I use paraffine and wax, which by experience I find superior to straight bees-wax, as the work can be kept much cleaner. Now I have my teeth ground up and waxed. The next process is to chill the wax, removing each block, commencing at the molar block. Be careful not to dam- age the wax. After all the blocks have been removed, then, with a sharp knife, shave off the feather edge of the wax, above the place where the pins come, as high as you want the rubber to come after completion of plate. Before re- placing the teeth in the wax. put them in boiling water, in order to remove surplus wax; wash with soap and water so as to get them perfectly clean, and trim the plate. Then mix a little of any of the cements to a thin mixture, and place a small quantity on the joint surface, which will thoroughly seal the joints. Next, finish up the wax, as you want the rubber when done. The more pains taken in waxing, the less work in removing plate from vulcanizer. -If ev- erything is kept clean up to this point, TO AVOID DARK JOINTS. Everything should be scrupulously clean. To grind the teeth, I use two corundum wheels, a coarse one to be followed by a fine. For waxing up the plates paraffine and wax is cleaner than wax alone. To clean the joints, remove each block, commencing with the molars, being careful not to dam- age the wax; then, with a sharp knife, shave oflf the feather edge of the wax impression near the pins, as high as you want the rubber to come, after the completion of the plate. Before replacing the teeth, put them in boil- ing water to remove any surplus wax, and then wa;^h with soapy water. Now place a little thin mixed oxiphosphate on the surface of the joints and place the blocks in position. Finish up the wax, as you want the rubber when done. The more pains you take in waxing, the less work you will have in finishing the rubber. Flask as usual, using soapy water instead of oil, After unflasking, to remove all wax, flood with hot water. In packing, use a little more rubber than you did of wax. Place over the rubber a piece of thin, wet cloth, and press in boil- ing water. In ten minutes separate, and remove the cloth, trim off the excess of rubber, close, and vulcanize. THE PRACTICE BUILDER 245 you will next be ready to flask. You will flask as usual, except, after varnish- ing, instead of using oil, you will find soap-water much better. Use as little oil as possible. The oil, in my opinion, has a great deal to do with dark joints. Now you have the plate flasked. Lay it aside for four or five hours in order to give the cement time to harden. Sep- arate flask and flood with hot water, so as to remove all particles of wax that may have been left by heating flask for separation. After this is accomplished, pack your rubber. Use a little more rubber than wax. Place over the rub- ber a piece of thin, wet cloth. Then put your flask together and place it in boil- ing water. After remaining ten min- utes, put under screw - press, tight- pressed. Separate and remove the cloth, trim off the excess of rubber, close, and vulcanize. If the above instructions are followed, I think dark joints will be avoided. Many words are used improperly and there is need for the employ- ment of great care on the part of the writer to prevent him from using words in the wrong places. The following list will prove helpful to writers: Abortive^ means untimely in its birth, and so brought out before it is well ma- tured. A plan may be abortive, but an act cannot. Accord, is a stilted substitute for give. Ability and capacity are not exact synonyms. The former is the power of ap- plying, the latter of acquiring, knowledge. Administer. Blows are dealt. Medicine is administered. Aggravate, means to add to the weight of, and is not equivalent to irritate. Adopt, is a poor substitute for take, in such phrases as " What course will you adopt ? " Aggressive, does not mean enterprising, or even pushing, but hitting first, mak- ing the first attack. Balance, should not be used in the sense of rest, remainder, or remnant. The word is only permissible where the simile of the scales will apply, as in a book-keeper's balance. Beautifully. Looked beautiful, not beautifully. 246 'lli^ PRACTICE BUILDER Boiiiiii/ul, should not be confounded with plentiful. Bountiful means liberal, beneficent. Beg. Say, " I beg leave to acknowledge." Belongs to. Do not use for " as a member of." But, should not be used for only. Often in doubtful taste. Convent-, should not be used for convoke. Convene [con and venio), to come to- gether. Convoke {con and vocd), to call together. Crime, vice, and sin should not be used as synonyms : crime is a violation of a statute l.iw of a particular country ; sin is the violation of a religious law ; vice is a moral wrong, not dependent on the country or creed of the person. What is criminal may not be sinful or vicious. Murder is not a vicious act, unless it become a habit to murder. Parricide cannot become vicious, be- cause a man has only one father and one mother. Deal. Great deal, not good deal. Deprecate is wrongly used for disapprove, censure, condemn ; the word really means " to beg," or pray against. Die wiih. Persons die of, not with disease. Dirt, means filth. A thing that is dirty is foul. Do not use for earth, loam, gravel, or sand. Either, means the one or the other of two. Equally well. Do not say equally as well. Evacuate, should not be used for " to go away." (It means to make empty.) Every, should not be used for all. " He deserved every praise." Exemplary, should not be used for excellent. Had have. Never use together. Hardly. Do not use with don't and can't. Healthy. Distinguish from wholesome. Humanitarian, means '* one who denies the godhead of Christ." Hundred. Use the singular form with numerals. Inaugurate, should not be misused for beginning or opening. Introduce. In using the word observe the general rule that the man is introduced to the woman, unless the man is of extreme age. Just. Incorrect in the sense of now. Jeopardize, should not be used. Jewelry. Should not be misused for jewels. The above will serve as illustrations of things to be avoided. A good working library is a great help to any writer. A few books are almost indispensable. First among these is a good dictionary, the Standard, Century, American Encyclopedic, Webster, or Worcester. Next in value comes Roget's Thesaurus, and after that Smith's " Synonyms Dis- criminated." Goold Brown's Grammar, Alfred Ayres' edition of Cob- bett's Grammar, Richard Grant White's " Words and Their Uses," are books that are of very great value. THE PRACTICE BUILDER 247 WORDS AND THEIR USES. By Richard Grant White. Twenty-fifth edi- tion. 467 pp. Cloth, $2.00. The purpose of Mr. White's book is the consideration of the right use and the abuse of words and idioms, with an occasional examination of their origin and their history. " It is occupied," as the preface says, " almost exclusively with the cor- rectness and fitness of verbal expression, and any excursion into higher walks of philology is transient and incidental." Its chapter headings are: Newspaper English; British English and "American" English; Style; Misused Words; Some Briticisms; Words that are not Words; Formation of Pronouns — Some — Adjectives in En — Either and Neither — Shall and Will; Grammar, English and Latin; The Grammarless Tongue; Is Being Done; and A Desultory Denunciation of English Dic- tionaries. EVERY-DAY ENGLISH. By Richard Grant White. 512 pp. Cloth, $2.00. " Every-day English " is a sequel to " Words and Their Uses." The first part, " Speech," discusses the subject of pronunciation; the second part, " Writ- ing," discusses spelling; the third part is devoted to " Grammar; " and the fourth part to " Words and Phrases." ROGET'S THESAURUS OF ENGLISH WORDS AND PHRASES. Clas- sified and arranged so as to facilitate the expression of ideas and assist in literary composition. By Peter Mark Roget and John Lewis Roget. 745 pp. Cloth, $2.00. Roget's " Thesaurus " is the only work giving a complete collection of the words in the English language, and of the idiomatic combinations peculiar to it, arranged according to the idea they express, rather than the alphabetical order of a dictionary. It has a copious index, making access easy to all the words express- ing any idea. The book is the best dictionary of synonyms published, and should be on the desk of every writer for constant, daily use, as a means both of refer- ence and of word study. SYNONYMS DISCRIMINATED. By C. J. Smith. 781 pp. Fourth edition. Cloth, $2.00. The author of " Synonyms Discriminated " has taken advantage of the works of Crabbe, Taylor, Graham, and Whately, and has combined his own ideas with those of these earlier writers on English Synonymy. He has also derived useful material from Guizot's book on French Sj'nonyms, and from other sources. THE ENGLISH GRAMMAR OF WILLIAM COBBETT. Alfred Ayres' edition. 254 pp. Cloth, $1.00. Cobbett's Grammar is probably the most readable grammar ever written. For the purposes of self-education it is unrivalled. Persons who studied grammar 2^3 THE PRACTICE BUILDER when at school and failed to comprehend its principles— and there are many such as well as those who never have studied grammar at all, will find the book specially suited to their needs. Any one of average intelligence who will give it a careful reading will be rewarded with at least a tolerable knowledge of the subject, as nothing could be more simple or more lucid than its expositions. THE GRAMMAR OF ENGLISH GRAMMARS. By Goold Brown. 1,102 pp. Cloth, $5.00. Sheep, ^6.00. This is the grammar of all grammars. The most exhaustive treatise on the subject known. It should be owned as a book of reference by every writer. THE TRADE OF AUTHORSHIP. By Wolstan Dixey. 128 pp. Cloth, $1.00. Mr. Dixey's book is divided into three parts, the first discussing the author's market, the second the author's trade, and the third the author's life. It is a practical book, and young writers will find it full of help and inspiration. Among the subjects taken up in it are newspaper work, special articles, general articles, the market for short stories, serial stories, " Why that manuscript came back," book making, compilations, an editor's good will, good copy, desk tools, method, the art of writing, play writing, and the art of the short story. WRITING FOR THE PRESS. A Manual for Editors, Reporters, Corre- spondents, and Printers. By Robert Luce. 96 pp. Cloth, $1.00. Luce's "Writing for the Press " is a practical hand-book of the art of news- paper writing, written by a practical newspaper man. There is no " padding " in it; almost every line contains a useful hint or suggestion about the proper preparation of newspaper copy, and a wonderful amount of information of use to writers is crowded into its carefully written pages. The work is the result of the practical experience of the author as desk editor on the Boston Globe, and was written in the main from notes made while handling manuscripts there and elsewhere. While it is intended primarily for newspaper men, literary workers of every class will find '" Writing for the Press " exceedingly helpful, both for study and for reference, as is shown by these subject headings: The Preparation of Copy: How to Write Clearly; Grammar, Good and Bad; Use and Misuse of Common Words and Phrases (with several hundred examples) : Mixed Metaphors; Slang; The Use of Titles; Puzzling Plurals; Condensa- tion; Points on Proof Reading; Addressing Editors; Getting into Print, etc. The book is one that every writer should keep upon his desk for constant reference and study. THE VERBALIST. By Alfred Ayres. A Manual devoted to brief discussion of the Right and Wrong Use of Words, and to some other matters of interest to those who would speak and write with propriety. Cloth, $1.00. Besides these books there are journals of special interest to writers. THE PRACTICE BUILDER 249 The most prominent and most helpful of these are The Editor and TJie Writer. Both are monthly magazines, and both are very interest- ing. They may be ordered of any newsdealer. DENTAL JOURNALS. America. Monthly. American Journal of Dental Scietice, Baltimore, Md., 9 West Fayette St. Edi- tors, F.J. S. Gorgas, A.M., M.D., D.D.S.; Richard Grady, M.D., D.D.S. Publishers, Snowden & Cowman Mfg. Co. Price, $2.50. Dental Cosmos, Philadelphia, Pa., Chestnut, corner Twelfth St. Editor, E. C. Kirk, D.D.S. Publisher, The S. S. White Dental Mfg. Co. Price, $2.50. Dental Register, Cincinnati, O., 117 West Fifth St. Editors, J. Taft, D.D.S.; W. H. Whitslar, D.D.S. ; N. S. Hoff, D.D.S. Publishers, S. A. Crocker & Co. Price, $2.00. Dental Review, Chicago, 111., 66 Madison St. Editors, A. W. Harlan, M.D., D.D.S.; T. L. Gilmer, M.D., D.D.S.; Geo. J. Dennis, M.D., D.D.S.; Thos. E. Weeks, D.D.S. Publishers, H. D. Justi & Son. Price, $2.50. International Dental Journal, Philadelphia, Pa., 716 Filbert St. Editors, James Truman, D.D.S. ; Geo. W. Warren, D.D.S. Publishers, International Dental Publication Co. Price, $2.50. Dominion Dental Journal, Toronto, Canada, P.O. Box, 418. Editors, W. Geo. Beers, L.D.S., 47 Union Av., Montreal, and associates. Publishers, Do- minion Dental Journal Co. Price, $1.00. Items of Interest, New York, N. Y., 115 West 42d St. Editor, R. Ottolengui, M.D.S., 115 Madison Ave., New York. Publishers, Consolidated Dental Mfg. Co. Price, $1 .go. Ohio Dental Journal, Toledo, O. Editor, L. P. Bethel, M.D., D.D.S., Kent, O- Publishers, Ransom & Randolph Co. Price, $2.00. Pacific Stomatological Gazette, San Francisco, Cal., 536 Clay St. Editors, R. H. Cool, D.D.S., and associates. Publishers, Pacific Stomatological Gazette Publishing Co. Price, $2.50. Southern Dental Journal, Macon, Ga. Editors and Publishers, Holmes & Ma- son. Price, $2.00. Western Dental Journal, Kansas City, Mo., 906 Grand Av. Editor, J. D. Pat- terson, D.D.S. Publishers, R. I. Pearson & Co. Price, $2.00. 250 THE PRACTICE BUILDER llWc/t's Monthly, Philadelphia, Pa., 718 Fidelity Mutual Life Building. Editor, T. B. Welch, M. D., Vineland, N. J. Publisher, A. S. Robinson. Price, $1 .00. Denial Digest, Chicago, 111., 2231 Prairie Av. Editor, J.N. Crouse, D.D.S. Publisher, J.N. Crouse, D.U.S. Price, $2.00. Bi- Monthly. Dental Office and Laboratory, Philadelphia, Pa., 620 Race St. Editor, Theodore F. Chupein, D.D.S. Publishers, Johnson & Lund. Price, $1.00. Dental Journal, Ann Arbor, Mich. Edited by students. Price, 50 cents. La Revista Dental Americana, Philadelphia, Pa. Editor, C. E. Edwards, D.D.S. Publisher, R. W. Edwards, D.D.S. Price, $1.00. Qvarierly. Atlanta Dental Journal, Atlanta, Ga. Editor, \V. G. Browne. Publishers, W. G. Browne Dental Co. Dental Practitioner and Advertiser, Bufifalo, N. Y., 587 Main St. Editor, W, C. Barrett, M.D., D.D.S. Publisher, Buffalo Dental Mfg. Co. Price, $1 .00. Dental Headlight, Nashville, Tenn., 307 N. Summer St. Editors, H. W. Mor- gan, M.D., D.D.S. ; Ambrose Morrison, M.D. Publishers, Morrison Bros. Price, 50 cents. Odontographic Journal, Rochester, N. Y. , 117 State St. Editor, J. Edward Line, D.D.S. Publisher, Rochester Dental Mfg. Co. Price, $1.00. Facijic Dental Journal, Tacoma, Wash. Editor, W. E. Burkart. Publishers, Burkart Dental Supply Co. Price, $1.00. Texas Dental Journal, Dallas, Tex. Editor, John C. Storey, M.D., D.D.S. Publisher, A. P. Carey. Price, $1.00. England. Semi- Monthly. British Journal of Dental Science, London, 289 Regent St., W. Editor not given. Publishers, J. P. Segg & Co. Price, 14 shillings. Monthly. Dental Record, London, 6 to 10 Lexington St. Editor not given. Publishers, The Dental Mfg. Co. Price 7 shillings, 6 pence. Journal of the British Dental Association, London, 20 and 21 King William St., Strand. Editor not given. Publishers, Bailliere, Tindall & Co. Price 7 shillings. THE PRACTICE BUILDER 251 France. Monthly. V Odontologie et la Revue Internationale cV O dontologie , Paris, 57 Rue Roche- chouart. Editor, Paul Dubois. Price, 12 francs. Le Monde Dentaire, Paris, 9 Rue de Londres. Publisher, Paul Vasseur. Price, ■ 5 francs. Revice Odontologique, Paris, 3 Rue de I'Abbaye. Publishers, I'Association de I'Ecole Odontotechnique. Price, 12 francs. L'Avenir Dentaire, Paris, 37 Boulevard de Sebastopol. Editor, Dr. Delaunay. Publisher, F. Menetrier. Price, 5 francs. Le Progres Dentaire, Paris, 22 Rue du 4 Septembre. Editor not given. Pub- lishers, C. Ash & Son. Price, 12 francs. Germany. Weekly. 'Journalfiir Zahnheilkiinde , Berlin, Chausseestrasse, la. Editor, Dr. Erich Richter. Publisher, Erich Richter. Price 7 marks. ZaJuidrztliche Rundschau, Berlin, Claudiusstrasse, 15. Editor, Max Bejach. Price, 10 marks. Monthly. Deutsche Monatsschriftfiir Zahnheilkunde, Leipzig, Konigsstrasse, 18. Editor, Jul. Parreidt. Publisher, Arthur Felix. Price, 14 marks. Monatsschrift des Vereins Deutscher Zahnkiinstler, Leipzig, Hainstrasse, 26. Editor, Arthur Stolper. Price, 9 marks. Bi- Monthly. Die Zahntechnik Reform, Berlin, Kopenickerstrasse, 114. Editor, G. H. Pa- w^elz. Publisher, R. F. Funcke. Price, 7 marks. Quarterly Correspondenz-Blatt fiir Zahndrzte, Berlin, Jagerstrasse, 68. Publishers, C. Ash & Son. Price, 5 marks. Austria. Bi-Monthly. Odonioskop, Budapest, Gizella Ten 2. Editor, Iszlai Jozsef. Publisher, I Jozsef. Price, 2 marks. 252 THE PRACTICE BUILDER Qttarterly. Oesterreichisch-Ungarische Vierteljahrsschrift fiir Zahnheilkundc, Vienna, Sin- gerstrasse No. 8. Editor, Julius Weiss. Publisher, Julius Weiss. Price 5 marks. Holland. Monthly . Tijiischrift voor Tandheelkunde, Amsterdam. Publishers, Dr. Erven H. Van Munstcr & Son. Switzerland. Quarterly. Schiucizcrische Vierteljahrsschrift fiir Zahnheilkunde, Zurich, Lowenplatz, 45. Editors, Dr. C. Redard and Dr. Theo. Frick. Publishers, Societe Odonto- logique Suisse. Price, 12 francs. Italy. Bi-Monthly. L Odontologia, Palermo, V. Montevergini, 2. Editor, Luigi RiboUa-Nicodemi. Publibhcr. Luigi RiboUa-Nicodemi. Price, 5 lira. Quarterly. Gironale di Correspondcnza pei Dentista, Milano, ViaTomaso Crossi, 2. Edi- tor, Cav. Dott. Alberto CouUiaux. Publishers, C. Ash & Sons. Sweden. Quarterly. Odonfologisk Tidskrift, Stockholm. Editor, Ernst. Sjoberg. Price, 10 kroner, Denmark. Monthly. Skandinaviska Tandlakareforengens Tidskrift, Copenhagen, Radsusstraedc, i. Editor, Carl Christensan. Publisher, Martius Truslsens Bogtrykkcri. Price, 8 kronor. Russia. Monthly. Messac^er Odontologique, St. Petersburg, Newsky, 79. Editor, Dr. A. P. Si- nitzin. Publisher, A. P. Sinitzin. THE PRACTICE BUILDER 253 Spain. Monthly. La Odontologia, Cadiz, San Jose, 2. Editor, Dr. Florestan Aguilar. Publishers, Aguilar y Cia. Price, 10 pesetas. Revista Estomatologica, Madrid, Paseo de Recoletos, 21, entresuelo. Editor, D. L. Whitmarsh. Publisher, C. Garcia Velez. Price, 20 francos. Norway. Monthly. Den Norske Tandlaegeforenings Tidende, Christiania. Editor, O. Seel. Finland. Quartirly. Skandinaviska Tandlakakareforeningsns Tidskrift, Helsingfors. Editor, Dr. Matti Ayrapaa. Price, 8 kronor. Cuba. Monthly. Revista Dental, Havana, Salud. 39. Editor, Alberto Colon. Publisher, A. Co- lon. Price, $2.50. Japan. Dental Journal, Tokio. Publisher, Ousaburo Midzuhoya. The Shikwa-I^aku-Sodan. Editor, M. Chiwaki. Publisher, Tokayama Dental College, Tokio. Price, 60 sen. South America. Monthly. Anales de la Sociedad Dental de Bogota, Colombia, Apartado, 122. Editor, Dr. Sebastian Carrasquilla. Price, $2.00. The Dental Society " A potent factor in professional growth " The dental college, the dental journal, and the dental society form the tripod upon which is based the progress of dentistry. Before the coming of these, dentistry was in a lowly position ; its jiractitioners were uneducated persons who performed the duties of the dentist as a side line to their regular vocations. Barbers, jewelers, and blacksmiths were in the habit of performing the less important operations of dentistry. With the birth of these three elements of professional progress, den- tistry took on new life and became divorced from the position which it had held. The first dental society formed was the New York Society of Dental Surgeons, but, owing to lack of interest and combined effort in the organization, its existence was brief. The plans of organization were imperfect, and it is probable that the organizers worked with no specially definite objects in view. Later, the American Dental Convention was organized; and this, though in existence for twenty-five years, was finally abandoned because many of the members objected to admitting dentists wdio belonged to the lower ranks of the profession, not liking the idea of associating with men of mediocre talents. The apathy of dental societies has often been remarked. The failure to reach the profession as a whole, and through them win from the world a better appreciation of dentistry, is greatly regretted. It is understood by all that successful results for general welfare can only be secured by general effort; but this has so far failed. Association stimulates ambition, develops the intellect, and makes one brighter and more companionable. It gives a man greater power for growth. The growing man learns something from everything he 254 THE PRACTICE BUILDER 255 sees or hears; nothing can touch him that does not teach him, and he perfects this learning, and gets the good out of it by putting it into practical application. If the knowledge is worthy, he continues to be benefited by it as long as he is capable of applying it; if it proves to be unworthy, he can discard it. Men prominent in public and political affairs, brilliant speakers, and skilful tacticians, become proficient and polished by rubbing up against other men in their own walks in life. So with the physician and the dentist. The best and most representative members of these profes- sions are found to be active in their society affairs. The dental society contributes largely to the fraternal intercourse and good-fellowship of its members. By the interchange of ideas, through the presentation of papers and their subsequent discussion, and by the demonstrations of the clinics, professional knowledge is increased and the standing of the profession thereby elevated. The superior knowledge of one becomes the property of all. It may truth- fully be said that isolation dulls the ambition and the intellect, makes one selfish, narrow-minded, and cynical. In the early days of modern dentistry, before the establishment of dental societies, the members of the profession were much nearer on a line of equality than they are to-day, but at the same time that standard of equality was very much lower than it is now. Then each member of the profession learned what he could, and what he learned he kept to himself; for any superiority to which he may have attained added to his commercial value, and it was to his individual interest to keep his distinctive style of operating, and any secret methods or processes for the performance of work, to himself. Through the influence and stimulus of the dental society all this has been changed and a more liberal tone imparted to the profession, and a desire has been created to give to the other members as liberally as they have themselves been given of the fruits of knowledge and ex- perience. To the younger members of the profession the dental society is a very great stimulant, giving them, as it does, an equal opportunity with the older and more experienced practitioners of observing the per- formance of operations in the clinics, and of themselves performing op- 256 THE PRACTICE BUILDER erations in which they may be proficient. More than this, the dental society has been the means of making many of its members rich. N'ery often men of observing tendencies have noted that some instrument is needed to facihtate the performance of tliis or that operation, and they have not rested until they have solved the problem and invented an instrument or appliance that has brought them a handsome sum or a good income. Again, a young man practicing in some smaller town attends the meetings of his district society, and, by seeing operations performed bv skilful members, becomes ambitious to make of himself a skilful operator. In a few years he is known as such, and has presented several papers at his society meetings and has contributed liberally to the pages of the dental journals, and before long he leaves his little village and enters practice in a large city. If it had not been for the dental society, the young man might have been content to plod along year in and year out. merely an average dentist. Dr. J. X. Crouse, of Chicago, has estimated that out of 17.000 den- tists in the United States, less than 5,000 are members of the dental societies. There should be a great many more members of societies than there are, but because the 12,000 are not members does not indicate that they are not progressive men, nor that they are not worthy representatives of their profession. Most of them are, indeed, men of most excellent character, and thoroughly conscientious in their operations. They have never realized the benefits to be derived from attending dental meetings. Many of them have a firm impression that such gatherings are in the interest of dealers in dental goods ; others that they are chiefly for the purpose of gratifying the ambition or booming the reputation of am- bitious men. In short, misunderstandings and misconceptions, which we all have of things with which we are not familiar, are dominant with this class. Many of the younger meml:)crs think that it costs too much, or that it takes too much time from their practice, but these are very poor reasons. Some time since one of the State societies deputized one of its offi- cers to get the opinions of practitioners who were not regular attendants of societies, and find out just why they did not take an interest in dental THE PRACTICE BUILDER 257 society work. A great variety of replies was received. Some said that they were in favor of dental societies if they were run right. Many said that the dental societies were run to suit those members who came from the larger cities, and that the city element controlled the societies. Some said that they attended, but had received no benefit, and others stated that they did not get back what they had put in. Some asserted that they had plenty to do at home without attending society meetings, and still others thought that they might be all right for poor operators and inexperienced persons to find out how to do operations in which they lacked skill. Some had entertained the idea that it was necessary to pass an examination to become a member, and had for this reason refrained from entering, while others remained out because they had never been asked to join. The code of ethics and the requirements for its observance seemed to be a stumbling block to many who would otherwise have joined. The question of advertising has been the cause of keeping many from becoming members of the societies, but the latter have decided that advertising is not dignified and that it tends to degrade the profession, and they have decided against it. The reasons given in most of the answers, it will readily be seen, are not sound. There is the best of reason for becoming a member of a dental society, and for attending its meetings regularly and for taking active part. The member of a dental society has opportunity for extending his acquaintance. This is a source of much satisfaction, and results in making many permanent friendships. To brush up against successful men. men who are making names for themselves in the profession, is very helpful, and cannot help instilling ambition within those who are looking on and noting the efforts of others to get to the front. It is only in the dental societies that one can come in direct contact with the shining lights of the profession. It is here that the man with an idea can place it before the profession and receive due credit for what- ever good he may do. Here the individual expands and grows and paves the way to a future of success. Here, in a word, he has an oppor- tunity of comparing himself with the other members of the profession, and judging of his own capabilities thereby. When clinics were made a prominent feature at the society meet- 23S THE PRACTICE BUILDER ings there was an increase in tlie attendance, but, as the cHnics are con- ducted, only a few can get near enough to see the operation ; thus many present get no real benefit, owing to the fact that they cannot get near enough to see clearly what is being done. It has been suggested that, instead of performing operations in the mouths of patients, a large dummy be used, and the operation be explained by this means and by illustrations on the blackboard. Then, too, many societies are late in issuing programs. These should be announced in the journals or the announcements sent out at least one month in advance of the meeting. There are few men who can present interesting thoughts in the discussion of a paper without some preparation, and a few weeks' notice would prove very helpful in this respect. All papers should be completed, and copies sent to those who are to discuss them, at least one month in advance of the meeting. Every college faculty should encourage its graduates to attend the meetings of the society of his district, after he enters practice, and they should report to the students just what of interest is taking place in the societies at the time. The formation of students' societies in the col- leges should be encouraged and fostered. To become a member of a dental society it is only necessary to sig- nify a desire to this effect to the secretary of the society, or to any mem- ber. The names of all the officers of the societies can be learned from Polk's Dental Register of the United States, and the time of meeting. The same information can also be had of your local dealer in dental sup- plies. The person may present himself at the meeting of the society and indicate his desire to any of the members. If he lives some distance from the place of meeting he may write to the secretary, who will answer any inquiries. The new member agrees to abide by the rules of the society and the code of ethics. After having become a member of the society, it becomes a duty to present articles and to discuss those of others. The subjects presented should be those that are " open questions," because these admit of discussion, and their unsettled condition demands careful attention and thorough consideration. Cases from actual prac- tice, wherein unusual or instructive particulars attach, are always in- teresting. The articles usually presented, however, will be found to deal THE PRACTICE BUILDER 259 with all the great variety of subjects that are presented in the journals, and these are the same from year to year. It will be found that all those subjects that relate to the betterment of conditions in dentistry per se are presented in the societies, because they demand thorough discussion from all points, and their full worth cannot be brought out in journal articles. The same general rules which pertain to writing for the jour- nals, are to be observed in the preparation of articles for society meetings. In beginning an article, avoid a long preamble, and do not waste time in getting at the subject. Boil the matter down and present the facts in the most succinct form. Some societies have limited their speakers to a certain number of minutes. Do not hesitate to take part in debates whenever you have anything valuable to offer, whether it is gleaned from literature or from the great school of experience. If your views differ from another's, express them with courtesy and respect. If you have a contribution or new fact to offer, an invention, or new pathological views, or a new discovery or new secret to announce, a new instrument to show, an operation to de- scribe, a specimen to present, a report to make, or a new treatment, a new therapeutic agent, a promising theory to tell of, or anything what- ever to say, do it in a careful, clear, methodical manner, then sit down; but when you have nothing worth offering, do not talk for talk's sake, but make Ciceronian silence your law, and do not break it. When on the floor, take care neither to abandon your vocabulary or technical terms for the vernacular, nor let your professional manner degenerate. This will teach you to arrange your thoughts quickly and to express them clearly. Remember in debate, as elsewhere, that there is nothing infallible; that the dentist must school his prejudices and be open to conviction. Toleration of a difference of opinion is a lofty virtue, therefore say or do nothing to wound the pride or feeling of any other member ; and if any incautious remark, misstatement, or other personal reflection drops from your lips, be not slow to make proper atonement. Those who are always positively right, while all others are positively wrong, who can brook no opinion that does not accord with their own, are usually deemed hot-headed, rash, and indiscreet, and very unsafe guides. ,(3o THE PRACTICE BUILDER Also, remember that dififerences of opinion are quite compatible with friendship, and that controversies, discussions, and parliamentary battle, no matter how short or excited, are usually conducted by men of discretion within the bounds of decorum, and without violation of the ordinary rules of good breeding; and also that there is no mode of practice nor treatment of any condition, which has not been the subject of obstinate dispute, and that every great discovery or startling an- nouncement stirs the dental world to testing and reporting, asserting and denying. A good dental society is something of a post-graduate school and, next to actual experience, there is nothing so valuable to the young practitioner, for there the collision of mind with mind, and of thought with thought, in amicable discussion, awakens retiection and deeper reasoning, increases the intellectual grasp, stimulates the mental diges- tive power, and liberalizes and enlarges the scope of both the speaker and the listener, and acts as a leaven to the entire profession. Nowhere else can you study so well the individuality and the styles of different dentists, and discover why each one is what he is, so fully as at dental society meetings. There the specialist, the teacher, the general prac- titioner, and the book-worm all meet, and each in his own way con- tributes to the instruction and intellectual recreation of the others. There you can meet your neighbors on common ground, grasp each other by the hand, look into one another's faces, and compare investiga- tions, experience, and opinion by face to face discussion. There rivalries, dissensions, jealousies, and controversies can be softened, and professional friendships be formed and cemented. There you can find opportunities for pleasant, social intercourse with worthy men. There you can also silently measure the height and depth of your dental contemporaries, and see the difference between the serious and the superficial thinker, the convincing and the faulty logician, the judi- cious and the injudicious, the alert and the stupid, intellectual giants and mental dwarfs; there you can also estimate the influence of pleasing actions and deportment, and the intellectual and moral worth of those who command respect, and discover and learn to avoid the glaring imperfections of others who do not, and in many other respects learn effectually to separate the chaff from the wheat. THE PRACTICE BUILDER 261 Intercourse at a dental society does serve as an intellectual exchange, ■ where one may hear the discussion of moot points and live questions in dentistry, and at the same time establish with his brethren friendly and honorable relations. One often sees distrust converted into friendship merely by acquaintance. Independently of the benefits and improvement accruing to the members of dental societies individually, they give a sound and healthy tone to the entire profession, stimulate the growth of dental science, and also generate and keep alive a genuine professional and brotherly spirit that tends to minimize all that is unprofessional. Booki " Knmi'ledge is of two kinds ; one of inner consciousness or memory, and an- other of knowing where to go to find out all about a given subject ; which latter kind is often the more valuable. " Dentistry is in a large degree an art, and requires finger skill for its practice. This cannot be acquired from books. All of the books de- voted to dentistry may be read, and the reader be far from becoming a good dentist. The book literature of dentistry is not profuse, yet it may be said that all the important phases of practice are covered by appropriate text books. While dentistry is in a large degree an art depending upon manipulative dexterity and artistic sense, together with mechanical in- genuity, its scientific aspect requires close study to perfect its practi- tioners. A dentist who has not become a diligent and efficient reader of the literature of his profession is at a very great disadvantage. To keep pace with professional progress, and to grow and expand in a profes- sional sense, it is necessary for him to have a thorough grasp upon the book literature of dentistry. When we enter the office of a learned physician, or of a lawyer of great reputation, almost the first thing we see is a very extensive library of text books costing, in some instances, especially in law books, many thousand dollars. Professional knowledge is a professional man's cap- ital ; it would seem the part of wisdom, therefore, for those who are am- bitious for professional preference, to add to this capital by having a good working library of reference books. Many dentists have held lucrative practices for years, and yet have not a good collection of the books relating to their profession : but there is no doubt that they could have served their patrons to better ad- 262 THE PRACTICE BUILDER 263 vantage if they had possessed good Hbraries. One should have a Hbrary of dental books in which every aspect of his work is so fully treated that there could be no condition present but that he could successfully at- tend it. The more successful medical men are generally found to have col- lected extensive libraries. There are individual dentists who have large libraries; but we generally find them with but few books, and not given to extensive reading. Authors are always at their best in their books — they tell the very best they know. Much of the information that is contained in books cannot be had in any other place. The really au- thoritative writers are not in the habit of contributing their best thought to the dental journals, but instead save it for their books. Books contain the most mature thought; they are grounded upon the best judgment and most refined experience, while journal articles are often unre- liable and there is almost necessarily much that is of little value. Much that finds its way into the dental journals is immature, and cannot be practically applied with full confidence. To successfully avoid these matters demands judgment, refined by experience or by knowledge gained from authorities; this knowledge can be gained only from the books. Judgment is refined by reading the text books on various lines of work, and thus the reader is qualified to judge of the value of articles offered and of the practicability of the theories propounded. One of the most important books is a good dictionary on medical or dental science. Either of the following is good: Harris's Dictionary of Dental Science. Sheep, $6.00. Gould's Medical Dictionary. Half leather, $3.25. Thomas's Medical Dictionary. Sheep, $3.50. ANATOMY OF THE HUMAN TEETH. By G. V. Black, M.D., D.D.S., Sc.D. Third edition. 171 pp. Illustrated. Cloth, $2.50. This is the best and most complete work as a ready reference that we have. It is a very valuable book, not only as an aid to distinguishing the teeth, but its measurements of the teeth and their roots make it a reliable authority and guide for operations in and upon the roots of teeth. If a dentist were to be called into court as an expert witness, and the case depended upon an ability to diagnose teeth, the owner of this book would be safe, so long as he kept close to its teaching. 264 THE PRACTICE BUILDER METHODS OF FILLING TEETH. By R. Ottolengui. M.D.S. Cloth, pp. 200. 236 illustrations. We cannot too highly commend this book. Until its appearance there was no really practical book that fully covered this subject. This book is as practical as words can make it. Mot a case is described that has not occurred in the author's practice. Not a method is advocated that he has not tested. Its language is clear, and anyone who knows anything about dentistry can under- stand every statement made, and can put into practice any of the methods de- scribed. Not the least interesting feature about this book is the illustrations; these are also clear and most easily understood. There is nothing of value relating to filling teeth that it does not tell about. The man who cannot get ten times the cost of the book out of it is not very bright. There is not a dentist in the world who cannot profit by the information it gives, and there are very few men whose ability as operators might not be materially enhanced. The book shows what constitutes the highest art in operative dentistry, by men who are accustomed to operating for the most fastidious people in the world, and those who go to make up the very highest class clientele in the world. The explanations are so clear, and the illustrations so helpful, that no one can read and study the book without being enabled thereby to make artistically beautiful and abidingly satisfactory gold fillings. Every dentist prides himself upon his ability to insert beautiful gold fillings, and there is no one who cannot be benefited in this respect by Ottolengui's book. It treats of The Preparation of Cavities, Keeping Cavities Dry. The Uses of the Various Filling Materials, Contour and Flat Fillings. Special Principles Involved in the Preparation of Cav- ities and the Insertion of Fillings in all varieties of Cavities in all Teeth, Root Filling, etc., besides containing a great amount of information of value, every-day hints, knacks, and pointers that help to work faster and better. If you have not this book do not practice another day without it. ARTIFICIAL CROWN AND BRIDGE WORK. By George Evans. Fifth edition. Cloth. Pp. 330, with index, $3.00. This book is one of the most complete works published. In its pages are described the methods of construction and adaption of every variety of crown. No one who makes any pretence of performing any of the operations indicated in the line of crown work or bridge work can afTord to be without it. By its use the study of bridge and crown work is greatly simplified. The book con- tains 625 illu-strations. The fact that the work has demanded three new editions in three years attests its great popularity. It gives the Preparatory Treatment of Teeth and Roots for Crown work. The Pulps of Teeth, Preservation, Devitalization, Pulp Capping, Treatment of Pulpless Teeth, Chronic Alveolar Abscess, Shaping Teeth and Roots for Crown work. Artificial crown work is then treated of with special reference to the Porcelain System. Every form of procelain crown is thoroughly considered. The Gold Crown System next receives attention and every form of crown is treated of. THE PRACTICE BUILDER 265 Bridge work in all its forms, removable and fixed, is presented thoroughly; and so clear are the descriptions and so perfectly plain the illustrations, that every step is easily understood; the author leaves nothing to the imagination, nor does he make allowance for experience, but presents his subject with such thoroughness that no one can fail to understand. Special methods of noted operators are given, and information is given concerning materials and pro- cesses in crown and bridge work. DENTAL PATHOLOGY AND THERAPEUTICS, In the Form of Ques- tions and Answers. By J. Foster Flagg, D.D.S. and Otto E. Inglis, D.D.S Third edition. Cloth, 105 pp. $2.00. In the 719 questions and answers in this book, the whole field of dental pathology is gone over. There is not in the whole range of dental literature a book that is more practical and more to be desired as a reference book, nor one that should be more constantly at the operator's disposal. Scarcely a day passes but that there is need for such information as is herein conveyed. There is no greater authority on this branch than Dr. Flagg, and there never was so great a subject presented in such compact shape without losing its practical value. Within the limit of these questions and answers is presented every possible phase of every subject that forms a part of pathology and therapeutics in den- tistry. Without this for reference in the numerous cases that present we should feel lost. There is a full and complete list of dental medicaments at the end of the book. In this list are some very valuable formulae, the result of Dr. Flagg's long term of experience and observation. ORTHODONTIA. By S. H. Guilford, A.M., D.D.S., Ph.D. Second edition. Revised and Enlarged. 228 pp. 180 illustrations. Cloth, $2.25. The author presents his subject in the clearest and simplest language pos- sible. He takes first the underlying principles of the art, and then presents the principal methods which are employed for the treatment of the different cases, and after this the correlation of principles and methods in their application to typical cases. The book is an eminently practical one, and does not incline to any one method for the treatment of cases of irregularity of the teeth, but shows the application of the various appliances to a variety of cases. We consider the book to be the best comprehensive work on the subject. THE ANGLE SYSTEM OF REGULATION AND RETENTION OF THE TEETH AND TREATMENT OF FRACTURES OF THE MAXIL- LA. By Dr. Edward H. Angle. Revised and Enlarged. 113 illus- trations. This work illustrates Dr. Angle's system for regulating the teeth, and re- taining the regulated teeth after they have been brought into proper position. Dr. Angle's appliances for the regulation and retention of regulated teeth, as is well known, are manufactured ready for use; and this book shows their practical application to cases in practice. The book will prove a valuable one for ready- reference. 266 THE PRACTICE BUILDER ORAL DEFORMITIES. By Norman W. Kingsley, M.D.S., D.D.S. 54i PP- 350 illustrations. Cloth, $5.00. Sheep. $6.00. Dr. Kingsley's book is the best one upon its subject. All other works that treit this subject at all draw heavily upon Dr. Kingsley's book for cases and for illustrations. It is a most exhaustive work, and the author's great skill and wide experience eminently fitted him for such a task as is indicated by such a work. It may be possible to get some of the information it contains in other books, but if you really wish to know all the subjects you must go back to Kings- ley after you get through experimenting. Part One, under Irregularities of the Teeth, treats of: Etiology — Correla- tion of Irregularities to Idiocy — Diagnosis — Physiology and Pathology— Me- chanical Forces Used in Regulating Teeth, Impressions and Models — Cases from Practice in Regulating Teeth. In Part Two, Palatine Defects are treated under the heads of: Congenital and Acquired Palatal Lesions — History of Obturators — Appliances for Acciuired Palatal Lesions — History of Artificial Vela — Treatment of Congenital Fissure of the Palate — Method of Making Artificial Palates — Introduction and Use of Artificial Vela — Buccal and Nasal Prosthesis. Part Three: Maxillary Fractures. Location Diagnosis, Interdental Splints. Part Four: Mechanism of Speech, Physics of Sound. The Formation of Vowels and Consonants. Part Five: The .Esthetics of Dentistry. Art Culture Required in Dental Prosthetics. Anatomy and Physiology of Expression. A SYSTEM OF ORAL SURGERY. By James E. Garretson, A.M., M.D., D.D.S. Sixth edition, i.ooo pages. Cloth, $9.00. Sheep, $10.00. Garretson's " System of Oral Surgery," is one of the most remarkable text- books in the world. Its author was one of the most profound thinkers, as well as the most able man in the world in his specialty. He was, in fact, the first Oral Surgeon. His book is a remarkable contribution to the literature of dentistry. It is a treatise on diseases and surgery of the mouth, jaws, face, teeth, and asso- ciate parts. It is the most complete and the most comprehensive work in den- tistry. It is really a system of dentistry, for it treats of operative and mechan- ical dentistry in all its phases. If there were but one book a dentist could aflford to buy. that one book would be Garretson's System of Oral Surgery. PLASTICS AND PLASTIC FILLING. By J. Foster Flagg, D.D.S. Cloth, pp. 211. Illustrated. Price $4.00. Dr. Flagg has always been the leading authority on plastics. He has been called " The Apostle of Plastics," and no man has given to the study of this subject equal care and attention. He championed the cause of plastics when it had few friends, and no other champion than himself; when men openly decried the use of plastics, and privately used them in their own practices. In his book he has given the results of his great experience in the making and use of all the plastics. His book is interesting, so interesting in fact that few can lay it down without reading it through. It is as interesting as a story book, and yet it is a THE PRACTICE BUILDER. 267 scientific treatise. Anyone who thinks he knows all about plastics should read it, and then he will know how to insert an amalgam filling. THE AMERICAN TEXT BOOK OF PROSTHETIC DENTISTRY. Ed- ited by Charles J. Essig, M.D., D.D.S. Professor of Mechanical Dentistry and Metallurgy, University of Pennsylvania, Philadelphia. In one octavo \olume of 760 pages, with 983 engravings. Price, cloth, $6.00. Leather, $7.00. This is the latest and most complete book on this subject. It consists of con- tributions by eminent authorities. As a text-book on prosthetic dentistry it is a decided step in advance of anything which has appeared on that subject. PRACTICAL TREATISE ON MECHANICAL DENTISTRY. By Joseph Richardson. Cloth, $4.50. Sheep, $5.50. This book is very complete and thorough, and is illustrated with several hundred cuts. xAill the procedures of mechanical dentistry are carefully con- sidered, and much space is given to crown and bridge work and to oral de- formities. ANATOMY AND PATHOLOGY OF THE TEETH. By C. F. W. B6- decker, D.D.S., M.D.S. xA.dopted by The National Association of Dental Faculties as a Text-book. 676 pp. 325 illustrations. Cloth. $5.00. Sheep, $6.00. This is a great book. It is the work of ten years on the part of Dr. Bodecker. Any one interested in the study of Pathology cannot fail to find it very valuable as a work of reference. DENTAL JURISPRUDENCE. By Wm. F. Rehfuss, D.D.S. 468 pp. Cloth, $2.50. Half morocco, $3.50. When a dentist needs advice about dental jurisprudence he needs it in a hurry. It is impossible for him to know at w^hat moment he may be sued by a patient, or when he may have to sue. This book gives all the information there is concerning the legal aspect of the practice of dentistry. It tells all about Dental Expert Witnesses — The Legal Protection Afiforded the Dentist — Malpractice — The Degree of Skill — Damages — Rape — Compensation — this chapter is very valuable, because it tells all about the payment of dentist's accounts, and shows him the law in the matter when he decides to bring suit to recover payment — The Book Accounts of Dentists — Patent Rights — and a great fund of information of value to every practicing dentist. By all means have this book; it wall save many dollars: saving dollars is making dollars. This is a pointer that is worth putting into practice. ARTIFICIAL ANAESTHESIA. By Laurence Turnbull, M.D., Ph. G. Cloth. Fourth edition Revised and Enlarged. Illustrated. Price, $3.00. In this work Dr. Turnbull treats the subject of Ansesthetics and Anaes- thesia in the most thorough manner. The author's sole object has been to make this work a scientific, yet practical and safe guide, no labor or expense having been spared to accomplish this object. 268 THE PRACTICE BUILDER CATCHING'S COMPENDIUM OF PRACTICAL DENTISTRY. By B. H. Catching, D.D.S. Cloth. Averaging about 320 pp. Illustrated. First volume 1890; Second volume 1891; Third volume 1892; Fourth volume 1893; Fifth volume 1894; Sixth volume 1895; Seventh volume 1896. Price, 1891, 1892, 1893. 1894, $2.50 each; Price, 1895, 1896, $3.00 each. " Catching's Compendium " of each year contains all the best practical articles that appear in all the dental journals, both foreign and domestic, for that year, so that he who owns it can have the gist of all the really practical ideas in one volume. To the man who cannot afiford to take several journals this book will prove a very good investment, for he will get all that is worth preserving in con- densed form. Dr. Catching does all this for him, and he has done it admirably. The departments are — Operative Dentistry — Prosthetic Dentistry — Crown and Bridge Work— Orthodontia — Dental Medicine — Oral Surgery — Miscellaneous — Science in Dentistry. There are many little points that come up during a day in a dental office, that puzzle an operator; but he can by reference to these books find out just what he wishes to know. Have them, by all means. FIVE HUNDRED AND SIXTY-SEVEN HINTS FOR THE BUSY DEN- TIST. By Wm. H. Steele, D.D.S. USEFUL HINTS FOR THE BUSY DENTIST. By Wm. H. Steele, D.D.S. Cloth, each 300 pages. Price each, $2.50. In these books Dr. Steele has gathered, winnowed, sifted, sorted, and boiled down all the best practical hints, pointers, and helpful aids to performing work as it is done every day at the chair. These pointers are gathered from the dental journals, the dental societies, from personal talks with dentists, and from Dr. Steele's own experience. They make a very valuable addition to any dentist's library, and there is no dentist who will not be amply repaid for buying them. NITROUS OXIDE. Its Properties, Methods of Administration, and Effects. By S. H. Guilford, A.M., D.D.S. Cloth. Price $1.00. Every dentist should have this book. To go on from day to day administer- ing Nitrous Oxide Gas without having it is not justice to a dentist's patrons nor to himself. The book contains a vast amount of information and is prac- tical, useful, from beginning to end. Among the other works of reference that dentists are advised to have are the following: Buxton's " Anesthetics." Clifford's " Manual of Materia Medica, Pharmacology, and Therapeutics." " Dental Microscopy." Hopewell Smith. L.D.S. " Dental Pathology and Practice." Frank Abbott, M.D. " Dental Laboratory." Theodore Chupein. Essig's " Dental Metallurgy." Gorgas's " Dental Medicine." Harris's " Principles and Practice of Dental Surgery." Haskell's " Students' Manual." THE PRACTICE BUILDER. 269 Lennmalm's " History and Review of Dentistry." Miller's " Micro-Organisms of the Human Mouth." Mitchell's " Dental Chemistry." Manual of '" Dental Chemistry." "Manual of Dental Anatomy, Human and Comparative." Tomes. " Manual of Operative Technics." Weeks. " Practical Dental Metallurgy." Hodgen. " Rise, Fall, and Revival of Dental Prosthesis." Cigrand. Polk's " Dental Register." " City Directory." Besides these books, every progressive dentist should have works of reference that do not relate to his professional work. A dentist should be well informed on other subjects as well as upon his profession. He should have a good Encyclopedia, and such works of reference as are necessary in the library of a professionally educated gentleman. Lady Assistants " Let thy maid he faithful, strong, and homely " As soon as vou can afford it have a lady assistant. Her services will be found valuable in many ways. The presence of a woman in an office is indicated by the care and attention which is given the arrangement of the furniture, and by the neatness and cleanliness which prevails; things that a man never notices are always observed by a woman's watchful eye. Dust that is not noticed by a man will always be seen by a woman. When a lady patient enters an office she looks around to see if she can discern any dirt. If a young lady takes care of the office, it is probable that the patient will not see any dirt. A young woman selected for an assistant should be sufficiently well paid to enable her to dress neatly. While she should be neat in appear- ance, care should be taken that she is not too good looking; an assist- ant should not be selected because of her good looks. Good looking assistants in dental offices have caused more or less trouble, from the time of their first employment. We hope we will be excused from any extended discussion of this matter, and trust that every man will govern his selection by good sense and sound judgment. As an aid to operating, a girl is of very great assistance; after a short time she becomes habituated to the peculiar style of operating practiced by her employer. Thus, she passes gold, anneals it. passes it to the proper position in the cavity and condenses it with the mallet. It is estimated that by the aid of an assistant fully thirty-three per cent, better time is made on gold work. There can be no doubt that the work is done better, because the dentist can give his whole attention to packing 270 THE PRACTICE BUILDER 271 the gold. The saving to the patient is not less important. One-third less time in the chair would be a grateful prospect. The advantage of a lady assistant in receiving and dismissing pa- tients is very great ; in helping the ladies of¥ with their wraps and hang- ing them up, and after the operation is finished, helping them on with them; in entertaining those who wait, and in keeping children amused before and during operations — no insignificant tasks. The saving in time to the operator is so great that with an assistant he can get all his gold work done during the lightest hours of the day. He can, if he has to do it, perform one-third more work; or he can give one-third more time to his plate work. The saving in time will save the dentist's nerves. This means longer life to him. It should be a part of the lady assistant's work to see that the nap- kins used to dam the flow of saliva in filling operations be properly laundered. For this she should receive extra pay. She should keep the books, and attend to the details connected with the book-keeping. In this connection it may be said that one should deliberate before employing a lady assistant; the position is a very confidential one, and few dentists care to trust the details of their practice to girls. She should render the bills, monthly, from the books, and should be made familiar with the different forms used in letter writing, in the cases of delin- quents. Some dentists allow their assistants to collect from slowly pay- ing patrons. It is an effective method. People do not care to have them call more than two or three times. She should typewrite his articles for publication and attend to his business correspondence. He should so familiarize her with the dental journals that she could mark for him the most desirable articles to read, and should index the articles from the various journals after the plan shown by the Ohio Dental Journal, so that an article could be found without loss of time, and requiring reference only to the index. The method as used by the OJiio Dental Journal, was to have a blank page inserted in the front each month, on which the interesting articles of all the other journals taken by the subscriber could be in- dexed: Article Journal Page She should file his notes in their appropriate places in the portfolio 272 THK PRACTICE BUILDER scrap book, or pigeon-hole boxes of the desk. She should arrange the list of those whose teeth are to be examined at regular intervals, so that the cards can be filled out on the typewriter, the envelopes addressed likewise, and the cards mailed and the reminder cards sent without any hitch occurring. The cement cards, the crown and bridge cards, should be so systematically arranged that everything will move ofY without the slightest interference on the part of the dentist. It should be her duty to attend to the corres^^ondence, and the filing and entering of the hills received from the dental dealers and from others. She should attend to the mailing of " The American Dental Instructor," as described in " Holding Patronage." Wiien extracting is to be done, a lady assistant is a great help, whether the extracting be done by use of gas or local anaesthetic. If ether is used the lady assistant should always be at hand. This for the dentist's protection. Again, amalgam fillings can rarely be finely finished at the same ap- pointment that they are inserted, and it will be the very best business policy for the dentist to have appropriate cards which should be sent to the patients a day or so after the operation has been performed, telling I hem to call at such and such an hour to have the filling polished, whether amalgam or cement. If a higher polish is intended to be given a gold filling, the lady assis- tant can do this. There are a great many other duties that will suggest themselves to the practitioner. An assistant should be selected who possesses tact and good manners, one who can converse intelligently with the clients of her employer. She should know her place and keep it. The manifold nature of her duties and the confidential personal character of her work makes it necessary to place her in complete charge of the financial aspect of the practice, thus relieving the practitioner of any laborious book-keeping and accounts of any kind. Thus he is given all this time to devote to the scientific side of his work. A trained assistant soon becomes so valuable an aid that the prac- titioner would not care to be without one. The promptness with which accounts may be rendered, and the tight rein a man has on his practice when everything moves along smoothly, is w^orth everything it costs to have it so. THE PRACTICE BUILDER 273 When everything moves along in a slip-shod manner, it is surprising how quickly a practice will drop. It is like a trotting horse, the moment the driver loosens up on the reins the horse either " goes off his feet," or slacks his speed at once. A dental practice is just the same. As long as a man keeps in touch with every phase of its conduct, everything will go swimmingly ; but if anything is neglected, look out for a calm. Boy Assistants " Boys should learn that "which they shall use as men " A great many boys who gave promise of brilliant careers as railroad section hands have been ruthlessly torn from their more appropriate bent in life, to be taken into dental offices as assistants. Boys are taken up by dentists wholly without regard to their fitness for the work, and who are without a proper preliminary education, or comprehension of dentistry. In this way hundreds of young men, better fitted both by natural inclination and by education for some other vocation, are added to our ranks. Hundreds of dentists practising to-day ought to be anything else. Their fathers or mothers thought there was money in dentistry, and they wanted their sons to be dentists. When a boy applies to a dentist, to become an assistant, he should be told that dentistry is not the EI Dorado he seems to think it. He should be told of the preliminary edu- cation demanded of the dental student to-day, the length of time it takes to complete a course of training, the expense of attending a dental col- lege, and of the long period of enforced idleness while waiting to acquire a good practice. It should be explained to him that the reports concerning the in- comes of dentists are very erroneous, that the popular opinion con- cerning the profits from dental work are based upon an improper un- derstanding of the matter, and that a competency is only gained by years of toil. He should be told that the incomes are out of all proportion to the time given to educating themselves, and to the money spent in their education and to maintaining themselves after entering practice; that in proportion to the time, study, money, and nerve racking work per- 274 THE PRACTICE BUILDER 27" formed, the dentist is illy paid; that the same amount of money used as capital, the same amount of study and the same individual talent, would be better rewarded at the end of twenty years in almost any other voca- tion than in dentistry ; that hundreds of dentists in practice to-day, yes, thousands, have little more than a good living, and that hundreds are dying and leaving nothing to their families but a good name. This doesn't keep the family, however. If the dentist would shut off about fifty per cent, of the aspirants for dental fame, the quality of the annual crop of graduates would be materially improved. No worthy young man should be discouraged. We have plenty of room for good dentists, but we have neither time nor room for the hundreds who annually become infatuated with a sudden desire to be dentists. It is a fact that cannot be denied, that a young man who proposes to be a dentist actually throws away his time by going into a dental ofhce as assistant. This is because he has no systematic course of instruction, and does the simple duties assigned him without being any better pre- pared for college than if he had never seen a dental office. If he remains in the office for a year or more he is allowed the privilege of cleaning out the office every morning, of taking care of the laboratory, of mixing plaster, and of scraping the plaster bench, of watching the vulcanizer, scraping the plates when they are vulcanized and polishing them for the final finish. This is not a proper return for the length of time he is usually employed in such pursuits. This work is altogether too trivial. It is a waste of time for a young man to perform these menial duties for the mere sake of learning the little that he does. The dental colleges as a general rule say they prefer to take a green young man who knows nothing about laboratory work, and train him themselves; because it is necessary to make the majority of those w^ho have been under a preceptor unlearn a great deal of what they were taught. This is sometimes hard to do, as the student is likely to think his preceptor was right. A dentist should not take in a boy assistant without having a very definite understanding with his parents. He should tell them plainly that if the boy enters the office as is the usual custom, it will be a loss of time to him; but tell them, if they are really anxious for the boy to 276 THE PRACTICE BUILDER prepare himself for a dental college, you can be of great assistance to him provided they wish to pay for your services, which should not be less than $ioo.OQ for one year, and more according to the reputation of the dentist. By this means the boy is assured of a systematic course of instruc- tion; the dentist, being remunerated, has an interest in his advance- ment and instructs him for college, and advises him how and what to study, and what to avoid. Thus, when he enters college, he is prepared to get the most benefit from his studies. Not only this, but his instructor can show him how to avoid many expenses that otherwise he would find it difficult to refrain from making. An assistant should not be allowed to insert amalgam fillings or cement fillings. Some dentists permit their student assistants to do this, but it is not professionally right, nor is it good business policy. If one allows his assistant to do these things, people will think it does not take much study or practice to be a dentist, and if the work does not go just right the dentist is blamed for it, and rightly, too. When a dentist's practice has grown sufficiently for him to need some aid, he should secure the services of a graduate. Much of the lighter work that consumes time may be done by the assistant, such as the use of plastics, and cleaning teeth and plate work, after the latter has undergone the personal supervision of the dentist himself. Thus the operator has more time to devote to his crown and bridge work, to his regulating cases, and to his gold filling. His ability is more likely to be improved, and his value to his patrons materially increased. He has more time to study the needs of his prac- tice; he is given opportunity to think and devise means for its exten- sion; and he is afforded abundant opportunity to attend the societies, and to visit his brother dentists in their offices, to exchange ideas with them; to go home, put them into operation, and if they are good to profit by them. The presence of an assistant prevents many undesirable things from happening, especially in the matter of women. An assistant is valuable as a witness to transactions between the dentist and patients that are otherwise likely to be troublesome. The Dentist's Home " Hie him home at evening's close, to sweet repast and calm repose " It is the ambition of every dentist to have a home of his own, and this is possible, by the exercise of the same prudence that it is necessary for a man to exhibit in any other calling. To own his own home should be the aim of every man. When a man has attained a competency he builds for himself a home, and this, it will usually be found, especially in th« smaller cities, has a value which is a very large share of the total wealth of its owner. The striving for a home, and the heedfulness which it is necessary for him to exhibit in so doing, make the dentist an object of interest to his patrons, because thus he shows his own interest in the community in which he lives. When one owns his own home, it is an indication of success. People have a habit of patronizing successful men. They may have no proof of his ability as a dentist, but the fact that he is successful in a financial way is convincing proof that he became so by the exercise of professional skill. A dentist should be sure of his position before building or buying a home, and it would be folly for him to attempt this before he has money enough not only to build and furnish it as becomes his position, but he should as well have at least as much to back him against any unforeseen circumstances; as, for instance, prolonged sickness of himself or any member of his family, or any other ills that beset men in all the walks of life. The dentist should have a bright and inviting home, furnished attrac- tively, where he may take his ease after the exacting duties of his pro- fession. Here he may rest, surrounded by the members of his family, or here he can read the journals of his profession, enjoy a quiet smoke, or amuse himself as may best suit his fancy. 277 278 THE PRACTICE BUILDER His home should be furnished as befits his position in the com- munity, and his income from his profession. Everything that does not pertain to the performance of his work should be kept at his home; all books but those that relate to dentistry, all his account books, etc., should be there, except such as are needed for daily use. In this way his home becomes more attractive to him, leaving, as it does, everything that relates to his daily duties at his office. Everything that will relieve his mind of anxiety and will make life comfortable should be his. Every day, filled as it is with the nerve- racking work of operating for nervous women and children, makes it necessary for him to take all the enjoyment that is to be had in a pleasant home, to equalize matters. Many dentists attempt to have offices which outshine the attractiveness of their homes. This should not be. The home should be the more attractive. It should be a matter of pride to the dentist to have a better furnished home than office. His family should be his first consideration, and a home for them in which life may be enjoyed should be his ambition. The dentist who enters upon his duties with the hope of becoming rich in the practice of his profession, without any other medium for personal advancement, is a very deluded mortal. Let him but note the thousands of members of the dental profession who have a good living, a very good living, but nothing more. Let him at least have a good home. The practice of his profession will return him a good yearly income, and the income is likely to re- main the same year in and year out, so that he is sure of his income and after he gets a home he is sure of keeping it. " While we journey through life let us live by the way." He is always his own master, and the failure of corporations and hard times cannot throw him out of a position, as may be the case with employes. This should in a measure compensate him for the unlikeli- hood of ever making a ten-strike in dentistry. His Person " Genteel in personage, conduct, and equipage " Few dentists appear to realize the importance of an intimate re- gard for their personal appearance, in the ofhce as well as on the street. Thousands pay no attention whatever to their appearance while in the office, in the active duties of operating-. If they only knew what a favorable impression is made upon the patient by a neat, professional, dignified appearance, if they only knew what a pride patients take in patronizing the dentist who not only pos- sesses superior skill, but who takes great care to always appear to the best advantage in his reception room, as he does on the street, they would at once make a great change in their careless office attire. No dentist should appear before his patients in any but the most scrupu- lously correct manner. Many are in the habit of operating in their shirt sleeves. This is extremely objectionable, and marks the dentist as a very common man. People have a right to expect that a dentist will ob- serve the proprieties and avoid such exhibitions of bad taste. A dentist should appear before his patrons in a neat operating coat, made to his measure, from a suitable material. A tennis blazer won't do, neither will a smoking jacket be proper; yet we see in every town dentists who wear tennis blazers and smoking jackets for operating coats. This is in poor taste. In the large cities, white operating coats, of bleached drilling, shrunk, are worn. While dififerent from barber's coats, these are yet so similar that in small towns it is probably best to use some other color. Prominent operators keep a good number of these white coats on hand so that they can always have plenty of clean ones while the soiled ones are being laundered. This is one great advantage of the white 279 28o THE PRACTICE BUILDER coats, their color necessitates a change as soon as the sUghtest spot ap- pears, and the operator is always immaculate. If other colors are se- lected, dark brown, dark blue, and gray will be found appropriate. Ladies' cloth is used, and any tailor can make them to measure. Whether the white drilling coats or the tailor-made coats are used, they should button closely up the front as high as the neck. The wrist should be fitted with wrist straps which may be buttoned, clasping the sleeve wrist tightly about. A sleeve allowed to remain loose in operat- ing, permitting, as it does, the patient to see up to the elbow, is disgust- ing. The pockets, if any, should be false, to prevent their being caught on the operating chair. One pocket, in which a pair of forceps may be carried, is sufftcient. The coat should be cut square across the bottom, and should reach ten or twelve inches below the hips. Many dentists are careless in the arrangement of their hair, or wear it so long as to be objectionable. Many are partially or completely bald. A silk skull cap should be worn by all such. By wearing a pair of slip- pers, a light step and quiet movement in the office is possible. This adds neatness to the appearance and is altogether desirable. The style of slipper known as the Romeo is one of the best for the dentist's purpose. That a dentist should be guilty of allowing his breath to become dis- agreeable would seem to be almost beyond belief; but we have known patients to leave dentists for no other reason than that their breath was offensive. We know of eminent operators whose breath is so foul as to make conversation with them most unpleasant. If this is not attended to, there is likely to be a loss of patronage, and that too of the most desir- able element. Dentists are, of course, careful of their teeth, so that the difficulty may be traced usually to a disordered condition of the stomach. This should be remedied by appropriate means and the mouth rinsed with a disinfectant mouth wash. Many are in the habit of using small quantities of charcoal for this purpose. A few crystals of permanganate of potash in water makes one of the most efficient purifiers for the breath. Euthymol, prepared by Park, Davis & Co., is also a very ex- cellent preparation for this purpose. A sample is sent free on request. We have used this for patients having such a disagreeable breath as to make working for them very unpleasant. A little Euthymol makes THE PRACTICE BUILDER 281 everything all right. Borolyptol, a somewhat similar preparation, is also held in high esteem. Bad breath sometimes results from the slight accumulations of sali- vary calculus observable at the gingival portion of the lingual surface of the lower incisors. This is more especially the case with fair-haired men and women than with brunettes. Dentists, above all others, should exercise great care to prevent this accumulation from forming. The care of the hands is one of the most important matters of per- sonal appearance. Nothing is more closely scrutinized by the patient than the hands of the operator. Great care should be taken to keep them always in good condition. This is sometimes very difficult, espe- cially when the dentist does all his own plate work, the polishing of which grinds the polishing powder into the skin and under the nails so thoroughly that it is absolutely impossible to wash it off. When the dentist has a large operating practice he should not do all his own plate work, and so keep his hands in such an undesirable condition as to lay himself open to the unfavorable and often uncomplimentary comments of his patrons. When he does do his own plate work, however, he should explain to his patients that the condition of his hands was caused by the laboratory work, and that he had scrubbed vigorously to get it ofif, but failed. The greatest care should be taken to trim the nails so that they will always be presentable. They should be kept moderately long — very short nails have a plebeian look — and be so cut that they are a little more pointed than the upper ends of the nails are. They should not be scraped, and in cutting care should be taken not to encroach too much on the angles. Either practice, in time, results in serious injury. They cannot be kept in good shape without using a file. Of course the nails should be kept scrupulously clean. There is a difference of opinion as to whether perfumed soap should be used for cleaning the hands. Many favor a highly flavored toilet soap, while others are equally emphatic in the belief that an unscented soap should be used; we incline to the latter opinion; people of the better class do not care to. smell highly scented toilet soaps. If any flavor is used at all it should be lavender of the very best sort. This is very expensive. Where it is desired to impart an odor to the hands a 282 THE PRACTICE BUILDER delicate toilet water should be used after the hands have been dried. It is more refined to use no odor in the soaps. A careful observance of all these points will save the reader from many mortifying circumstances, and the patients will note his scrupulous cleanliness and report it to their friends. A failure to observe these important matters, or any neglect of their performance, cannot but result in revolting comment and con- sequent loss of patronage. Ideas "The brain contains ten thousand cells, in each some active fancy dwells" Ideas have made men rich, and will continue to make men rich, pro- viding the ideas themselves are all right. But as much depends upon the man as upon the ideas. Some men evolve such impractical ideas, so incapable of being put into practice, that their time is wholly lost in evolving them. The ideas need not always be new to be effective. Improvements pay as big returns as originality. A bright mind may polish a rough idea until it becomes a diamond. Shakespeare adapted the ideas of others to his own uses, but in adapting them he wrought such a change that they could be recognized with difficulty. Men who can originate ideas, or who can adapt the ideas of others, or who can improve ideas, do not have to work at hard labor. They can evolve plans which, when ready, they can charge others for using. In other words, those who think, charge for their thoughts. When the thoughts are good there is a large profit on them. When they are not good there is no loss, so long as the thinker possesses judgment and does not foolishly attempt to force them upon those who realize their deficiencies. Ideas that are worth nothing cost nothing. Ideas that are the result of great industry and study are worth having, therefore worth paying for ; and hence it will pay any man well to evolve an idea for which other men are willing to pay. We all have plans and ideas and schemes. All men who think have ideas, but all men do not develop them. Often one takes possession of a man's brain, and he lives with it and sleeps with it for weeks only to finally let it go without having put it into effect. Another idea is treated 283 284 '^^^^ PRACTICE BUILDER in the same way, and another, and another, until time is gone and Hfe itself is slipping rapidly away. If only these ideas had been nourished, they would have budded and blossomed and then brought forth fruit — life-supporting fruit to make tiieir possessors happy and to keep them in afifluence for the remainder of their days. Don't let good ideas go to waste. Keep them. Lie awake at night. Plan, scheme. This is how men get rich. Neglect of these things is why poor men stay poor. The road to wealth is narrow and the way is filled with dangerous places. There is no short cut. Thousands upon thousands of ideas which, if carefully developed and put into operation, would make their possessors rich, are neglected and forgotten; and the men who thought them out go plodding along through life earning a living by their muscles, where they might have lived like princes upon the product of their brains. The man who concentrates his attention upon one idea and devotes his spare time to that one idea until it is de- veloped, until he knows it as a father knows a child — it is a child — the child of his brain — until he knows the subject from every side, and, knowing it so, puts the idea or \)\an into operation, reaps his reward. In the course of the day many ideas fly through the brain. Some of these are worthy of being recorded; some are not. There can be no harm in recording them all. There is no better plan that we know of than to carry at all times a note-book and to put down all ideas as they present themselves. A person may put down a hundred of these thoughts, and a week or a month afterward in looking them over may only find one or two that are really good; but if only one is. good, he is well repaid for recording them. A good plan is to get a dozen or more of the very smallest pencil pads that can be had. measuring about four inches by two. Keep one of these at all times on the desk, and when an idea strikes put it down on a sheet of the pad, which is just large enough to accommodate a few lines, tear it ofif and place it in one of the pigeon- hole boxes of the desk, labelled " Ideas," and add to the number from day to day. When the box becomes filled the slips should be taken out and put into a file, such, for instance, as "Breed's Portfolio Scrap Book," or any other similar device. These slips should be classified. All that relates to one subject should be placed in one compartment of the file. Thus all upon that subject is accessible instantly. When enough in- THE PRACTICE BUILDER 285 formation has been gained to cover the ground thoroughly, the idea, plan, or scheme is ready to be put into operation. This method of always recording ideas promotes carefulness and precision, and at the same time trains the mind to busy itself during spare moments. Brain work pays. It pays big. And the more the mine is worked the more it is worth; the better its product. There are just as good ideas in the convolutions of men's brains as have ever been produced. Keep digging. You'll find a nugget some day. Only keep at it. A workman applied one day to the foreman of a factory for a raise in wages. He was told that he was paid all he earned. The workman said he had a large family. The foreman said to him: "Tom, when you go home at night jot down any idea you may have and put it on my desk in the morning." The man did so. The ideas presented proved to be impracticable, or had been discovered years before by some one else. The foreman encouraged him. He persevered. One morning on one of the slips he handed in was a little idea. It did not amount to much, but it was worth something. The foreman put it into operation. The workman kept on trying, and in a year or so had produced such good practical ideas that they were rapidly put into use. In a few years that workman's share of the profits of some of his ideas amounted to $60,000. He did not have to go to work at seven o'clock in the morning with a dinner-pail in his hand. His children were educated and became more useful to the community than if he had remained a plodder at day's wages. Another instance: Two men stood at the same table in a large fac- tory in Philadelphia, working at the same trade. Having an hour for their nooning every day, each undertook to use it in accomplishing a definite purpose ; each persevered for about the same number of months, and each won success at last. One used his daily hour in working out the invention of a machine for sawing a block of wood into almost any desired shape. When his invention was complete he sold the patent for a fortune, changed his workman's apron for a broadcloth suit, and moved out of a tenement house into a brown-stone mansion. The other man, what did he do? Well, he spent an hour every day most of the year in the very difficult undertaking of teaching a little dog to stand on his 286 THE PRACTICE BUILDER hind feet and dance a jig wliile he played the tune. At last account, he was working ten hours a day at the same trade and at his old wages, and finding fault with the fate that made his fellow-workman rich while leaving him poor. Leisure moments may bring golden grain to mind as well as to purse, if one harvests wheat instead of chafif. Do not, therefore, employ your time in idle work or play. Do some- thing that will do some good. Don't wait for something to turn up. Turn something up. Don't train a little dog. If you have a brain, you have the power of thought. Think ! Think ! ! Think ! ! ! Oh ! the peace and contentment of concentrated thought. Of a mind with a purpose, perseverance, and stick-to-it-ive-ness. Don't waste your ideas. Don't let them come and go like idle winds. Record your thoughts. Consider them. Reflect over them, and if they are good, apply them. Qassifying Information " Classification is simplification " Observe, read, question, and record. One thought written means another born. Business is truth combined with practical activity, A great deal of error is due to mystery, and classified experience is its enemy. Useful information should be digested and used as a stepping stone. Wisdom is applicable knowledge worked out between the lines. Much depends upon who uses it, and where and how it is used. Few dentists appear to appreciate the value of classified information. Few make any effort to classify facts. Facts are valuable. To store them away until the occasion for their use makes itself apparent, is the part of wisdom and practical good sense. Many dentists subscribe to the dental journals, but they merely glance through the pages and toss the magazine aside without a thought, disregardful of the value of its contents. If it does contain good they do not see it, or they fail to mentally record the particulars and to apply the matter in their daily work. This results in drifting and falling back of the great caravan of progress, and in failure to keep in touch with all the good new things. A dentist must be up with all that is good, new, up-to- date; he must go forward, or he will go back; there is no such thing as standing still ; the rate at which the profession is advancing makes it imperative on the part of its members to advance accordingly. In- activity means retrogression, stagnation. Stagnation means death to a professional man, professional extinction. Every book of reference should have its place, and its table of con- tents should be familiar. Every dental journal should be carefully read, and every page carefully scanned for ideas, big and little ; many 287 28S THE PRACTICE BUILDER little ideas are the cciuivalent of one big one; the advertising pages are just as worthy of careful consideration as the pages of the text; the rapidity uitli which new appliances, new processes, and new materials are introduced is such that to always have the latest productions of inventors and manufacturers, it is necessary to constantly watch the back pages of every issue of the dental publications. Many men keep ahead by being the first to introduce the latest innovation. In reading over the journals, articles of interest and matters of im- portance as discussed in the societies should be marked in a manner to be understood by the lady assistant, and it should be her duty to transfer the title or leading idea of such article, or the address, to a specially prepared blank book. This would be no trouble to the dentist, and would result in his having all the facts from all the journals in one place. Thus he has ready for use at any moment the information which he may require at the chair. Often during an operation it is necessary to refer to works of reference, or to the dental journals, and with such a book one can easily find what he is looking for. This has been referred to in the chapter on " Records." In preparing articles for the journals, or addresses to be delivered be- fore dental societies, it is necessary to refer constantly to articles on sim- ilar subjects. Few are qualified to present an original matter in the most enthusiastic manner, and even the foremost writers are in the habit of consulting the authorities in verification of their assertions. Many professional men are in the habit of employing the press clipping bureaus to collect information pertinent to the subject they are writing about ; in this way the most comprehensive treatment is made possible. Clipping bureaus read all publications, and they are patron- ized by authors, actors, artists, politicians, public speakers, and business and professional men in all lines. The clippings are furnished at very low rates, and in some instances a monthly rate is given which is very reasonable. By some bureaus the rate is so much per clipping, from three cents to five cents each. There are clipping bureaus in many of the larger cities; special information is to be had on application. Two prominent bureaus are the Chicago Press Clipping Bureau, 36 La Salle Street, Chicago, and Romeike's Press Clipping Bureau, 139 Fifth Avenue, New York, THE PRACTICE BUILDER 289 Some dentists do not care to save their dental journals, but instead clip the best articles each month and paste them under their appropriate headings in a large scrap book. This method enables those who do not care to preserve their journals, to save all articles of real interest in convenient form. Another way of keeping scraps, clippings, special articles, etc., is by use of the portfolio scrap book or document file. From twenty-five to fifty strong envelopes are bound in covers, and used to file away infor- mation of all kinds. The subject is written on the envelope and is then classified in the index. A very convenient and desirable device for this purpose is " Breed's Portfolio Scrap Book." Purchasing " Buy tvhat thou hast no need of, and before long ihou shall sell thy necessaries " Dentists do too much purchasing. No one who has been present in the sample room of the travelHng representative of a dental supply house will deny this statement. When dentists get in these sample rooms they buy things for which they have no present or prospective need. They do not seem to learn that it is the business of the other to sell all the goods he possibly can. The trouble lies very largely in the present system of extending liberal credits to dentists. This may prove very profitable to the dealer, but it results in every dental ofifice becoming cluttered up with a great many appliances that are rarely, if ever, used. Thousands of dollars' worth of unnecessary material is purchased in this way every year, not only by young dentists but by the older ones as well. By indulging in procedures so obviously unwise, the dentist puts his cash in a position where he can get no use from it. His capital is thus placed beyond his own reach. This is a most fallacious business policy. A dentist should never buy anything for which he has no immediate need. When he does need it, the supply house will be in its usual place, and most dentists are within a day's mail of a dealer. When buying goods upon credit, one should never lose sight of the fact that he has to pay for them; it don't make any difference whether the dentist gets paid or not, the dental dealer must be paid. If this fact were borne in mind, fewer dentists would have uncomfortably large accounts with the dealers. Credit is a good thing, but it can be abused. Credit should be employed with care, or not at all. Credit can be easily impaired, and once lost is diflficult to regain. Make out a list of what is wanted, before the agent calls and buy 290 THE PRACTICE BUILDER 291 just what the list shows you need, and no more. When you have bought all you need, go. Some dentists hang around the supply room of the agent, and buy this and that contrivance, until they have run up a bill for a lot of goods they have no need for. It really looks sometimes as if some of the dentists were buying just to show off before a rival that they use a large amount of material. This is foolish, but it is done. Such things do not result in convincing the other person that the purchaser is doing anything more than throwing good money away. Such petty exhibitions are unworthy of grown men. In purchasing, those who have large plate work practices will find that there is a great saving in buying plaster by the barrel, half barrel, or quarter barrel. Alloys, if bought in ten or twenty ounce lots, may be had at a very good discount from the ounce price. This will pay the practitioner, when he can afford to purchase in this quantity. One of the lines of goods in which inducements are offered by the agents, is excavating burs. In this connection we should like to warn all young practitioners that usually the best costs the most. We do not wish to say that because this or that kind of burs cost more than another kind, it is better, but it is our experience that when you pay less than a standard price you get less. Engine mandrels and disk holders are very expensive, considering the simplicity of their construction and their wide-spread use. Do not buy every new kind that comes out; enough of those that are lying around the drawers of the operating cabinet can be found to do all that is needed of them for years to come. Gold plate should not be bought in large pieces without regard to the amount actually needed, and it should be ordered according to the requirements of the individual cases. Measure the roots approximately, both in circumference and length of finished crown, then measure the size necessary to make a cusp, approximately. By ordering gold in this way a large amount of waste is avoided. Gold bills run up almost before one knows it. Some of the supply houses refuse to sell precious metals except for cash. If this were generally adopted it would result in gain to all parties concerned. Think well before buying large outfits for the performance of crown and bridge work. These are usually very expensive, and their posses- 292 THE PRACTICE BUILDER sion in small practices docs not always admit of prompt returns for the investment. Investing in large amounts, comparatively speaking, for apparatus of this class, is not warranted except in such practices as employ one or two assistants, or when the cjuality of the practice is such as to demand the frequent use of the highest grade of material and appliances, and that constantly. Complicated instruments, so frequently introduced, should be let alone until the absolute necessity for their use is established. Don't be ready to grab for everything that comes along. Much is made to sell more than to use. Conduct at the Chair " Month shut, eyes ope ft " A dentist should be dignified in his demeanor while working at the chair; not too formal, nor unapproachable, but he should conduct him- self in a manner consistent with his professional standing. This subject is an important one, because here it is that patrons form their opinion of the man. No matter how aesthetically pleasing nor how accurately scientific his work may be, if the operator lacks any of the factors of personal conduct which go to make the gentleman and the professional man, not only will the impression created upon the patients be unfavorable, but such impressions will be repeated to their friends whenever the dentist's name happens to be brought up. A certain class have a way, when going to the dentist, of letting the entire neighborhood know about it; and when they return home and give their impressions of the dentist himself — woe to him if he does not meet their idea of what a dentist should be. A dentist's conduct is regulated largely by the individuality of the person for whom he is working. By this we mean that it is proper for him to understand the temperamental attributes of his patients, and thus be able to either engage them in such conversation as may divert the mind or so conduct himself as not to irritate them. There are men who irritate their patients from the first moment they get into the chair, and after the work is done the patient decides to go elsewhere in the future. This is because the dentist does not understand the patient. Of all the various classes which present, in our experience we have found old maids, we mean those above forty years of age, most trouble- 293 294 THE PRACTICE BUILDER some. They will find more fault and make more disparaging remarks than anv one else, no matter how near to an ideal the operator may strive to make himself. It seems it is more difficult to satisfy them, and they do more talking about the dentist behind his back than any other class of patients. He is wise, then, if in their presence lie remains silent, and com- pletes his task as rapidly as is consistent with good work. If he talks at all, it should be upon some subject of general interest; but he should not engage in an argument of any kind, especially upon politics, re- ligion, questions of morality or that relate to temperance. Some men have a habit of joking, and they carry this to extremes. It becomes tiresome, and is wholly out of place in a dentist, as much as it would be for a physician to constantly banter. But it must be remembered also that some patients enjoy this sort of thing; yet a sen- sible man will not gratify these persons by engaging in conversation that is really foolish. Once we remember a patient, a peculiar whining patient, one of those women who make a room look gloomy almost the moment they enter, saying to us, " Dr. Blank, you seem such a strange dentist." " Why, how is that, Mrs. ? " " Oh," she answered, " you never laugh and joke, as Dr. Green used to do. He used to tell the funniest stories while he was working for me, and all the time cutting up and making me laugh." " If I remember rightly, you told me you liked my work better than that of any dentist who had ever worked for you." " Yes," she said, " I do." " Well, if I conducted myself before you like a child, or made a monkey of myself to please you, do you think I could have my mind on my work and do it as satisfactorily as it has been done? " The patient saw the point and did not pursue the subject further. A man who is willing to make a fool of himself to please a thought- less patient, must remember that people are judged by their actions, and a continual desire to be funny will not inspire his patrons with con- fidence in him. Said a well known politician: " If I had not been such an habitual joker I might have been elected to some high office, but people took THE PRACTICE BUILDER 295 everything I did as a joke; I got a reputation for being a great joker, a funny man, and people could not take me seriously." If a dentist continually conducts himself after such a manner he may expect the same thing; he may get a reputation as being a very funny man, but he is not likely to add to his reputation as a dentist. In our experience we do not see the need of talking at all at the dental chair. A dentist who will attempt to talk with a man whose face is tied up in a rubber dam is likely to be considered a bore. Some people take delight in conversation that deals with person- alities. This is dangerous. The dentist who permits it is treading upon dangerous ground. People who deal in personalities are unsafe; they are usually two-faced; they will learn what they can of one person, and go to another — perhaps the very one they were talking about — and repeat what the first individual had to say. A dentist cannot be too careful about this matter. Do not let women become so friendly that they can ask you this or that about some one else ; they may mean well, but you should always be on your guard, and when the conversation takes this turn, change the subject so as not to give offence, and any intelligent person will see the point at once. Some people have a desire to talk about other dentists, telling what they know about them, what they have heard about them; something that relates to their work, their temper, or their family afifairs. The dentist who knows what he is about will tactfully avoid being drawn into a conversation of this kind. Persons of the better class will not wilfully enter into the discussion of anything personal. A dentist could m.ake a great deal of trouble for other people, and himself too, for that matter, if he were so idiotic as to retail the scandal that is poured into his unwilling ears by people he never saw before, and before he had been in town a month. Never let it be said of you by a patient, " Dr. Blank was telling me to-day ." When fast women apply to you for work, and it is your custom to work for them, be sure and maintain a courteous but dignified demeanor toward them. Usually they are accompanied by one other member of the house, to wait for them; the one who waits is likely to bring a Police Gazette, or Standard, or some other flashy literature with her, to while away the time. 296 THE PRACTICE BUILDER In making an appointment with a member of this class it will be to the practitioner's best interest to make the appointment for a time when he has made no other appointments during that half of the day, and charge the person accordingly; for if an appointment is made for the same forenoon with a lady who is a member of the better grade of society, she is likely, especially in the smaller towns, to know that the women are of the demi-monde, and may take offence; at least she has a right to show her displeasure at being given an appointment so close to theirs. Do not under any circumstances make any other than the most casual remarks, and only those that relate strictly to the work being done. It takes very little encouragement for these persons to become very friendly, and to engage in banter that is more or less discreditable. They laugh loud and long when a remark is made that is more or less funny, and if the dentist engages with them in talk, and a joke is passed, they will laugh in hearty appreciation of their ow'n wit, and just as likely as not the door will open while they are yet in the midst of their laugh- ing, and in will walk one of the most fashionable patrons, or perhaps it will be the young lady whom he most admires. He will turn as red as fire, too: the laughing will stop as if it had been cut short, the dentist will stand before his patient the most confused individual imaginable. Perhaps the young lady will say to herself, " Dr. Blank seems to be very well acquainted with those w^omen. I don't think I'll go up to his office again without ATamma." Or it may be his wife has just dropped in for a moment; she will see the persons in the ofifice, will note the look of confusion on her husband's face, and will mentally decide to drop into the office from time to time just to see how things are going. If he ever goes past their house, he is likely to hear one of them call to another, " Say, Pearl, Doc Blank just went past." There is danger of getting the name of doing all the work of this class of people, and this does no dentist any good. It is harmful to his practice to have it whispered about that he does the work for all the fast v'omen in the town. Do not make references to your other patients. Do not speak about one patient to another. Do not let one patient know what you are doing for another patient. THE PRACTICE BUILDER 297 Teeth are to be considered as personal, and people don't care to have their dental troubles talked about. They don't want other people to know that they have crowns, or bridges, or plates, or anything of the kind, and the dentist who tells one patient of the wonderful operation that he did for Mrs. Smith, should take care. Mrs. Smith may not like it. The professional relation which exists between the patient and the dentist is similar to that which exists between the physician and his patient, and the dentist should consider it as confidential, and make no references to the dental work of any of his patrons. Treatment of Other Dentists " All ambushed attacks are both cowardly and iiiea?i " Dentists are sometimes guilty of a great disregard of the principles of professional courtesy. Some are guilty of conduct unbecoming gentle- men, in their treatment of other dentists. A man is supposed to be a gentleman, before he can become a professional man. Unfortunately, this is not always the case. It has been said, and truly too, that there is a remarkable want of concordance in diagnosis and in treatment in dental practice, an absence of fellow feeling, and indifiference to the ethics of questions of judgment between dentists; when, as is often the case, the patient is made a party to controversies growing out of difference in treatment, this has un- doubtedly been a serious injury to our profession. The dental profession cannot hope to gain nor to hold the highest respect of the people, while its individuals exhibit the ethics of the artisan. The actual ill feeling which very generally prevails among den- tists in the smaller towns is lamentable, not only because of the personal animosity engendered, but because of the mutual helpfulness which might otherwise prevail, to the interest of the dentists and to their patients. This personal dislike is in most cases caused by patients going from one dentist to another and reporting unfavorably upon the conduct or workmanship of the previous operator. These things always get back to the first dentist in a surprisingly short time. Often they come from a bosom friend of the dissatisfied person. Such things are very disagree- able, but they are happening every day. These things happen among the most prominent practitioners, in the largest cities, just as frequently as among the modest practitioners in rural districts. 298 THE PRACTICE BUILDER 299 A few instances may suffice to show this. One of the most promi- nent dentists in Philadelphia, Dr. Chas. J. Essig, stated in an article bearing on this subject, in the International Dental Journal, that a dentist made an examination of fillings done by another, in the presence of two of the patient's relatives, pointing out alleged defects, and using other arguments to destroy the confidence which they had felt for many years in their family dentist. Another case was that of a gentleman who applied to a dentist to have his teeth examined, and was informed that it would take about six weeks to put them in order; he kept appointments every day for three weeks, and then becoming tired he asked the dentist how much more remained to be done, and was told, " I am about half through." " Well," said the patient, " I think I will stop for awhile." But soon after he had occasion to consult another practitioner, who, after an examination told him that with the exception of a few trifling repairs needed in one tooth, his teeth were in perfect order. In commenting on this case, the writer said he preferred not to characterize this remarkable difiference of opinion, but presuming that the incident was one of an honest difference of judgment between two professional men of equal intelligence, skill, and training, how may we account for such diagnostic uncertainty? The public is coming more and more to attribute such differences to the commercial spirit, and thus our profession is, to a certain extent, made to rest under a stigma. A dentist who has been in continuous practice for more than half a century, remarked that, " The most discouraging feature which he had met in practice was to be found in those cases in which he had en- deavored to save the soft and inferior teeth of early childhood by filling with gutta percha and other plastic materials, and just when the age had been reached when sufficient improvement in the quality of such teeth seemed to warrant the use of gold with some degree of perma- nency, the patient would fall into the hands of some other practitioner, presumably through loss of confidence in the family dentist; for some patients think that unless gold is used from the first as a filling material, we have not used our best efforts, and will seek the service of some one else who perhaps will be only too ready to encourage the wavering con- fidence in his professional brother." 30O THE PRACTICE BUILDER It is in just such cases that the individual of this class finds his most prolific opportunity ; he gets a patient of fifteen or sixteen years of age, in whose moutli during early childhood the teeth were of the frailest character, in some cases, perhaps, showing decalcification of the enamel on the labial surfaces of both upper and lower incisors. No class of cases causes the earnest practitioner more anxiety than these ; it would seem almost like malpractice to attempt to bridge over that precarious period of early dentition with any other of our too few and often unsatisfactory filling materials than gutta percha. But if the patient is unlucky enough to get into the hands of such a man, who habitually ignores the ethical side of cases, he frowns, looks unutterable things, condemns the earlier treatment, and fills with gold, the very thing the family dentist would have done at that time, had the patient remained in his charge, for by the fifteenth to the seventeenth year the teeth often show great improvement, and sometimes the tendency to decay at that age will have entirely disappeared. Continuing, the gentleman states that some years ago one of his young patients who had teeth of the frailest character, so frail, indeed, that up to his fourteenth year it was believed that the progress of decay could be better arrested by the use of gutta percha, got into the hands of a dentist at one of the fashionable watering places, who, between him- self and his assistant, after much severe and outspoken criticism, re- placed all the gutta percha fillings with very inferior gold ones, yet that individual has on more than one occasion publicly advocated the use of gutta percha as a preliminary filling material in " children's teeth of the frailest class." Some people change dentists often. They change dentists oftener than "they change physicians. The better class do not. When they get a good dentist, one who satisfactorily performs their work, they will retain him; but the less intelligent persons, those who form the lower grades, are in the habit of changing dentists almost as often as they have work to do. Many have heard their patients refer to other dentists, indicating that they have had work done in a comparatively few years by three or four dififerent operators. By such changes the patient is the loser, because, not being under the care of any one dentist long enough for him to observe the characteristics of the decay, an opportunity for THE PRACTICE BUILDER 301 careful consideration of the most appropriate filling materials is not afforded. These people are sometimes in the habit of quoting the preceding dentist, and they usually do so by the use of statements not compli- mentary in the least. No reply should be made to such remarks, and the subject should be changed. Such things can lead to no good. It is a very good rule that if you cannot say anything good of a person, to say nothing at all. Sometimes people will call and ask a dentist to pass his opinion on the work done by another. All such persons should be answered in the most peremptory manner, by saying, " I am not in the habit of criticis- ing the work of others. If there is anything wrong with your work, and you will return to your dentist, no doubt he will make everything sat- isfactory." No dentist knows what moment he may have need for the friendship of another. At the very moment when he least expects it, he may need evidence, in a law suit, as to his ability. He may need the corroborative evidence of another dentist in support of his testimony as to the value of certain services. A patient may die in his chair as the result of the administration of an anaesthetic. He may be sued for damages by some patient. There is no telling what may happen. Thus it is the part of wisdom to preserve a friendly footing with some other dentist of equal standing in the community. There are some of them whom it is best not to cultivate ; their ac- quaintance is worth little and their friendship less. When you do need the friendship of another dentist you need it badly. ■ When another dentist makes slanderous remarks about you, you will find it to your best interest to pay absolutely no attention to them, no matter what they are. This will seem almost impossible, but it will be for the best. If, however, the statements are made often, and by a person who does so thinking he will not be found out, it will be the proper thing to go right to him and tell him what you have heard, and that you think it is altogether wrong in him to do so ; tell him that all these stories have come right back to you, and that if you hear of any more of them you will make it warm for him. On one occasion, having been called out of the city for a week, we ^02 THE PRACTICE BUILDER found on returning that a patient complaining of a toothache had called; not being in town, the patient called on another dentist who, after ex- amining the teeth, said that they were all filled wrong and advised the removal of all the work. This he started to do, meanwhile making the most unprofessional and ungentlemanly statements, statements actuated by envy antl malice. He indicated to the patient that all the work was (lone wrong, and poorly done. The most disparaging statements as to our ability were made, the most deliberately false statements were made as to the amount and quality of our practice. The facts in the case were: That the dentist knew nothing of the true science of dentistry, being a slip-shod, state-board specimen, had lost many of his patients to the person he so loudly denounced, could do no really high-grade work, had to ask us to show him how to do work, had no materials to work with and borrowed them from us, sat around his office doing nothing and cursing every one who was suc- cessful. In return for kindness he stabbed his benefactor in the back at every opportunity. No complaint was ever made by us. we never indicated by word or deed that we had ever heard of the matter, never repeated his name, and dozens of times when patients applied to us to do over the work he had done improperly, no unfavorable comment was permitted to pass our lips. Some of the work was so unscientific as to make him liable for damages. Yet no comment was made. Not all men can restrain themselves from giving vehement expres- sion to their wrath in such cases, yet such an individual will do himself greater damage than those whom he seeks to harm; he will do right because he is a gentleman born ; rules or codes of ethics will not afTect such an individual. Paying Bills " Pay as yon go " Pay your bills promptly. By so doing you will enhance your reputa- tion. When a dentist pays his bills promptly it is evidence that he has ready money. Ready money is a power in this wabbling old world. The man who has ready money is respected. The man who has it not may be respected, but it is a different kind of jespect. No matter what the obligation may be, strive in every way to keep vour credit good. Pay all bills as soon as presented, after verifying their correctness. If a dentist gets into the habit of neglecting his bills his credit will fall, and it will soon become common report that he is slow in paying. This is a very unenviable reputation. Dentists who get such a reputation are not sought after, for people reason that a man who does not pay his bills, does not have much to do, and that such an one cannot do good work, because he does not have enough to keep him busy. It is surprising how swiftly such things become known, especially in small towns. People say, " I wonder how is doing? He never seems to be busy, and they say that more people go into his office to collect bills than for any other purpose." A man's credit should be preserved with his dental dealer. This is almost imperative. Of course he can change dealers, but he won't find it to be good policy to do this more than once, if at all. When your account becomes large at the dental dealer's, and they send you a statement that they will draw on you on a date mentioned, make a memorandum of it and when the draft comes honor it. Do not become offended when you receive notice of draft. Dental dealers rarely draw for more than a portion of an account — one-fifth or 303 304 THE PRACTICE BUILDER one-fourth of the full amount. If, for any reason, you cannot meet the draft, write courteously that you would consider it a favor if they would defer drawing for a time, and giving some reason for making the request. This should not be done unless there is reason for it, and such a request should not be made often. It is not business policy, and is likely to cause your account to be watched more closely. If a dentist's account shows that he is ordering a fair amount of material, an amount indicative of success and plenty of work, and he at the same time asks for extension of credit, the dealers are likely to be- come suspicious, and to think that something is wrong; and unless a satisfactory explanation is made will undoubtedly act accordingly. To pay bills promptly necessitates prompt collections. Young men, especially, are very foolish in this matter; they think that they expose their financial condition by asking for payment of accounts a short time after work is finished, and they think it shows liberality to allow an account to run a month or more before rendering a bill. This is wrong. People appreciate dental work more shortly after it is finished than they are likely to at any other time. The long time spent in its performance, and the relief of the patient when it is all over with, are fresh in the mind, and this is the time to render the bill. The longer the bill runs the dinmier becomes the recollection of the patient, and the appreciation of the work diminishes at the same rate. If bills are paid upon the completion of work there is rarely any complaint. People who don't pay promptly find fault with their work. Honesty " No legacy is so rich as honesty " We have narrowed the caution against a common sin when we con- fine the meaning of the word " dishonesty " to the hmits of taking with- out return what belongs to another, and without the other's knowledge. This is the broader and more obvious meaning of the term, but the most common form of dishonesty has to do with ourselves rather than with the goods and chattels of our neighbor. Sin against ourselves is, after all, the most dangerous form of wrong doing, for it strikes at the root of being, and prepares the life for almost any species of outbreak against society. The man who is false to him- self, who runs away from the infinite voice which calls within him, may not have become a falsifier in words to others, but he is ready to do so should extra pressure come through temptation. So with honesty. Un- less we are honest with ourselves we are close to the borderland of dis- honesty in our dealings with others. It is best, in all the processes of mental and moral culture through which we go, to first be true and honest with self. Tell yourself again and again the truth about your- self. It may not be always pleasant — this sort of honest dealing with one's self — but it is healthier. Do not be warped by the judgment, or even law, of another. The suppression through fear or favor of our truer, better selves, is more often cause for angel's tearsthan grafted sins of habit. It is not so much the appearance, the manner, or even the speech which tell character. These may be plain, awkward, and stammering, and yet the influence soothing. Our company may be handsome, polite, and brilliant, and yet repulsive. We may reprove ourselves for our whims, our caprice, and call it nonsense; yet an unseen, inexplicable 305 3o6 THE PRACTICE BUILDER inrtucncc is there, and we feel that one is our friend and that another is well, we hardly know what — but in spite of ourselves we form a dis- like or a friendship, and can't help it. The fact is, it is harder to act the hypocrite than we imagine. What we are will show itself somehow. Though for a time it may be hidden even from ourselves, it will crop out. and reveal something of our char- acter, which long habits and prevailing thoughts and choice of doing has matured. It is well, therefore, to weigh well the tendencies of our habits while they are in their incipiency, to remember that " as a man thinketh so is he," and that even our imagination, our image making, gives character to our life. If our thoughts and feelings, our passions and motives are normal and healthy, there will be internal harmony and sweetness and good will which will make our very presence a benedic- tion. But if there is a war of elements within, the prevalence of evil pas- sions " throwing up mire and dirt," how can it be hidden? There is no vice more hurtful to a dentist than dishonesty. There are plenty of cases where actual gain has sprung from following the twisted adage, that " dishonesty is the best business policy." It is useless for moralists to deny the truth of this statement, for they are overwhelmed with the evidence of many recorded cases where mis- representation and fraud have enabled men to make money and to keep money. A solid and more permanent foundation can be built by strict hon- esty than by any amount of gilt-edged misrepresentation. Dishonesty is a sign of weakness. Truer words were never spoken than those of Abraham Lincoln, when he said, " You can't fool all the people all of the time." Any fool can be dishonest ; there is nothing bright about it. Policy " Turn him to any cause of policy " It is necessary for every dentist to employ policy in his relations with his patrons. The more policy he possesses, the more successful he may be. Policy relates here to the business side of his relations with his patrons, and not to operative procedures. It is the policy which affects his income, and not the policy which affects his professional standing; that policy must be regulated wholly by his training and by his indi- vidual merit. Usually it takes years for a man to acquire a knowledge of the best business policy, or at least to be able to practically apply it. It is well for him to understand what policy it is best to pursue with relation to the collection of bad accounts. The prominence of the pa- tient, the social position which he enjoys, and the influence he wields in the community, must be taken into consideration before urgent meas- ures are adopted to enforce collection; also the friendly or unfriendly feeling of the person, and the probability of his carrying the lower court decision to a higher court, if he contests the bill. It may be business policy to institute proceedings, but in the great majority ol cases it will be found the best policy to refrain from bringing suit, because the expense, time, and attention which it demands, together with the fact that some damage may be done to the practice in the way of prejudicing the friends of the person sued, make the venture a losing one, and in most instances it would be better to charge the unpaid accounts to loss and gain. Again in the matter of collecting accounts, there are in every town men whose influence is very great and whose recommendation is worth a great deal, but who are not prompt in paying their bills. In view of the fact that these persons have such influence, and that they take occasion 307 3oS THE PRACTICE BUILDER to speak a good word for their dentist whenever an opportunity presents itself, it is not poHcy to try to collect an account of this kind ; their words of praise are worth much more than the amount of the account. Ac- counts should not be pushed when the debtors are lawyers, physicians, i:>r ministers. Another phase of practice in which policy is necessary, is that which relates to the performance of work for persons of doubtful character. This must be regulated by the class of patronage enjoyed by the dentist. If it is a thoroughly high class practice it must be evident that fast women, and the like, are not acceptable as patrons of the office, and their patronage should not therefore be allowed to come into contact in any way with that of persons of the better sort. The most important consideration relating to policy is that which concerns the character of the practice to be conducted by the dentist. Thus, a man possessed of a very superior training will not care to cater to a low class practice, and he will have no desire to associate himself with an advertising establishment. Consistency must be practised in this matter of the policy to be pursued, and this policy must gradually change for the better as the ([uality of the practice improves, and the appreciation of the clients manifests itself in a willingness to pay a good price for good work. Tact " Talent knows what to do ; tact knows how to do " " Talent is something; tact is everything." So runs the old adage. There are men in dentistry who possess a great deal more tact than talent, and tact appears to pay them better than superior talent pays some of their professional friends. Dentistry affords its practitioners many opportunities for the exhibition of tact. That kind of tact that makes men in business life capable of winning friendship and support, when possessed by professional men is productive of similar results. Many men in dentistry are wholly devoid Of tact. It is to them an unknown quantity. When called upon to exercise tact in handling a patient they are totally at sea, and frequently get into an argument that results in the client consulting another dentist. Thus, for instance, if a person tells you that he has a plate to be repaired, and that he has to have it repaired every few months, but that it fits beautifully and he don't want any change made in the fit of it, you may know that it can't fit beautifully and yet break every two or three months. But you don't say so. You look at the individual and you see that his bump of firm- ness is about the size of a goose egg. It would be folly to enter into an argument with this man. It would do no good to say, " This plate don't fit and never will." On the contrary, you would avoid all argument by taking the person gently by the hand and leading him tenderly to the impression chair, where you would proceed to take an impression and then make a model, on which you would show that the plate fitted his mouth about as well as a piece of sole leather. This practical demonstration will usually con- vince the most stubborn, where an hour of argument would not be heeded. 309 3IO THE PRACTICE BUILDER In every branch of dental service tact must be shown, to successfully handle the great variety of temperaments. It is not alone in the actual performance of the work that it is necessary, but it must as well be practised before the work is attempted and after it is performed. Talent is power, tact is skill; talent is weight, tact is momentum; talent knows what to do. tact knows how to do it. To do easily what is difficult to others, is talent. To do what is impossible for talent, is a mark of genius. Ambition " Ambition has no rest " " Ambition in an individual may be either his bane or his benison. It may lift him to an honored niche in the temple of fame, where his record will be written with that of the immortals, or it may smother him into oblivion or ridicule by the reflex of its own misspent energy. Ambition which is honorable, uprightly unselfish, and above board, is a laudable quality for one to possess and to cultivate; but ambition which seeks aggrandizement at the expense of honor, which attempts to lift up the individual through the process of pulling down some one else, is a quality which every professional man should spurn as beneath his dignity. " There are ambitious men of both kinds in the dental profession. There are men who work on year after year with a laudable ambition not only to make a mark for themselves, but to elevate thereby the dignity and reputation of their profession. There are others, more's the. pity, whose sole aim seems to be to boost themselves above their fellows, irrespective of method and merit. And a lamentable phase of this matter reveals itself in the propensity some of these men have for attempting to belittle others. " Men who apparently stand well in the profession, and who cer- tainly do stand well in their own estimation, never lose an opportunity of saying or intimating something derogatory to their fellow practition- ers behind their backs, more especially if those practitioners are men of reputation in the profession. " It is said that ' death loves a shining mark,' and so assuredly does the unduly ambitious man when he wishes to foist his own abilities be- fore the world at the expense of some one else. He will select men who 311 .12 THE PRACTICE BUILDER are claiming the attention of the profession everywhere, men who are recognized for their abihty and genius, and he will i)oint out adroitly and insinuatingly to a choice coterie of friends some very serious limita- tions in the great men, which he avers the profession generally are not astute enough to perceive. In this way he seeks not only to gain credit for greater insight than the majority, but hopes to himself rise on the wave which he has created for the submergence of his more worthy colleague. Too much of this back-handed undermining has been done bv men who ought to be above it. Surely ' ambition should be made of sterner stuff than this.' A man never yet built himself a worthy and permanent reputation based on the ruins of others, especially when those ruins were created by his own hands. " The ambition for a young man to cultivate is that which urges him to accomplish something for the profession that no other man has ever been able to accomplish. Let him take some problem which to-day is puzzling the profession, and let his ambition inspire him to labor un- ceasingly for the solution of that problem. If he succeeds, his name is linked indissolubly with the advancement of his profession, and if he does not succeed in whole, he will at least have left his imprint on the scientific progress of the question and his work will eventually count for just what it is worth. " No man may labor in a rapidly developing profession like dentistry without accomplishing something of real value to humanity, and without bringing his name into fair repute. He may encounter disappointments, discouragements, and moments of disheartening depression, he may be criticised unjustly and even harshly, but sooner or later, if he sows earnestly and profitably, so shall he also reap. " The ambition which impels a young man to bring honor to his pro- fession and happiness to humanity, irrespective of personal aggrandize- ment, is the ambition which, after all. proves to be the surest road to a worthy prominence. " If a young man wishes to be truly famous let him seek fame through these channels. Political prominence in a profession does not always imply personal respect. A man may be a president and yet be looked at askance by all good men. He may be a private in the ranks, and yet carry with him the respect and good will of all whose respect and THE PRACTICE BUILDER 313 good will are worth having. A man may be modest, and even reticent, and yet wield a greater influence among his fellows than all the spread- eagle enthusiasm of the victim of a false ambition. A young man should be ambitious, should be full of ambition, but his ambition should be di- rected into legitimate channels." Confidence " Confidence is a plant of shnu gro7vth " The successful practice of dentistry demands of its votaries the pos- session of confidence. Confidence in their abiHty to perform opera- tions, by reason of their knowledge of the mode of performance, whether or not they have done the particular work before. Many of the successful ideas in life come to us second hand. The originator of them lacks the confidence to materialize the same, and in a moment of discouragement reveals his pet idea to some one who does possess sufficient confidence to push it to success and to reap the re- wards. A man may possess so much confidence in himself as to be dis- tasteful to his friends, and yet, when his rapid strides to success are noted, we are willing to forgive his failing, and to wish that this same confidence was also an inherent quality of our own nature. Confidence can be fatal ; when this is so, it is called over-confidence. If there is one fault more fatal to the future prospects of the young dentist than lack of confidence, it is over-confidence. A man is com- paratively safe when he realizes his limitations, if he has sufficient man- hood to make the effort to overcome them : but the man who fails to realize his limitations will never advance, because he sees no necessity for the effort. A young man who has successfully coped with the different problems of life which confronted him in college, is likely to believe that he has reached the summit, and is in some danger of contenting himself with present attainments, but no man in the contemporaneous development of dentistry may feel secure in his position, when the knowledge of to- day is so often supplemented and overshadowed by the knowledge of to-morrow. Neither must the young man think that because the brief 314 THE PRACTICE BUILDER 315 span of his college course has passed with few failures, that failures will ■ always continue to conveniently pass him by. Failures will come, and the progressive man is he who learns more by the failures, than by the successes of his early efforts. It is the ripened experience of maturer years that teaches the most lasting lessons, and it is the fate of most men to live the greater part of a lifetime before they discover their own lim- itations. You had better know that you do not know, than to believe you know when you do not know. An overabundance of confidence is reason for congratulation, rather than the opposite. More men have been ruined by lack of confidence, than by over-confidence. All that pertains to the advancement of per- sonal interests, demands that the individual possess sufficient confidence to put into efifect the necessary elements to the accomplishment of such professional advancement. For lack of confidence in their own abilities and in their own personalities, hundreds of dentists capable of taking their places in the very front rank are moulding in unheard-of towns; pretty good dentists, with a " but " With a little more confidence in their make-up, these men might have become prominent in their profession. The man who creates the impression that he is something superior to the general run of men, and who can live up to the impression which he creates in the minds of others, will live on Easy Street. Because he thinks he is superior, and because they believe him to be superior, makes it so. His very air of confidence and security in his position makes people say, " He is all right." But if he lacks confidence in himself and shows that he realizes his inferiority, and if his actions say — " I am a poor weak worm," — the people say — " You look it, get out of the way." Economy " Economy is the fuel of magnificence " Economy is a good quality. There are several kinds of economy. Don't get them confounded. Economy is in some men an element of character that carries them to success. Economy, in its application, means attention to the little things, the details. Attention to the details gives a firmer grasp upon the broader and more important matters of life. It is right and proper to practice economy, but it must be of the right kind. Its right practice is backed by sense and judgment. In dentistry there can be but one kind of economy, namely, that which has for its aim the highest interest of those most concerned in its application, the patrons of the practice. Different men have dififerent ideas as to what constitutes economy. Economy is to be practiced in dentistry. Economy is to be practiced in everything. Dentistry need not have all the economy. The old business maxim that, " That which is worth doing is worth doing well," applies in its full strength to dentistry. One may use toO' much economy and lose money. That economy which has for its purpose the use of tha very best materials that money will buy, without variation, irrespective of maker or seller, is the only true economy. It is the only economy that can be practiced in dentistry. It is true dental economy. It is economy for the dentist, and it is the only economy the patient can wish to have employed in his interest. A few years since we were so unfortunate as to be thrown into asso- ciation with an old-timer whose ideas of economy were tinged with penuriousness that would make a miser blush. 316 THE PRACTICE BUILDER 317 Instead of using the finishing strips for poHshing gold filHngs, furnished by the dental dealers, he was in the habit of buying sand-paper at the hardware store and cutting this into strips with the shears. The sand-paper was No. i to No. i|. The laceration of the gums and the injury done to the enamel of teeth from the use of such barbaric methods, can be better imagined than de- scribed. All this to save a few cents. Instead of using the best plaster for impressions and models, he bought cheap plaster at the hardware store, little better than builders' plaster. His argument was that anything that was cheap was " just as good " as anything that cost more. In his own work he used the opposite argument. Consistency, what a jewel thou art! He was in the habit of trying everything that was cheap. Pinless teeth, for instance, and had them turned back for repair with great regularity. Having several diplomas, of which we were naturally very proud, we suggested framing them and hanging them on the wall, but our economical friend objected, saying that it would not pay. We framed them and put them in place. A few days after a man called, and the first thing he noticed was the diplomas; he said he had been told by the patient of another dentist that the owner of the diplomas was not a graduate, and he thought he would find out for himself, having quite an amount of work to do. The inquirer became a patron of the office, and in less than two years over $700.00 could be traced directly to his influence. Therefore, it was economy to frame the diplomas. If you take your diplomas and put them in the wood-shed, people won't know you have any. Don't hide your light under a bushel. Tell the people your business, that you may do more business with the people. It may safely be said that economy, in the sense that it is generally understood, has no place in a dental practice wherein the practitioner seeks to give his patrons the best material and the best services for their money. The practice of the right kind of economy, the kind that is based 3i8 THE PRACTICE BUILDER upon liberal conceptions of a dentist's obligations to his patrons, cannot but result in profit to hini who employs it; while that economy that finds expression in smallness, in meanness, and all that has for its aim the giv- ing of as little as possible and the getting of as much for that little as can be got, cannot but result in permanent injury to the dentist who is guilty of it, and to the dissatisfaction of the patrons. Practice economy then, but practice the right kind of economy; and practice it continually throughout your practice. There is no better rule in this respect than the golden rule. Emergencies " Much caution does no harm " Be ready when your opportunity comes. An opportunity comes to every dentist, and to every man in every walk of life. One of the secrets of success consists in being ready when opportunity presents itself. Being ready, is nothing more than being so thoroughly qualified that, when opportunity does present, it is recognized and the individual understands how to make the most of it. This needs a trained mind, a mind ready on the instant, not the next day. The opportunities which present to a dentist in his daily practice are wholly in the nature of operations more or less difficult of per- formance. They are nevertheless the opportunities upon which he may build, or which he may fail to comprehend, and, therefore, fail to advance his interests and his reputation. Every man who enters dentistry knows beforehand that his opportunities will be vastly different from those which come to men in the great world of affairs; he knows that no opportunity will present, nor no emergency confront him, whereby he will be able to make a fortune, or at one bound attain distinction and wealth. The possibilities of his profession are known to him. He un- derstands that, so far as financial possibilities are concerned, it is totally different from mercantile affairs. It is from the professional aspect, that proper preparation for the treatment of emergency cases will enable him to make a reputation which will favorably affect the finances of his practice. One of the commonest forms of emergency cases is dental hemor- rhage. To promptly and scientifically take charge of cases of this kind is of the highest importance, and reflects great credit on the dentist who does it. 319 320 THE PRACTICE BUILDER Fractures of the maxillae also demand thorough knowledge, with the ability to act promptly and decisively. The treatment demands a thorough knowledge of the literature of the subject, and no one is war- ranted in attempting the work who has not this knowledge. Dislocation of the Inferior Maxilla, either partial or complete, affords to the dentist opportunity for the display of skill, and adds greatly to his reputation when handled with promptness and expcrtness. Those rare and unusual conditions of facial deformity caused either bv disease or wounds, especially when the patient is prominent, and the dentist is successful in his work, add greatly to his distinction and credit. Advanced pathological conditions, such as eruption of the third molar, when the patient applies after the condition has become difficult to treat, are to be considered in the light of emergency cases, and call for the same superior skill in their consideration as those we have mentioned. Anchylosis is to be considered in the nature of emergency, because it presents to the dentist in that condition. Frequently in the employ- ment of anaesthetics, whether general or local, the patient may become so affected, by reason of a weak heart, or by the unfavorable action of the anaesthetic, as to require heroic measures to restore him to the normal condition. This is to be considered as being in the nature of an emergency. Therefore a careful study of all these conditions, with a view to handling them with ease and certainty, is not only advisable but absolutely necessary. Accidents in the Office "He is 7nost free from danger who, even whe?t safe, zs on his guard" In the most carefully conducted practice, when the utmost care is taken to avoid them, accidents will happen. No matter how superior the skill, nor what precautions the practitioner may employ, accidents will occur. Their frequency, or the fact that every office is subject to them, makes them none the less to be dreaded. Accidents are hurtful to a practice, because even if the patients are most friendly, the facts somehow leak out, and after the story gets into circulation it seems to enlarge to a most distressing extent. Stories of this kind travel with alarming rapidity, and the comments made are capable of doing great financial damage. This is true more especially of the average practice in the smaller towns or cities, where rumors are put into circulation and go through every house in the town in the course of a day. We do not know of any single factor which will do more to kill a practice than ugly rumors ; it m.akes no difference whether these refer to a stigma against the professional reputation of the dentist or against his moral character, the effect is just the same. Among the accidents which are likely to happen in any dental office at any time are : F'ractures of the Inferior Maxilla in attempted extraction. This may occur the very first day a young dentist enters practice, or it may not happen in a practice of fifty years. An instance has occurred where this took place with the very first patient a young dentist had when he entered practice. There are hundreds of practices of fifty years' stand- ing where it never happened. This demands of the dentist a cool head and a steady hand. It is 321 222 THE PRACTICE BUILDER necessary for him to know his subject from the word go. Tlie position is a most trying one, especially to a young man, for the reason that the patient is likely to consider it the fault of the operator, due to a lack of ability. Promptness and accurate knowledge is demanded in these cases, and it is necessary to make and insert the splint as soon as pos- sible, and to assure the patient that it was no fault of the dentist; and in this connection we wish to state that we know of no instance of this kind where the fault was the dentist's. The confidence of the patient should be gained, and assurance of his good will and reliance. In some in- stances, when this unfortunate accident occurs, the patient threat- ens to bring suit for damage. To such threats the dentist must listen courteously, and never for an instant become excited or lose his temper. He must tell the patient that the matter was wholly accidental, and would have occurred, to the most skilful dentist in the world; but that under no circumstances would a suit for damage hold good, and that the legal authorities have decided that a dentist is not liable for damage in cases of accidents, because accidents are beyond their power to prevent. It is necessary for the plaintiff in these cases to show that the injury was due to malpractice, and to show the nature thereof; whether from ignorance, due to want of skill, or wilful or negligent malpractice from carelessness in performing the operation. In many instances small portions of the alveolar process are removed when a tooth is extracted, and the patient, seeing these pieces, thinks the jaw has been fractured, and proceeds to institute legal action against the dentist. The patient can usually be made to understand the foolish- ness of proceeding in this manner when he is shown the dentist's legal position. To break ofT a tooth while attempting to extract it, is an accident which makes the work of extracting much more difficult and painful, and casts discredit on the dentist. Too much care cannot be bestowed on this simple operation of extraction. It is looked upon by the patient as the simplest operation which the dentist is called upon to perform, and he does not realize that the condition under which the work is done, and the state of decay in which the tooth is found, may add considerably to the difficulty of the undertaking; he is greatly disappointed if the THE PRACTICE BUILDER 323 tooth breaks, and sometimes expresses himself quite forcibly to that effect. If the tooth is broken in such a manner as to make its removal dif- ficult or inadvisable, and great pain is experienced by the patient, he should be kept in the ofBce until the pain has subsided and some ar- rangement made with him whereby the tooth is to be removed at some future time. People never forget nor forgive a dentist for breaking off a tooth, and they do not hesitate to say uncomplimentary things about him to their friends. In view of these facts it behooves a dentist to ex- amine a tooth very carefully before extracting it, and if it is very badly broken down, as for instance the lower third molar, especially when the buccal surface is nearly all broken down and decayed below the gum margin, he is justified in telling the person that he prefers not to attempt to remove the tooth. When the patient is a stranger, and there is only one tooth to take out, this is the proper thing to do. If the dentist at- tempted to remove the tooth and broke it he would not be paid for his trouble, and would at the same time be severely censured, and the person would report him to his friends as a man of poor ability. Removing two teeth at one extraction, when it was the intention to have but one tooth removed, is another accident decidedly aggravating to the patient and extremely embarrassing to the operator. It fre- quently happens that two teeth may be attached to one another by means of the alveolar plates and septum. In attempting to extract one, the other tooth, or perhaps two teeth may also come out, and with a considerable portion of the alveolus attached. Again, one tooth may be so crowded between its neighbors as to make its removal very difficult, or wholly impossible. These circumstances should be fully explained to the patient before attempting extraction, and if the diffi- culties in the way are such as to make the operation a hazardous one, the dentist loses nothing by refusing to do the work, which he has a perfect right to do, whereas if he does take the tooth out, with little trouble or much, he gains nothing but a small fee. When the wrong tooth is removed there is little or no excuse for the dentist, and when the patient is suilEiciently aggravated thereat to bring suit it will be found to be policy to adjust the matter without allow- ing it to get into court. ^24 THE TRACTICE BUILDER There seems to be no valid reason wliy the operator cannot get the right tooth, and any operator who is at all careful will examine the par- ticular tooth and those adjacent before making any attempt to remove it. Other accidents relate to the administration of anaesthetics, par- ticularly to those that happen when gas is used; as, for instance, a tooth slipping from the forceps and falling into the trachea or aesophagus. Prompt action is necessary here to prevent distressing results. Slipping of the forceps, and laceration of the tongue or cheeks while under the influence of Nitrous Oxide, is something which must be guarded against. In the use of local anaesthetics accidental injection of parts which arc not essential to the production of insensibility sometimes results un- favorably. The action of all local anaesthetics must be carefully watched, as their employment is frequently attended with manifesta- tions which it is very difficult to aid by restoratives. Slips in the use of operating instruments other than forceps, as for instance engine burs, excavators, etc., have been known to cause serious trouble and grave results have followed. Accidents happening fre- quently in a dentist's office damage his practice, just as a large number of deaths prove hurtful to the practice of a physician. Recreation '''Recreation invigorates the body and refreshes the mind " Men who have no recreation, stagnate. Stagnation is death to professional advancement. It can be no gratification to a man to achieve success in his profession, if in doing so he loses his health. We see about us men who have made wrecks of themselves by their continuous employment without recreation. Men who have not attained their fortieth year are observed to be crabbed and nervous. Working day in and day out in the performance of duties that wear on the nerves and make young men old, with no relaxation save sleep, cannot but result in damage both physically and mentally. He is a wise man who sets aside two or three weeks each year to in- dulge in his favorite pastime — fishing, hunting, or whatever it may liap- pen to be. He returns to his practice with bounding spirits and elastic step, and an appetite that would make a farm hand turn green with envy. If in search of recreation, you decide to visit some resort, seek the place best adapted to your condition. The sea-shore is not necessarily the best place of resort. For some, the refreshing salt air and frequent bathing and absence of excitement is just what is wanted; for others the clear, dry, bracing air of the mountain is best. Recreation does not mean dissipation. The very appetite begotten of an outing may bring an undefinable longing which we may seek to dissipate by stimulants and excesses which may satisfy for the moment, but which thwart nature. A normal appetite must be satisfied with normal food, and the call for excitement must be gratified with normal activity, or the recreation will bring weakness and languor, instead of rest and recuperation. Sleep all you can; rest thoroughly, and be a child. To those who 325 ^26 THE PRACTICE BUILDER can afford it, horseback riding is the best. ]\lany dentists are in the habit of riding every morning for an hour, or an hour and a half, before taking up the work of the day. Nothing can be more exhilarating, when one is properly situated for it. The large cities, especially where one resides near the business portion, deprive horseback riding of nuich of its en- chantment. Those who live in the smaller towns and cities enjoy 't more. An hour and a half in the morning and a half hour before supper is about the proper amount of time to devote to this form of recreation. The bicycle has supplanted many of the former out-door forms of exercise, and it has met with a very cordial reception by thousands of members of the dental profession. A spin in the cool bracing air of the early morning is most enjoyable, and when not overdone makes one feel ready for the most wearing work that he is called upon to do. A spin to a near-by village or town for an early morning breakfast is just the thing to raise the spirits. Many are so enthusiastic as to assert that it is the very best form of out-door exercise for dentists. It is one of the best means for diverting the attention from the active duties of a busy practice. Of indoor exercises, w^e believe the use of dumb-bells and Indian clubs will be found especially beneficial. A few minutes at this just be- fore going to bed will insure a sound and refreshing sleep. The Whitely Exerciser is a recently introduced apparatus for phys- ical culture. It is a very cheap and exceedingly effective appliance for the purpose. It takes up no room, and by its use every form of physical exercise may be indulged in without leaving the ofifice. Deep inspirations of cool air are especially beneficial to those con- fined indoors, and particularly to such as are compelled to stoop in the performance of their work. Take recreation, and take it often. Making Money Outside of Dentistry " He who waits ujitil circumstattces completely favor his tinder takitig will never accomplish atiy thing" Not long since the statement was made in one of the dental journals, that a man bright enough to make a good dentist could accomplish more in some other pursuit. This would depend on whether he pursued any other vocation in the same manner that he would dentistry, so far as the financial side of the question would be concerned. " Those who look upon the financial aspect of dentistry as unworthy the attention of those whose highest aim is the advancement of the pro- fession, and who regard close attention to the dollar side of professional work as not in accord with ethical dentistry, are one-sided in their logic. It is not a sin to desire wealth. It is the impecunious and lazy, the shift- less and the thoughtless, who denounce the successful man and the acquisition of wealth. It is the sentiment of the anarchist. A high order of intellectual attainment, in any field of human endeavor, is en- titled to its reward. " It is estimated that about thirty-five million dollars are annually paid in the United States for dental services, and only about one-fourth of the people patronize dentists. It is true that honesty and faithfulness in the discharge of professional obligations enforce close attention to the details of all the departments of practice. It is not possible for any man to be universally apt in every department of life ; but with so much dependent upon business success, it is next to criminal negligence to give it no thought. To accumulate property is the proper safeguard against poverty. The impulse is healthful. Healthful progress lies in stimulation of this impulse up to a certain point. A general distribution of wealth gives a high average quality of citizenship and self-depend- 327 328 THE PRACTICE BUILDER dice. A profit-making business is a great fascination, and no dentist ever yet, in private conversation, has left the impression that he was ambitionless in this respect. " The nature of the dentist's calhng, unfortunately, makes accumula- tion of large sums for investment exceptional. Investments that elimi- nate, as far as possible, the necessity for close attention or risk of rein- vestment will prove the most favorable for dentists, because they need to be as free as possible from distracting thoughts. So, long-time loans on real estate mortgages, while they are made at lower rates, will be found more satisfactory than short-time loans on promissory notes or chattel mortgage collateral. So, investments made in real estate, re- quiring little attention, give less trouble than investments made in com- mercial concerns, in which, to be safe, attention to details cannot be ignored. Any one who has observed the rapid growth of our cities should appreciate the fact that values are almost sure to increase. Real estate in city, timber districts, or mining regions has always been the most steady and certain investment to be had. To be able to buy and to know where and how to buy. is worth some study. The advice given Benjamin Butler at the beginning of his career will apply as well to-day: ' Buy land: if you arc doubtful of your judgment, buy at auction, be- cause in this way you cannot lose much, for you will have to pay but a trifle more than some one else is willing to pay.' " A good and safe place to invest small sums may be found in our building and loan associations, especially to those who would enjoy the most hopeful of hopes, the hope of a home, but whose accumulations forbid the immediate realization of it. The monthly deposits become immediately productive, which is always encouraging in any venture, and fair returns may be expected. It is safe to predict that not a dentist in the land need be homeless if he will follow so sure a road to so good an end. As a class we are among the least able to pay rent, and it is a reflection on our financial acumen that the necessity is so universal. There is no tax more onerous upon us than this monthlv exaction for the privilege of shelter; nothing more destructive of thrift than the un- ceasing demand for tribute for a place in which to eat and sleep. Nine- tenths of the dentists are on a level with the wage earners, a semi-genteel proletariat, as it were. Our income is entirely dependent upon steady THE PRACTICE BUILDER 329 employment and good health. It ceases at death. The family must do without it. Doing without it, represents the loss of their entire capital. In many cases it means misery. " In the confidence of young manhood and sturdy health we may court the sternest activities and rejoice in constant operating, but there surely comes a time when the eye dims with advancing years, when ambition flags. " The road to success is narrow and somewhat difficult, but it is open to all who love the prospect and are willing to comply with the require- ments. The degree of ability, industry, integrity, and management which characterizes our conduct indicates the degree of success we may expect to realize. " A brilliant dash and display does not promise wonderful results to the experienced. Be content to creep before you walk; strive to know how, and trust to established rules and persistent effort. If mistakes occur, profit by them; this is the law of progress. Great achievement in any realm is the consummate result of years of struggle." Ambition, persistence, self-reliance, and know how, are the founda- tions of permanent success. Because the dentist daily performs the required duties of the dental practitioner is no reason why he should not exercise his mental faculties in any other direction, with a view to adding to his worldly possessions. In his duties he is brought into contact with every variety of temperament and every variet}^ of condition in life. He is brought into almost daily contact with some of the wealthiest in the land, and to thus rub up against successful men is a stimulus to ambi- tion. All the avenues to wealth, where wealth is to be attained by use of superior mental attainment, are open to the dentist. He lives in a coun- try where all men are equal, and where he can, if he has the brains, attain to a high position. Unfortunately for the average dentist, he does not possess the capital necessary to put his plans into operation. This need not prevent him from having plans, however. A few dentists are in receipt of comfortable incomes from patents. There is abundant room for the display of inventive talent, in the devising of efifective means for performing work more expeditiously or more thoroughly. Confucius said, " He who waits until circumstances completely favor his undertaking will never accomplish anything." There are several -20 THE PRACTICE BUILDER dentists who are making money through their hterary quahty. This is somewhat uncertain. It is no easy matter to gauge the pulse of the great mass of the people, and write something that may at once become popular. Authors are divided into three classes*: The first class make fame ; the second class make books; and the third class make money. We know of several dentists who are talented enough to have their articles accepted by periodicals. Dramatic writing is a field that pays well for good ability. Good ability is very rare, however, but the opportunity for its display is ever present; literature offers to the dentist an opportunity for the exercise of his brain, without leaving his daily vocation. The one can be de- veloped without harm to the other. To the man who intends to succeed, means are always available. One of the surest ways to success is by sighting a popular or profes- sional want and proceeding to supply it. To sight such a want demands eternal vigilance; the mind must be ever active, ever on the alert; and when an idea is once born it must be nourished and developed until it blossoms and expands, until it becomes a grand life-supporting fruit. Men give too much time to pleasure, and too little time to consecutive thought. Consecutive thought on one subject cannot but bring some thoughts that are valuable, some thoughts that are worth studying, worth keeping close to, in the hope of expanding them. Conservatism " Reliable men are conservative meti " That there is need for the exercise of conservatism, to a greater ex- tent than it has been shown in the past, no one can deny. There is greater need for moderation and for judgment in the use of that knowl- edge which is already ours, than there is for a more extended knowledge of dentistry. " Moderation in all things " is an old adage. It is good for all people. Moderation in practice, and moderation in statement, is good for a dentist. Moderation in practice would mean the use of such means for the performance of work, in individual instances, as would be approved by judgment refined by observation and experience; it would mean the use of gold where gold was indicated; the use of amalgam where amalgam was indicated; the use of cements where cements were indi- cated; and it would mean using these materials for the patient's best good, irrespective of his wishes in the matter; it would mean their use in their indicated places, and nowhere else. The opposite of this proposition is the practice of many men, who use one material almost to the exclusion of others. Thus we observe that some are enthusiastic in the use of cement, both as a filling material by itself and as a support for other fillings, both amalgam and gold. Others employ amalgam in every possible place; while others still, use gold w^here any excuse for its use may be made. Again, we find that in bridge work many practitioners are emphatic as to the propriety of its use in nearly all cases where there is a space caused by the removal of natural teeth. The most conservative prac- titioner would in these cases advise the use of a partial gold plate where 331 232 THE PRACTICE BUILDER any question would arise, through the condition of the teeth or gums, as to the permanency of the bridge piece. Many beheve tliat exposed pulps can be permanently capped with success in all cases that present. Other operators of equal skill, and capable of exercising the same technique in the performance of the operation, are equally positive that the pulp should be devitalized when- ever there is any exposure, no matter how minute it may be. There may be no trouble with capped pulps for a year or two years, or more, but it is likely to come, and when it does — look out for squalls. As great a variety of opinion exists as to the mode of precedurc in the treatment of pulpless teeth as in any other performance in operative dentistry. A series of articles written in the journals in one year will show that the greater proportion of them relate to treatment, and the variety of opinions offered is somewhat surprising, because all cannot be wholly correct. The whole profession was thrown into a furore a few years since by the wholesale endorsement of copper amalgam ; but this was followed by such condemnation, that to mention it in the presence of those once most enthusiastic in its endorsement provokes the most emphatic de- nunciation of its use. Copper amalgam wrecked many practices. Some years back, men of supposedly sound judgment advocated filing the approximating surfaces of the teeth as a preventative of de- cay. A war of words was waged between those who advocated this practice and those who believed in the teeth " knuckling " against each other at the point of contact, either naturally or by the fillings being inserted when necessary so as to touch the adjoining tooth. Those who were most emphatic in their endorsement of the filing lost patronage rapidly, and many of those who were prominent practitioners were soon compelled to go to the back streets. These are only a few of the instances where a lack of conservatism has wrought damage. More might be enumerated. What we have said, however, serves to show what enthusiasm will do when it is not backed by the soundest judgment. There is need for more conservative statement from the dentist to his patient. Many times practitioners make statements with reference to the performance of work, which cannot always be sustained by the history of such cases. Care should THE PRACTICE BUILDER 333 he taken not to arouse false hopes as to the ease with which certain work may be done, nor its permanency. Moderation in statement is necessary in our societies. In the strict sense of the term, dentists are not very exact in practice, nor in the tabulation and report of their experience. This is shown by the fact that in society discussions, when a statement is made that a certain line of practice is the best known, it is often met at once by another statement that the opposite is true. As both cannot be true, the natural conclusion is that the real truth is somewhere between the two extremes, but we cannot tell just where; and in trying to adjust the sliding scale we finally comprehend the fact that we are not dealing with the exact truth itself at all, but with indi- vidual opinions of it, even our own opinion. Facts, carefully observed and clearly and tersely stated, have great value to earnest seekers after truth in a field where there must always exist, to some extent, conjecture and uncertainty. Opinions of those who have had long experience also have great value, but a man's opinions must not be confounded with his facts. To- day, in the dental societies, the articles presented are often filled with wild ideas and hysterical statements. Reflect for an instant on the mis- representation relative to the treatment of pulpless teeth, the highly colored reports of some of the individuals who report a list of 837 cases of immediate root filling without the slightest unpleasant manifesta- tions; these are enough to make the white-haired men, who have lived through fifty years of dentistry, blush for shame. These statements are misleading, and cannot but result in damage to those members of the profession who take what is said in the journals to be gospel truth, little knowing that many of these articles are prepared for the sole purpose of enabling the author to see his name in print. Impractical Ideas "Men ought not to investigate things from words, but words frotn things ! " Lack of experience leads men into attempting things which later thought demonstrates to have been impractical. Putting impractical ideas into execution cannot but result in damage to a practice. It is not always easy to know that an idea is impractical until the fact is estab- lished by experience. During the course of a year a great many impractical ideas find their way into the dental journals. More impractical ideas are disseminated through these mediums than in any other way; thus many members of the profession, and more especially the younger members, are de- ceived as to their worth. Articles in the dental journals are given too much credence; there is no valid reason why these journal articles should be considered au- thoritative. The publishers particularly specify that " The editors and publishers are not responsible for the views of authors of papers pub- lished, nor for any claims that may be made for them." As a matter of fact, the great mass of articles published are mere individual opinions, which are just as fallible as personal opinions expressed in any other manner. Many of the articles are backed by no other reason for their appearance than the desire of the author to see his name in print. The impractical ideas are not confined to any one branch of work. Nothing in dentistry is free from them, but they may be more numerous in one class of work than another. Bridge work has been abused in this direction, possibly with greater frequency than any other branch of dental work. The wonderful variety of cases which present, and the opportunity afforded for the employment of individual methods, very naturally resulted in the evolution of more or less original ideas which 334 THE PRACTICE BUILDER 335 their originators considered worthy of the attention of their professional brethren. Among the more prominent of the impractical ideas which have been advanced from time to time, may be mentioned the detachable bridge dentures for use in the superior arch. Upon first thought, the use of this form of bridge work would appear advisable. The usual form in which this variety of bridge work is employed relates to the attachment to the abutment teeth of sockets, and to the bridge piece bars which fit the sockets. The construction of this calls for the greatest manipulative ability. When inserted, the work appears to be perfect in appearance and utility, but with use it is soon observed that the rigidity of the piece is not what it should be. Continuous use seems to affect the abutment teeth, and the bridge piece becomes loose and often falls into the mouth, the mere weight of the work being sufificient to displace it. When used in the lower arch this form of construction is much more successful, be- cause the tendency is to cause the work to be more firmly attached by use. The weight of the piece and the lower arch are favorable to this variety. In regulating, impractical ideas often play sad havoc. It is well for the practitioner to employ only such methods as have been sanctioned by the most eminent authorities. One of the ideas which has seemed to us to be impractical, is that which relates to the use of cement under gold; especially in those cases which require the insertion of contour gold fillings. Take, for in- stance, a large cavity in a cuspid tooth. It may not be considered ad- visable to use gold all the way through. Cement into which gold may be embedded, or cement allowed to harden and then prepared for the insertion of gold is employed. The plan is a questionable one. Gold is best when inserted on a foundation of gold. Combination fillings other than contour, are in many cases of great benefit to teeth. Our remarks concern the contour filling only. An idea in filling, which was endorsed some time ago by an eminent operator, related to the use of reheated amalgam to be added to the portion of amalgam already in place, insuring a hard filling. After the filling is completely inserted and still kept dry, a portion of an amalgam mix several hours old is held in the flame of the alcohol lamp and added 33^ THE PRACTICE BUILDER to the filling already in place. We have never been able to successfully use this idea. Impractical ideas in plate work are quite numerous. Among the most prominent may be mentioned the various clasp devices which, while aiding slightly in the retention of the plate, are questionable ex- pedients. The same is to be said of those combinations of plate work and bridge work which depend on clasps, and obviate the use of plates which cover the palate. Springs, and other like ideas, are not looked upon with favor by the more experienced. Impractical ideas have been numerous in dental medicine. These relate to every variety of dental disturbance which allows of medication. Many of them may not be so impractical as they are lacking in notice- ably successful results. Of all the forms of disturbance of the dental tissues, more has probably been written concerning Pyorrhoea Alveo- laris than any other ailment. The literature of this disease has been most voluminous in the past two or three years. Scarcely a month has passed but that some individual has come forward with a " new " treat- ment which has consisted largely in what every body else has been doing for years, with the addition of a drop of some other kind of med- icine which will admit of changing the name of the mixture. Root filling has received its share of impractical ideas, and these are multiplying from day to day and from month to month. The education received by most practitioners while at college should place a guard against the majority of these ideas, which are not l)acked by broad experience, close observation, or the test which time gives to all work. Time is a prover or disprover of all theories. It establishes them as worthy, or it relegates them to the past if unworthy. Do not experi- ment ; use only such methods as by experience you know to be worthy. Patience " He that can have patience can have what he will" If a dentist does not have patience he won't have patients. This is not a joke. It is a fact. Without this one attribute a large practice can- not be built; and if one has the latter, and loses his equanimity and becomes habitually impatient he will lose his practice, no matter what his skill may be. Dentists have had new patients in many instances refer to the impatient and even irritable temperament of those who had previously treated them. There may be many reasons for a lack of patience, but none of them are beyond remedy. In many instances this irritability can be traced to the ph3^sical con- dition. A long list of appointments, chiefly for gold work, and a large part of this for nervous women, cannot but affect the operator. Many are of the opinion that a really trying patient draws on the vitality of the operator, and renders him less able to perform his duties with equanim- ity. Many times the temper is severely tried by persons of a complain- ing, whining disposition. Long operations are naturally trying to both patient and operator. It will be the part of wisdom to change patients as often as possible, working for two or three persons in a forenoon or afternoon. In this way the patient is less liable to nervousness, and the operator is saved the worry of controlling one who is nervous. Work- ing continuously for several months, without a vacation, nearly always results in some disturbance of the nervous system, which may result in irritability, nervousness, insomnia, or troubles of a like nature. Perhaps there is no class of patients more trying than children. Many dentists never attain to any success in the management of the little ones. Their preconceived ideas of the treatment accorded them 337 338 THE PRACTICE BUILDER by tlie dentist, are such that tact and sense are necessary to impress the fact that one does not intend to hurt them if it can be avoided. Patience can be cultivated; those who have it not can, by the exer- cise of a little forethought, arrange their work so as to avoid that which is likely to cause impatience. With a particularly aggravating patient, the dentist will serve his own and the patient's best interest by cour- teously explaining that he cannot do his best for him, and that perhaps another dentist would be better suited to the performance of his work. Standing by Work " Reputatio7i is a guarantee of quality " Dentists are frequently asked by their patrons if they warrant their work. This question is rarely, if ever, asked in high-class city prac- tices; but in practices in the smaller towns, and among a clientele more or less mixed, the less intelligent patrons are likely to make such in- quiries. This is because these people fail to recognize the difiference between a profession and a business or a trade. They do not understand that physicians, lawyers, or dentists are not to be considered as warrantors of their work. They do not understand that if services of either one of these prove unsatisfactory, they are at perfect liberty to go to some one else. It is well to explain these points to prospective patrons. Some people walk into a dental ofBce expecting to get everything in sight. When people show by their conduct that they are particularly exacting, the dentist will save himself a great deal of annoyance if he will give them to understand that he does not care to accept their work upon the conditions they may name. For instance, one may say that he wishes to have certain work per- formed; that he has had such and such work performed by another dentist, and that it proved unsatisfactory; also, that he does not pro- pose to pay for any work until it is done according to the conditions which he has prescribed. Such people will prove to be not only unreasonable, but grasping and unfair as well. Give them to understand that when your work is ready their money must be ready ; that it makes no difiference whether 339 340 THE PRACTICE BUILDER all the work is done, or not; that it is your practice to present your bills as fast as any part of the work is finished; thus, if an upper continuous gum or gold plate were to be made, and a lower one to be inserted, the bill for the upper one should be presented before the lower one is at- tempted. If you do complete the work for them, render the bill the very next day; and if it is not paid at once, deal with them just as you would with delinquents; use all the forms that appropriately apply, as shown in the chapters on " Credit," and " Compensation," and do not delay. Send the letters within a few days of each other, and keep the matter in view until a settlement is made. Then, when they apply again for work, politely inform them that your time is all engaged. The best plan is not to do any work for them in the first place. It is proper to indicate to these people that it is customary to require a deposit when expensive work is to be done, and tell them that no excep- tion is made in the case of anyone. When a patient applies, making inquiries about plate work, and asks you if you warrant a perfect fit, or if you guarantee that he can bite apples without throwing the plate, say that you don't engage to do any- thing of the kind; that if the conditions of the mouth are favorable, this can be done, and if not favorable it cannot be done. If he states that he docs not propose to pay for a set of teeth until sure they will be all right, simply say that you cannot engage to do the work upon any other than your usual conditions ; that it will be neces- sary for intending patrons to conform to the established rules of your practice ; that they take no more risk than the hundreds of other patrons whom you have served with satisfaction. Never, under any circumstances, warrant work for any person, no matter how prominent he may be; do not engage to do work that shall be thus and so, according to conditions which may be imposed by the individual. Usually these people have either left other dentists, or have been dismissed, and they are loud in their claims of ill-treatment. Gen- erally, it will be found that they failed to pay the last dentist in full. Every honorable man is willing to do what is right with work, and to remedy it when it gives trouble through some fault in the material or construction. Fillings, cement, amalgam, or gold, often fail in a short time, even when the greatest care has been taken in their insertion. This THE PRACTICE BUILDER 341 it is proper to make right, with appropriate regrets for the necessity for doing the work again. When patients ask for a warrant, and the conditions under which the work was performed were favorable, the words, " Warranted one year," may be added to the receipted bill, but not on any other bill. A plate should be warranted as the best material, but it should not be warranted against falling and breaking off a block, nor against misuse of any kind. The term of warrant should not exceed one year. It is not neces- sary, and it is not fair to expect it of a dentist. His work is constantly exposed to hard use and is continually liable to accident. Continuous gum should never be warranted against breaks ; people should be made to understand its delicate nature, and to pay for any disregard of its delicacy and the difficulty of repair. By giving attention to all the points contained herein the dentist will be saved much embarrassment and a great many dollars. These things are only learned by having been bitten. Those who haven't been bitten will do well to take the word of those who have been there. Influence and How to Get It " Influence is power " A dentist's financial success depends largely upon his friends, and their influence. His professional reputation is largely the result of the opinion of his professional brethren. A practice may be built wholly upon the influence of friends, without the advantage of a good reputa- tion for superior ability among the members of the profession. It may be built upon the reputation of the practitioner among his fellows, but the practice is of slower growth ; decidedly so, so decided in fact that the instances are few in which it has been done. Some dentists do not possess the power or tact of securing the in- fluence of their clients in their behalf, or else fail to realize to what an extent the growth of a practice depends on the influence wielded by satisfied patrons. First of all, let us speak of the influence of woman. A dental prac- tice is composed mostly of women. Woman is the active partner of the home, and the silent i)artncr of the office. Every married man, and every brother of a married sister, and every fellow who goes with some other fellow's, sister, ought to know that a woman has an influence over man that he has never measured, because he does not know how to measure it, and because the woman would not permit him to measure it if he did. Man is a busy being; he thinks he is, whether he is or not. He is nervous, and doesn't have time for this and tliat, doesn't know how to keep up his wardrobe or his office. His office is cluttered up. Half the time he doesn't know that his office carpet is shabby. The chances are that it will take his wife, or a nail, to tell him that the soles on his boots are worn through, or that the weight of his trousers hangs on half the 342 THE PRACTICE BUILDER 343 regulation number of buttons. The average man doesn't know about those things that he thinks he knows about. Upon the pocketless dress of woman hang the keys of trade. The influence of woman can either build a dental practice or wreck it. If women like a man as a dentist they are unstinted in his praise. If they dislike him, they are just as quick to say so. The man who, early in practice, sees the policy of winning the favor of women, is the man who will get to the front. The influence of one woman is worth that of ten men. It makes no difference whether she is a married woman or single. If she is married, she has a husband over whom she wields an influence, and she will send him to her dentist to have his teeth put in order. She will send her children to him, and she will send her sister or her brother. She will talk him up until you would think she had a special interest in that particular dentist's welfare. She will tell how careful he is, what beautiful work he does, and if she compares him to other dentists the comparison is always favorable to him. Treat lady patients with every consideration which it is possible for a man to show a woman. Perhaps you think you do this. There may be room for improvement. Never, under any circumstances, discuss another patient, nor be drawn into any utterances uncomplimentary to other ladies. Be a good listener, and a poor talker. Always be gracious in your demeanor toward them. Let your personal appearance and cleanliness be without fault. In all that relates to the instruction of patients, see to it that your lady patients are not neglected. Try to make a favorite of every one of them. The influence of physicians is in many places a powerful factor in the building of a dental practice. A good word spoken by a physician in behalf of a dentist is always helpful. Friendly relations should at all times exist between the members of the medical and dental, professions. To secure the influence of physicians, mail them the printed matter such as is used for the patrons of your ofifice, and also such articles or re- prints of articles as may have appeared under your name in any of the journals of your profession. This serves to them as evidence of your qualifications for practice. Many little professional favors can be shown to physicians or to the members of their immediate family. For in- stance, when the wife or children of a physician apply for dental service, 244 THE PRACTICE BUILDER the work should be clone promptly and in the best manner; and when the bill is sent in, it should be made as low as possible. When the work does not demand the use of the precious metals, it is proper not to send in a bill at all. A most important point is to see that the physician re- ceives all of the published articles of the dentist which show him to be a superior dentist. Druggists, especially in the smaller towns and cities, are exceedingly helpful. During the changeable weather of fall and spring a great deal of tooth ache medicine is sold by them; and afterward they tell the person that if he would consult a dentist, Dr. So and So is the man. It is well, therefore, to get on friendly terms with a druggist in the neigh- borhood. In the course of a year a great many dollars can be credited to this one source. When giving prescriptions to patients it is proper to indicate that you would prefer they should go to your druggist. The favor of attorneys can be secured by sending to them such of your literary efforts as have an interest to members of the legal fra- ternity. This is professional, because it is something of mutual interest to professional men. We do not believe in making any special effort to secure the in- fluence of ministers. If it is given by the ministers, accept it. but make no efifort to gain it. The dentist who curries favor w'ith a minister with a view to securing his influence, seems to us to make a sort of com- mercial use of the church and its representative. It is well to show such favors as you can to reporters, and to other persons connected with the newspaper business. The day may come when their friendships may be of great benefit to you. But again let us say, " Don't forget the women! " Don't forget the powerful influence they wield in the home circle and in society. Don't forget that there is no better advertisement in the world for a dentist than that the wives of the most prominent men in the town are seen in his office. Other people who happen in take note of this, and it soon becomes known in the community which dentist is the favorite with the class of people who want the best and are willing to pay for it. People take a pride in patronizing a dentist whose oflfice is frequented by the representative citizens. They take a pride in knowing that their dentist is the dentist. Reputation ' A great reputation is a great charge " Reputation, and nothing else, permits a dentist to secure a high- class patronage. A man who has attained a good reputation usually charges more than those who have not attained to the personal dis- tinction which he enjoys. His reputation is a guarantee to his patrons. Reputation represents public opinion. Character represents actual truth regarding one. One's character may or may not be one's reputa- tion. Conscience is one's opinion of one's own action. One's opinion may be true, or, by education, perverted. Character is always true. Conscience is always sincere. Reputation is wavering. One should profit by a character reputation, secured by years of sincere work, the same as if it were government bonds. It is a true method of attaining true publicity. Reputation, as an advertising method or quality, occupies a limited field. The masses are floating, and time breaks many cards in sociology. Yet there are those who look to this, and this alone, as their real source of patronage, and in some cases it is a " gold mine." In morals a dentist cannot have one character for his family and an- other for his office; one for the public and another for his club; one to be seen and another to be hidden. A dentist may appear ever so clean, but if there is the stale stench of tobacco or beer, it cannot be hidden by the most aesthetic perfumes; and it is then that you have a call from a lady of special distinction whom you would give anything to please. The conduct may be polite, the language select, and the clothes im- maculate, but she will detect the insidious fumes from the breath, and even from the body's million pores, and be disgusted. Do not expect a better reputation than your character will bear. You may get it, but 345 346 THE PRACTICE BUILDER you cannot keep it ; you may close it about you as a beautiful garment, but somewhere there will be a rent which will reveal the truth. A good reputation is earned only by toil and conscientious en- deavor; and it is only by the exercise of eternal vigilance that it can be maintained. To gain a good reputation means great toil, alertness, and constant watchfulness. A lost reputation cannot be regained as readily as a reputation can be built. The real value of a reputation is greater than dollars and cents. Money cannot purchase it. It is the result of honor, time, and labor. Reputation is prestige, and business or professional prestige is much sought after. People who know absolutely nothing about the skill possessed by dentists, ask who is the " best dentist," and according to the opinion of the individual answering, the reply is given. In the course of a year this phase of reputation is very valuable; it is clear profit, because without reputation this patronage would not have been received. In commercial life there are several instances in every city where the reputation of the firm is such that it is not necessary for them to ad- vertise ; the mere name suffices and is a guarantee of quality. When persons wish anything really nice they go to such a firm ; when they wish to invest in something, jewelry for instance, about which they know nothing, they go to such a firm because they have the assur- ance, by reason of the established reputation, that they w^ill be honorably dealt w^ith. So it is in dentistry; when people have really difificult or unusual work to be performed they will entrust it to the dentist with a reputation. They cannot afford to experiment with some one who has not achieved a distinctive place in the public esteem. It is essential to success in professional life to gain reputation first, for that is the ground-work. Reputation will be illusory, position will be a snare, and the greatest honors will soon take to themselves wings and f^y away, if all are not weighted with a substantial character. Wine and Women " Wine and women, game and deceit, make the wealth small and the want great " More or less trouble has been caused by pretty women from the very beginning of history. Of this we have no desire to treat. As Rudyard Kipling would say, " That's another story." What is of special interest to us is a consideration of the moral relations of dentists and the mem- bers of the opposite sex with whom they are thrown into association. The greater proportion of those for whom the dentist is called upon to operate are women, and among this proportion it is not at all strange that many should be possessed of proclivities of a more or less hilarious nature. Right at the beginning of his professional career every dentist must decide upon what course he proposes to adopt with reference to this matter. Either he is going to " have fun," or he is going to make for himself a reputation. If he goes in to have fun, he must abandon all hope of attaining a reputation ; not that he cannot have fun and attain a reputation too — but the reputation will not be as abidingly satisfactory as that which is based upon a foundation upon which no taint of moral obliquity rests. These little things have a way of leaking out, and when they do leak out they gain a circulation in a surprisingly short time, and once having gained a circulation it is impossible to overcome their un- favorable efifect; stories reflecting on the morality of professional men cling persistently, and their evil influence cannot be counteracted by years of the most punctilious conduct. One of the most frequent causes of trouble to a dentist is the selection of a very pretty female assistant. A pretty assistant is all right but she should not be too pretty. A girl assistant should be selected who is not too good looking, and who knows her place and how to keep it. No familiarity of any kind should be tolerated, and the assistant should 347 348 THE PRACTICE BUILDER refrain from addressing her employer in any but the most respectful manner. No joking nor laughing, and no attempt to join in conversa- tion with the dentist and his patients should be tolerated. If it comes to the ears of the dentist that unkind aspersions are being made with reference to his assistant and himself, he should at once dismiss the assistant and get another. This is justice to both. Again — a lady assis- tant is a good investment as an advertisement, and this is especially true in a small city. The fact that one employs a girl assistant indicates that he is busy enough to need her. People like to go to a dentist whom they think is busy. He must be a good dentist, if he is busy. A lady assistant will have friends, and it is natural that many of them should patronize the dentist who employs her. It becomes known in the neighborhood in which she resides that she works for Dr. Blank, and Dr. Blank is thereby given some publicity that he would not otherwise have gained. The presence of a lady assistant has another advantage: Women who are given to freedom and flippancy of speech will be much more careful when another person is present. This is particularly true of fast women ; when they are having work performed which re- quires several appointments, they usually manage to become very well acquainted in very short order, after the manner of their class, and their familiar speech and manner is sometimes likely to make it very em- barrassing for the dentist; but if there is an assistant present the conduct of these persons is most decorous, and nothing is said or done to indi- cate their station in life. Be especially careful in your treatment of married women; do not for one instant engage in conversation that savors of questionable sub- jects, and do not permit yourself to be drawn into such conversations. Married women are the most reckless of all those who exhibit freedom of speech and action. They do not seem to care. In the matter of the administration of general anaesthetics to women patients, a word of caution is here necessary. While the use of Chloro- form and Ether and their several combinations is being rapidly super- seded by Nitrous Oxide Gas as a general anaesthetic — still there are in some communities practitioners who still employ and advise the use of these agents for tooth extraction. Every dentist is advised by his pro- THE PRACTICE BUILDER 349 lessors and by his elders in practice to always have a third person present when a general anaesthetic is to be administered to a woman. Failure to do this has brought many men a life of misery. It is a precaution which every man should take. His knowledge of the action of these anaesthetics should teach him to be careful when they are used to anaesthetize women ; not that a woman may be dishonest and have a blackmailing scheme, such as have been operated, having den- tists for their victims, time and again, but that honest women may be so .affected by the anaesthetic as to believe themselves to have been mal- treated. A great many such cases have come to court, and in some instances the statements made by the woman have been such as to convince judge and jury that the dentist was guilty. It is only necessary to refer to Rehfuss' " Dental Jurisprudence," to see that in several instances the dentists have been sent to prison. Rehfuss says on this question : In the whole domain of dental jurisprudence, no criminal charge brought in a court of justice against a dentist can be conceived more grave than the accusation of having committed rape on a female in whom he was inducing anaesthesia. Several legal cases of this character are recorded, where the den- tist was found guilty and sentenced to imprisonment for his alleged crime. The women no doubt believed that they had been violated, but it is certain that, in many of these cases, and probably in all of them, they mistook the real act for the subjective erotic sensations induced by the anaesthetic. That a dental practitioner in the pursuit of his calling is exposed to grave charges of this nature, is a serious matter for consideration and reflection, requir- ing careful and delicate interpretation, both morally and legally. Frequently the accusation is based upon and solely sustained by the evidence of the plain- tifif, and in view of the known tendency of anaesthetics to excite erotic sensations, such evidence should not be received without the corroborative testimony of other witnesses, or circumstances, as the unsupported evidence of women under such conditions cannot be relied upon. Manifestations of erotic sensation during artificial anaesthesia have been witnessed, although rarely; but dreams of a sexual character are doubtless more frequently experienced, and very vividly; women undoubtedly are more liable to them than men, especially when the administration of the anaesthetic takes place at or about the time of the periodical congestion. Ether, from its more stimulating effect, produces these dreams more fre- quently than chloroform. Cases have occurred where the woman was so positive that liberties had been taken with her person during anaesthesia, that the testimony of relatives. 350 THE PRACTICE BUILDER who were present all the time, scarcely sufficccl to convince her that she was laboring under a delusion. These cases occur more frequently than we have knowledge of, and are compromised without judicial proceedings being insti- tuted. It is not good policy for a dentist to keep wine in his office. It is proper for him to have at hand whiskey and brandy for use as stimulants before or after extracting teeth, or to administer to patients suffering from extreme nervousness or weakness incident to any of the operations that are usually productive of depression or weakness. Unmarried dentists, who make their offices their lounging places, and keep a stock of cigars and wines on hand, where they may enjoy themselves with one or more boon companions, will find it to their interest to refrain from such conduct. Such things have a way of be- coming known, and they have a very undesirable effect. It is all right to have a good time, but there is a proper place and time for everything. Besides this, the practice of keeping wine in the office is likely to establish the habit of drinking; until, before one knows it, he is drink- ing to excess, or his breath is so continually laden with the odor of wine as to cause his patrons to look upon him with some suspicion; and too, he will find that his boon companions present themselves with a fre- quency and punctuality that would indicate them to be under salary, and they are likely to become such habitual guests at his office as to make it impossible for him to have any time to himself. All will find it the part of wisdom not to have wine in the office ex- cept for medicinal purposes. There is no valid excuse for keeping it there, outside of its medicinal use. How to Become a Specialist " Study what you most affect " The tendency of the times is toward specialism. This is true of all the professions. While it has been noticeable only within the past few years, many practitioners have been following particular specialties for a long time. The fact that many establish themselves as specialists is evidence that such were needed, and the appreciation given their work clinches the belief. Specialism is essential to the proper development of a specialty. The one man, one thing, idea is as old as Egypt. That it is practical cannot be denied. It is too well established to admit of argument. In medicine, specialties have been observed for many years, and their in- corporation in the courses of instruction at m.edical colleges, with spec- ialist instructors in the faculty, has resulted in their most favorable ac- ceptation by the medical profession at large. A similar condition is noticeable in law schools. The establishment of special courses of instruction was early adopted at the various schools of dentistry, and to-day there is no institution of any prominence in which all specialties of interest are not thoroughly presented. One of the earliest specialties to attract the attention of the dental profession, and of the dental colleges, was Orthodontia. This branch of practice rapidly developed from one of little or no importance to one of the most absorbing interest, enlisting the brightest and rfiost progressive men in the profession. The study of the subject demands artistic sense, and the greatest inventive ingenuity, together with a thorough understand- ing of the underlying principles involved in the performance of the 351 ... THE PRACTICE BUILDER work; and a very high order of professional training, so far as the comprehension of Anatomy, Physiology, and Pathology in its relation thereto is concerned. The perfection of crown and bridge work, and the acceptance of certain modes of practice, followed in rapid succession as specialties demanding special instructors in the schools. Among the more prominent specialties now practiced may be mentioned: individual methods of correcting irregularities of the teeth and improving facial contours; special methods of constructing and in- serting bridge work; oi)erations relating to the implantation of teeth; special methods of filling teeth with gold and i)orcclaiii inlays; the con- struction of apparatus for the concealment of facial and oral deformities and the improvement of speech, and those surgical operations which re- late to performances for the removal of malformations, and the treat- ment of lesions of the mouth, jaws, teeth, etc. At the present time there are only a few who devote their entire time to the exclusive practice of the specialties, and these are to be found only in the larger cities. The reason for this is that most dentists are capable of performing all the operations of dentistry, including those which en- gage the attention of the specialists, and as they are usually capable of performing them quite as satisfactorily they do the work themselves and receive the fee rather than recommend the patient to a specialist; except where the operation, such as an exceedingly difificult one in Or- thodontia, calls for the exercise of really superior skill, and demands that close attention wdiich the regular practitioner cannot give because of his complicated duties in his practice. He therefore does not have opportunity, or rather does not accept the opportunity of developing his ability with reference to the more difificult performances in Ortho- dontia. It is impossible to establish a practice for the exclusive performance of specialties, except in a large city, because a specialty commands a patronage of a very limited number of people, who are never patrons of the office but once. In considering the question of specialism, there are several points which demand very careful thought : In the first place, will the practice of a specialty be more lucrative than a full practice in which the usual THE PRACTICE BUILDER 353 routine of work is performed? Has the individual given evidence of a sufficiently high order of talent to warrant him in leaving general prac- tice to take up special work? Has he sufficient financial backing to en- able him to operate a high class office in the centre of a city until such time as it shall become self-supporting? There is more than one in- stance of really skilful specialists leaving cities of average size, to en- gage in the practice of a specialty in large cities, and not securing a practice for several years — and that too in the metropolitan cities. This has meant the loss of the accumulations of years in regular practice, to back a special practice. Special practices may be classed in three divisions: One of these re- lates to work demanding an accurate knowledge of Pathology and Therapeutics. This is so rare that it can hardly be called a specialty, because there is no one who conducts this class of practice exclusively. Several practitioners in the larger cities have attained considerable dis- tinction in the treatment of pathological conditions of the teeth and gums. We are not aware that such practices are very profitable, but we know that many men have attained very creditable standing in the profession by published results of their modes of diagnosis and treat- ment. Another branch is the mechanical. This relates chiefly to the con- struction of mechanical devices for the improvement of speech and ap- pearance. There are very few names associated with this class of prac- tice, few have attained wide reputation for the successful performance of this work. It is, however, one of the best paid specialties in dentistry. By reason of the comparative rarity of the deformities which indicate the employment of these mechanical devices, it is at once apparent that a specialty of this kind can only be practiced in a very large city, for here only can publicity and reputation be attained; and it is to the centres of population that persons who are the victims of such defects will go for aid. The practice of mechanical dentistry as a specialty is not conducted exclusively by many, although there are a few in the larger cities who give special attention to continuous gum work dentures, but who do other mechanical work as well. Bridge work as a specialty is practiced by many, but the practitioner ,,^ THE PRACTICE BUILDER is usually located in a large city. The bridge work is usually con- structed according to the individual methods of the practitioner, and in many instances is protected by patents, or at least is patented. Special forms of bridge work, special materials for its construction, and special modes of insertion and retention or removability, constitute the claims of specialism. This form of specialty is a very lucrative one, where the practitioner is possessed of superior skill and has attained a reputation for successful work. The most recent development of Orthodontia, that which relates to the improvement of facial appearance through interference with the natural teeth, has afforded several very talented men the opportunity to follow out their favorite branch of practice, and to introduce and employ many ingenious modes and appliances for the correction of irregulari- ties of the teeth, and to successfully improve the personal appearance of individuals by changing the relation of the teeth or jaws. Oral surgery is a specialty having few practitioners, and since the death of the lamented Garretson the specialty lacks a head. He was the father of the specialty, and the greatest Oral Surgeon in the world. His book on Oral Surgery is a monument to his name. His practice was probably the most lucrative of its kind in the world, but he was a man whose talents are eciuallcd by few in any profession and exceeded by none. As a practitioner and a teacher he stood unrivalled. It is recognized that no one can rightfully claim the title of Oral Surgeon without being a graduate both in medicine and dentistry. Supposing, now. that a person in the possession of a regular practice is desirous of becoming a specialist in any one of the branches which we have enumerated, what is the proper course for him to take that he may perfect himself for its successful practice? In the first place, it is necessary for him to give to the subject special thought. The progress and mode of procedure which characterized the advancement of other men should be of very great value to those who would follow in their footsteps or break a new path. To change from a general practice into a specialty is a thing that can- not be done in a few months; it takes years of preparation, planning, and faithful work, having always in view the special work. If a man has a desire to become a specialist he will take that branch of specialism THE PRACTICE BUILDER ;55 in which he is most interested and in which he hopes to win a name for himself because of his experience and special fitness. He must view the future of that branch, and consider its growth and its position and relation to dentistry ten or twenty years hence. These are very impor- tant considerations. If desirous of becoming a practitioner in any branch of specialism it is apparent that the surest road to a proper foundation training is a term of association with one or more of the most prominent exponents of that branch of practice. The most prominent specialists are of neces- sity in the large cities ; a practice of this kind could not be conducted anywhere else. The percentage of persons whose dental apparatus would require special interference is so small, that only in a large city can such a practice be maintained; and the city practice attracts those from smaller places, who can afiford to undergo such expensive opera- tions. After a term of such association as we have indicated — and we should consider it proper for a person intending to practice a specialty to associate himself with all the really prominent specialists in the branch to which he intended to devote his attention — the person would be pre- pared to practice the specialty, but only as a special branch of a general practice ; he could not start right out to practice a specialty. He would return to his home, and there indicate his fitness for the performance of such operations as would come within the domain of his special knowl- edge, but this practice would be supported by his general practice. After several successful operations, he should prepare articles for pub- lication in the dental journals, for presentation at the meetings of his society, and should take particular pains to present accurate models of the conditions, that appropriate engravings may be made or that good models may be shown. In specialism it is necessary to make a reputation with the members of the profession that are in the habit of recommending special cases to specialists, when those cases are out of their usual line of work; and the man who achieves a good reputation among them will have a healthy and permanent support for his practice from the start. It must be borne in mind that a specialist in a large city must let it 156 THE PRACTICE BUILDER be known from the start that he docs no operating or ])late work, but that his whole time is given exclusively to special operations. General practitioners of dentistry are not so likely to recommend their patients to specialists if the specialists perform routine dental work, such as operating, plate work, etc. It is necessary for the specialist, whether he be a new aspirant for honors or whether he has been in successful practice for years, to have all the literature of dentistry at his command, including the books, journals, and society proceedings. Every case is in itself a special study, and it is important to have at all times the advantage of comparison with previously recorded cases, and to have the experience of others in cases of general similarity. To become a specialist in bridge work, one should have a term of association with one or more, the more the better, of the men whose names are most prominently connected with that specialty. Bridge work cannot be practiced to the exclusion of all other work ; w^e do not know of any one practice in this country, or anywhere else, where no other dental work is performed. In Oral deformities, it is proper to adopt the same course we have advised with reference to the other branches. This, like the others, can- not be successfully conducted except in a large city, and it depends, for its growth and publicity, upon the same principles of making the gen- eral profession acquainted with the progress of the individual practi- tioner. The specialty which is comprehended in the correction of ir- regularities of the teeth has more really prominent representatives than any of the others enumerated. The correction of irregularities of the teeth, oral deformities, and orthopaedic dentistry, seem to be more dis- tinctly defined so far as the duties of each branch are concerned, and the practitioners of each appear to devote their attention more closely to the special work involved. Porcelain dental art, as a specialty, has few representatives. Many improvements have been made in the work in the past few years, and it engages the attention of several of our best practitioners. As a spe- cialty capable of being practiced to the exclusion of all other work, it does not at the present time give great promise, although there are THE PRACTICE BUILDER 357 many who are so busily engaged in it as to amount almost to specialism. Special duty and special preparation, together with the appropriate methods of keeping in touch with both the profession at large and the dental constituency, are the same as those which should be employed in advancing the personal interests in any of the specialties treated of herein. Book-keeping " That tnan is but of the lower order of the world who is not brought up to business and affairs " The object of book-keeping is to exhibit a correct statement of one's afifairs, in such a manner that he may ascertain the nature and extent of his business, the money he receives and pays out, his profits, or avail- able income, and if necessary, the extent of his losses. These are factors which must receive attention, no matter how little or how great the business may be. Upon their proper consideration depend the stability and reputation of the man of business. Viewed as credentials, a set of books arc invested with a character which the possil)ilities of the business itself cannot give. The transactions of any one engaged in business or professional life are regulated and determined by the extent of his capital and credit. These are shown conclusively by an accurate and satisfactory system of book-keeping; without such, one must of necessity be proceeding upon vague and possibly erroneous conclusions, the result of which may bring financial disaster and the terror of bankruptcy. To-day's doings are governed in no uncertain degree by the suc- cesses or failures of the past. In our books we have recorded those transactions and experiences, and the record usually enables us to de- cide whether a contemplated investment shall or shall not be made. The data of every transaction cannot be carried in one's head ; besides, if one who does not keep a set of books, will do so, he will introduce with it some systematic methods of business which he doesn't follow now; for, to be honest, his business is characterized by lack of system. But he tells us, " T do a cash business, I pay cash for everything I buy, and I do not do very much unless I get the cash for it. What is 358 THE PRACTICE BUILDER 359 the use of recording all these transactions? At the end of a given time will not the amount of my profits be the amount of cash I have in the bank? " Yes, in a measure true, but he has failed to fully consider the possi- bilities of his business. It is impossible to do a strictly cash business, no matter how much we may wish to. This being the case, how may one dispose of the little transactions where the money is not forthcom- ing? Again, in what branch of his work has he received the best profits and made the most money? Did he try to increase his income in these particular lines, because he was making more relatively from them than from some others? No, he did not, because he had no record of transactions, and could not begin to remember them all. Then, too, he does not keep an in- voice file, and hence cannot compare prices paid for material in the past with those he pays now. He says he doesn't keep a ledger, for such a book was never intended for a petty business like his, but he does keep a kind of " want book." And after much probing the fact is brought to light that the want book is a " kind of a want book — " a kind whose possessor lacked the energy and methods necessary to make it in the least degree useful to him. The slight records kept by such a man will show the same carelessness. Further information brings to light a woful lack of business shrewd- ness, mainly because he does not believe in adopting the tactics and •methods of business men. The dentist, no matter how sma41 his practice, must keep a set of books. And he must put as much energy and system into them as into his efforts in performing his work. Book-keeping, when conducted upon sound principles, will prove of great value to him; it will show the general results of his professional career, and bring to light his suc- cesses and failures and the value or worthlessness of each factor. The system chosen must not only be perfectly comprehensible to him.self, but it should be intelligible to any one should circumstances ever arise in which an examination by others would be necessary. Good book- keeping promotes order, regularity, and honorable methods of business. It also defeats dishonesty and gives standing and credence to our trans- actions with our fellow men. 36o THE PRACTICE BUILDER- A careful account of the best years of a business is a very important guide in determining future policies. If a man knows just how much money he has spent in one year in any branch, and also knows exactly the amount of money he made on his investments and expenditures, he has some basis to work on. Some men feel that because their business is small, and there is as a rule but one person interested, it is not necessary to keep an exact ac- count of everything that comes in and goes out. They content them- selves, as a rule, with a me*-e record of outstanding accounts, and even this is usually no more than a memorandum book which contains the entries of the amount of the" work, and when it was done, and which is crossed ofY when payment has been received. There is, as a rule, no record whatever of goods which have been bought, or the amounts of cash operations. Sometimes there is no proper cash account, and the practice is allowed to run on until, in many cases, the proprietor finds that money is not coming in fast enough to pay his bills, and he is com- pelled to make explanations and ask extensions, a condition which might have been averted had he known how things were going. Suppose the building in which such a carelessly managed office is located, were to burn down. What sort of a claim would its owner have upon the insurance company, if he was insured? It would be necessary to show a record of goods bought recently, and the amount of such materials that still remained unused, the cost of the furniture and fix- tures, books, instruments, and operating and laboratory appliances, to- gether with the hundreds of other things that go to make up a com- pletely equipped of^ce. In the absence of any such record it is almost certain that the insured would be the loser, to the extent of a very large amount of the insurance money to which he would have been entitled had he been able to show conclusively that he was possessed of a certain amount of stock at the time of the fire. In a dental practice, the book-keeping can be done readily by the practitioner. The cash operations can of course be entered as they are made, without extra trouble whatever. The charge accounts have to be entered any way; and in an hour each week all the other business of keeping books could be attended to. It is necessary to keep accounts with patients as definite as possible, and to always take time to record THE PRACTICE BUILDER 361 intelligently and in detail the work as soon as done, and while being done, if it is to extend beyond a single sitting. Leave nothing to mem- ory. Let the book tell the whole story. The books necessary for a full set of records, are: First, the day- book. In this are entered all the transactions of the business side, the dollar side of the practice. All the work done for cash, all the work done on credit, all the expenditures, all the receipts, and all the bills received are entered on the day book. This is in fact the most important of all, because from it, if the other books were lost, a complete record of the business could be made. The cash-book has entered in it all receipts and expenditures of cash. A memorandum of the small cash items may be kept on a tab, and at the close of the day the sum total may be added and entered as one item. A balance should be taken from the cash-book at the end of a week, and this must agree with the amount of money on hand. Work that is done on account is entered in the day-book. It may be mentioned here that in book-keeping all entries are made precisely as though they were so much cash. Work that is done is charged just the same as though it were so much cash. Materials that are received from the dental dealers are charged just as so much cash would be credited, for the reason that all material is reckoned at its value in money. To take care of the invoices, a bill-book may be used, or a file may be utilized to take care of the invoices of goods received from the depots. In the bill-book all bills for material bought are posted every month, all the bills from one house being placed together and the total of their amount being set opposite the last bill. Rather than a bill book we prefer to use a desk file (see Office Business Fittings) ; this dispenses with the work of posting and adding, while the bills are readily acces- sible. The record of the amounts of the bills is entered in lead pencil in a suitable book (a bills-payable book will do). As received, the bills are placed in the current month in the desk file (see OfiEice Business Fit- tings), and when ready to make up the day-book they are entered on the bill-book and checked and transferred to the invoice file, as ex- plained in the chapter referred to. The ledger is the book wherein a condensed account of all the trans- -52 THE PRACTICE BUILDER actions of a business arc recorded. A ledger account is always divided into two separate parts, the debit and the credit. The journal is used to exhibit the debits and the credits which are derived from the transactions which are recorded in the day-book. These debits and credits are so arranged as to indicate upon which side of the accounts they are severally to be placed in the ledger. Deciding upon which accounts shall be debited and which credited, and arrang- ing and recording these debits and credits in proper order in the journal, is called journalizing. The sum of the items credited must be equal to the sum of the item or items debited, in each and every double entry journal entry. Debit and credit are terms generally used in book-keeping. The term debit means owing, credit means being owed. These terms are frequently abbreviated and written Dr. and Cr. The application of these terms relates to things as well as to persons, but when applied strictly to individuals their meaning will be more easily understood. To facilitate the keeping of a set of books we have been in the habit of using a Dental Cosmos Calendar, or a Calendar Desk Pad, hav- ing blank space below the date for memorandums whereon may be placed the items for entering in the day-book, just as they occur. We present herewith an explanation of book-keeping suitable to the needs of practicing dentists. Those who do not as yet keep a double entry set of books, should gather together all the bills which they owe to any one else, and should make out the amounts of bills which are due to the practice. Also the value of the of^ce furniture and fixtures, books, implements, and the amount of cash on hand, including what may be on deposit in the bank. For convenience it is best to begin the set on the first of any month, as the total amount of bills due to any one firm may thus be entered in a lump figure as represented on the monthly statement which they send out to customers. The amounts due from patrons of the office mav be entered in individual accounts, and these indexed in the ledger so as to be readily accessible on the first of every month, that bills may be made out and sent promptly. In buying a set of blank books, it should be remembered that they are intended for thirty or forty years' use; hence the very best quality should be bought. Books that are leather bound throughout, the very THE PRACTICE BUILDER 363 best, can be had for eight or nine dollars. This price includes a ledger of 300 pages, a cash book of 300 pages, a day book of 450 or 500 pages, and a journal of 450 or 500 pages. A 300 page ledger should be divided off as follows : The cash account should have about 50 pages. Expense, 30 pages. Material, 30 pages. Operative Dentistry, 30 pages. Plate Work, 15 pages. Crown and Bridge Work, 4 pages. Extracting, 20 pages. Rent, 10 pages. Personal account of the dentist, 20 pages. Advertis- ing, 2 pages. Individual accounts of patients, about 30 pages, two or three accounts to the page. The dental dealer most patronized by the office should have 30 pages. These accounts should be indexed in the ledger, and we are ready for work. Supposing, now, that all the bills against the office have been got- ten together, and all accounts against patients have been made out, we are ready to make the entries in the day-book. The proprietor is credited for his investments, and for any sums afterward put into the business. He is debited for his liabilities brought into the business, and for all sums withdrawn. A person is debited, when he becomes indebted to us without a written promise to pay, and when we pay him anything on account. He is credited, when we be- come indebted to him without giving a written promise to pay, and when he pays us on account. Cash is debited when we receive money, and credited when we pay out money. Bills Receivable is debited v/hen we receive other people's notes, and credited when we receive payment on them, or otherwise dispose of them. Bills Payable is credited when we give out our notes, and is debited when we pay them or otherwise redeem them. Material is debited for its cost, and is credited by the profits when disposed of. Expense is debited for items of outlay in carrying on the business, not charged to any general account. It is credited, when anything is produced from that which has been charged to expense. Other accounts are embraced in the general rule which debits any account when it costs value, and credits it when it produces value. To illustrate we give a few forms: 364 THE PRACTICE BUILDER FORM I. Day- Book. Material, S. S. White Dental Mfg. Co. Dr. 'Journal Entry. $1 75 Cr. Material $1 75 I S. S. White Dental Mfg. Co. $1 75 FORM II. Day-Book. Gold plate, Mrs. H. White, $75 00 ' Received cash, $50. Balance on ac- count. Dr. 'Journal Entry. Cr. Mrs. H. White Cash $75 00 Plate work 50 00 H. White $75 00 50 00 FORM III. Day-Book. Bought of Consolidated Dental Mfg. Co. Operating Chair, Paid Cash, $50 00. Balance on account. Dr. Furniture and fixtures Journal Entry. ) 1 50 00 Cr. J150 00 Cash I $50 00 ll Consolidated Dental Mfg. Co. 100 00 FORM IV. Day-Book. Mrs. J. Williams, Bridge Work, $100 00. Operative Dentistry $50 00. Received in payment, cash, $50 00. Balance on account, $100 00. Dr. Journal Entry. Cr. J. Williams Cash 3150 00 50 00 Bridge Work Operative Dentistry J. Williams $100 00 50 00 50 00 THE PRACTICE BUILDER 365 These examples show that there may be : One debit and one credit. Two or more debits and one credit. One debit and two or more credits. Two or more debits and two or more credits. We now proceed to exhibit the book-keeping as it appears in a den- tal practice : DAY BOOK. i«9-. Oct. I. Oct. 2. " 4- " 8. " 9- " 10. IS- 16. 24. 25. 28. 31- Opened up a set of books with the following Resources and Liabilities : Resources : Furniture and Fixtures $400 Instruments 250 Books 100 Laboratory Apparatus 1 50 . Material 50 Cash 400 Individual account, F. B. Smith Liabilities : S. S. White Dental Mfg. Co $80 50 — Paid cash for rent, September Operating, Wm. Watson, cash Electric light F. B. Smith, paid cash on account Paid Assistant H. F. Apworth, bridge work (as per Record Book), cash. Ad in Church Programme . . Printing stationery, cash Extracting O. H. Harding, Miss Flora, correcting irregularity, charge. Mrs. S. M. Moorehead, par. up. gold plate, charge American Dental Publishing Co.. CO. D., 1,000 copies " American Dental Instructor," $30.00. Express and C. O. D. charge, 45c Bridge work, Harrison Clark, cash in full Crown (gold), Hobart Emmons, cash Operating, A Mountell, 6 gold fillings, cash Plate work, full denture, Mrs. Ames, cash Plate work, partial upper, gold, Mrs. E. B. Wilmot... Bridge work, Mrs. H. F. Parmelee, cash Operating, Allen Coe, 2 gold, $8.00; 3 amalgam, $6.00, cash Plate work, Mrs. J. B. Janes, cash i>35o 00 50 00 80 50 25 00 17 00 2 50 25 00 3 SO 65 00 2 00 10 00 I 00 25 00 35 00 30 4S 175 00 10 00 25 00 24 00 30 00 125 00 14 00 12 00 366 THE PRACTICE BUILDER JOURNAL. Dr. Ck. Oct. I . Furniture and Fixtures, etc A. H. Blank Instruments A. B. Blank Books A. B. Blank Laboratory Apparatus A. B. Blank Material A. B. Blank Cash A. B. Blank F. B. Smith Operative Dentistry Material S. S. White Dental Mfg. Co. Oct. 2. Rent Cash Cash Operating " 4. Expense Cash " 8. Cash F. B. Smith " 9. Labor Cash Cash Crown and bridge work " 10. Advertising Cash Expense Cash Cash Extracting O. H. Harding Regulating Mrs. S. M. Aloorehead Plate work " II. "Instructors" Cash " 13. Cash Crown and bridge work " 15. Cash Crown and bridge work " 16. Cash Operating Cash Plate work " 24. Cash Plate work Cash , Bridge work " 28. Cash Operative dentistry " 31. Cash Operative dentistry 400 00 $400 250 00 250 100 CXD 100 150 00 150 50 400 00 00 50 400 50 CX) 50 80 50 80 25 00 25 17 00 17 2 50 2 25 00 25 3 50 3 65 00 65 2 00 2 10 I 00 00 10 25 00 25 35 00 35 30 45 30 175 00 175 10 00 10 25 00 25 24 00 24 30 00 30 125 00 125 14 00 >4 12 00 12 THE PRACTICE BUILDER CASH-BOOK. -h^l Dr. A. B. Blank. Operating . . Receipts . . . CASH-BOOK. Rent Electric light Labor Advertising Printing Printed matter (" Instructors ") Balance on hand $400 17 25 65 I 175 10 49 30 125 14 12 923 Cr. 25 2 3 2 10 $73 849 $923 I 00 LEDGER. Dr. Cash. Or. I I $400 2 I 17 8 2 25 9 2 65 10 3 I 13 3 175 15 4 10 16 4 25 16 5 24 24 5 30 ^^ t) 125 28 6 14 31 6 12 $923 00 00 00 00 00 00 00 00 00 00 00 00 00 Oct. 2 I $25 4 2 2 9 2 3 10 3 2 10 3 10 II 4 30 %n Bala nee on ha nd $849 $923 368 THE PRACTICE BUILDER Dr. LEDGER. A. B. Blank (Proprietor). Cr. Oct. I I I I I I $400 250 100 150 50 400 i $1,350 00 00 00 00 00 00 00 Furniture and Fixtures. Oct. I I 1 $400 $400 00 00 MatcriaL Oct. I I I I $ 50 80 1 $130 00 50 50 In ventor y $40 00 Plate Work. Oct. 10 16 24 5 $35 1 24 ' 30 1 $89 00 00 00 00 Instruments. Oct. I I 1 $250 00 Books. Oct. I 1 I $100 00 1 1 1 1 1 THE PRACTICE BUILDER Laboratory Apparatus. 369 Oct. $150 Oct. Nov. I I F. B. Smith. Balan • $50 I 00 $50 00 25 00 Oct, 8 31 Balan ce $25 25 $50 00 S. S. W. D. M. Co. Oct. 50 Operative Dentistry. Oct, I $50 2 17 16 25 28 14 31 12 $118 GO 00 GO GO OG Crown and Bridge Work. Oct 9 I $65 13 3 175 14 3 10 25 125 $375 GG 00 OG OG Rent. Oct. 525 GO 3/0 THE PRACTICE BUILDER Expense. Oct. 4 lO I I $2 lO 50 CX) 50 $12 Extracting. Oct. 10 3 $1 $1 Labor. Oct. 9 2 $3 5° Advertising. Oct. lO 2 $2 00 Instructors. Oct. II 3 $3° 45 In ventor y $30 45 0. H. Harding. Oct. lO 2 $25 00 Regulating. Oct. 10 I $25 00 Mrs. S. M. Moorehead. Oct. lO I $35 00 THE PRACTICE BUILDER 371 TRIAL BALANCE. LEDGER ACCOUNTS. Dr. Cr. Cash A. B. Blank Furniture and Fixtures Material Plate work Instruments Books Laboratory Apparatus . F. B. Smith S. S. W. D. M. Co.... Operative dentistry Crown and bridge work Rent Expense Extracting Labor " Instructors" Advertising O. H. Harding Regulating Mrs. S. M. Moorehead. $923 GO 400 00 130 SO 250 00 100 00 150 00 50 00 25 GO 12 50 3 50 30 45 2 00 25 00 35 00 95 $2,136 $73 1.350 25 $2,136 45 00 25 00 80 I 50 118 00 375 00 95 372 THE PRACTICE BUILDER STATEMENT, October 31, 189-. Resources. Cash Furniture Fixtures j Material Instruments ' Books I Laboratory Apparatus .... 1 F. B. Smith '. ' " Instructors " (American Dental Instructor) O . H . Harding Mrs. S. M. Moorehead Total ' Liabilities. I S. S. White Dental Mfg. Co | Resources i Liabilities I Present worth . . Gains. Plate work Operative dentistry . Crown and bridge work Extracting Regulating Total Losses. Material Rent Expense Labor Total Gains Losses Net gain A. B. Blank's net credit A. B. Blank's net gain A. B. Blank's present worth $849 65 400 40 250 00 100 150 25 30 45 25 25 35 00 1,905 80 118 375 I 25 00 50 00 00 00 00 00 80 50 25 00 12 50 3 50 662 00 121 50 1,350 00 540 50 $1,905 $1,824 50 50 $662 $121 $540 $1,890 50 50 50 THE PRACTICE BUILDER 373 It is a fundamental principle in double entry book-keeping, that the sum of the debits must be equal to the sum of the credits in each and £^^r)/ journal entry; it therefore follows that the sum of the debits of all the entries must be equal to the sum of \ki€\xcrcdits ; if, then, the journal entries have all been posted correctly, the two sides of the ledger must be equal. A simple test, therefore, is made by adding up all the items on the debit side and also on the credit side of the ledger accounts, and if the two footings are equal it is accepted as evidence that the ledger is correct. This is called the trial balance, and has been shown. Assum- ing that the journal entries were correctly made, and that they have all been correctly posted to the ledger, the equality of the two sides is satis- factory proof of its correctness. The ledger cannot be correct unless the 'two sides are equal, but there may be equality of the two sides and yet the ledger may be incorrect, by reason of the omission of one or more journal entries, or by posting an item on the right side but under the wrong account. Still it is a useful test, and when care is taken it is generally accepted as reliable. A statement of results is obtained, after having ascertained that the two sides of the ledger are equal, by taking into consideration the value of any property on hand, which is not shown in the trial balance. The inventory of material may be estimated readily by reference to the bills for the same, which have been received, and noting whether it has been used. Things which have a cash value are estimated at their cost, as for instance, " The American Dental Instructor." Handling Patients " The successful man is tJie man who understands human nature, as well as his profession " Upon ability to tactfully handle patients, depends in a great measure the success of any dentist. We all know men who are not specially skil- ful, but who, by reason of an engaging manner, and by possession of a keen insight into human nature, are able to satisfactorily conduct the business and professional sides of their work, and to materially extend their interests and reputation. These are qualities which some men possess to such an extent that they could not lose their practices except by the most complete carelessness. These qualities may be cultivated by all men to some extent, accord- ing to the temperament. But some men are so lacking in urbanity and approachableness that it is surprising they can attract patients, and hold patronage. A chilly and forbidding presence is singularly out of place in a dental office ; and the opposite extreme is quite as unde- sirable. We know of many instances where dentists began their prac- tice by the exhibition of that suavity so essential to making friends, but \\ ho, after a few years, became careless and lost all outward evidences of affability. It is at such a period in a man's life that his practice comes to a stand-still. Thus it is that there are so many men whose practice amounts to the same sum year after year. Their ability to extend their practice does not seem to keep pace with their advance in ability. The great variety of temperaments with which a dentist is called upon to deal makes it necessary for him to be a many-sided man, a man capable of exhibiting his talents to good advantage, no matter with whom he may be transacting business, for all that which does not relate to the scientific aspect of his profession is business. 374 THE PRACTICE BUILDER 375 The handling of patients does not differ in city practice from that of smaller towns, except in the cases of extensive advertising practices. People are the same in one place as in another — just people. The ability to handle patients successfully arises from appreciation of dif- ferent temperaments and different grades. The most troublesome peo- ple are admitted to be " shoppers." These are usually women, and gen- erally married women. They are an annoyance to nearly every dentist; few escape them. In the cities the high-class practitioners are not bothered so much with them ; the burden of attention from shoppers is directed chiefly at the advertising office, so that those who are known to get good fees for their work and who charge for consultation, escape them. Those who have been in practice for two or three years come to know the shopper at sight. The shopper is usually a member of the lower grade of society, but not always. When the shopper enters the office she sometimes asks right out, before anything else is said, what the price is for this or that piece of work. For instance, almost before the door is closed behind her, she says, " I called to ask what you charge for making false teeth? " The dentist should always be guarded in answering these questions in order to make sure whether the person really wants teeth. He should reply, " I cannot tell what the fee would be until I see the mouth." The shopper is seated in the chair, and is al- ways careful to explain that she " didn't care to have the work done to-day, and just called to get your advice." From talk of this kind you can generally be sure that the woman is making the rounds of the offices, and that the dentist who offers the lowest price is the one who will get the work. If you are bound to do the work even if you have to do it at loss, you will probably succeed in taking the impression; but there is no satisfaction in working for shop- pers, at any price. If you do the work they will attempt to stand you off, and if you try to collect they will be continually complaining that the plate does not fit, or that it drops down when they go to speak, or that the teeth you filled hart them, or that just as soon as they feel all right they will pay you. People who pay for their work when it is finished seldom if ever complain ; and if they do, some slight alteration will be satisfactory to 376 THE PRACTICE BUILDER them; but not so with the shopper, especially if she owes. She ex- l)ects more for less money than anyone else, and she will put you to more trouble than twenty other patients. Sometimes a person will come into the office for work and will ask you what you charge for this or that work, and may engage you to do it. and you will afterward find out that your caller has been to every other office in town. You may do the work, and after you have sent the bill (for such will not pay cash), you will find that you have been fooled. It does no good to dun these people. If you persist they will lie about it in such an artful and vigorous manner that they will hurt your practice and influence many good people against employing you. It is a good plan to shut off the shoppers by giving them a cold shoulder; when they ask wdiat you would charge to do this or that work, mention a fee ten or twenty times higher than regular prices. Sometimes a shopper goes from one office to another, and when the dentist tells her how much he will charge she will say, " Oh, I can get it done at 's for a good deal less than that." To the question of a typical shopper, asking what would be charged for a piece of work, the reply was given that it would be two and a half. " Two dollars and a half? " " Oh, no. Two hundred and fifty dollars." She nearly had a hemorrhage when she heard it. She looked in stupefied amazement, but she was game. " I could not afiford that just now," she said. " I believe I'll have to wait awhile." In speaking about it to another den- tist, she said, " He spoke of that as if he never did any work for less than a hundred dollars." There arc people who come into a dental office and start in to tell about their teeth, then they tell about their husbands' teeth; then their children's teeth; then their mother's, and father's, and brother's and all their relatives' until the dentist is almost ready to explode in an attempt to hold his temper. If it is operating that will permit the use of the rubber dam, put it on by all means, for if you do not, you will never get through with the work. These persons are in nearly every instance women, and they are not content to go when their work is finished, but stand around talking, thus keeping the dentist at the door for a half hour or more. If you are tactful you will have the door open and the patient gracefully shown into the hallway almost before she knows it, and have THE PRACTICE BUILDER 377 it done so politely that she will speak to her friends of your gentle manner. Sometimes persons will enter the office and state that they want this or that work performed, saying they want good work, and are willing to pay for it, but not until satisfied that it is all right; that they have been to two or three dentists before and never received satisfaction, and that they do not intend to pay for any more dental work until they are sure it is all right. Tell these people right on the start, no matter how prominent they may be, socially or financially, that you cannot under- take to do work on such conditions, that if they care to have you do their work they must conform to the same conditions other people do; that they take no more risk than any one else, and if they wish you to do the work these are the only conditions upon which it will be attempted; and if the work is very expensive, tell them frankly and plainly that you must have a deposit in advance, because you have to pay for your material whether or not the work is successful, and you will engage in no work that may mean a possibility of loss in cash. It is understood that most persons of the better sort want the very best work, irrespective of cost, and when a patient applies for work, a dentist should understand his rank, and should not suggest the per- formance of a grade of work below what his position in life entitles him to receive. For instance : The wife of a man whose wealth is such that he can afford, if necessary, to send her to a large city to a celebrated specialist, should not have it suggested to her that she should have a rubber plate inserted. A denture of continuous gum or gold plate should be suggested, and she should be told the great advantages of these over the rubber base, and be allowed to indicate her preference in the matter of the base and the cost of the same. Some men are so accustomed to doing work for people who want something cheap that they do it for every one, without consulting the wishes of the patient; consequently many people are wearing cheap artificial dentures who are perfectly able to have the best, because the dentist never explained the matter to them, and who, if they had known, would have been satisfied with nothing but the very best. There should be no attempt to cater for the patronage of complain- ing people; they are useless, and dangerous. It would be better for one 378 THE PRACTICE BUILDER not to liavc them apply to him, and if he docs their work he will find that eventually they will complain, no matter how conscientiously he does it. They are constantly changing dentists, and the most skilful man cannot hold their patronage. The temporary gain through doing their work will be more than counteracted by the condcnuiation which they heap upon the dentist. They are people who rarely, if ever, sjjeak well in private of any one, and of a physician or dentist they seem to think they have a perfect right to say anything they please. Again, there are some people whose temperaments are such that their presence is like sunshine, and it is a pleasure to work for them; their simple " Thank you. Doctor," being more gratifying than the amount of the fee, while there are others who cast a gloom over one, and who grumble continually. There are some women so trying to the nerves that it is almost impossible to do justice to the work. Many operators have been utterly worn out after a short appointment with a person of this kind. A practitioner will serve his own and the patient's best interests if he will honestly tell such an one that he cannot work for her; or if, when she applies for a second appointment, he will not find it convenient to make one. We know several men who tell the patient plainly that they think some other dentist could do the work more satis- factorily for her. This is the proper thing to do ; it is manly and candid, and it is wholly in accordance with professionalism. All dentists should remember that all people arc children in the dental chair. A gentle, soothing manner goes far toward winning con- fidence. It is helpful to a dentist to have his own teeth filled once in a while, so that he may appreciate the feelings of the patient. He will know then that it is not proper to approach the patient w'ith a clatter of instruments and a rattling of draw'ers, and to make the engine run like all possessed; but he will, on the contrary, approach the patient with every possible care, parting the lips gently with fingers that are not cold and clammy; he will operate the engine so as to make the least noise, and as slowly as is compatible with efficient work. If it is neces- sary to employ hand instruments, such as excavators, etc., he will use them as gently as possible, and if it is necessary to adjust the rubber dam, he cannot too early cultivate the practice of swabbing the gums carefully with a six to ten per cent, preparation of cocaine, and by so THE PRACTICE BUILDER 37^ doing earn the everlasting praise of his patient. The gums are thereby protected from the painful adjustment of the silk ligature. These are the little things that count. The manner in which the dentist greets and dismisses his patients has much to do with raising or lowering him in their esteem. A cold " Good-morning," '' Take a chair," " What can I do for you? " in a cold, heartless, business tone of voice, strikes like ice on the nerves of a person who has been for weeks, even months, trying to get his courage up to the point of going to the dentist; on the contrary, there should be a kind look, a pleasant smile, a friendly greeting, a tender solicitude such as we would extend to a child. There should be a kind assurance that you will be as gentle as possible, and all through the operation words of sympathy should be given as well as looks of kindness, a gentle pat on the head, and a soothing " we'll soon be through now — " " just a little bit longer." Dental operations are not a luxury, but a dreaded neces- sity; and an understanding of human suffering and gentle solicitude rec- ommend themselves to those who must suffer the trying ordeal of the dental chair. The dentist can impress his kindness and skill so firmly on the mind and appreciation of his patient as to oftentimes expel fear and nervousness, and, in other instances, induce the endurance of pain that would be otherwise impossible. The extent and good influence of kindness in the performance of dental work cannot be estimated, and it is within the reach of every man who adopts dentistry as a profession. The man in any profession who is honest and diligent, and who has average intelligence, will soon acquire sufficient skill to do substantial work and render service to his fellow-men; but unless he also possesses the finer elements of kindness and sympathy toward suffering and sorrow, he is unfitted for the prac- tice of his profession, and should confine his attention to laboratory work ; otherwise he cannot rise above the lower ranks. When the pa- tient is about to depart it is proper for the dentist to accompany her personally to the door, even if he has a young lady assistant; and a few moments of pleasant conversation and expression of regret that you were compelled to hurt a little, are at least an assurance to the patient that you were not intentionally rough, and are sorry that the nature of your work is such that pain accompanies it through no desire of yours. 38o THE PRACTICE BUILDER When a patient enters the offiee many extend a hand and give a warm grasp and a hearty shake of welcome. There is no doubt that this is verv reassuring to the patient, and is certainly more pleasant than a stonv good-morning. We have, in common with many surgeons, al- ways refrained from this, because we were always bus\- and the hands were sometimes soiled. We have found it to be very gratifying to the patient to be called by name at the moment of entrance, and have made it a practice to remember names. When a patient goes to the trouble of recommending a dentist to a friend, and even accompanies the patient to the of^ce to introduce her, one should show his appreciation by thanking his patron, and if the person recommending the patient does not accompany her to the office, but the patient mentions the fact that she was sent by another patron, the dentist should send a polite note to his client thanking her for being so thoughtful. In every city and in every practice there are some fast women, and it requires tact to handle their patronage, or to dispense with it, as the conditions may demand. It is well known that these people pay cash, and the conditions governing practice in the locality must be considered. In some towns the practice is evenly divided; one dentist has as large a share of high-class practice as another, and as large a share of every other class as any other; and while the more desirable element may be evenly divided, all other classes are also evenly divided. So a dentist is rarely found whose practice is composed altogether of the best pa- trons, and equally true is it that rarely is one found whose patronage is made up wholly of the least desirable clients. Fast women, as a class, do not usually patronize one dentist, but each dentist has a share of their work. If a man is in possession of a very ex- clusive patronage, he must exercise some judgment in this matter. If he is in the habit of performing work for such people, he must be careful that they are not brought in contact with his other patrons, and he should see to it that appointments for them are not made on the same day that work is to be done for persons of the better sort. Nothing could be more harmful than to have it become generally known that he has all the fast women. The peculiar nature of his work and the popular dread of infectious diseases render this phase one to be considered with THE PRACTICE BUILDER 381 great seriousness. It would appear to be unnecessary to caution the practitioner against indulging in familiar conversation with these peo- ple. Besides, if the dentist allows one of them to talk with freedom in his office, one or more of his favorite patients may walk in; then, when it is too late, he will wish he had never seen the other. There are just two ways of successfully handling these persons: one is to select an hour or day when no interruption is expected from more desirable patrons, and the other is to allow some one else to get their patronage. When the latter is the wish of the dentist, all he need say, without asking them to be seated in the chair, is that his time is taken up; and to state that, ov/ing to the condition and structure of the teeth, it would be best to consult another dentist. When, however, the dentist does not discover until after the person has left the office that she be- longs to the class under consideration, it is proper for him to address her by mail and state that it will not be convenient for him to keep his ap- pointment, and that since the time following is so closely taken up, it would be best not to wait for him. Of all the crotchety people that a dentist is called upon to work for, there is not one who equals the old maid. There may be some who are mild-mannered and gentle, but we have failed to meet them. No matter how carefully the work is done, they find cause for complaint, and keep it dragging to such an extent that it is a source of greatest relief to get it ofif one's hands. Better by far to get out of doing it at all, than to be compelled to hear reports of dissatisfaction. Theatrical people are generally undesirable patrons during their travels at one-night stands; but when in large cities they are good patrons, especially the ladies. So long as the operations are simple, they are all right; but when the work demands pulp treatment, devitalization, and canal work, it is exceedingly unsatisfactory; especially when they can stop but a few days. The practitioner should refuse to do anything of this kind for them, no matter how favorable the temperament may be, because of the troubles which are likely to follow, the nature of the comments that may be made, and the likeHhood of dissatisfaction on the part of the patient. Care should be taken to avoid cultivating an extracting patronage, that is to say, a class of people who believe in having teeth removed 3S: THE PRACTICE BUILDER ratlicr than saved; and who say, " have it out and be done with it." By catering to this patronage, which is not enduring and is not the kind that makes good dentists, a man gets a reputation for being a good extractor, but good for nothing else; and when people want impor- tant work done they go to some one else. When the practice is too much of this kind it indicates stagnation, and demands prompt action to prevent one from falling into the rut of the plate worker. Plate work is not the most reliable foundation on which to base a modern practice that aims to be above the ordinary. In the large cities generally plate work is not considered a factor of great importance to the permanent well-being of the practice, and one nearly always depends for extension of patronage upon operative work, and for professional prestige upon special operations. We have also a warning word to those who have offered to them the county-house or poor-house work. There is no advantage in doing this work, from any point of view; it lowers the practitioner in the esteem of his better patrons, and savors of cheapness. No attempt should be made to acquire this, or any other petty position, as such are undesirable in every way, not to mention the great loss of time in attending to the work. A dentist should not show partiality ordinarily; but in every prac- tice there is a class that is more appreciative of earnest efforts. As there are grades and distinctions in every walk of life, it is but natural that the dentist should come to realize the difference and should conduct himself accordingly. If some people show a higher appreciation of the dentist than others, it is only right that he should recognize this fact by such attentions as are compatible with his duty. His conversation should be adapted to the patient, if there is occasion to indulge in conversation, and we are of a belief that a tendency to talk should not be cultivated by the dentist. He should sviit himself to the patient's pleasure in this matter, and should refrain from personalities. When a lady, a member of the better class, enters the office, the treat- ment accorded her should be in conformity with her position. For in- stance, upon entering she says, " Good-morning, Doctor Blank. I am Mrs. Waters." " How do you do, Mrs. Waters. I am glad to know you. Will you not be seated? " THE PRACTICE BUILDER 383 " Yes, thank you." A few moments' pleasant conversation to put the patient at her ease may be indulged in, and at an appropriate moment the dentist may hes- itate in an expectant manner, and the patient will then proceed to ex- plain her case. " I have come, Dr. Blank, to have you examine my teeth and make an appointment to have some work done, if you find it necessary." " Very good. Please be seated in the operating chair, and I will ascertain the condition." The examination is made, the condition of the denture reported, and the appointment is set; the patient is bowed out of the office with a few appropriate remarks, and the interview is ended. Enter another patient. " How much do you hev fer haulin' teeth? I hev a stumick tooth here that's ben a botherin' me for a long while. Now I'm goin' to hev it out and be done with it." A finger is here rammed half way down her throat to show the operator just where the tooth is. " It will cost you fifty cents to have it taken out without pain." " You don't say. Why, my sister had one hauled up at 's, and he only charged her a quarter. You look kinder young. Hev you hauled many teeth? 'Pears to me yer a little high, ain't you? Some den- tises only charges a quarter. That's enough, 'pears to me, for sich a little job. Stid of me payin' you, 'pears to me, you hed ought to pay me. Fifty cents, eh? Well, go ahead, but mind ye, if it hurts I won't pay you a cent. I've ben a threatenin' an' a threatenin' to have all my teeth jerked an' new ones put in. Do you charge extry fer temp'rance set? Nearly all my double teeth is so bad I can't chaw on 'em an' I ort to had 'em out years ago, but I'd ruther go to a butcher shop any day than to a dentical office. Now go easy Dock an' when I holler you let go." Why should this second person be treated with the consideration that is accorded the first? The difference in the grades may be em- phasized rather strongly, but it is done for the purpose of more clearly showing the contrasts that are every day brought before the observation of most practitioners in dentistry. The dentist must adapt himself to handling this second class in a 3^4 THE PRACTICE BUILDER inaniKT most beneficial to himself, but he slioukl not under any circum- stances allow these persons to kill time by arguments of any kind. It is far better to do no work for a person of the second class illustrated, when one of such propensities applies for work. There is nothing in it any way, and it does a practice no good to have these persons seen as patrons of the office. Currying favor with them may secure their patronage, but as we have intimated, their patronage is dangerous to the business interests of a practice aiming to secure a clientele of the better class. Judgment is more necessary here than in any phase of the practice of dentistry; judgment means much, it means everything. Popular Dental Education " The noblest motive is the public good'''' One of the most important considerations demanding the attention of the dental profession, is that which pertains to the instruction of pa- tients in all that relates to the care of the natural teeth, and information regarding the various forms of artificial substitution. Such instruction is the duty of every practitioner, and yet it would appear that it is not so considered by the profession in general. If a systematic course had been pursued from the earlier days of modern dentistry to the present time, there would be a greater apprecia- tion on the part of the public for dental work, and there would be more work done, by one hundred per cent., than there is at present. The fact that this was never attempted, so far as any methodical effort is con- cerned, or if attempted at all was so inadequately performed, is re- sponsible for the lack of attention which the public has displayed with reference to this most important subject. It is not only the duty of the dentist to impart it, but it is the right of the patron to expect such in- struction. The dental profession, in the journals and by addresses and discus- sions in the societies, have devoted gallons of ink and stacks of paper, and have consumed hours of time in the discussion of the education of the dentist and of the need for reform in the present system of educating him; but to this question of educating the public, little attention has been given. From the earliest history of professions, it has been the custom to wrap the sciences in the garb of mystery. One efifect of this was to keep the public from knowing how much the professions didn't know. Lat- terly this has been superseded by a desire on the part of professional 385 386 THE PRACTICE BUILDER men to acquaint the general public with the advances made in their sev- eral sciences, and the effect has been most beneficial, resulting in a higher appreciation on the part of the public for the professions which have thus indicated their liberality. A writer of force and grace, speaking on this theme in the Dental Cosmos, stated the condition so well that we cannot do better than to present the matter herewith. ■■ To those to whom the subject of personal appearance counts but little, who know nothing of enunciation as a fine art, who never plan for future comfort and health, or with whom hygiene and cleanliness is a vague fancy unworthy of serious consideration, a tooth is of little value. Outcropping popular notions concerning the importance of dentistry are often humiliating, indicating vividly and truly our position among the professions. " Lack of professional qualifications and of moral responsibility to some extent now, but more especially in the past, are responsible for this lack of confidence in us. Promises unsupported by actions belittle us professionally. Indiscriminate harm is worked by destroying public confidence. The miserable inefficiency and deceit of the dregs of the profession is recognized by the few. but not by the many. " There are millions of teeth being sacrificed because the masses do not know the possibilities of our art. Thousands are suffering agony untold because they do not know where to get relief, or have not the educated courage to apply to a dentist. Occasionally people die from causes that we should understand, and can remedy better than anyone else; at the same time there are many of us impatiently sitting in our offices waiting to sell our services to just such people. With a lack and a want of dental services on the one hand, and a lack and a want of em- ployment on the other, matters are left to balance themselves somehow. There are a great many thousand dentists in the United States of whom many are desperately idle, while there is dentistry enough undone, that should be done, to satisfy fifty thousand, \\hat is lacking is some method of establishing a change of sentiment on the part of the public, giving information concerning their dental needs and possible better- ment, directing attention to the proper source of service, etc., denounc- ing bad and announcing good, thus counteracting the efifect of fraudu- THE PRACTICE BUILDER 387 lent and inefficient practices. The needs of the people and the needs of the dentist should be made to fit each other. Such a way should have the support of the best elements in the profession, but should not be perverted to support its selfish ends to the exclusion of popular need. It should be attractive to the average practitioners, and if possible to those on the lower rounds of the professional ladder. To meet these requirements it must be in an educational way. The benefits likely to result from the popularizing of such information have been seen and discussed, but no acceptable plan devised. The subject should not be shelved. " With everybody needing dental aid, and large additions to our ranks being made yearly, some modern means of conveying thoughts sure to be of benefit to mankind seems a logical necessity. It is but concrete professionalism and common-sense combined. " Among the various plans proposed for the dissemination of a proper knowledge of the teeth, and of their importance to the human economy, some have been good and some have been either impracti- cable or unworthy of attention; but the more important plans suggested are presented for the consideration of the reader. First : That the edu- cation of the masses can best be attained by introducing into the studies of the public schools certain fundamental principles of dentistry, bring- ing into prominence the oral cavity as the beginning of the alimentary canal and its relations thereto. It is there that instruction of the young is effected in a simple way and by the most approved methods. These impressions should be made in youth, which is the most effective period of life. Proper instruction would supply knowledge of lasting benefit, the importance of which the public does not realize from the fact that it is almost totally ignorant of the conditions and results which prevail in the mouth. Professor Miller has given a potent reason, by tabulated proofs of undoubted authenticity, that no fewer than thirty-eight dif- ferent infections may be traced with more or less directness to the human mouth as the focal or starting-point. "Second: By causing to be inserted in the current text-books on physiology, well written chapters on the teeth and their conditions, and the methods for their protection. " Third : Arranging at the annual meeting under the auspices of the 388 THE PRACTICE BUILDER State Dental Society, before the close of the session, a public lecture or lectures to which a general invitation be extended to the public at large and to teachers in particular. The efforts in this direction shall be in the nature of popular and well written treatises on the teeth, and their allied parts, their function in mastication and importance in the proper digestion of food, etc., which cannot but result in the enlightenment of the people as to the importance of our calling, and also demonstrate to them the following facts, viz. : that a clean mouth is as essential to health as a clean skin ; that preventive and protective measures there are as im- portant as the protection of any other part of the body, and that the care of the mouth is as much a duty as the purchase of food with which to fill it. " Fourth: By appointing an educational committee, which shall, if necessary, appoint its subcommittees consisting of members of the State Society residing in different cities and towns of the State, whose duty it shall be to confer with the respective school boards, ami if possible by such concerted efforts succeed in devising and planning the proper course to pursue in accomplishing our aim. A plan which has been suggested in this relation is as follows: As the text-books on physiology in the public schools undergo a change but once in every three to five years, it may not be w-ell to attempt to accomplish our aim in this direc- tion only. It would seem wise if the State Society as a body would take the initiatory steps and consider the advisability of ])ublishing in book or pamphlet form well written treatises on the oral cavity, the teeth, and their associate parts, the relation to and the importance of the same to other parts of the body, etc., avoiding of course all selfish or mercenary tactics, and obtaining by proper consent of the school boards the mtro- duction of the same in the respective classes of the public schools, where this branch may be taught, including it as a part of the study of physi- ology. After this has been accomplished, and the study introduced, it would seem a comparatively easy matter to finally succeed in having it embodied in the regular text-books on physiology, as the school board is vested with the power to make such alterations or additions as it may deem fit, and recommend the same to the publishers when new text- books are to be ordered. " Fifth: In view of the expense of such an undertaking, the suggest THE PRACTICE BUILDER 389 tion is made that it may be possible to reduce such expense materially by appealing to the support of the profession at large throughout the State, for voluntary contributions, offering in return for such contribu- tion a certain number of copies of this book or pamphlet for distribu- tion, which would certainly result in supplying knowledge of lasting benefit, and eventually compensate each contributor an hundredfold for his financial support in a matter of such magnitude and importance to the entire dental profession. The desirability of general instruction in dental subjects, both for the good of the people and the benefit of the dental profession, the necessity for concerted action to secure recogni- tion of the importance of the subject by the authorities who have charge of the educational interests of the State ; and the necessity for thought and effort to stimulate a desire for this knowledge, are all apparent to those who consider the matter. " Many thoughtful writers on this subject consider the newspaper to be one of the most desirable mediums through which the dental pro- fession may educate the people on matters of interest. " The masses read the newspapers when they read anything, there- fore, to ignore them is to shut out the dawning hope of popular dental education. It may be, it should be, a powerful factor on the side of right and reform, and a silent worker of extensive influence against which no argument can be sustained. It can be made the best, as it is now the most dangerous missionary agent in the world. It is the resource we need for popularizing effective dental teaching. Impatient contempt of such means is not wisdom, and is not justified in the light of failure of other means. " We, the profession, are responsible for the widespread ignorance and misinformation about dental affairs which prevails everywhere ; the meagre scraps of information circulating among the masses are ill chosen and unrepresentative. Proper sentiment and correct instruction spread in the newspapers would counteract these absurd popular impres- sions. Then, too, teaching implies growth and continuous self-culture. We will grow intellectually by our efforts to instruct ; our services will be more valuable to our patients, and they in turn will more quickly learn to appreciate our success. " This tendency to oppose any method of instruction that does not -^ THE PRACTICE BUILDER savor of the old-fashioned, is one of the brakes that prevent the quick transmission of acceptable impressions of our aim and status. Such op- position is based on the erroneous notion that we are not justified in adopting any means used by the commercial world. All matters of human interest may now appear in our newspapers. The most trifling things, as well as science, religion, and philanthropy, constitute its legiti- mate domain. The great question of life in all its forms is its constant theme. Information that is educative and correct should be acceptable to the profession and the people, and without catering to a low^ plane of traffic, it will direct the community in dental intelligence. Profit to the masses and ourselves will follow. Secretly we are all conversant with the causes and springs of action in professional life. There is such a thing as legitimate gain. To protect or increase it is an admissible, ad- mirable ambition. The better educated the dentist, and the better edu- cated his patient, in dentistry, the more secure the former is in his prac- tice and the better compensation he may expect. The talk of the time, which assumes that we forfeit the interest of the profession by attention to the business side of it, is not justified by results." Dental Instructors " Give instruction utito those who cannot procure it for themselves " We have given the plans which have been suggested by practitioners of repute as to the best methods of instructing the general public in mat- ters pertaining to the care of the teeth and in popularizing dental educa- tion. These indicate that careful thought has been given the subject, but we observe that none of these plans have as yet been adopted, and that even those which should be easily put into operation are still inoperative. So far as instruction in the public schools, on matters pertaining to the care of the teeth is concerned, we believe that this would receive the hearty encouragement of the general public and of the dental profession. The advantage of such instruction cannot be over-estimated, and if a properly prepared treatise, concisely stating the facts of most impor- tance, presented without the use of technicalities of any sort, were placed in the hands of school-children, the result would be most bene- ficial. With reference to the newspapers, we have to say : People read the papers for information concerning persons and events, not for information relative to the care of the body, nor to the special processes in the work of professional mpn. Again, the subject could not be treated clearly or comprehensively in one number of a paper. It is an important one, and cannot be pre- sented thoroughly or properly in less than ten to a dozen articles of from one to two columns ; and in presenting the matter serially, much of its force and effectiveness would be lost, for the reason that not one reader in a hundred would follow the matter from the beginning to the end. It is not practical for the dentist to give his clients complete informa- 391 39- THE PRACTICE BUILDER tion regarding the teeth, while working for them at the chair, because he must (levt'ite his attention exchisivcly to the work in hand. and his mental faculties must be concentrated, to insure correctness and precision; be- sides, people do not go to the dentist to be lectured; and if they did. no dentist in possession of anything like a lucrative practice could afford to give the necessary time to this instruction, even if he felt inclined to do so. The use of tracts has been suggested, by having several dif- ferent subjects presented on separate tracts and giving the patient the one best suited to his needs. Thus, one who has been neglectful of the natural teeth, should be given a tract on the importance of having the teeth examined at frequent intervals, and giving them such remedial attention as may be indicated. In this way each patient might receive the information best suited to his individual needs. The objection to this plan is that it cannot be presented in an artistic manner because of its form, appearing, as it does, simply as a circular or folder; and the expense of presenting all the different subjects on separate tracts would be so great as to deter many from using them. Some one has suggested that these tracts should take the form of ques- tions and answers, such questions as the dentist is asked every day. While we are of the opinion that this method would prove more effective than that of having a scries of essays or dissertations on the tcetli ajjpear in the daily papers, we are also certain that it falls short of doing the greatest good in the most effective manner at a moderate cost. The only manner in which tracts ma)- be presented is where the practitioner sends reprints of his published articles, with special refer- ence to those which would be of interest to the patient. Sending to patients reprints of articles which are vmintelligible because of their technical nature, or which deal with subjects that it is not proper for the general public to know, cannot be considered in good taste. We are convinced that the most effective form in which information can be communicated to the patient is by means of booklets, treating the subject in a clear, comprehensive manner. To be effective, these booklets should be printed on good paper, and bound so as to be in- viting to the eye. and they should be sufficiently attractive to hold the attention of the reader. The subjects under the various heads should be treated thoroughly, and yet in as few words as possible, and the use of THE PRACTICE BUILDER 393 technicalities should be avoided. The use of illustrations in booklets of this kind is confusing, because anatomical cuts are not readily com- prehended except by the professional reader, and those which are usually presented are not pleasant to look upon. A plain, straightforward oresentation of the facts is needed, ac- companied by such convincing arguments as may be necessary to more fully impress upon the reader the great importance which attaches to the subject. That the patient appreciates a carefully prepared treatise we know, and can positively state that the use of such a booklet was at- tended with profit to ourselves, and with many expressions of satisfac- tion and gratitude on the part of the recipients. The booklet presents a single subject at once, and attracts and holds the attention of the reader at a time when he cannot, if he w^ould, be reading something else. It begins at the beginning, presents the subject from beginning to end, and when it gets through, stops. To whom should such a booklet be sent, and when and how? To get the best results, it should be sent to the patient, by mail, after he has applied for the first appointment. Strike while the iron is hot. When one calls on the dentist the mind is in a condition to be appreciative of instruction and information regarding the teeth, and it is the only time that the mind is wholly receptive to such information. This is the only time when an instructor will do real, effective, good — because then it will be thoroughly read and fully appreciated. If the person were not in need of dental work, and experienced no inconvenience from the condition of the dental apparatus, the forcefulness of the matter would be lost. We hear altogether too much about the necessity for raising the standard of dental education in these days. The subject is presented with a frequency that is not warranted by the circumstances. The den- tal journals are overloaded with such articles, and in the societies the discussions pertaining to the matter are out of all proportion to the de- mands of the case. What is more to the point, and what is more needed,, is to raise the standard of the popular conception of dentistry, and to in- culcate in the minds of the people a higher appreciation of its standing as a profession, and a greater confidence in its practitioners. This end can be attained only by the systematic use of instructors through which 394 THE PRACTICE BUILDEF the dental profession may speak to the pubHc, and wherein may be pre- sented the facts which demonstrate fully the advance which dentistry has made within a single generation, and the firm foundation of profes- sional training on which its success in the past has been made, and which insures for it steady progress in the future. By raising the standard of popular appreciation of dentistry as a profession, and with more practical systems and an aim to more thor- oughly disseminate such information, the people will be in a position to judge of what is good and what is not good. Of course a dentist who does not know much about dentistry is wise in keeping that little to himself. If he sent to his patients instruction books, they would soon learn what good dentistry is, and this would be followed by a change of patronage that would not have occurred had he kept them in ignorance. It is a fact too well known to require any argument, that only a very small proportion of the people are in the habit of having the teeth at- tended to regularly, or have established the custom of seeking dental service before the condition of the teeth and mouth imperatively demand such attention. Only about twenty-five per cent, of the population of this country become a part of the dentist's constituency. Only about twenty-five per cent, of the people employ dentists; and it must be remembered that of this proportion a very large majority have no other operations performed than the extraction of aching teeth. There is but one way by which this constituency can be increased, and that is by educating the people up to a proper appreciation of the dental apparatus, and by disabusing their minds of the prevailing ideas concerning dentists. Among many of the less intelligent, the dentist is looked on as being little better than a confidence man; an individual who gives little, and takes much in payment. They must be taught that the neglect of their teeth harms no one but themselves; that their teeth are necessaries and not luxuries ; that if they do not take care of them, themselves, no one else will. \Micn people understand the true position of dentistry and the dentist, and when they realize the vast anwunt of pain that can be avoided by prompt attention to the teeth, dentistry will advance at a rapid pace, until every person of average intelligence will give the teeth the attention which their importance merits. By the dissemination of such information the people would be better THE PRACTICE BUILDER 395 informed as to whom they could trust as men of science and honor, and as to what constitutes a true dentist. It would define the line of duty between the family dentist and the family physician, where very many contentions are daily arising; it would place a serious stumbling block in the path of the advertising dentist, who throws his advertising cards broadcast upon the street, setting forth " My system of Bridge Work is unequalled," " Coralite plates," " My fresh vitalized air," " Teeth ex- tracted by my special process without pain or danger to the patient," etc. What should constitute the subject-matter of such a treatise, and how should it be presented to be of the greatest benefit to the patient? In the first place, it must be understood that such a work will fall into the hands of persons of varying grades of intelligence, and that it will be read by old and young, children of both sexes, and that the rich and poor will receive their instruction from the same source; consequently the treatise should be so written that every person of every class can readily comprehend the meaning of everyword and of every proposition. Every feature that is not absolutely necessary to the thorough under- standing of the work should be eliminated from the text, and in its place should be substituted such facts as are of absolute interest to the reader. In the beginning it is necessary to call attention to the early history of dentistry; this will go a long way toward conveying to the reader the [act that dentistry is grounded on a footing which entitles it to con- sideration among the professions. Thousands of people labor under the impression that dentistry was unknown or little practiced until the last fifty years, and to remove such erroneous impressions cannot but result in increasing the respect for dentistry as a science and an art. It is necessary to call attention to the important relation which the teeth bear to the general system, and to the fact that every particle of food and every drop of liquid which enters the system for its sustenance must first pass the teeth, which are thus constantly exposed to the at- tacks of insidious foes, and that because of the vast amount of work which they are called upon to do, it is not surprising that they should, when neglected, become decayed and cause their owners much dis- comfort that might have been avoided bv prompt attention. Appropriate particulars should be given concerning the importance 396 THE PRACTICE BUILDER of thorough mastication of the food, aiul its relations to tlie general heahh, and the disturbances which are likely to arise when this is im- properly performed. The effect which a clean, regular denture of natural teeth produces upon others, and the agreeable satisfaction which it gives the possessor, should be dwelt upon. Few seem to realize the effect that the teeth have on speech, and how the loss of several teeth may seriously aifect the enunciation of words in speech or song. The fact that decayed teeth are the cause, in most instances, of bad breath, should not be overlooked; and it should be impressed upon the patient that when the teeth are in good condition and there is no tartar on them, the breath is pure except when the person suffers from a disordered stomach, besides it should be shown that decayed teeth fre- quently cause indigestion, and that indigestion is likely to result in dyspepsia, with its train of ills and disturbances of the general system. A general idea of decay of the teeth, its cause, and the means by which its progress mav be counteracted, should be set forth in plain language: especially should this subject be clearly presented with reference to conditions of the system which have a deleterious effect upon the structural condition of the teeth, such as long illness and a weakened condition of the system, whether caused by a depressed state of vitality or by physiological processes, such as pregnancy. In this connection, the importance of caring for the teeth at such a period in the life of a woman should be presented thoroughly and delicately, so- as not to offend the most fastidious, and yet impress upon those for whom such information may be appropriate, should it happen to fall into the hands of one in timely need of such advice, just how to care for her own teeth to counteract the physiological process of softening of the teeth, and what food should be eaten to insure sound teeth to the child. The disturbances of first dentition, and the means by which such dis- turbances may be counteracted, should be clearly set forth. Definite in- formation should be given concerning the teeth of children, and the importance of retaining them in good condition until the second teeth empt. Many of those who apply for dental services have no adequate THE PRACTICE BUILDER 397 knowledge as to the proper way of cleaning the teeth, and the use of the best preparations for accomplishing this. Many give absolutely no at- tention to caring for the teeth, so far as the use of any special prepara- tion is concerned. It is a most important duty for the dentist to instruct his patrons in the use of preparations intended to cleanse the teeth, and the proper times for using them. Every person applying to the dentist should be so instructed, and especially in the case of children. Every dentist has observed that the mouths of children, even of the better class, have given little evidence of the use of prophylactics, and in most instances the teeth are covered with the remains of the last meal. Correct habits of cleanliness es- tablished early in life cannot but result in preserving the teeth, so that decay will not be nearly so rapid and the cavities will not get so large before attention can be given them. A few facts should be presented concerning the dentist himself; and the manner in which he receives his professional training for his life vocation; the length of time taken in such preparation, and the thor- oughness demanded by the institutions and the laws which regulate the practice of dentistry. People do not realize the thoroughness with which dentists are trained, and those who know how long it is neces- sary to study for the degree do not understand why so much time should be spent in the study of a subject which to them seems so small. Wrong impressions of this sort it is the duty of the dentist to remove. Another matter that for many years has needed attention, but which up to the present time has been given little or no cognizance, is that of professional fees. It is proper for the general public to have a more rational knowledge of the basis upon which professional fees are com- puted, and the principles upon which are based the right of one man to charge more than another in the same profession for certain work. In the past, and at present, more or less dissatisfaction has been caused by reason of the people being improperly informed upon this question. When the public are more fully acquainted with the reason why ap- parently high fees are charged for the performance of certain work, they will the more readily pay such fees, and the relations of patients and dentists will be more cordial. The instructions which have been g-iven reg:arding" the use of denti- 398 THE PRACTICE BUILDER frices have been unsatisfactory, and there are many who never offer their patients the shghtest information in this regard. This is a lamentable condition of affairs. It is a duty of the dentist to instruct every patient who falls into his hands, in this very important matter. Children should be impressed with the statement that it is just as important to keep the mouth and teeth clean, as it is to wash the face and hands; they should be told the importance of cleansing the teeth, especially before going to bed. and the reason for so doing. Proper advice should be given as to the dentifrice used, or one should be supplied by the dentist himself. By looking over the stock of dentifrices in a well-conducted drug- store, it is to be observed that over forty dentifrices are for sale, and these are made by as many different manufacturers. Many of these preparations are compounded by persons in ignorance of the purposes to be subserved by the use of such articles, and many of them are unsafe, either because of their coarseness and consequent abrasive action on the enamel, or because containing chemicals which affect tooth sub- stance unfavorably. There should be a separate instructor, giving more extended in- formation relating to artificial teeth, than can properly be given in an instructor treating of the care of the natural teeth along the lines we have indicated in this chapter. Few of those who apply to the dentist have any realization of the different kinds of plate work. A great many know nothing of it, more than that plates are made of rubber, and that they cost so much for a set. Many persons wearing artificial teeth on a rubber base would gladly have paid the difference in cost and had a gold plate, had they been told by the dentist of the advantages which the metal plates have over the others. Some, perfectly able to have the best, would wear sets of teeth on continuous gum base, but they are in ignorance of the existence of any such process and are in consequence thereof wearing inferior dentures. It is not at all necessary to enter into any statements regarding the manner in w'hich any of the plate work is constructed, nor to tell of what any of the substances may be composed; but to present clearly the facts which bear upon the advantages of one kind of plate over an- other, and to show why and how one possesses superior advantages. THE PRACTICE BUILDER ^gg The people want to know why, they don't care anything about the proc- esses involved, but wish to know wherein, for instance, a continuous gum work denture is better than a vulcanite denture, so far as appear- ance, permanence, utility, cleanliness, etc., are concerned. When one thinks to what extent a practice is indebted to plate work for its sup- port, the fact becomes apparent that it is worth cultivating; and the most effective way of doing this is by educating the people, by the use of instruction books. Bridge Work has become very popular in the past several years. It owes its popularity to the fact that it has been very extensively adver- tised by the advertising dentists. To this class of practitioners must be given the credit, largely, for the knowledge which the general public has of this class of work, and at the same time this same constituency, or its less skilful representatives, is responsible for the lack of faith mani- fested in this branch of work by many people. An instructor giving such information as the public is desirous of having, will do much toward restoring confidence. It is not necessary to confuse the mind of the reader with engravings of Bridge Work, as simple language suf- fices to convey the proper idea and the principles of its construction. Erroneous impressions prevail as to the cost of Bridge Work and the painfulness of the operation; by many its permanency is questioned, and in such a treatise the proof of its substantial character should be presented. Properly presented, the facts concerning Bridge Work are so convincing as to its worth, that such booklets presented to persons in whose mouths it is applicable may lead to having the work inserted. It is only within the last few years, and particularly in the larger cities, that the people have become even slightly conversant with regulating the teeth, as a specialty of dentistry, and the wonderful possibilities of the work in all its phases, speech, personal appearance, mastication, comfort. This subject has never been presented for the consideration of the pu-blic, yet in an average dental practice a great many persons apply in the course of a year, whose teeth are so irregular as to warrant interference by mechanical means to correct them. If their attention were called to such irregularity, and the means ex- plained by which it might be corrected, there would be an amount of this work done that would surprise the most sanguine members of the 400 THE PRACTICE BUILDER profession. It would be for persons whose intelligence is to be re- spected, and whose powers of appreciation are such that work of this kind can be attempted in their behalf, and full contidence be reposed in the hearty co-operation of the patient, with the knowledge that they are very desirous of being made familiar with whatever is for their benefit; and the wide-awake dentist who satisfies this desire in the best manner, and most promptly, is the one who will get to the front. The sending of a series of books of this kind constitutes a system of dental education which has its direct reaction for the dentist's good. Better appreciation by the people means better dentistry. A series of books on the subjects considered in this chapter has been prepared by the American Dental Publishing Co. They are writ- ten clearly and tersely; every phase of every important subject is pre- sented so as to be easily comprehended by any one into whose hands they may happen to fall. " The American Dental Instructor " is intended to meet the require- ments of a general practice, and does so more acceptably than any other similar publication. It is handsomely printed in clear type, on line paper, and is very attractively bound. " The British Dental Instructor " has been prepared to meet the requirements of the dentists of England, and their patients. The same may be said of the " Dominion " and " Australian " InstructOFs. The same book is also prepared under appropriate titles, to meet the requirements for its use in the principal countries of Europe, and much care has been taken in the translations, that the subject may lose none of its convincing quality. These books, being produced as they are, m very large quantities, the publishers are enabled to furnish to dentists at a price per hundred or thousand which is merely nominal. " Artificial Teeth " is another booklet in which the subject indicated by the title receives the fullest treatment; much fuller, in fact, than would be possible in a booklet wherein all topics of interest to the den- tist's patients must be presented. Herein is shown why a temporary plate should be worn, a convincing argument that results in many per- sons wearing such, who would not otherwise do so, thinking only of the additional expense. All that relates to the instruction of the patient is THE PRACTICE BUILDER 4OI here presented; the different bases upon which artificial teeth are con- structed; everything that is of interest so far as the aesthetic side of the subject is concerned, and all the various matters indicated by the ques- tions asked the busy dentist by inquiring patients. This booklet is uni- form in size and style with " The American Dental Instructor." " Interesting Facts About Crown Work and Bridge Work in Den- tistry " is prepared to more clearly and satisfactorily acquaint its readers with this branch of work and its great possibilities in restoration and artificial substitution. It is believed that the subject has never before been so satisfactorily treated, both from the dentist's and the reader's point of view. It is uniform in size and style with " The American Dental Instructor " and " Artificial Teeth." " Irregularities of the Teeth; How They are Corrected." This sub- ject is treated in a manner to make it easily understood by the general reader; it is so presented as to command the attention of anyone whose teeth are irregular, and whose speech, comfort, or appearance is affected thereby ; and at the same time he is made to perceive the necessity for prompt action in order to secure the best results. The use of this book- let is conducive to a wider dissemination of knowledge pertaining to this specialty. Same size and style as the other booklets of the series. When a patient applies for work, the dentist, after examining the mouth, is made aware of the fact that perhaps a piece of Bridge W'ork is needed, but the patient expresses no desire for the work; an appoint- ment card is given, and in the next mail a copy of " The American Den- tal Instructor " is sent, not in an unsealed envelope, but in a sealed en- velope of the best quality under letter postage. In the same mail a letter is sent; this letter is a form which conveys to the patient the fact that the dentist is in the habit of sending an instructor to all his patients and requesting a careful perusal. The letter should be type written, on the very best stationery. In the same or the next mail should be sent a copy of the " Bridge Work " booklet, which in many instances is the means of influencing patients to have Bridge Work done; as the book- lets cost a very small amount per hundred, and as one piece of Bridge Work, no matter how small, will more than pay for several hundred books, the wisdom of using them is apparent. Where the person anticipates having artificial teeth inserted, the ^Q2 THE PRACTICE BUILDER dentist should send tlic booklet on " Tlate W ork," also " The Ameri- can Dental Instructor." The booklet relating to irregularities of the teeth is usually sent to a patient whose teeth are more or less irregular, but some dentists pos- sessed of foresight are in the habit of sending this booklet, after having sent one of each of the others mentioned, whether the teeth of the pa- tient are irregular or not; because it is likely to be perused by some other member of the family whose teeth are irregular, and in conse- quence of their being made aware of the fact that the trouble can be corrected, they are led to consult the practitioner. It is only by arous- ing the interest of persons in need of dental work, no matter what class of work, that they are led to consult the dentist. After this, it is easy for the dentist to explain what work is needed; and the individual hav- ing been made aware of the necessity for its early performance, becomes another patron whose influence soon makes itself felt in sending still others to the office. " The Children's Dental Instructor " is, as its name iniplies, intended for the betterment of the instruction of children on matters pertaining to the teeth. It is written in a style easily understood by children, and is printed as attractively as are the other booklets of this series. Correspondence is solicited by the American Dental Publishing Co. regarding the booklets, and any kindred subject. Prices made known on application. The Question of Saving Teeth " Circumstatices alter cases " During that period of dental progress contemporaneous with the introduction of vulcanite as a base for artificial dentures, all that work which relates to the treatment of the natural teeth with filling materials received a great set back. The great difference in price between the gold plates and the vulcanite plates made it possible for thousands who could not afford the former to avail themselves of the other. No attempt was made to inform the public as to the wisdom of re- taining the natural teeth, and many thousands who might have kept their natural teeth had them extracted and artificial teeth inserted. Few gave to the natural teeth the care which most intelligent persons at the present time bestow, and often when one or more of them gave trouble, all were removed in order to insert a plate. To-day, among the more intelligent persons, there is nothing attrac- tive about a set of artificial teeth and no one would exchange natural teeth, that perform their work without trouble, for artificial ones. During the period when such wholesale extraction of teeth was being done, a reaction set in, and a great deal of attention was given to saving the natural teeth. This was very materially aided by the general favor with which amalgam was received, after it had been championed by some of the foremost representatives of the profession. To save the natural teeth was then the aim of the better class of dentists. A dental practice, especially of the average city or town, is composed of patrons possessed of varied degrees of intelligence, or at least, pos- sessed of a varied conception of the dentist and his motives for having them retain their natural teeth. Many of these persons, when calling 403 404 THE PRACTICE BUILDER upon a dentist to have a tooth removed, will listen to no argument as to the propriety of having the tooth filled. Not a day passes, in a full practice, but that there is occasion for the employment of judgment in this matter, and the necessity for taking circumstances into consideration in individual cases. One of the first of these considerations is in connection with the insertion of artificial teeth. A person applies to have artificial teeth inserted, and it is ob- served that there are a few natural teeth remaining. Thus, for instance, one molar may remain, or a cuspid on one side and a central incisor, a lateral incisor or bicuspid on the other side, and the person may express a wish to have the plate made to fit between these teeth. On the lower arch a molar on either side may remain, or one or more of the anterior teeth may still be in place. It should be explained to the patient that a virtue must be made of necessity, and the teeth must be removed, because their presence would not aid in the retention of the plate and they are likely to interfere seriously with the proper articula- tion of the denture. Where only one or two teeth remain, the fitting of clasps around these teeth to aid in holding the plate in place, is looked upon with growing disfavor by the more experienced members of the profession. The fact that in many instances the teeth have become elongated, owing to the age of the patient, makes it apparent to the ex- perienced practitioner that the teeth would not be likely to remain in place as long, after the plate \vere made to fit around them, as the}' would if the plate did not bear against them. It is very difficult to fit a plate around one or two remaining front teeth, particularly, so that a good match in size and color may be made. The teeth should be removed. The lower anterior teeth are often greatly elongated, and their lingual surfaces covered with accretions of salivary calculus; and when the patient has reached an age when they are likely to become loosened, it is proper to advise their extraction and the insertion of a full set, rather than a partial set. Occasionally it is necessary to extract teeth to aid in the correction of irregularities; but where the irregular tooth is an anterior one, it is the custom to extract a tooth posterior to it, and to draw the irregular tooth to place by mechanical means. A great many times it becomes necessary to advise the extraction THE PRACTICE BUILDER 405 of teeth because of disease; for instance, chronic Periodontitis, which is likely to affect teeth adjoining those in which the disease commenced. When Periodontitis has reached the fifth grade, it is necessary to extract the affected tooth immediately and to give persistent antiphlogistic treatment to the adjoining teeth and alveolar walls. Even this some- times fails to save the adjoining teeth. In Absorption of the Permanent Roots there is but one remedy, and that is careful and complete extraction of the affected teeth. It takes very good diagnostic ability to diagnose this condition, and there is no other remedy for it. Exostosis is another condition that it is very difficult to diagnose, and its treatment is the same as for Absorption of the Permanent Roots, careful and complete extraction. It would be interesting if we could only know how many bridges are attached to teeth that have exos- tosed roots. Some practitioners let their desire to save teeth run away with their better judgment. They are so anxious to save teeth that they attempt to fill, and save many that should be extracted. The same teeth might be saved by the placing of gold crowns, but when teeth are so badly broken down and decayed that nothing but the enamel portions of the walls is left standing, it is not probable that fillings of amalgam and cement will save them, because the walls cannot support such fillings; but when the person is willing to pay for a gold crown, the teeth may be restored to usefulness for several years. When a person applies, suffer- ing from a tooth that is aching and that has caused the gums to become affected and swollen, and the cavity is very large and it would require several treatments to restore the tooth to comfort, and the patient ex- presses himself forcibly to the effect that the tooth must be removed, it will be found to be the part of wisdom to remove it. The uncertainty connected with the treatment of roots where external complications exist makes it imprudent to do other than extract. If the dentist at- tempts to treat and fill the roots and tooth, and the treatment eventuates unfavorably, he will have lost the patronage and good-will of the patient who wanted the tooth out in the first place. Parents should be advised to have children's teeth attended to promptly, and to have them examined at frequent intervals to see that 4o6 THE PRACTICE BUILDER decay does not progress far enough to make filling operations painful. The condition of the mouths of children of the poorer classes is very discouraging. The parents either think they cannot afford to send the children to the dentist, or the child is afraid to go and they do not insist, and the child is allowed to suffer and ♦:o masticate its food with teeth that are carious and disgusting. Points for Special Study " Many things, obscure to me before, now clear tip and become visible " Many dentists are rusty on the scientific aspect of their work. Some become so rusty that they reaHze that it would be difficult for them to get in touch with the most recent modes of operating and treatment, without superior instruction, and return to the college for post-graduate study; returning to their practices in a few weeks or months better able to cope successfully with the conditions which before had baffled their best en- deavors. It is in the treatment of diseased conditions of the teeth and gums that we find a lack of an intimate knowledge. We observe, for instance, that in the treatment of Odontalgia little time is taken to diagnose the exact character of the pain and its cause, whether it is the first, second, or third cause for odontalgia. This is true of many of the pathological conditions. There are many dentists who are not properly qualified to treat the pathological eruption of the temporary teeth understandingly. Pathological eruption of the third molar is much more troublesome to some than it is to others, solely because they have given the subject less study. The necessity for prompt action is not more prominent in the treatment of any of the pathological conditions met with by the dentist than in this, because of the severe systemic complications which sometimes ensue. Those who have been in practice for a number of years are enabled to observe, by reason of patients leaving other den- tists through dissatisfaction with their work, that in many instances it was necessary to remove the fillings because of pulp trouble. The re- moval of these fillings demonstrated the fact that the preceding dentists either were not wholly familiar with the treatment of carious teeth of the class referred to by Flagg as " very deep decay," or if they were, they 407 4o8 THE PRACTICE BUILDER did not practice as they were taught. Tliere is need for the exercise of judgment in this matter of proper protection to pulps in deep cavities of decay, prior to the insertion of the filHng. We regret to say that in talking with many otherwise well informed men, we were unable to elicit satisfactory replies to questions relating to the characteristic pains which are diagnostic of pulp irritation, pulp exposure, dying pulp, and dead pulp. The importance of the most thorough knowledge of these matters cannot be overestimated; yet many are daily performing their work with insufficient knowledge of the case. Again, we find that many men are wholly incapable of a nicety of diagnosis. For instance, we find few who can give any reliable data concerning the symptoms by which Absorption of the Permanent Roots could be diagnosticated. True, the condition does not present fre- quently, but when it docs there is need for as much knowledge of its characteristics as if it were met with ten times a day. Some sorry ex- hibitions have been made in the attempt to handle these cases of Ab- sorption of Permanent Roots — filling and filing and crowning, and grinding and medicating, etc., without avail. Exostosis is another condition which gives trouble to one deficient in knowledge of pathology. The similarity of the pains is confusing sometimes to the most experienced. The same is true of Xodular Calci- fication of the dental pulp or Pulp Xodules. The pains from Absorption of the Permanent Roots. Exostosis, and Pulp Xodules, are very similar in some points, and to distinguish, requires the use of knowledge gained by close study of the subject. It is necessary to give special study to the subject of pulp capping, either one of two modes of practice; our subject matter relates wholly to that which afTects the financial side of a prac- tice : but as nothing can efifect a practice more for good or bad than the gaining or loss of patronage, we wish to say to our younger readers that it will be to their advantage to devitalize every pulp that is exposed, no matter how minute that exposure may be. Before adopting any of the methods suggested by writers, for the successful capping of pulps, talk with some practitioner in some other city, in whom you have confidence. He will tell you that the history of these capped pulps is that they give trouble. It matters little how much care is given the work — one, two, or three years may elapse without THE PRACTICE BUILDER 409 trouble, but when it comes it is very difficult to put the tooth in shape again with anything like the amount of time and labor with which the case could have been treated if the pulp had been devitalized, and the canal filled, in the first place. The subject of devitalization and extirpation of the dental pulp is one in the study of which much time can be spent to very good advanta£'e. Related subjects of equal interest are those of Root Sterilization and Root Filling. Enough has been written on these matters in the last few years to fill several good-sized books. After the smoke is all cleared away, we do not perceive that the work is done any more thoroughly, or with less pain, than it was live or six years ago. Inability to diagnosticate between Fungus Gum and Fungus Pulp is seen quite often. The subject should be studied, as the condition pre- sents quite frequently in the mouths of those who give little attention to the teeth. Strange as it may seem, such an important subject as dental caries receives little attention by men after they have graduated. It is important to keep in close touch with this subject, because within the past few years much additional matter has been added to the literature of this field of inquiry. Periodontitis will always require close study. The treating of this condition takes up a good share of the dentist's time, and no one can know so much about it that it will do any damage to know more. The number of articles appearing with Periodontitis as the caption, does not noticeably diminish from year to year. Alveolar Abscess should be studied carefully; the frequency with which the condition is met makes it necessary to give to it close atten- tion. Pyorrhoea Alveolaris has been the subject of much discussion, more especially during the last three years. Examination of Catching's Com- pendium for 1894, 1895, and 1896 reveals the fact that pyorrhoea, during those three years, received more attention and was the subject of more original articles by prominent men, and was discussed oftener than any other single condition under the consideration of the societies. The journal literature of this subject is now somewhat prolific. A solution of the problem of its causation and cure seems to be quite as remote as at the beginning. 4IO TTIK TRACTICE BUILDER Caries and Necrosis should he studied with care. Distinctly within the province of the dentist, the int're(|uency of its occurrence demands that the practitioner should be prepared when it does present. Degen- erations and Atrophies of the dental pulp relate to a species of a patho- logical condition about which we heard but little a few years back. The recent investigations of writers have invested the subject with an in- terest that attracts the attention of all who are studiously inclined. Studv the diseases of the Antrum of Ilighmore. It requires one thoroughlv versed in pathology to diagnose the diseased conditions of tliis cavit}-. It may be years before a case may present that will give opportunity for display of the practitioner's knowledge of the pari, but if he takes hold promptly and understandingly, especially after other operators have failed to diagnose the trouble, he will profit by it. It was an understanding of the Antrum and its diseases that ]>ut Dr. Thos. W. Evans to the front, and made him dentist to the royalty of Europe. The study of fractures and dislocations of the jaw is of moment, be- cause a thorough and varied knowledge is necessary, owing to the fact that no fractures are likely to require exactly similar treatment. When these cases present is not the time to study them. The dentist must be ready instantly to treat them. Anchylosis likewise requires prompt treatment, therefore readiness to meet it. Dental Anatomy is a very interesting subject, and one in which much time may be spent with profit. After leaving college we observe that the subject is not given the attention it was given while in college. Dental Jurisprudence should be studied for the purpose of inform- ing one's self how to avoid doing things that might cause embarrass- ment and trouble. It tells the dentist what to do if he is not paid for his work, and shows him exactly what his rights are in the case. It shows him his responsibilities, and in short tells him not so much what to do, as what to avoid doing. It is remarkable how soon one can forget what he has learned about Materia Medica, and the rapidity with which new remedies are intro- duced makes it necessary for the active practitioner to keep in close touch with so important a subject. THE PRACTICE BUILDER 411 A pathological condition met with more frequently than was formerly the case is Denudation. It should be studied. Replantation, Transplantation, and Implantation make a most in- teresting study, and should be pursued thoroughly. For information regarding text-books of value upon these subjects, see chapter on " Books." Duty of Young Men to the Professi " YotiJig tit en for action " ion Every young man who has graduated from a dental college, and every young man who is about to do so, and every man who practices dentistry, whether he is a graduate or not, owes to his profession a duty. Few of the younger men realize to what an extent they are indebted to their profession; but they are not the only ones who fail to realize this. Many of the older practitioners have gone on year after year regardless of the fact that they have given nothing to the profession from which they have received so liberally. We speak now solely with reference to the giving of knowledge to the general fund of professional experience and proven facts. One of the most surprising facts with relation to the young men in dentistry is that so few contribute articles to the dental journals, and that so few become active in the dental societies until after a consider- able lapse of time — anywhere from five to ten years after graduation. It is very unusual to see an article in a dental journal written by a young man who has been graduated for four or five years, and yet it would seem that few are so well prepared to contribute information to the journal literature of the profession, not necessarily from the store of their own experience and skill, but from that of their professors, whose knowledge has become theirs. This information, although it may appear to the recent graduate to be something with which the members of the profession in general are familiar, may yet be known only to a small proportion. There are thousands of small points which are really valuable, that would prove of great benefit to practitioners everywhere; but which do no good stored away in pigeon-holes, or which are kept by those who own them 412 THE PRACTICE BUILDER 413 because they fear the information to be too trivial to write about. It is not too trivial. Professional knowledge is made up of little facts — facts which by themselves may amount to little, but which play their part and fulfil their purpose in the great granary of dental knowledge. The younger members of the profession to-day do not exhibit the same interest which the younger element showed a generation back. Those who are at all familiar with the journal literature of twenty years back, can recollect the names that appeared most frequently in connec- tion with articles of real live interest; and those who cannot recollect, can readily find out by referring to the volumes of the Cosmos^and other journals of that time — the seventies. The names that were most promi- nent in the journals were equally prominent in the society proceedings. The names of Garretson, Flagg, McOuillen, Webb, and many others, show the great interest which men who were then in the earlier 3'ears of their practices displayed in their professional work. At that time men entered dentistry as a vocation much later in life, so that most of these had been in practice only a few years. Original research and investiga- tion has been credited to these men, and they were entitled to it; they worked night and day, and the results of these investigations have been of incalculable value to dentistry. This period was one of the most fruit- ful of results. More real hard work, more investigating, more research, was instituted and more really valuable results were given to the profes- sion, than at any other period with which we are acquainted. The work done in the dental societies by these men was very great, and we sometimes wonder how they attended to the duties of a full practice and found time to write articles for the journals and to take such an active part in the proceedings of the societies; but they did it, never- theless, and at that time they were in the possession of lucrative prac- tices composed of the most exclusive persons. A great deal has been said, and a great deal more might be said re- garding patents, as to whether an idea of value should be patented, or given to the profession without patenting it. Ultra ethical members of the profession are very much opposed to inventors securing patents, and assert that as the members of the profession have received liberally from their stores of knowledge, it is their duty to give freely of what they may discover. 4,^ THE PRACTICE BUILDER Theoretically, this may be very satisfactory, but practically it is not. To give inventions to the profession without payment for the time, labor, and expense spent in evolving them, is not to the taste of most persons. In this country, if a thing is good you must pay for it, and usually you get your money's worth. Ideas that are worth nothing cost nothing, but ideas that are the result of great industry and study are worth hav- ing, and are therefore worth paying for. Financial appreciation is a stimulus that actuates most inventors to the evolution of ideas that result in labor-saving devices, or implements that facilitate the per- formance of work. Because of a financial stimulus, we have many in- ventions that, without the financial appreciation, we would not have. The history of inventions in dentistry is proof that a man should be paid for his brain work. Dr. Barnum, the inventor of the rubber dam. gave the idea to the dental profession without patenting it, and without exacting from those who used it any payment. Dr. Barnum died a poor man. Had he patented his invention his family would have been left in independent circumstances, and the individual members of the dental profession would never have felt the slight additional pay- ment necessary to secure the benefits of one of the most valuable, if not the most valuable aids to operating. No one denies Dr. Bonwill's right to patent his inventions, and no one questions the propriety of his so doing. Without financial stimulus it is doubtful if his appliances would have been evolved and brought into use, because few men could devote to their production and perfec- tion the necessary time and labor, were it not for the fact that liberal payment was to be made therefor. Talent and ingenuity have a right to secure for their possessor the re- wards to which study and labor are entitled in any calling, antl we be- lieve it is proper for persons possessed of a high order of inventive talent to patent any useful idea that may be evolved. They owe this to them- selves and to their families. Records " Records that defy the tooth of time " A system for recording all transactions is of paramount importance. Lack of attention to these details has made it necessary to display a red card bearing the legend, " For Rent," in many an apartment formerly occupied by a dentist. Attention to details means attention to matters of large import. Lack of attention to details begets carelessness in matters large and small. Many have gone on year after year with no other record than that which can be shown by the cash book. They know nothing of the his- tory of their cases ; have no' knowledge of the value of this or that filling material as a permanent stopping, or whether or not their own work in any mouth compares favorably with the work of other operators. They are at a loss to tell whether certain work is or is not their own, and are thus sometimes placed in the embarrassing position of being told that their work has failed — without means of verifying or disproving the assertion. It is probably truer of dentistry, than of any other profession, that a practitioner rarely leaves his vocation to engage in other business; he is fully committed to it, it is his life work, and he will be doing twenty years hence just what he is doing to-day, if he lives and has his health; consequently it should become impressed on his mind that the present is the time to make records, never trusting such matters to memory. There is nothing complicated or difficult to understand in this work; it is simplicity itself, and once the habit becomes established of record- ing the operations performed, it becomes as natural to the operator as the use of the mouth mirror. 415 4i6 THE PRACTICE BUILDER There liave been many plans submitted for the keeping of records dealing with the tilhng of teeth and the treatment of their diseased con- ditions, but we find that simphcity is the chief desideratum, and a mass of signs and figures understood only by the operator are not to be com- mended. When a patient is seated in the operating chair to have the teeth examined, a suitable blank should be at hand whereon may be noted the characteristics of the case, location, and size of cavities. One of the most practical and comprehensive of these is Dr. Chas. F. Allan's examination tablet. It is supplied by the S. S. White Dental Manufacturing Company. Each pad contains lOO blanks, and these are numbered ; in the front are ruled pages to index the names for ready reference. At the top of each page is shown a labial and lingual aspect of the anterior teeth, and the buccal and coronal aspects of the posterior teeth, both superior and inferior. At the bottom are ruled lines for the name and address of the patient and a line for dating, while all the space between the diagram and the line for patient's name may be utilized for recording the points of interest. In using this blank, after having dated it and inserted the patient's name, the location and extent of the cavities of decay should be indicated by use of a black lead pancil; and if the patient asks for an estimate it can be given, and the items of the estimate be recorded on the back of the page for future reference. As fast as the work is done, the kind of filling should be indicated by a suitably colored pencil, and the exact size and extent of the filling should be clearly shown. The color of the pencil should indicate the filling. Red should denote gold; green, cement; dark blue, amalgam; and light blue, gutta percha. Underneath the appropriate teeth, and indicated by a straight line, should be written the information of special interest pertaining to them. If. for instance, it is necessary to devitalize the pulp, this may be indi- cated by the abbreviation " de." and the date, " 6I23." The removal of the destroyed pulp may be noted by saying, " Pulp removed 6J30. G. G. Drills (meaning Gates-Glidden Drills). S. A. (meaning Sulphuric Acid). B. S. (meaning Bicarbonate of Soda). Cot. ol. cl. (meaning Cotton and Oil of Cloves). T. S. (meaning Temporary Stopping)." If THE PRACTICE BUILDER 417 it were necessary to change this cotton again this could be indicated by the appropriate date and abbreviations. At the final sitting the whole operation of filling should be shown by the date and the nature of the materials; as, for instance, " W. C. (Watts Crystal), R. f (Rowans No. f), Fin. 30 (Finished with No. 30 gold)." Where amalgam is used, the maker's name should be shown; as, " F. S. A." (Flagg's Submarine Alloy), because it is of advantage to observe the action of the different makes of alloy in the mouth. If cement is used the name should be indicated; as " H. C. 8." (meaning Harvard Cement No. 8). When Crown and Bridge Work is inserted, the karat of the gold should be shown; also the lowest karat of solder used any place on the piece, so that if for any reason the piece had to be removed for repair the operator would not make the mistake of using then a higher karat. In regulating, the dates should be shown on which regulating or re- taining pieces were inserted or changed, so that this information could be had instantly when needed. This is important. The address book is an important factor in keeping records, and should be kept up close with the work. It should be about 5x8 inches, of the very best quality, bound in seal, the top and bottom of pages gilt edged, the paper of the best quality and heavy enough to permit of erasure. It should have a thumb index. The names should be written with a hard pencil, so as to be easily erased, in case of the removal of the pa- tient. Soft pencil blurs the opposite page. A book, such as we have described, can be ordered of any stationery store, for from two to two and one-half dollars. The names should be taken from the Allan Examination Pad, by the lady assistant, and entered under their appropriate index letter in the address book. Whenever a patient dies, either erase the name or indi- cate his decease in some manner. It has been our custom to keep a record of extracting on a separate slip, using for this purpose the small examination pads which are sold at ten or twenty cents, and which have diagrams of both the temporary and permanent teeth. In this way it is not necessary to refer to the operating records for information regarding the extracting. 4iS THE PRACTICE BUILDER These slips are bundled together after the names have been trans- ferred to the address book, and kept in small heavy card envelope files, so as to be easily referred to, or they may be enclosed in unsealed en- velopes, which should have an appropriate index letter to indicate the contents. A careful record of plate work should be kept, because of its liability to damage and the necessity for its prompt repair and the use of a block to match the broken part. When the teeth are extracted the particular ones which have been removed should be shown either on the Allan tablet or on the slips we have spoken of. Before the artificial teeth are made up into a plate, the make, color, and mould should be put down ; and when the plate is returned for repair and a new block must be in- serted, it is only necessary to refer to the record where all the informa- tion is at the disposal of the dentist. He can thus order an exact dupli- cate from his dealer, or from the manufacturer direct, insuring to his patient a match of the injured block with an exact dui)licate in size, color, and every feature. An appointment book should not contain a diagram of the teeth; it complicates matters to have diagrams of the work of two or three in- dividuals on one page, and is of no possible aid. This book is for the purpose of showing the day and hour wdien certain work is to be done, and it is not intended for any other purpose. It is only necessary for it to show the days of the week, and a space for the date, lines for the names of patients, and suitable places for memoranda. There should be on the desk a calendar like that which is furnished to subscribers of The Dental Cosmos, ox one with an iron base and hav- ing a separate slip for each day; w^e prefer the latter, because there is sufficient room to record the transactions of the day. On this slip we are in the habit of entering all cash receipts and disbursements, together with all accounts which are to be charged. These items are entered in the day-book at the end of the day, and the slips either destroyed or filed away for reference. The bills rendered by the dental supply houses should, for conve- nience, be entered in a bill-book. If goods were all ordered from the same house and bills were re- ceived from but one firm, it would only be necessary to keep these to- THE PRACTICE BUILDER 419 gether and add their amounts to find the total indebtedness; but as bills are received from many firms this necessitates the keeping of a record in compact shape. Get a book at the stationer's, known as the Bills Receivable and Bills Payable book. It is intended for keeping account of the notes that are due to firms, and those that are owed other firms. When the bills are received they are placed in the desk file (See OfBce Business Fittings), and the lady assistant takes them from the current month in the desk file and enters the date, name of dealer, and amount, in the bill- book, and the amounts are transferred to the day-book and the bills are checked as entered and placed in the invoice file in the desk. (See Office Business Fittings.) It is important to have orders copied, so that the specific instruc- tions connected with an order can be seen at any time. Those who have a letter-copying book and press can easily copy their orders ; but it is not necessary to go to the expense of a copying press, stand, and book to have the advantage of such record. One of the simplest and cheapest devices. of this kind is Bushnell's Perfect Letter Copying Book. It con- tains 150 pages, and the price is $1.30. It can be ordered through any stationer or of the manufacturer, Alvah Bushnell, 106 South 4th Street, Philadelphia. By use of this device, which does not require a copying press, the dentist can at any time see just what the order called for. This is of ad- vantage in ordering teeth, where the color and specifications concerning the bite and thickness of the gum, etc., are wanted. In ordering gold for Crown and Bridge Work, it is of great advantage to know just what size pieces to order; and as many men take a measure of the tooth to be crowned and order gold accordingly, it is only necessary, after a few orders have been copied, to refer to the copying book, where the record shows the length and width of a piece of gold for any case, and the size of the cusp pieces as well. This makes a saving in gold alone that is worth the cost of the book. It is necessary to have a book in which all the names of the patients may be shown, and which is appropriately ruled. This book should be used only for the examination cards shown in the chapter on " Hold- ing Patronage." 420 THK PRACTICE BUILDER First should come the i)aticnt's name, then in tlie next space the date when card is sent, then the date of the card for the examination of the teeth; in the next space should be shown the date on which the reminder card was sent, and if the patient calls to have the teeth ex- amined on the date mentioned, it should be checked by an appropriate mark; then if an ajipointment is necessary, the date on wliich the ap- pointment falls should be shown in the next space. When the work has been performed, the appointment date should be checked off. There should be spaces enough to allow for ten or twelve examinations and appointments, because some of the examinations should be made four or more times a year. The form of entry is shown here: " Brown, Emma— 6;30—7; 15— 7114—7125." This, as we see, shows the name, date card is sent, date of examina- tion appointment, date reminder card is sent, and date of appointment. The book, as we have said, should have pages wide enough to permit of several such examinations being made, without transferring the name to another page. The record of cement examination cards should be kept in the same book, or in another similarly ruled. (The ruling of either book may be done by use of red ink and a ruler.) First should come the name of the patient, then the date on which the card is sent, then the date of the examination; and if the cement has worn sufficiently to require any addition, the date upon which the work is done should be marked in another column, just as shown for the examination cards: and if the work has been done it should be checked in the book so as to be readily understood; but if it is not necessary to add more cement, this can be shown l:)y an appropriate mark, such, for instance, as " O. K." Thus: "Smith. Bertha — 6] 15 — 6|25 — 7|6. O. K." In this book there should also be sufficient room to allow for several such examinations, the work running across on the opposite page, al- ways using the left hand page for the name and the first two or three records complete; in this w^ay one page may be made to do for two or three years. By referring to the chapter on Office Business Fittings the reader will be made acquainted with the manner in which an accurate and THE PRACTICE BUILDER 421 systematic arrangement of these record cards is kept, and the cards sent out promptly at the proper times. It requires no argument to show that the employment of these record cards cannot fail to be an aid to securing prestige and dignity in any dental practice. People become impressed with the dentist's earnestness, and his singleness of purpose, when they note that he uses such care, and appears to have their best interests at heart. " To have a legal value, all records of work done should be made on the same day the work is done." — Re Ji fuss. It is of practical consequence that the entries be made in the day- book on the same day the service is rendered, although some author- ities allow a short grace after the day. The account should be charged to the person who is to pay it, and give dates, items, and prices. The charges should not be lumped, but should be as specific as possible; not one charge for two or more fillings, or for several treatments, but each should be distinctly itemized. If this is not done the books are im- perfect ; and if admissible at all, are unsatisfactory in proving the value of the services charged. Various methods are used by dentists, wherein day-book and ledger are combined; and various marks and signs are substituted for plain language, to represent a certain class of operations. These methods are viewed with disfavor by the court and juries, and are sometimes ex- cluded as evidence. As stated, it is the best practice to enter the charge for the service at once, because it is of importance to do so in case the debtor should die. Under these circumstances, the dentist would have to prove the value of his service by other persons, as no reliance could be placed in the books. If the debtor is living, the dentist can be a witness himself to prove his claim in any way; but in case the debtor is dead he is confined to his book account and other testimony besides his own. Advertising " He doih give us bold advertisement " Advertisings in dentistry is the most delicate subject that we have to consider. Much has been said and written on the topic, but there has never been given to it as thorough consideration as it merits. It is a very complex theme, and to discuss it adequately one must be pos- sessed of a thorough knowledge and experience of every phase of adver- tising, as well as a proper comprehension of the code of ethics. This question of advertising divides the entire dental profession into two great classes, the advertisers, and the non-advertisers; and be- tween them there exists, instead of a bond of professional union, a feel- ing of resentment. Throughout the world the advertising dentist is looked upon as one who has deserted the camp of professionalism, and has thereby lowered his standard to the level of the tradesman. The question is one largely of sentiment and individual taste. There are thousands of really skilful dentists who advertise, and there are thousands of very inferior dentists who do not advertise and who are loud in their condemnation of their fellow craftsmen who do. No other question of interest to the dental profession is the cause of such widespread feeling as this one. The feeling which it engenders is such that friendly relations cannot be maintained between the votaries of the two classes, and professional ambition is superseded by a commer- .■\uthor's Notr. — This chapter is intended exclusively for dentists who advertise and not for dentists who do not advertise ; those who are opposed to advertising will, therefore, pass this chapter, as its contents can have no interest for them. There can be no reason why the subject should not be considered, and there can be no valid excuse for ignoring the large number of dentists who do advertise. This book would not be complete if it failed to properly consider the subject and to show wherein improvements can be made whereby the present undesirable features of dental advertising may be remedied. 422 THE PRACTICE BUILDER 423 cial rivalry, which is not only hurtful to the profession and its practi- tioners, but also instils within the minds of the dental constituency a feel- ing of distrust. But we must consider that there are two kinds of advertising, good and bad, and that some men conduct their advertising with the best taste and discernment, so that it is not to be classed with the horrible examples that deface the pages of our newspapers in the cities, and which occupy space enough for commercial houses of the largest kind. There seems to be some question in the minds of many dentists as to what constitutes advertising, for men who are supposed to be opposed to it have been in the habit of employing some of the same methods that are used by advertising dentists. Recently, in a report submitted to a prominent dental society, the names of the advertising dentists were taken from the business directory of the city, and among them was that of a man who had been twice elected president of that society; also the name of one who had been president of another prominent society in the same city. When asked why these gentlemen were considered to be advertising dentists, the answer was given that their names were in larger type than those of others, just as advertising dentists have their names in larger type, and consequently they were considered to be ad- vertising dentists. This makes us ask if it is advertising to have one's name in larger type than is commonly used in the directory? The real purpose of advertising is to attract attention to one's business, with the object of gaining patronage. Any published matter which accomplishes this, especially if it be paid for, must be considered advertising. A business directory is a directory in which the publisher groups together the names of men occupied in given occupations. One use of a business directory is for such cases as one in which a person desires the address of an individual whose name he had forgotten, and he turns to the known business of that individual and looks through the list until the eye is attracted by this familiar name. The appearance of the name and address of a professional man in such a list, in the same type as his neighbors, cannot possibly be criticised. But there is another use to which the directory is put. This is where a stranger at a hotel, desiring service, looks over the list, designing to choose some one living convenient to his address. Suppose that in glancing through the list, he sees a name conspicuously larger than the 424 THE PRACTICE BUILDER Others. He will certainly decide that such a man is conspicuously bet- ter than the others, that he is famous in his profession, and that the directory publisher has piven this conspicuous type as a mark of merit. Many persons would certainly take this view. But, suppose that, with due caution, the stranger makes incjuirics and learns that the man is indeed a distin£juishe(l practitioner, he will then at once decide to bestow his patronage upon him. So that, by analysis, it is seen that this very mild form of advertising, especially since it is so skilfully veiled, is, after all, the most attractive that the distinguished man can adopt. In a city business directory the name in ordinary type costs nothing, while that set in large type is charged for. This is probably the very mildest form of advertising. As to whether it is a violation of the code of ethics or not we are not prepared to say. The next higher stage of advertising that is employed by ethical den- tists is in what is known as the " Blue Book," or " Society List," in which there is a " Dentist's List." There is usually a note at the head of this list which reads something like the following: " The object of this department is to furnish families who annually purchase the book, with a readv reference list of reputable practitioners, their office hours and correct addresses." Just as the business directory seemed to ad- vance the idea of superior merit for the names in large letters, the pub- lishers of the " Blue Book " and " Society List " do the same thing more thoroughly by announcing that the names on their list are safe men for the best families to employ. There is no doubt that this " Blue Book " advertising is very profitable: these books go into the representative families of the cities in which they are issued. This kind of advertising, if it can really be called so, is seen only by the most desirable class of people and less publicity is given to it than any other kind of announcements. It is never submitted to the pub- licity which attaches to other printed announcements, and is not, there- fore, subjected to criticism, either professional or private. For these reasons it is particularly attractive to many practitioners w-ho have attained distinction. Men who have attained more than ordinary distinction seem to think it proper for them to do things which if done by less well-known men would be the subject of much unfavorable comment. A few years since there appeared in a prominent weekly publication an article, accom- THE PRACTICE BUILDER 425 panied bv pictures, in which attention was directed to the superior skill of the subject in the performance of various operations, together with some history of his work. This was, of course, unfavorably commented on and was discussed at length in the more prominent societies. Whether or not it was advertising, we are not prepared to say. At another time a series of articles appeared in the Sunday edition of The Xew York Herald, bearing the title, " What the Dentists are Doing." These articles, we believe, were not signed by any one, but they were commented upon as being unworthy of the profession. The subject-matter of these dissertations was devoted to the more recent improvements introduced into dental practice, and was illustrated with cuts of bridge dentures, etc. Again, when hypnotism became so interesting a subject to the dental profession, and when dental journals were filled with communications on the subject, and the proceedings of the societies were given up largely to discussions relating to it by gentlemen who were devoting time, money, and energy to a solution of the problem with reference to its appropriate application to dental practice, there appeared in one of Bos- ton's foremost dailies an article of two or three columns on hypnotism in dental practice, with several instances of the successful performance of dental operations without pain when done in conjunction with hyp- notic suggestion. Through all this article there was the air of a com- munication intended to enlighten the reading public upon a remark- able innovation, but near the end of the review there was introduced the name of a prominent Boston practitioner, with the statement that so far Dr. Blank was the only person who had been specially successful in performing operations by the aid of hypnotic suggestion. Was this really any less of an advertisement than the statements made in the space advertisements in the same paper? To be sure, it was in the nature of a scientific dissertation prepared for the general public, but the name of the gentleman was artfully introduced and the article was, no doubt, the means of giving him much publicity; while the individuals whose names are prominently mentioned in such articles may not be the authors of them, they are, in the majority of instances, published at their suggestion. As to whether such newspaper and magazine communications con- stitute a violation of the code of ethics, we do not care to say ; perhaps 426 THE PRACTICK BUILDER a liberal conception of the code would permit such use of the press, but we believe that professional conuuunications might better be made direct to the newspaper or other publications from the dental societies. These articles could not be criticised, and the publication would benefit the entire profession. These instances which we have just mentioned are the means which ethical dentists have from time to time employed to attract attention and patronage to themselves. We now propose to discuss advertising as it is used in the large cities by those who conduct advertising practices. Before entering into a discussion of newspaper advertising as employed by the proprietors of " dental parlors," " dental associations." " dental infirmaries," " den- tal companies," " dental institutes," etc., we will consider those prac- tices which depend more upon their favorable location than upon any other factor for gaining patronage. There are several of these offices in all of the larger cities, and, instead of using space in the newspapers, they have at the entrance to their stairway a large case filled with speci- mens of work and a large number of extracted teeth. The stairway usually has a number of attractive signs that mdicate the name of the establishment. Generally there is an employee stationed at the foot of the stairs who hands out picture cards or small envelopes containing samples of tooth powder. In most instances the offices are nicely fur- nisheil, and an appearance of substantial success is given to the office by the cleanliness and air of business activity. In many instances these offices are conducted by those who have had several years' experience in private practices and have abandoned the latter for what is presumed to be a more rapid way of making money. These offices appear to do a good business in the majority of instances, and some are patronized by a very good class of people. The proprietors are generally men of good business judgment, and many of them are possessed of superior ability as dentists. Special attention is usually given to one branch of practice — plate work, crown and bridge work, or extracting — and very little is lost in bad accounts as in a private practice, the business being conducted on a cash basis. The printed matter which is distributed might be very greatly im- proved. Xo one cares for picture cards but children, and children do not patronize these offices to a very great extent. The argument THE PRACTICE BUILDER * 427 may be made that the children carry the picture cards home, and grown members of the family see the cards and are thereby influenced to give the office a call. If this is so, why not make the printed matter appeal directly to the grown people, by presenting them with such printed matter as will be of special interest to them? On the crowded streets of a large city there is so much advertising by circulars and handbills that most people refuse to accept them. The best form to use is a small folder or booklet; if a booklet, one of eight or twelve pages is a very desirable size, and it should have nothing but the title on the front page, and on the last page nothing but the name and address of the giver. About three inches long by two and one- fourth inches wide is a good size for a booklet. The paper should be white, of very good quality, preferably of linen, and the printing should be clear and the type not smaller than eight point. The ink used should be black. The title of the booklet should not exceed five words, and should tell the whole story in those five words. There should be no pictures either of the advertiser, bridge work, plate work, or anything of such a nature. An appropriate title for such a booklet would be " Modern Den- tistry for Modern People," " Sound Teeth in a Sound Head," " Tooth Facts," " Tooth Talks," " How to Have Good Teeth," " Bad Teeth and Dyspepsia." The subject matter should, of course, follow the tenor in- dicated by the title. Prices should not be given, but, if one so desires, he may indicate that the fees are not high; the word " cheap " should be avoided. The general tone should be argumentative, and the facts should be shown in regard to the neglect of so personal a duty as prop- erly caring for the teeth, and the necessity for prompt attention to any of the disturbances to which the teeth are liable. It will readily be recognized that this kind of advertising -will be much more satisfactory in every way than the practice we have spoken of which relates to the distribution of picture cards, etc. The next class of advertisers in large cities is in possession of good practices, but they are not composed of the inferior people who patron- ize some of the advertising offices. Advertising offices are probably patronized by a greater variety of people than other practices. The class of which we are about to speak has few representatives. They do not advertise after the usual manner in the daily papers, but instead 428 THE PRACTICE BUILDER they use only such publications as have an exclusive high-class con- stituency, as, for instance, those that are devoted to linance, real estate, insurance, and education or such other publications, though h.aving a comparatively small circulation, as go to a class of readers who read in order to keep thoroughly posted upon matters of vital interest to their business. Sometimes these advertisers use certain trade and class papers, as, for instance, those dealing with banking, art, railroads, ad- vertising, teaching, wheeling, horses, etc. This class of advertising never becomes so public as that which appears in the daily papers, and it is usually conducted in the advertiser's own name, without the use of " parlors," " association," or similar distinctive titles. In these prac- tices there is no attempt to gain patronage by the use of statements relating to the cheapness of the work. The " ads " are more in the form of announcements and there are no special claims made concerning superior ability, and they may be said to pursue ethical advertising. Before entering more fully into a discussion of advertising in the larger cities, we will pay some attention to advertising in newspapers and other periodicals in the small cities and towns. In the smaller cities advertising is done in the name of individual dentists, and also by those who operate " dental parlors " ; the former kind is usually much milder in tone than the latter. Two kinds of newspaper adver- tising are used — the " local," which consists of short statements ap- pearing among the news items, and " space " advertising, which ap- pears in that portion of the paper given up to display type. Both of these forms of advertising could be much improved so far as appearance and eflfectiveness are concerned. In these smaller cities which we are now considering, the mediums which may be used by the dentist are the daily papers, the weekly papers, and such other weekly or monthly publications as may be issued in the I)lace of his residence. The first point to be considered relates to the circulation of the paper or papers to be used. It is advisable to use the paper that will be seen by the most people, but there are circum- stances which might make it advisable to use a paper having a smaller circulation. If the paper that has the largest circulation gives little attention to its advertisers, and does not show by its advertising col- umns that it has a good assortment of type for " ads," and if its adver- THE PRACTICE BUILDER 429 tising columns are not given prominence, and no attention given to display the " ads " artistically, it will readily be seen that a paper hav- ing a smaller circulation, but which does give attention to all these points, will make a more desirable publication in which to advertise, because, while it may have a smaller circulation, more people will really see and read the " ads." The appearance which a paper makes has much to do with its advertising value. Papers charge for their adver- tising according to their circulation, and, as circulation varies in differ- ent places, the rates cannot be estimated on. In making arrangements to advertise in any paper, be sure to know just what you are paying for, and have the representative of the paper make out the contract and have it stated in just what position the " ad " is to be placed, the size of the " ad," how long it is to run, how often it is to be changed, and what the cost is to be. Unless these points are attended to, the advertiser may have trouble when it comes to changing the " ads," or the " ad " may be crowded out of its position frequently, or, if he decides to stop advertising at the end of a year, they might continue it and charge for it. No directions can be given concerning the rates, as personal inter- views with the person who attends to the work for the paper is the only way of arriving at a satisfactory understanding. Usually publishers refuse to depart from their regular card rates, but sometimes a reduc- tion is made. The next point to decide upon is that of continuity. When once a person decides to advertise he must understand that it is not advisable to advertise intermittently. Advertising must be continuous to be prof- itable. We do not mean by this that the advertiser must advertise every day, but that he must advertise continuously, must not allow any great length of time to pass between the appearance of his advertisements. Thus, he may, for instance, arrange to have his " ads " appear on Tues- days, Thursdays, and Saturdays. Some papers have a larger circula- tion on Wednesdays and Saturdays than on other days. Friday is said to be one of the best days for the daily papers of towns to which a large agricultural district is tributary. Experience shows that the first appearance of a new advertiser sel- dom brings more than the least desirable transient patronage. The second appearance does little more than open to the reader an excuse 430 THE PRACTICE BUILDER for his attention. The third suggests business. The fourth suggests more of it. The fifth is hable to impress upon the reader that it may be to his advantage to consider the advertiser, or, more Hkely, to so strongly impress him that the memory of what is advertised may be recalled by subsequent advertising. It has sown seed, but has not watered it. The sixth appearance of the advertisement is liable to be felt in the office. Then, and then only, does advertising begin to tell. To discontinue advertising is simply to destroy a heavy proportion of the preliminary education of the possible patrons who are just be- ginning to be influenced. The strength of advertising is in its contin- uity; continuity begets confidence in the advertiser and in what is ad- vertised. Persons that expect advertising to pay after the first few appearances of the advertisement arc very much mistaken. .Advertising must be done for some time before people begin to notice that it is being done. Daily papers in the smaller cities should not be used oftener than every other day. In cities having a population of from ten thousand to thirty thousand this is often enough, and the notices will probably be seen nearly as often as if they appeared every day. Weekly newspapers circulate largely in territory which is tributary in a com- mercial way to the city or town in which the weekly paper is published. Weekly papers are more thoroughly read than daily papers; those that receive them read the advertisements as thoroughly as they do the read- ing matter. Aside from the daily and weekly newspapers there are other publica- tions which may be used with profit. Among these may be mentioned the monthly magazines of colleges in towns or cities where thc^e are colleges, and the papers or magazines which are published by churches for their own members. Sometimes, when a practitioner is located in a town which is a county seat, and there are several papers throughout the county which have good circulations in their own towns, it will ])ay to keep a card or " ad " running in those papers. When the printing offices in which the papers are printed do not have desirable or modern types with which to eiifectively display the " ads," the advertiser should have the " ads " displayed by experts in typography, and electros made. The space which it is proper to use varies according to the taste of THE PRACTICE BUILDER 431 the advertiser, but we believe that in dentists' advertisements only a small space should be used. Two and one-half inches, single column, makes a nice-sized " ad." It may run to three inches, three and one-half inches, or four inches single column, but the first-mentioned size makes a very good display. A dental advertisement, when double-column display is used, should never be larger than three inches. A very attractive double column display can be made of one and three-quarters or two inches double column, having a light border, and, when a small cut of a pretty girl is used, is striking in its effect. In "ads" of this kind the wording must be short, sharp, pithy; there must be no waste of words, no straining after effect. A good position should be had. The most desirable positions are just above or just below the fold of the paper in dailies. The same is true of weeklies, although in some papers the inside local pages are preferred when a good position near the top and centre can be had. The " ads " should be changed often. An " ad " that runs along with the same matter is said to be a " dead ad." And so it is, because it fails to attract attention or patronage; as soon as people see it they glance away, but if it contains some new statements it is read. People sometimes look for the " ads " of some advertisers, because they are al- ways interesting, and many contain arguments of interest to the readers. It is throwing away money to let an " ad " stand through a month without changing the style of display or wording. A uniform style should be preserved in the wording of the " ads " ; this gives to them an individuality, and when that is forceful without being exaggerated it will prove effective. We are not in favor of pict- ures in advertising dentistry, although many are partial to them. Pict- ures of plate or bridge work are especially objectionable; they do not tell anything and they use up bpace. Poetry should never be used. All that is to be said can be said with greater clearness and force when it is written in prose than if it is written in rhyme. Many persons are so proud of their wit that they cannot resist the temptation to let some of it get into their advertisements. This is very unwise. Funny " ads " may be very amusing, especially to the person who writes them, but they do not advertise as well as straightforward statements do. One may get a reputation for being a very funny man, but he will not there- by enhance his reputation as a dentist. 432 THE PRACTICE BUILDER Never bring politics into advertising. This is in the worst possible taste. There should be no juggling with political words or phrases, and it is rarely that such advertisements can be so constructed that they will not give offense to someone. There is neither wit nor business sense in this. Do not under any circumstances use the names of candi- dates or refer to any of the issues of a campaign, either national or local. The " ad " writer's business is dentistry, and not politics. Local advertising is sometimes done by dentists in towns and cities of the size of which we have been speaking, ten thousand to thirty thou- sand population. We do not consider squibs, or one, two, or three-line advertisements of this kind to be advisable. There are several reasons for this. In the first place, these locals are used by every other line of business; we note, for instance, in these little items announcements such as these: " New assortment of calicoes at Wright and Smith's;" " New Tan Shoes at Jones's; " " Go to the Rip and Tear Laundry for your work;" "Hosiery and Underwear, always the lowest prices at the Racket Store;" "Special sale of Sacks at McHenry's; " "More new Novelty Dress Skirts just received at Watson's; " " Dandy Suits at Levi's." A dental " local " is lost in this mixture of business announcements. They are verv undignified, and the dentist who uses them makes his own announcement less dignified merely by being in such an assort- ment. They are very expensive, costing ten, twenty, or thirty cents a line, and it is difficult to get a statement of any kind in less than three lines when the name must always be included. We advise those who are bound to advertise to avoid " locals." Space advertising, rightly conducted, will be more profitable and will cost less. It is difficult to word " locals " so that they will read easily, and it is next to impossible to word them so they will not look like advertisements. Local advertising can consist only of single statements, such, for instance, as " Perfect fitting, natural appearing, artificial teeth. Dr. Blank. Smith Block;" "Extracting teeth without pain. Dr. Blank. Smith Block;" "'The Perfect' crown system. Dr. Blank. Smith Block." Never say. "Go to Blank, the dentist, for your dental work;" " Blank leads in painless dentistry." THE PRACTICE BUILDER 433 The puff is used by physicians, lawyers, and dentists, and is by them considered ethical and proper. The puff is a form of reading notice intended to be complimentary to the individual mentioned. Its use is universal, and is evidence of its popularity. Puffs, to be effective, must alv^^ays be indirect. They must be written as if the person mentioned has no knowledge of them. They must be artfully artless. Physicians are in the habit of using puffs oftener than any other class of men. Favors to newspaper men are responsible for more of this than any- thing else. Physicians aim to keep on friendly terms with reporters, so that when accidents occur they may the more readily receive news- paper mention. In fact, it is well understood by them. " John Smith was struck on the head by a falling bolt from the new building going up at the corner of Elm and Archer Streets. He was carried to his home unconscious. Dr. Howe was called in, and pro- nounces the injuries to be serious. The doctor is in hopes that by to- morrow an operation may be performed that will be highly advan- tageous." If such publicity is ethical for the physician, why is it not equally so for the dentist? Besides puffs, it is proper for a dentist to receive the benefit of such personal announcements as are used by physicians. Thus, when a dentist attends a society meeting in a distant city, or when he presents an interesting paper at such a gathering, he should be allowed the same freedom that physicians enjoy in the same direction. As, for in- stance, " Dr. Blank left yesterday to attend a convention of prominent dentists, to be held in Chicago. While there Dr. Blank will deliver an essay on ' The Systemic Treatment of Dental Disturbances.' " Sometimes a special edition of a paper is issued for a special purpose — a celebration, or something of the kind — and the pubHshers decide to have special " write-ups," of prominent citizens, professional men, etc., and when this is done it will sometimes be found profitable to be one of the number so written up. One should see to it that his article 434 THE PRACTICE BUILDER is well written, ami that it should be more in the nature of a puff than a biographical sketch, ami that it does not look like an advertisement, and that special claims are not made for the skill of the individual. Something like the following should be used: Dr. A. B. Blank is one of the most prominent and deservedly popular of our dentists. He is a graduate of the Dental College, and is an active representative of that latter-day school of progressive, scientifically educated dentists who have made for their pro- fession a worthy name. The doctor is the possessor of a large and fashionable practice. His office is beautifully fur- nished with all the latest appliances nec- essary to the performance of the work demanded, which latter is done accord- ing to the highest standard that pre- vails in the largest cities. There is a well-stocked library of scientific books of reference and periodicals of the pro- fession. The doctor is a member of sev- eral scientific societies and takes an ac- tive part in their proceedings. Before entering on a discussion of advertisement wTiting and dis- play, we will consider circulars, booklets, handbills, and the money- wasting advertisement schemes used by many dentists. Circulars have been used by every class of advertisers for so long that their usefulness was long ago outlived. We do not believe that they have ever paid the advertiser for the cost of the printing. Usually they are printed on cheap paper, with poor ink and the larger sizes of type so jumbled to- gether that it is almost impossible to make out what is meant by the announcement. Every clothing store, every dry goods store, and al- most every class of business uses the circular. Why on earth a dentist wants to use them passes understanding. The man who believes in handbills and circulars has only to stand upon the sidewalks when boys are passing them out, to be forever convinced that this kind of adver- tising is worth nothing. It will be found that ten thousand cheaply THE PRACTICE BUILDER 435 printed circulars cost fifteen dollars. A boy to give them out, either from house to house, or to pedestrians, will charge, say two dollars. If he leaves only one at a house, and gives only one at a time on the street, he will not make much on the job at two dollars. Boys are not built that way. One must take them as they are. Circulars may be seen any day littering the streets, blowing around over the doorsteps, in the gutter, and where the boy gets a chance he will stick a big bunch of them in some out-of-the-way ash-barrel. Booklets, we spoke about in the beginning of this chapter. When rightly used, they will be found more profitable than the picture cards, etc., which are used by some advertisers. We will now give a list of the advertising schemes that dentists sometimes use, and we propose to show that they are not worthy and that it is a waste of money to use them. First in order comes the directory. Directory advertising will not pay a dentist, and we are of the opinion that it will not pay anyone else but the publisher. The directory is like a dictionary, only one particular part of it at a time has any interest for the reader; no one reads a direc- tory for pleasure, and no one turns the next page to see what is upon it. The circulation of directories is exceedingly small, hardly one-quarter as large as may be supposed, although their reading circulation is un- limited. The reader grabs the directory, turns to a certain name, closes the book with a bang, and all is over. Look at the matter from your own point of view. Have you ever, at any time, been attracted to patronize a person or firm because you saw the advertisement in a directory? We venture to answer. No. The advertising rates m a di- rectory are high, and the money paid might better be used for some other purpose, for it will never come back. Wall maps and hangers of any sort should be classed as fakes. They can be of no possible advertising value and the rates are ver}' high. Thousands of dollars are wasted yearly on the worthless trash. Framed time cards for display in hotel reading-rooms are useless and worthless. The agent may call, and dilate upon the advantages of this form of advertising, and say that he has " just one more space left which he will let you have at a great reduction." If you take the space and pay 436 THE PRACTICE BUILDER the price you may call at the hotel in a few weeks and find that the elaborate scheme is stowed away in the rubbish room. Hotel Register advertising is about as foolish as any we know of. No one refers to a hotel register for information, and no one remem- bers the advertisements shown thereon, for five minutes. Hotel room cards are just as worthless and should be avoided. Theatrical pro- gramme advertising is a worthless form. Tlie circulation is small, the rates high, and the people do not read them, and if they do read, are not influenced by them. Theatre curtains are worthless, the " ads " are usually of an inferior kind, and the dentist who puts an " ad " on one gets into bad company. There are some people in this world who will not take good advice when it is offered to them on a silver platter. They will continue to advertise in theatre programmes in spite of what we say. If we cannot stop them from throwing away their money, wc may at least advise them as to a more effective wording for their advertisements. Never in a theatrical programme or other advertisement take a space and fill it with this statement: This space belongs to Dr. Blank, Dentist. To those who are bound to use theatrical programmes, the follow- ing will be found effective : " The next attraction will be " But the greatest attraction will al- ways be Painless dentistry at Dr. Blank's, Cor- ner Jackson and Water Streets." Blotters are among the most worthless forms of advertising; fair, horse show, poultry show, circus programmes, race cards, baseball pro- grammes, and every other scheme of a like nature will be found a waste of money. Calendars are equally worthless, expensive, and ineffective, and are a good medium by which to get rid of money. Memorandum THE PRACTICE BUILDER 437 books, gift novelties, and every form of advertising of that nature is just like throwing away so much good money. It makes no difference what claims the agent may make concerning the effectiveness of such schemes, the fact remains that persons who have experience, persons " that have been there," know a great deal better. Now we are ready to consider newspaper advertising. For this purpose we have employed all the foremost newspaper clipping bureaus in this country and Europe to supply us with clippings of dental ad- vertisements. The result has been that we have received thousands upon thousands of clippings which present forcibly the fact that the advertising done by dental establishments and individual dentists is about the poorest that it is possible to do. There is not one good ad- vertisement in ten thousand. This is pretty hard, but it is a fact, nev- ertheless. In looking over thousands of them there are only a few that are fit for reproduction. The poorest dental advertising is done in the largest cities. The best advertising should be done there, because there is every possible aid to making it good. Advertising costs more in these cities; the space costs more because the circulation of the papers is greater. Noting the advertisements of dental establisments in the large cities, we observe, first, that altogether too much space is used. Some adver- tisers use as much as two columns in such papers as the New York World. In other cities an eighth or quarter page is used. This is more than is used by many firms doing vastly more business than all the dental establishments in the city combined. The average space used all over the country by dental establishments operating under company names is eight inches, single column. This is altogether too much. Three inches single column, or two inches double column, is all that should be used; properly set and properly displayed, either of these could not fail to be more productive than the six or eight inches single column, with its half dozen headings, pictures of the advertiser, and of artificial teeth, plates, and bridge work. Note any of these advertisements in a daily paper. There are usually no less than six sizes of type; often there is a picture of a full or partial bridge denture. Note any of the advertisements of dentists in the larg- est cities and you will see that they are a jumble, a hodge-podge of den- 43^ THE PRACTICE BUILDER tal cuts, type, and prices. Instead of this, they should contain a straight- forward argument expounding the necessity for proper attention to the natural organs of mastication ; and, when artificial teeth are adver- tised, concise statements relating thereto are easily made without the use of unsightly cuts representing plates or bridge work. Artistic display and high-class typographical composition would be productive of a saving of space, while in no way detracting from the drawing power of the " ad," but would instead add materially thereto. Nearly all the advertising done by dentists, and nearly all the signs, cases, etc., outside their offices, and many of the things inside, are re- pellent to the sensibilities of those who seek their assistance. We here give two examples of good, sensible advertising: Has it ever occurred to you, Ladies? That though you may be dressed in the richest apparel, with eyes enchanting and features perfect, and still have ugly teeth or a movable plate, your friends can never approach you without a feel- ing of repugnance? Have you ever heard of Dr. Shef- field's crown and bridge work? Cost, the lowest consistent with good work. Call (consultation free), or send for pamphlet. L. T. Shefifield, D.M.D., 26 West 32d Street, New York. This, we see, is a direct argument. There is but one idea in it, and that idea is a good one. It appeals to pride, personal appearance, and does it without the use of offensive statements. It is a good " ad," too, because it does not tell about anything else. There is no mention of price in actual figures. That is right. But what mention there is might be improved upon. Another equally effective advertisement of the same dentist is shown herewith. In the original it was accompanied by an outline cut show- ing three gnomes balancing a see-saw on a full bridge denture. This cut w^e believe to be in poor taste and do not reproduce it. The " ad ' reads as follows: THE PRACTICE BUILDER 439 My crown and bridge work is the only method in dental science that is perma- nent and which perfectly equalizes the strain of mastication. It is the only pos- sible method which permits the fullest enjoyment while eating, because the functions of the whole mouth can be ex- ercised. This would be impossible in the old-fashioned plate. These teeth look like your own teeth, feel like your own teeth, and, to all intents and purposes, are your own teeth, and with moderate care will last a lifetime. Only gold and porcelain are used in their construction, but, notwithstanding, the cost is com- paratively low. Examinations and esti- mates free. L. T. Sheffield, D.M.D., 26 West 326. Street, New York City. Use Dr. Sheffield's Creme Dentifrice. For Sale everywhere. This is a very good advertisement of bridge work. It states its facts clearly, tersely, and to the point. In all the advertisements of bridge work that we have seen in the daily papers, none compare with this. It is probable that not one person in fifty understands what bridge work is, and the only way that they can be made to understand it is either by personal explanation or by use of printed matter. This kind of adver- tising makes people curious to know what bridge work is, and they are likely to make inquiries. This shows they are interested. When people become interested they are likely to have work done. We now beg to present to our readers some photographic repro- ductions of dentists' advertisements as they appear from day to day in the columns of the daily papers. These advertisements were selected from thousands which were clipped for us by the foremost clipping bu- reaus of the world. Only the best ones are shown. The poor ones can be seen any day in any paper. The following are selected because they are the only ones that are sensible, argumentative announcements : 440 THE PRACTICE BUILDER WASHINGTON, D. C. '^TTTT'f?f^'V''ST^?^PVt'WfV^TTtS 66 1 ,can a dentist afford to do good work at ■such prices?" / yA% M My New Invention Which are as good as natural teeth in every respect, at a fraction of the old-time cost. Up-to-date methods and scientific mastery of details have reduced the cost very mater- ially, and at the same time have eliminated the objectionable and fraught-with-fear features which made people defer a visit to a dentist. I make Artificial Teeth ' without the use of a plate ; I can transform a badly shaped mouth into a pretty one ; I can do the best work that expert dental science has evolved, and I can do it cheaper and more satis- factorily than anybody I know , , Examination and Consultation Free L. L Sheffield, D. M. D., 26 West 32d Street, N. Y. 2\, Enables Me to Supply Teeth m %. i®^l m m 'St' THE PRACTICE BUILDER 443 CHATTANOOGA, TENN. WASHINGTON, D. C. Tooth Hints, l^a? ** Whe7t otight we to go to the dentist f^"* Many think it unnecessary to devote particular attention to the feeth until the appearance of the mouth is affected by damaged, decayed or broken teeth. Others give their teeth no attention till pain com- pels them. The stupidity and short-sightedness of either policy is evident. Every ojie who thinks a moment on the subject knows that we cannot masticate our food satisfactorily if one or more of the teeth are tender, inflamed, decayed, or otherwise out of working order ; and that if this be the case, the mouth requires immediate attention. New York Dental Parlors, 22 AND 23 TIMES BUILDING, Chattanooga, Tenn, WASHINGTON, D. C. JA Blesslmig of Old Age. A set of sound teeth are a pride to the possessor at all times— much more BO Tfben advanced In years. The proper way to set about obtain- ing them Is to visit our modern par- lors, where scientific methods and reo- sonable prices reign. !e And Expemise Aie avoided by having your teeth thor- oughly examined at regular pertod3„ If you kt us extract your bad teethj now we can furnish you now ones by Xmas. Price allowance made In such cases. But come NOW, NOT LATER:. Painless Extracting, 50c. Best Set Aitiflclal Teeth, $8. ^Evamis' Dsmtall Parlors, ^1309 V ST. N.W. . . , ao21-24d PKOVIDENCE, R. I. i217 PA. AVE. N.W. ERN DENTISTRY. The dentists who tell you that we cannot do good work at our prices mean that THEY cannot do good work at our prices. They cannot afford our modern appli- ances for saving time, pain and labor. They pay just twice as much as we do for the best ma- terials, because we buy in im- mense quantities direct from the manufacturer. High prices go hand in hand with old-fashioned dentistry. These are the prices of modern dentistry. Painless extracting 50c. Best Toeth $S up. PaLuless Filllncrs 75e. up. SoUd Gold Crowns ?5. U. S. DENTAL ASS^N., MT7SIC HAIili. S2S SSTalUKWiTd 444 THE PRACTICE BUILDER WASHINGTON, D. C. LNTAL Appliances Vdry Willi the dentist. Any number can be found who are still adberlng Ir the old-style methodr which are the buKabor of the toothache sufferer. They never realize that thrt ache ritinuous Gum, tJold and Aluminite Plates. The larsest and most modi ra Dental ■ Parlors in tlie city of Xeiv Yorl;. equipped with every mod-'rn anplianc-i for RE- LIABLKand AP.S.")- tUlELY PaI.V- I-ES,SDt;XTIt^TKY. All work done by dentists of 12 to 20 yeais* experience, and rnannt^ed. Bjicony First F)oor. lI ''(^f'mBffr'MffxvfNim/ THE PRACTICE BUILDER 445 DENVER, COL. ^ She Is Pretty \ \ 4 \ 4 But suppose she should part Those lips in a smile and reveal Teeth that are anything hut Pearly and even and well cared. For— You'd be disappointed— Wouldn't you— Painless dentistry — Moderate charges— warranted work-—. When your own teeth need care- 5>5S' CHICAGO, ILL. SANITARY Millions of dollars are spent annually In ele- vating the sanitary elements. Dr. G. B. Cady has spent a lifetime on the study of pure sanitary dental work. Hard rubber dental plates poison the mouth and cause diseases. The Sanitary Plate Teeth are absolutely pure and healthy. Investi- gate by calling on DR. CADY. Suite 7. Central Music Hall. DENVER, COL. ( I Will Not Sit Down And wait— in the old way— for You to find out that I have a Good thing— a hew thing— some- Thing you want— Painless . dentistry'-^ Moderate charges — warranted Work — That's my good thing and I think it is worth while to Tell you about It— ftUumudi«ir^ 9cnVl&V.EQmVob\c . 446 THE PRACTICE BUILDER BARNSLEY, ENGLAND. All. joa'rr "tvmra" abnal Arlidrlil Tfclh mmj be wrniig; what wr liiov abnul Ihrm m the reaull ofloDf etperlrorr. FoMibly it would Rarprlie TOO lo knnw how rnnonahle lo iirirr ther are m«d- oor w.y We itiakr .o manr nrla that wr i- in afford lo fire jroa more reaaonable prioca than i lo.t den- tiala do ihat la tor (Iral-. la.a work. We are told atain anri a(ain llial our work la by Tar the beat Id Ihe dlatrict. We alwaya intrnded that It ahould be; we alwnya Iry lo five auperlatlve aervire We Qae Ihe l>e>t malerlala, have Ih' beat workmen, lake grealeal paina our lee dependa upon what require* to be done. We alwaya girt ealimalca moal f adiy, and we rnkrautea niltre aaliaraclloo. ARTIIL'R Oni.RSBV, MALVERN, ENGLAND. American Dentistry in Malvern. THE AMERICAN DENTISTS (MESSRS. BRADLAW, PHILLIPS. & Co.). Of LONDON and WORCESTER, HAVE, at the request of a large number of the Resideataof this Town, OPENED a BRANCH at 1, The PROMENADE icorner of), Worceeter Road, where they will attend Every TUESDAY and FRIDAY from 10 a.m. to 7 p.m. Every known Byelem of English and American Dentistry, at posiiirely One Half the Usual Cost- Absolute Batisfaction «uarrtnteed, or money returned, even after six months' iri*l. No need to extract teeth or stumps by our system, und consequently NO PAIN WHATEVER. NoTx Well thk Address— 1, The Promenade, MALVERN. EVERY TUESDAY and FRIDAY, And at 1 ANGEL STREET, WOBCESTEE every day. Advice and every information Free of Charife. NEWARK, ENGLAND. rpEETHi CONSULTING ROOMS fTlEETH I ABB NOW AT rpEETH ! MR. J. H. SMITH'S ^^ CHEMIST. TEETH ! rpEETH I rpEETH I rpEETH rilEETH I CHEMIST, BRIDGK-3TREKT, NEWARK. EVERY WEDNESDAY 1 TO 5. FROM FROM ONE GUINEA PER SET. 3300 1,000 TESTIMONIAIA 8000 SETS S.\TISFACTORILY FITTED. Muskham, Newark, October 24th, 1888. Dear Sir, — I have mnch pleasure in '^earinu teetl* mony to yonr great care, skill and kindness, whether in the case of extracting, scaling, stoppin)?, or 6tting new te»th, combined with noacconntable lowchargea. Believe me, yonrs very truly, T. W FOOTTIT THE PRACTICE BUILDER 447 BARNSLEY. ENGLAND. "Teeth Extracted Without Pain." "We are the most Skilful Mechanics." "Anybody's work re-modelled and made to fit." "All kinds of Repairs on the shortest notice.-' " We have a long record for perfect and life-like Artificial Teeth." " My Teeth, my wife's and daughters, are as good and more useful to-day than when you made them some years ago. I always advise (and do now) my friends to go to Mr. Stott's." J. C.^TOTT, MEDICAL HEEBALIST AND AETIFICIAL TEETH MAKEE, 132, SHEFFIELD ROAD, BARNSLEY. Established 1877, Pbitate Enxbancb to Consuxtino Rooms. REMIREMONT, FRANCE. CABINET FONDE A REMIREMONT DEPUIS 1877 WB. SGHER,dentiste h I^E]Vi:iIiE]V£0]NT a rhonneur de pr^venir sa clientele, que depuis le 20 mars 1894, son Cabinet de consultations est transf^r^ 48, Grande-Rue, 48, au premier, en face des grandes arcades et qu'elle continue, comme par le pass^, k poser sans douleur, DENTS et DENTIERS monUs sur or, de tous systSmes connus k ce jour. Visible tous les jours, ainsi que le dimanche, de 8 h. i 6 h. POUR EVITER L'EXTRAGTION DES DENTS Nouvellc dicouv9rt6 pour gv4rir les douleurs de dmts les pliis violentes Uae seule applicatioo sufflt. 448 THE PRACTICE BUILDER lat he was waving en man, seemingly ition with the ut- saw him fall, and iiat the bullet had '.'ovc the brisket. ^ enough to slip Jge in the lower j matter encasing ?.head of my pres- imbed to the upper le, across which I 'on coming to the of which we had own into its shad- sliding down its orable point. The 1 depth — near 200 id, though the sun was deep twilight ..ig down the bot- 11 came in sight of ath. There was a the hilltops, across ng through, iloiig I saw where lad idled away the he short grass or great wall. I now and when within mouth of the can- •ut 200 yards away side of the valley tly for perhaps 50 after the manner elk was standing a sentry at a dun- a fine view of him 1st the sunlit slope IS resembling the He seemed to be )articular, but just nteresting to turn ■: close at hand. .e deep gloom, at . I levelled the targets. But it V ves and deepen- ! Grafton street, afford all treatment perfectly painless ; all teeth saved ; no plates or pa'ates required; perfection for ma.stica- tion and articulation. Sets from 20s; single tooth, 2s 6d. THE Boston Dentists o-uarantee all cases supplied by them; our system on'y recommended by the Press in England, Ireland and America, and by the most emi- nent medical men. vide Press. 51 Grafton st. p5227oq "VTT'HY not consult the onlv original firm of Irish T T American Dentists from Dr Rettich, 124 West 34th street. New York; single tooth from 2e 6d; set from 2l8. Haroldscross trams pass the door. p5204mr .-cdiiiKiU at the U Lxact picture of rf. The largest red grew in these can* to the walls, and • topmost branch the level of the pi For some distan ern wall of the c high, and steep, merous openings Mom the outer tab. One evening, at as we were shov^'' on our camp-ro«> and saw, coming a great horned r^ magnificent bull « A hurried conn which it was dec* hunter then in ca* carried by a 2-3 twice without bei Then, by unan. the Kentucky Ba host gun in the o went after the elk My rifle was a which always fai, emergency, and story, or rather a concerning this gp hunters was lou one night, down Southwest Nebr:^ and demerits of Q Pawnee Indians' p cer was mentioned. ers, Lee Mo wry by thing, too, for they chief with it. " If," said he, " a he can outrun a \ them, on an even ' That, in turn, rt that occurred abo- of this story. I \ distance of what a 325 yards. I adjust rear sight at the » at the top of the e went off in a half- of way, and the ' space, making a apparently going =ky rocket. I th Spencer, but. as t. to extract. This n sity of taking out n the empty shell, w Some time duri let reached its des snat! The elk ma THE PRACTICE BUILDER 449 and you have an I have ever seen generally cUnging •re indeed that the of them reached 've. /e camp the west- illey was straight, this wall were nu- canyons came in before sundown, 1 last of the earth .ked up the creek of these fissures, of the plains — a :'ar was held in I was the best 3 proposition was id by my voting ;cted. vote, Will's rifle, was declared the So I took it and ^r 7-shot repeater, repeat in case of f^.minds me of a .rk, I heard once A. party of bufTalo bout the camp-fire ""tinking water, in assing the merits guns, when the 'e for the Spen- one of the hunt- ., said it was a good d do but little mis- is right bad scared fired from one of me of an episode hs after the date ng at an elk at a proved to be just iliding disc of the fd mark ?nd held houlder. The shot td click, bang sort :nt hissing through much fuss as, and out the speed of, a e lever of the old ;he extractor failed d me to the neces- ife and picking out [ did leisurely. operation the bul- with an emphatic >rt spring forward, YOU recollect; Gold Fillings a specialty; Crown Bridge and Bar work; latest improvements in Dentistry, which provide a set of teeth without plate or palate at the Irish- American Dental Sur- geons. p520'lmr YOU ought to consult the American Dental Sur- geons at 4 Harrington street, for Painless Extrac- tion by Gas or Cocaine; stoppings from 2s 6d; extrac- tions, is 6d. p5204mr. ZEAL; the Irish-American Dental Surgeons attend weekly, Thursdays, Messrs Hayes and Goff, Ennis- corthy ; Fridays, Plummer's, Post Office, iNew Eoss ; Satui'days, Mrs. Anglin's, 8 Anne street, Wexford. p5204mr ZEAL; I have great pleasure in bearing my testi- mony to the great skill and attention of the Irish American Dental Surgeons, of 4 Harrington street. 2fEAL; and the Set supplied to me are admirably ^good and pleasing. E G Campbell. Rector of Kil- derry, Philipstown. Single tooth from 2* 6d; set from 21s. 4 Harrington street. p5204mr CORK, IRELAND. AMERICAN DENTISTRY. THE ANGLO-AMERICAN DENTAL CO. 42, GRAND PARADE. CORK. AND 14th west 13th STREET, NEW YORK. Senior Consulting Dentist — L. H. ROBINSON, R.D.S.D.D.S. OUE AMEKICAN PEIZE-MEDAL TEETH Sets froms 5 dels. Equal to 21 /- Single Tooth from 60 cents " 2/6 Extraction from 60 cents " 2/6 Filling from LO cents " 2/6 WEEKLY ATTENDANCES. Mallow— Every Monday at Mr Rafferty's Town Hall. Killarney — Every Wednesday at Slattery's Imperial Hotel. Youghal — Every Monday at O'Neill's Imperial Hotel. FORTNIGHTLY ATTENDANCE. Listowel — Fridays, at Mrs Potter's. The Square, Oct. 2nd, 16th, and 30th. Newcastle West— Tliursdays, at Courtney's Hotel, Oct. 1st, 15th, 29th Charleville — Saturdays, at Madden's Imperial Hotel, Oct. 3rd, 17th, Hist. Dungarvan— Tuesdays, at Mr Keehan's, Main street, Oct. 6tli, 20tli. Mitclielstown — Thursdays, at Fitzgerald's Hotel. Oct. 8th and 22nd. Tipperarv — Fridays at Mr Burke's. Com- mercial Hotel, next "door to P. 0. Oct. 9th, 23rd. Thurles — Saturdays, Ryan's Hotel, Oct. 10th, 24th. Kenmare — Every alternate Wednesday, at Mr Courtney's. Next visits Oct. 14th, 28th. Note our onl}' Cork Address — 42. GRAND PARADE. CORK. Daily attendance from 9 a m to 9 p m. CONSULTATION FREE. 7305 From there we dr igain, C.I Loup Cit old, and consisted ;tore, and a dug-oi last of the supp.les A few miles ab<' the last settler's ( valley, and 6o niii river to the south our winter camp £ the river and abou bluffs. Here, wh sheltered from wi and near a small Lillian Creek, we we made our head ter. Digging a 1: feet deep, we ado by building a log- the whole with rai sod, and loose ea' This we made n^ and a trench cut creek, answered back end we dug clay wall, slanting upward to the sv side. Then, frorr. chimney of sod ar enough to insure when we had the i elk, deer, and ante covered with bea cat skins, as we very comfortable After we had g camp fairly unde. had returned to Li of provisions, gra ing Will and me t Looking south where our camp ■< cent-looking thing- of unbroken grt where the mout. on the valley a. on the river. C these innocent-loc elevated plain, ga directions by gull'i Standing on the himself looking < table-land, when v yards of him was or more in depth, lar walls. These gullies, w numerable summ( wide, and the bottc and level as the i better idea of thei winding sections dropped from th 450 THE PRACTICE BUILDER 5r up crossed the Meeting the site of miles back from rds back into the were somewhat rrounding hills. 1, which we called the dugout which !rs during the win- by i6 feet and 4 ;eet to the height .round it, covering lit from red cedar, bank of the creek, h, from cellar to ioorway. At the fireplace, into the at backward and . the prairie out- jUtside, we built a this opening, high od draught. This, carpeted with dried kins, and the walls er, wolf, and wild- lly did, made us a !»e building of the Wes and Henry •y for another load horses, etc., leav- h the work. river, the hills. 'ed, were inno- gly an even rise -; here and there .lyon opened out d sullenly down "inspection proved hills to be a great and seamed in all '. canyons. one might imagine niles of unbroken perhaps a hundred on a hundred feet Imost perpendicu- )y the rains of in- • 60 to 100 yards .enerally as smooth above. To give a igine certain long. ble-land to have nal position to a low, leaving the iding, which the places by washinc and depositing th( JOHANNESBURG, AFRICA. 1 HE Johannesburg JJental INSTITUTE, Scantlebury Buildings, Pritchard-st. Von Brandis Square, P-O- Box 366- UNDER the management of Qualified and Skilful Dentists, have opened an Office for the practice of Dentistry in all its Branches. The same as carried on in all the largest cities in England and America. Crown Bar and Bridge Work for ad- justing Artificial Teeth permanently, i.r. without plates, introduced into Africa by the Johannesburg Dental Institute. Artificial Teeth with Plates. All known and successful systems of adjusting the finest specimens of Artificial Teeth with plates, by the suction principle, so as to cause as little injury to the remaining Teeth and Gums as possible. Crown work implies the treatment of Teeth, too far decayed to be filled, by the adjustment of crowns. The Tightening of Loose Teeth, mech- anically and by restoring to health of the diseased gums and tissues. The Painless E.xtraction of Teeth, when necessary, with the aid of Nitrous Oxide and other anesthetics. Scientifically filling decayed Teeth per- manently with Gold and other suitable materials. Enamel and Porcelain Inlays, the exact representation and colour of the teeth, dispensing with the unsightly appearance of gold, which is often objected to. The Construction of Obturators for Cleft Palates The Painless treatment of exposed Nerves of Teeth and the Curing of Ab- scesses. Generally undertaking every Branch of Dentistry, including all known methods of preventing and curing pain, saving Teeth, and inserting artificial teeth. The privacy of the most refined Dental practice is observed throughout the In- stitute. Office Hours — 9 to 5. Sundays, 9 to i. to and fro like a < keeping his upng most difficulty, 'j the great prize wai investigation pr< struck about 4 in with just pcnetrati between the rib; part of the carti the heart. But ah ent story. Crossing the cre< level on the west' went to the south canyon out of th seen the elk emei-. owy depths I pli loose clay wall at canyon was of l I'eet, I should judg Aas still shining ah down there. Keep torn of the canyon the opening at tl glint of gold resti- the narrow valley, As I made my my friend the en afternoon nibblin lying in the shad' made my way ca. about 100 yards c yon, I saw the ei and across the ere The blufTs on '' at this point ris. feet, and then slo^ of bluffs in genera on this first bench geon's door, and there in bold relif beyond, his gre dead top of a srr thinking of noth . waiting for somct. up. That somethi Crouching ther the bottom of tl Ballard at that gr. was no use. Shal. ing shadows \youk satisfactory aim. of gaining the pi mound which I S2 I could rest my ri Keeping out o sible, and deper gloom, I stole al coveted position \entisteei Boulevard Gambetta, a EU BANGKOK, SIAM. PAINLESS DENTISTRY. J. F. TEUFERT, Dental Surgeon^ City Deutal OfBce, formerly occupied by Dr. McFarland. Office Hours : 8 A.M. to 5 P.M. Baugkoli, June 20, 1896. TREPORT, FRANCE. D' PARLAGHY dela Facull6 de New-1iork D E N T I ST E Americain Paris : 189, rue Saint-Honor^, 189 Pendant la saison des Bains, au TREPORr sur !a Plage, 46, rue Simon VISIBLE : LES MiRDI & f ENDREOI DE GHiQUE SEMAIHE de i h. du matin & 4 h. du soir EU, FRANCE. DENTISTE AMERICAIN. de la faculte "^e New-York. 28. rue d'Antibes. D' PARLAGHY, rue d'Antibes, 28 MEAUX, FRANCE. CABINET RECOMMANDE MEA UX-^ 8, QDAI SADl CARNOT — ME A UX (anckmiemcTit qnai Bellevue) E. BURGIIE Dentiste de la eompagnie du cncmin defer de I'Est, de'l'Association indvstnelle ct commcTcialcxuv, profit des fonctionnaires de I'Etat, des officiers de I'armee et de la marine, du college, du grand et du petit siminaxre, des pensions et des maisons religieuses de Meaux, du college de Juilly, du college et pensionnat Sainte-Foy, de Coulommiers. OONBULTATIONS CABINET DE SEAOX, 8, QUAI SAfll-CABNOT, (ANCIENPiEMENT QUAI EELLEVXJK) Mardi, Vendredi et Samedi, de 9 h. 30 du matin a 6 h. du soir. CABINET DE CGDLOKHIERS, 16, RUE DD lARCaE Mercredi de 10 h. a 7 h. el Jeudi de 8 heures a midi. CABINET DE PARIS, 15, EDE DE STBASBOURG Lundi de 2 a 7 heures Jcudi de 3 a 7 et DimaDche de 9 32 h> 45^ THE TRACTICE BUILDER ST. OMER, FRANCE. llll'lli IIEiTAllll ii.«Li.ii,i <1oDl UiopiralioDsouKid parloutcouroDu^es tie succii a dtabU 1 29, RueThiers,BOULOGNESUR/MEl( SuSIai^ ,4, Rue L,layel,e, CALAIS. I liU C;iiul<|u« eat oiiverte (uum lev |uurfi Consultations t Si-OMER, 39, Rue de Dunkerque, chaque Samedi, de 11 heures du matin ii 6 heuies du soir. OPfillWlOJiS !»AlllfAlTESET I'OSE HE MU SANS IIDlILEUllS DenU sans plaques ni allaches. Extraction des dents alisolument sans douleur- Prfeserva- tion des denls cariies avec limaille dor selon la Mh-thodb esskntiellkment ArfCRiCAiNK, La superioiite des niitliodes des dentistes americains sur tous les autres syslemes est reconnue depuis longtemps dans le monde enlier, mais les fiais eleves onl juaqu'a present empech6 la majority du public de s'en servir el d'en t;oiiiter les avanlages.Maintenant, I'As- sociATiON DES Dentistes AMtBic\rN8 a amene ses prix k la portee de tous car ils n'attcignent plus la nioili6 de ce que Ton reclame habituellenient pour les Iravaux, Ceux qui ont besoin d'un denliste devraient tout d'abord consulter Gratuitement les Dentistes Americains pour voir ce que la science peul isire pour eux. , ^ SPtciALiTfi de dents monlees sur Or, Platine, Caoutchouc et Celluloide, fails avec le \\ nouveav stst^ue Am^ricain. Oknts a partir de 5 fr. --- Dkntiers ii parlir de 50 fr. \^ VOIRON, FRANCE. BONON "-DENTISTE DE LYON Professeur «Ie Protliese Dentaire I POSE DE DENTS INUSABLES REOOMMANDEES PAR LEUR BEAUTE, LEUR LEQ^RET^ A LEUR SOLIDITi a 5 f rancs la Dent — OPERATIONS SANS DOULEUR PAR L'ANESTHESIE LOCALE — Visible tous les jours VOIRON, 6, Hue de la Gave, 6, ou rue des Fabriques, 5, VOIRON. THE PRACTICE BUILDER 453 Of all clippings which we were compelled to cast out as unavail- able and unworthy, none possessed any of the features which go to make a good advertisement. Most of them were " standing ads," which were permitted to run in the same form without change in wording or dis- play. This is money wasted. Besides, they were undignified in tone, and the price was made the chief feature of the announcement. The pictures used were disgusting and repulsive. We propose to present now some hints on advertisement writing, and some samples of good advertisements, with comments on their good and bad points. In writing an " ad " a good plan is first to sketch the idea on a sheet of paper, placing the chief display lines where they are wanted; and indi- cating size of type — brackets alongside. Don't be afraid of white space, and don't crowd in too much matter. A few words well displayed are more effective than crowded lines of type. Use the space down rather than across the page. Decide first what you wish to be the feature of your " ad," and then build around it. If you cannot display the leading lines, or sketch the design, leave it to the printer, after giving him an idea of what you would like. His brains are trained to this work. Give him time to do it, though. If you know anything of the time it takes to set type well, you will hardly ask for the proof of an " ad " in a few min- utes after you have given the copy. Type is made of metal and cannot be expanded or compressed. Se- lect type to fit your space, or let the printer make space to fit the type. Select a head, then carve your " ad." Go straight at your subject. Aim to hit the mark early in your " ad." Avoid elaborating. Make the "ad." effective by contrast with the other " ads." Say plainly just what you mean. Write as you talk. The shorter each sentence, the more it will be read. Refrain from surrounding any idea with too much verbiage. Short words give best expression. The styles of " ads " should not be ornate in language, nor similar to those of lectures, preachers, magazine or editorial writers. Be brief. Do not be too intense of expression. Avoid all terms and phrases that might indicate jealousy of other dentists. Remember there is room on earth for other people. 454 THE PRACTICE BUILDER Experts at advertising divide display into the following phases: " Ads " which owe tlieir efifectivcness to their position. " Ads " which arc effectively worded. " Ads " wliich have effectively displayed head- ings and borders. " Ads " which are illustrated. " Ads " which have one or more sub-headings. Those which owe their effectiveness to position we consider to be unsuitable for dental advertising. Ads which, however nicely worded, do not have display headings, will be found less effective than any of the others. The effectiveness of an " ad " is lessened when sub-headings are introduced. Each sub-heading is liable to counteract the force of the others. " Ads " which are illustrated are effective only as the illustrations are pertinent and artistic. Dental advertisements should never, under any circumstances, be illustrated with pictures of the advertiser, plate work, bridge work, crowns or other devices. All of these are repulsive. The only i)ictures which are suitable for these advertisements are those which show the heads of pretty women. Those that have effectively displayed headings and good borders are best. The heading, as we have said, should be pertinent to the thing advertised. The whole burden of an advertisement is in the heading and in the beginning of the descriptive matter. The following specimen advertisement, taken from a prominent pub- lication devoted to advertising, illustrates the point: A Camel's Back will stand a great deal, but the pro- verbial last straw breaks it. A fishing-rod will stand just so much strain before it breaks, ^'ou cannot put anything more into a bottle that is absolutely full. There is a limit to everything. Kconomy in Dentistry is a good thing down to a certain point; below that it is not economy. It is possible to do the verj- best Dentistry at the prices we charge. It is impossible to do good work for less. Everything we do is guaranteed. The heading has nothing to do with the subject-matter, and no one can tell what is advertised unless he reads the entire advertisement. The heading is too general : it is irrelevant. We show the same adver- tisement reset. The main idea refers to " economy." Repetition of the THE PRACTICE BUILDER 455 same statement in different words tends to diffuseness, and the one point that should be made is lost in the effort to be too intense, and in expressing it in different forms for fear the reader will not understand. Dental Economy ♦ ♦ I Cheap dentistry is not eco- T nomical dentistry. Pay less than T we charge, and you get less for J your money. Pay more, and you J pay more than is enough. Our t work is not expensive, yet it is not T "cheap." Our guarantee really guarantees. t Blank Dental Association ♦ 726 Broadway X Some dentists have permitted advertisement constructors to prepare their " ads " who were not fully in touch with the knowledge that dental advertising is more delicate than the usual business advertisement, and who did not know that greater care must be exercised to lend a tone of dignity to it. We show herewith an advertisement written by one who did not sufficiently consider this point. 456 THE PRACTICE BUILDER SAY What you will, think what you like, it's the person with the best set of teeth that every one admires. You know this ? WELL? I will attend to any irregulari- ties of your teeth. Fill the most sensitive with the least pain. Don't take my word for it, ask some of my patients who have used this method. Or, better still, come and have a tooth filled. All my work is posi- tively guaranteed. My prices surprise everyone. Call and see what they are. Dr. A. B. BLANK, DENTIST. The objection to this advertisement is that it lacks dignity. It is too much on the " Hello Bill! " order. In the effort to attract attention, the writer lost sight of the fact that his " ad " lias an offensive tone; it is " too smart." Otherwise it is a well-displayed " ad "; it illustrates the plan which some advertisement writers use; that of having a sub- heading. The wording of the advertisement is faulty; it lacks coherence. It will be observed that the " ad " is too diffuse; much space is used without making a point; furthermore, the argument besides being weak is not straightforward and to the point and the writer of it was not in touch with the requirements for a dental advertisement. Advertisements were afterward written for the same dentist by other advertisement writers, and one of these is here shown. THE PRACTICE BUILDER 457 t««»«H»H«W«W*WH«WH**H M» >«H MM M«MM«WH4H^ Teeth filled without pain — Not feeling, is believing X s It's a Regular Nightmare s X If you have your teeth filled by the j X users of the old-time methods. Why ± ^ have your nerves hacked up, when by ± 5 my process you can have your teeth ± X filled without sufiering- one bit of pain? S I — I X Bridge and Crown work a specialty. X X None but the latest methods and most * ♦ improved appliances in all branches of ♦ 5 dental work. * i I Dr. A. B. BLANK. % I OFFICE OVER 5 Dnnrnin 0. irnn AnoflnlQ'o * S I Beiole & Van Arsiale's. I I This advertisement is also faulty in that it is misleading; it is not cheerful; it is not hopeful. The heading is not a suitable one. The statement which is made with reference to filling teeth being a night- mare is not truthful. It is not a regular nightmare to have teeth filled. People who have never had teeth filled, and people who have had teeth filled, will not be attracted by an advertisement which states that the usual dental operations are painful. The " ad " fails of its purpose, and not alone prevents people from consulting the advertiser, but from em- ploying others. This kind of advertising is not profitable. What are people to think if the dentists themselves advertise and emphasize the features which they should not mention, and fail to men- tion those which they should. We have said that there should be but one idea in an ad, one thing at a time. This ad not only poorly adver- tises painless dentistry, but crown and bridge work as well. We show the ad reset and displayed. 458 THE PRACTICE BUILDER It will be noted that short sentences are used and the simplest state- ments that will convey the meaning intended are employed. The head- ing is more likely to cause a reader to peruse the " ad " than when objec- tionable or undignified headings are used. All that is told in this " ad " could also be told in a much smaller space, which is something to recom- mend it. In this no space or words are wasted in unnecessary references to old methods or to unpleasant statements. The facts are stated, then the ad stops. It tells all there is to tell, and that is all that's necessary. We show, following, some examples of advertisement writing and display. They are intended as examples of form and wording. THE PRACTICE BUILDER 459 n DEAR DELAYS Have your teeth attended to now. Don't put it off for a more convenient season. They may get in such con- dition as will be difficult to re- pair. Have them attended to here. Modern dentistry — mod- erate charges. Dr. blank DENTIST The same idea is shown in this "ad": Expensive ^ Procrastination fc Don't wait until you get time to attend to your teeth. Take time. The time is now. The expense andbother will be much less nowthan next year or next month. Dr. Blank, Dentist 86 Main Street i IS s mmim&mm^ 460 THE PRACTICE BUILDER We here show examples of ad- vertisements with sub-headings. We do not advise this form of dis- play because few have the skill to ^" Your Teeth ^ ^ fe I! !i fjij are necessaries — not luxu- m^ V\ ries. If yon do not attend ||l<^ -I'l to them no one else will. '.!-< M m I! Our Skill ^ ^ !!i ]\\ is at 3^our service. lit ^11 It is based on superior ser- j^ jii vice, and not on price. it -I'l Modern service— methods .i- /]ll — materials. jjJDr. BLANK, Dentist I !! 86 Main Street S A Grain « « of Prevention % « « In the care of the teeth at the proper time — when there are only minor defects is better than An Ounce of Gold After they have been neg- lected for months or years and means an immense gain in comfort and reduced ex- pense. 6old Bros., Dentists 4$5 State Street construct these ads in such a man- ner that the sub-head does not de- tract from the forcefulness and ef- fectiveness of the whole ^nMMWWWMWWM THE PRACTICE BUILDER 461 The following advertisement, exhibits two sub-heads to the an- nouncement: 1 { Cbe Plea -§- We want you to know of our j[ modern methods — painless op- -^ A e rations. ¥ I Cbe Bmnti I i I J Hundreds of satisfied patients • j^ who come back for more work * I S I Cbe Uerdict J Shall be as you say after you ^ have had work done. 1 S Dr« BlanK, Denmt j[ $6 main Street The following specimens of ad- vertisement writing and display composition will be found to be an improvement on the usual news- paper announcement: I Scientific Simplicity Expert service. Modern methods. Pleasantness and sat- isfaction combined. Dr. BLANK, Dentist | 462 THE PRACTICE BUILDER ^^^^^^^^^^ That fit well. Look well. Wear well. Not expensive and yet not " cheap." BROWN'S S^ ^ ^ Unprofitable Cheapness " Cheap " dentistry is extravagant, no matter what you pay for it. Our prices are low enough to be reasonable and high enough to pay for good dentistry. Blank Dental Parlors 88 MAIN STREET ^ ?e)VG)VE)VG)V^ THE PRACTICE BUILDER 463 Economy VS. Quality There is a point where cheapness ceases to be econ- omy. When you want real quality and real economy, come here. Why ? Because here you find skilled ex- perience — modern methods painstaking and painsaving. Dr. Brown, Dentist Opera House Block Ut^^^ In the examples shown, it will be seen that a dental advertisement can be written and displayed so that it will be neat, dignified, and not lacking in those qualities which convince people of the wisdom of having their teeth attended to promptly. Who shall say that these advertisements are not better than those which may be seen every day in the papers, so disfigured by poor display and unsuitable illustrations as to be difficult to read. ' ^t' 1 *¥ ¥ ¥ f¥ -¥ ¥ ¥ ¥ ¥ Expert Extracting Quickly. Painlessly. Safely. No failures. No bungling. Skilled experts. Modern appliances. Boston Dental Parlors Opera House Block 1 1 1 l¥ l¥ h t t Si ^i t I' II tl t! t •«« 464 THE PRACTICE BUILDER W'e now exhibit some advertise- ments which are illustrated with pictures, which can be used in den- tists' announcements, and which are attractive: She Smiles ft Why shouldn't she ? a y She has firm, even, white teeth, \) 1 They have been well cared for. | (j That's the secret of the smile. A i Would you smile sweetly ? » f I can help you. f i i Dr. BLANK, Dentist i V Opera House Block \ § I Copyright. 1897, by American Dental Publishing Co. 1 A Pretty Girl ! Pretty teeth are the prettiest thmg about a pretty girl. Hiiw often you hear — " Miss Blank has such pretty teeth." Modern dentistry makes it possible I I for all to have pretty teeth I We practice modern dentistry. I Dr. BROWN, Dentist j • OPERA HOUSE BLOCK | L»M« IH III W^^4W^^H« IH«J Copyright, 1897, by American Dental Publishing; Co. THE PRACTICE BUILDER 465 fl Fair Pictdre One of the most expressive features is tiie mouth, and the expression de- pends largely on the teeth. In vain the eyes sparkle with joy if the lips are compressed to hide de- fective teeth. We can make you smile sweeter. I If Drs. Bennet & Cooper, Dentists $ 272 Michigan Street ^ i Copyright, 1897, by American Dental Publishing Co. Copyright, 1897, by A -.eric 466 THE PRACTICE BUILDER Behind Her Fan Slie siiiUl'S— luT leelli are unsightly — gums diseased — breath impure. She neglected iier own teetii and she suffers pain and mortitication. Attend to _)w cc Q 1 ■^y ♦ ■a m 1 1 2 Ul 111 d 1 0. i IT # ;) 111 Q 1 § 1- «s q < ! 2 ■ 01 as s < 1 1 1 to -J 1 CO CQ <0 - CQ 1 C8 1 2 < a to f< (5 In >> Cj 9 "S on u « ^ « •a 1 >- > ^ 1 1^ 1^ ^ a. ■a Pq « "-i t C5 c; '«.> QJ "*H q t> q U tc V (4 s ci (0 5 03 JS * fl g S £ a IS ^ fiq ft. 1 1 ,0 ^ ^ « ^ ^ cq B5 ^ fe; 492 THE PRACTICE BUILDER Another very important piece of stationery is the bill head. It should be tasty and modest. It may be white or the same color as the letter heads, if the latter are printed on tinted paper. The bill head should be printed on unruled paper, and the same observations that were made w'ith reference to the high quality of paper to be used apply with equal force to these. One form is shown on page 490. While on this subject of bill heads, we wish to call special attention to the note and bill combined, which is shown in the chapter on " The Use and Abuse of Credit." This is a very useful business form, and is sometimes the means of saving ten times the cost of the printing in a single case. One of its great merits is that it hastens the payment of accounts that might otherwise hang for many months. There should be a notice in some prominent place in the office upon which the office hours are indicated, and an intimation given that inter- ruptions during these hours are not agreeable. A notice of this kind is a courteous reminder to the patrons that the regular office hours are for appointment work only. After the first visit the patient will take this point into considera- tion, and will be careful not to intrude upon the time given to others. The card should be about ten inches by six inches in size, and should be suspended in front of the operating chair. The card should have eyelets in it in which a ribbon or cord may be tied to hold it in position. The following is a good form of notice to use: The regular hours for appointment work are from 9 a»m» to 4 p.m., during which no interruptions should occur. Ap- plications for appointments, examinations, and consultation should be made from 8.30 to 9 a.m., and from 4 to 530 p.m. A form of announcement is shown herew-ith. It may be remodelled to suit the requirements of the user. It should be engraved, and printed on a double sheet: THE PRACTICE BUILDER 493 A. B. BLANK, D.D.S. 11 and 12 BATES BLOCK Wabash Avenue and Monroe Street ANNOUNCES TO HIS PATIENTS AND FRIENDS THAT HE HAS RETURNED FROM EUROPE; AND THAT HE HAS RESUMED THE ACTIVE PRACTICE OF HIS PROFESSION APPLICATIONS FOR APPOINTMENTS MAY BE MADE BY MAIL TIME WILL BE RESERVED IN THE ORDER OF THEIR RECEIPT CHICAGO SEPTEMBER 1, 1898 Announcement fonn. Should be on double sheet 494 THE PRACTICE BUILDER Besides a knowledge of printing, it is proper for the dentist to un- derstand some of tlie processes employed in the art as his needs are concerned. First comes engraving. Engraving is divided into three classes — wood-engraving and photo-engraving, steel and copper-en- graving, and lithography. ■■ Wood-engraving is the original method of reproducing drawings or pictures to be printed, with or without accompanying type, on the ordinary printing press, with printer's ink. " To obtain a wood-engraving, or a wood-cut, as the printers style it, it is necessary to have a drawing or photograph, the latter is prefer- able, of the subject to be engraved. If the drawing is for photo-engrav- ing, it must be drawn on white paper, in jet-black or India ink. Half- tone and some other process work, including portraits, can be executed directly from photographs; drawings, or photographs, for wood-en- graving, are generally transferred directly by photography upon box- wood, but if the design be simple, it is drawn directly on the boxwood. The drawing can be larger than the cut, or it can be photographed up or down to any convenient size, provided the artist has arranged for it in his method of handling the subject. W^ood-engraving is much preferred for cuts for illustration in dental journals. Half-tones are not so easily handled, and, because of the diflficulty of printing them and of securing really good half-tones of dental subjects, they are not in favor. Photo-engravings are very popular and are extensively used by several of the dental journals. '■ Photo-engraving is executed by many processes, similar, yet dif- ferent, in the method of handling. The article to be engraved must be photographed, and the photograph printed upon zinc, copper, or gela- tine, the latter being now little used. The copper or zinc, between the photographed lines, is then removed by the use of acids, and the plate then forms a matrix from which electrotypes may be taken, or the original plate may be used. Zinc and copper are almost universally used, the zinc process allowing the great daily papers to make, fre- quently in not exceeding an hour, an illustration in outlines of almost any subject. " Half-tone cuts are made from wash drawings — that is, drawings made with a brush, where the lines do not show, or directly from photo- THE PRACTICE BUILDER 495 graphs. This process produces the most dehcate and softest of reaHstic effects. " Steel and copper engraving differs from other methods of business printing in the pecuHarity of its process and the expense attending its production. A steel or copper-plate consists of a piece of steel, or copper, not over one quarter of an inch thick, smooth, and polished upon one side. The engraver, with a sharp instrument, cuts the letter- ing or design into the plate. In printing, the entire plate is inked, the ink being forced into the engraved crevices. The plate is then washed with benzine, polished with whiting, the paper or card to be printed is placed over its plate, and a press of great power, generally a hand press, forces the card and plate together, sufficient power being used to drive the ink in the crevices on to the card or paper to be printed. The process is slow, generally requiring two men. The plate has to be inked, washed, and polished for each impression, and no method has been devised for rapid work, the most expert workman being hardly able to print more than three or four hundred impressions in an hour. Copper-plates cost to engrave, for script type, from seventy-five cents to a dollar a line, for long lines, and from thirty-five to fifty cents for short lines, fancy lines costing two or three, and sometimes as much as twenty-five dollars. " For visiting and professional cards, high-grade announcements, bill heads, and other engraved work, where only a moderate number will be required, and for all transient work, the copper-plate, consid- ering its cost, is to be recommended ; but for work to run into the thou- sands, a steel-plate is much cheaper in the end. " Steel-engraving costs more than copper. A steel-plate will gener- ally produce fifty thousand impressions. A copper-plate will seldom allow more than five thousand, the minimum limit being as low as two thousand. A fresh copper and steel plate will produce about the same quality of work, but the copper plate does not retain its sharpness after the first few hundred impressions, while the steel plate holds its own into the thousands. " There is nothing richer, handsomer, and more truly in good taste, than steel and copper engraving. No method of engraving has ever been known to approach it, as sharp lines cannot be produced in any 496 THE PRACTICE BUILDER other way, and there is a certain distinctness, as well as artistic strength, about steel and copper engraving, liable to mark the true business taste of the man who uses them. " The professional card should always be engraved. " Considered commercially, engraved work is simply a step higher, artistically, than the highest grade of letter-press work and is to be recommended in every case where one can afford to go to the expense, and where the work is to be received into the hands of ladies, or people of the upper crust of society. " An announcement can be beautifully printed upon fine paper, with new type, and perhaps will answer the purpose; but it cannot compete with the engraved announcement, which shows its richness upon its face, and is sure to gain more respect from the recipient than the most artistically arranged letter-press creation. " The idea of restricting the letter head to the smallest amount of printed matter, having it in the corner, where it is conspicuous on ac- count of its minuteness, shows the true artistic and business sense of the professional man, and gives a strong identical character to his station- ery. Steel and copper plates, by being deeply cut, will produce em- bossed work, of all the sharpness of the ordinary engraving, with the increased advantage of raised letters. This class of work is very rich, and is to be recommended for letter heads and envelope corners, and frequently looks well for headings in engraved announcements, show- ing, as it does, in the strongest contrast with flat work. " Embossed lines should never be long, and there should be few words in them. " Electrotypes, as their name indicates, are produced through the assistance of electricity. An impression of the type, cut, or other matter to be electrotyped, is taken in wax of medium consistency. This im- pression is dusted or sprinkled with graphite (the material used in making lead-pencils, and which, in powder form, is supposed to be in- finitesimally fine). This fills into every crevice of the impression in the wax, and practically covers the impression of the thing to be electro- typed with a metallic coating. This mould, properly secured, is placed in an electric bath of copper dissolved in acid, and plated, the same way that spoons or other articles are plated. It remains in the bath until THE PRACTICE BUILDER 497 a film of copper has been deposited, sufficiently thick to allow it to be handled by itself, the strength of the electrotype largely depending upon the thickness of this copper. It is then taken out, and the inside filled with type-metal, the type-metal answering substantially the same pur- pose as the copper, and being much cheaper. If the electrotype is to be mounted on wood, the lead is only about an eighth of an inch thick. The electrotype is then fastened upon the wood with screws or nails, placed on the bottom and sides, so as to be on the square, and of the right height, and the electrotype is ready for the printer. " Stereotyping is more simple than electrotyping, there being, sub- stantially, but one process. The form to be electrotyped has an im- pression made of it, on papier-mache, and molten type-metal is poured over it and allowed to harden, the making of stereotypes being gener- ally the same process as the casting of anything in metal. After the castings are made, the stereotypes are mounted the same as electro- types. " Lithography consists of drawing upon a stone, the stones being from two and one-fourth to four inches thick, of convenient size. The printing is done from the stone itself, although the original stone is seldom used, as transfers are made from that to other stones, the orig- inal being kept for making more transfers, " After the drawing on stone, it presents, to the hand passed over it, a perfectly smooth appearance, the drawing practically not being any higher than the stone upon which it is drawn. The drawing is done in oily ink. Water will not stick to oil, and oil will not stick to water. " The lithograph press is arranged with two sets of rollers, one made of felt, and kept constantly moist, the other, like the usual printing roller, and covered with ink. The stone passes under the felt rollers first, which moisten the entire stone with water, the water not sticking to the drawing; the stone then passes under the inked rollers. The ink sticks to the drawing, consequently the drawing is inked, and the rest of the stone is not. The stone is then pressed against the paper to be printed, the whole process being similar to that of the usual cylinder press, only that there are two sets of rollers ; the presses are generally better made, and more care is taken in the printing. Dentists have little 498 THE PRACTICE BUILDER need for the employment of lithography, except in the printing of sta- tionery." One of the most recent innovations in printing is the three-color half-tone process. By this method the most beautiful color effects can be produced, which almost equal lithographic work in beauty. As the name indicates, it is done by the half-tone process, and by using one color for each half-tone plate. The three plates in combination make a very artistic production. If a dentist intends to send out printed matter of any kind, booklets, stationery, announcements, reprints, he should take cognizance of the fact that a handsome piece of printed matter gets more attention than one which is cheap and insignificant. Every man knows that he himself pays more attention to an ele- gantly printed booklet or circular than he does to a common one. He knows that he finds it pretty hard to throw something really handsome into the waste basket, without looking at it a second time. He knows that it is exceedingly easy to dispose of the general run of circulars that come to him. and yet this same man will have printed for himself exactly the same kind of stuff as he himself throws into the waste basket. Type " The constatit click of the type in the stick " Dentists, even though they use printed matter frequently, and have occasion to instruct printers as to just how they would like their work executed, are yet unfamiliar with a knowledge of type — the styles, their names and sizes. Because of this, many jobs are sent out that are not artistic and that are not representative of the person who sends them out. When work is put into the hands of really expert printers, they can be depended upon to execute it in the most desirable manner without suggestions from the dentist. For those who are accustomed to sending out neat announcements from time to time, and who like effectively printed appointment cards and bill heads, the specimens of type shown herewith may be of benefit. For those who would improve the appearance of their newspaper an- nouncements, the specimens will not prove less helpful. The sizes of body type (that type which is used in the reading matter of newspapers or books) are now designated by what is known as the " point " system. A " point " is one seventy-second of an inch. For- merly each size had a name of its own, and even now many printers refer to type sizes by their old names, as Pearl (five-point). Agate (five-and- a-half-point). Bourgeois (nine-point), etc. All type, rules, borders, leads, and other materials are now made on the point system, so that it is all interchangeable. 499 500 THE PRACTICE BUILDER lO-Point Roman No. 55-MacKellar. Smiths & Jordan He that sleeps feels not the toothache. i2-Point Ronaldson Old Style No. 72— MacKellar, Smiths & Jordan He that sleeps feels not the toothache. lo-Point Ronaldson Clarendon— MacKellar, Smiths & Jordan He that sleeps feels not the toothache. 10-Point French Elzevir No. 1— Dickinson He that sleeps feels not the toothache. lo-Point Elzevir Italic— Dickinson He that sleeps feels not the toothache. lo-Point Gushing Old Style— Dickinson He that sleeps feels not the toothache. lo-Point Jenson Old Style— Dickinson He that sleeps feels not the toothache. lo-Point DeVinne — Dickinson He that sleeps feels not the toothhche. i8-Point DeVinne Extra Condensed— Dickinson Be that sleeps feels not the toothache. i8-Point Columbus No. 2— MacKellar, Smiths & Jordan He that sleeps feels not THE PRACTICE BUILDER 501 lo-Point Howland— Dickinson He that sleeps feels not the toothache. 10-Point Howland Open — Dickinson lo-Point Tudor Black — Boston Type Foundry Ibe tbat sleeps teels not tbe tootbacbe. 6-Point Light Face Lining Gothic — MacKellar, Smiths & Jordan HE THAT SLEEPS FEELS NOT THE TOOTHACHE lo-Point Gothic Condensed — Dickinson HE THAT SLEEPS FEELS NOT THE TOOTHACHE. i2-Point American Old Style — Marder, Luse & Co. He that sleeps feels not the toothache. 18-Point Lippincott— Dickinson He that sleeps feels not the toothac 12-Point Typewriter — Any Foundry He that sleeps feels not the toothache. 24-Point Copper-Plate Script— Central Type Foundry lo-Point Bradley l)e tbat sleeps feels not tbe tootbacbe. 502 THE PRACTICE BUILDER i2Poiiit Florentine Old Style No. 2 He that sleeps feels not the toothache. i2-Point Quentill He that sleeps feels not the toothache. lo-Point Satanick f)c that sleeps feels not the toothache. Borders " There can be art in printing " Borders have come into very popular use in the last few years, and to-day the type founders vie with each other in their attempt to produce artistic effects in them. They are effective for booklet covers, and are frequently used with good results, artistically, on stationery and the various forms of cards in use by dentists. The best borders for general use are those that are clear-cut and distinct. The simpler the design the better the border. A border makes a small advertisement in a newspaper stand out from the other advertisements around it. We submit some borders to suit every purpose for which they are intended. NEWSPAPER BORDERS 6 Point No. 76 6 Point No. 77 ♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦♦ 6 Point No. 79 6 Point No. 80 6 Point No. 81 503 504 THE PRACTICE BUILDER 6 Point No. 83 f< Point No. 84 12 Point Xo. 79 12 Point No. Si iS Point No. s 0)0 1(0 2)° after the advance than he got for $10.00 before, and that it is not a mere clap-trap device to increase profits without an increase in the value of the output of the office. The notification should be sent by mail in an envelope of the best quality, under letter postage, and the announcement of the advance should preferably be printed upon an invitation folder of good quah*^y THE PRACTICE BUILDER 529 and the type should be plain and clear and the ink black. The type used may be Roman, Elzevir, or Gushing. The text should incorporate an argument which should convincingly present the reasons why an ad- vance in the fees of this particular dentist is a procedure that is not only timely, but that is warranted by the circumstances. We submit a form which may be altered to suit the practice of any one in any locality. It may be longer or shorter, as the user may see fit. It will not fit every practice, but is so constructed as to be amenable to adapting, and at the same time give a hint as to the general line of argument to be pursued in this delicate transaction: AN ADVANCE IN FEES AND THE REASON WHY From and after this date it is my intention to conduct my practice wholly in the interest of persons of the better sort — those who want the very best, and who are willing to pay for it. In conformity with this intention, I hereby give notice that I will not here- after perform any work according to the schedule of fees which has heretofore obtained in my practice. My reasons are: In the first place, I have given a longer time to preparing myself for my life-work than is usually the case. My office is one of the most completely equipped in the country. The material which I use is the best that money can buy; if I thought that a certain material made at Flunkton were the very best, I would have it; if it were made in England, Germany, anywhere, in fact, and I thought it the best, I would have it in my office and would use it and charge for it. Because I give careful attention to details, earnest effort to please and satisfy in the little things, thoroughness, conscientiousness in work. This involves definite plan, system, method. It puts duty before expediency; it is inspired by honest intention, and bears fruit in honest work. Because I am in close touch with the brightest men in dentistry, not only in this country, but abroad, and I give to my patrons all that I know myself and all that I am able to learn from my distinguished colleagues. I have every book that can possibly be helpful to me; every dental journal of prominence. All this is filed and indexed. I can turn to it any minute. Everything is classi- fied, ready for instant reference. My work compares most favorably with that done by the more prominent men of my profession in the larger cities, and I am entitled to a remuneration equivalent to the worth of my work. I constantly keep my patient's best interest in view. My work does not end with the insertion of a gold filling or the manipulations incidental to the per- formance of the work itself, but the record of the work is kept constantly ready 530 THE PRACTICE BUILDER lor reference, and the patient is seen at appropriate intervals and the need oi work foreseen without tlie patient ever having need for fear of pain or in- convenience. 1 have twice before raised my fees, and this has not affected the permanency of my cHentele, which is already an exclusive one. The reason for this is that my services are indispensable to the class of people who employ me; they don't want anyone else, and they won't have anyone else; therefore, it being impos- sible for me to do the work for all who apply to me at the old fees, I prefer to raise the fees and work only for those whose appreciation is manifested by their readiness to pay me my price. This naturally prevents many of my present patrons from securing my services, but, while I will naturally work for fewer people, I will receive more money and not be so continually rushed. No one who has been dunned by me for one year without paying me, and no one who has been recjuested by my attorney to pay for work done, is welcome in my ofifice. This move is adopted by me to defend me from an undesirable elements of well-dressed dead beats living on their debts, and to protect my pa- trons from overcharging to make up for bad debts. The statements made in this announcement may appear like egotism, but they are honest. If you think that I am the kind of dentist you want. I shall be glad to see you. If you belong to the undesirable element mentioned, I will not be glad to see you, and I will not work for you. I am, Respectfully yours, A. B. Blank. In this connection it may be proper to say that a dentist is not com- pelled to work for anyone. The law is that " A dental practitioner can- not, legally, be compelled to render professional services to a patient when requested ; though dentists have been threatened, if not actually sued, for their refusal to perform certain operations, there is no founda- tion in law for such compulsion. A dental surgeon is not a common carrier, as his professional services at their inception are purely volun- tary; but when once he has undertaken a case, he must continue hi.s services, unless he'is dismissed, or until reasonable time has been given to procure other attendance, even if the services are gratuitous." It is thus seen that a dentist is justified in intimating to time-con- suming, non-paying patients, that their patronage is not desired. Why should he give the money out of his pocket to pay for the gold or the silver with which their teeth are filled? Why should he, in short, pay cash for the privilege of inserting fillings in their teeth? We close bv saving that the same general rules apply to dentistry that are applicable to any other profession or business. THE PRACTICE BUILDER 531 The factors that enter into compensation are the same as those which regulate the remuneration of all professional men. The dentist has the same right to a compensation according to his fitness or worthiness, and he has the same right to advance his fees, that men in other professions have. It is his prerogative to indicate an unwillingness to accept work un-' suited to his inclination, and he can protect himself against imposition by persons whose disregard of obligations is known to him. To attempt to extend his practice when it is patronized by an unde- sirable element, is to attempt that which is almost impossible. The Development of Ability " Studies perfect nature and are perfected by experience " " Nothing comes out of the bag but what was in it." An old saying, but none the less true because of its age. If a man has not some ability it is not to be expected that he will achieve any special distinction. Some men enter medicine, law, and dentistry and after practicing forty years are no more skilful than at the beginning, and in niany instances are really inferior to their first years, because they have forgotten what of technicalities they may have known. No one has ever attained a skill so great but that it could have been enhanced, no one ever did attain to such skill but that it was eclipsed by some superior skill. In a profession such as medicine or dentistry there is no goal, but there is a law. and this law is ])rogrcss. Dentistry is neither a perfect nor a stationary science; not one of its specialties has yet reached scientific exactness; its practitioners are striving hard to bring its various departments as near perfection as possible and are willing to learn dental truth and scientific wisdom wherever they can be found. No man can be a successful dentist if he does not keep up with the procession; the first-class operators of the day would, if they did not persist in keeping pace with professional progress, be classed as men of mediocre ability ten years from now. The rapidity with which operations in dentistry tend to specialism makes it imperative for the practitioner to keep in close touch with every department of the profession ; a task by no means easy, since the strides taken in advance in one branch alone may be so rapid and so great, that at the end of a year it bears little or no semblance to its condition a year 532 THE PRACTICE BUILDER 533 previous. Such activity is not noted in any other profession or science, with the possible exception of the advance in electrical work. The brain must be receptive of ideas, and the hand capable of putting them into instant execution. The mind must be constantly alert, the eyes and ears open, and there must be a readiness to leave moss-grown theories when their further use is questionable. Perhaps no other elements are so important to advancement as alert- ness to opportunities and observation of everything that can possibly be helpful to one's knowledge, to one's patrons, or to one's profession. There are some men who do not exemplify in conduct that perfect motto of the Dental Cosmos, " Observe, Compare, Reflect, Record." Yet these words are the foundation upon which depends the progress of dentistry. A lady consults one dentist, and he does not notice that the decay is anything unusual and pursues his usual course; another dentist might, in the same case, instantly observe, mind you, " observe " is the word, that the decay is not only of a character to show that it is rapid, but that it is extended and affects several teeth, and in a manner some- what unusual; and he arrives at the conclusion, not only from the peculiar character of the decay but from other oral manifestations, that the patient is pregnant; and instead of simply filling the teeth as he would usually, he employs a material suitable to the character of the de- cay, its extent, and to the condition of the patient. But he does not allow his services to end here. He prescribes a suitable dentifrice, and sends to the patient a copy of " The American Dental Instructor " so that she may learn that which it is most impor- tant she should know. The alertness and observation of the second dentist cannot but result in advantage to the patient, because his more intimate knowledge of her physical condition renders him more able to judge what filling material is suitable; while the work and filling material of the first dentist may have been totally unsuited to the needs of the case, and might even result in permanent injury to the teeth. If is necessary for the practitioner to have a broad conception of his work, so as to constantly keep in view the best interests of his patients by the exhibition of such foresight as we have just indicated. The means afforded the members of the profession for the development of ability 534 THE PRACTICE BUILDER and the attainment of perfection in skill are: The Dental College, The Dental Journal, and the Dental Society, together with the rapidly grow- ing book literature. The dental college not only prepares the dentist for his work but also furbishes those who have become dull. The Post Graduate Dental School gives technical instruction under the eye of trained demonstra- tors. In the Post Ciraduate School of to-day the work comprehends complete instruction in crown and bridge work, plate work, both metal and vegetable bases, continuous gum work and porcelain work, includ- ing inlays, crowns, and bridges. The value of this post graduate in- struction cannot be over-estimated ; there are no lectures and the whole time and attention can be given to the practical work, and a knowledge of the use of metals, blow pipes and kindred subjects is gained. An ambition to excel as an operator in the use of gold possesses the minds of more dentists, than an ambition to attain superiority in any other procedures. The fact that the work is, in most practices, well paid for, and at the same time a source of pride to the dentist, well repays him for the outlay of time and talent which he is called upon to give in order to produce his best effects. The history of dentistry is filled with the names of men who were once great artists in the use of gold for filling; at the head and front of these the name of Webb \vill always stand pre-eminent. Those who have had an opportunity of seeing his work, long years after that master hand has mouldered and decayed, have wondered how such work was possible; how, with the instruments and finishing devices at his com- mand, he produced such beautiful results; man\- wonder how he ever inserted work in the almost inaccessible positions in which he often placed it. W^onderful work, simply wonderful! Aside from the advantage of instruction under the direction of an operator of great skill, a superior ability as a gold operator is obtained by study and practice. The advantage of clinical demonstration cannot be over-estimated. Nothing equals it in impressing facts upon the mind and in clinching these facts as truths that cannot be dislodged. • Next to the clinical instruction under the eye and hand of a practi- tioner of superior skill and experience, and the many pointers which can be picked up at clinical demonstrations in the dental societies, we THE PRACTICE BUILDER 535 think that a vast amount of practical tried and true pointers can be had from the book, " Methods of FilHng Teeth," by R. Ottolengui, pub- Hshed by the S. S. White Dental Mfg. Co. Never before has such a mass of really practically applicable information of known value been put into an instruction book of this kind. The subject is treated thoroughly and comprehensively. Not only are the various classes of cavities and their appropriate preparation treated with minuteness and care, but the various filling materials are considered in their order, and the opinion of the author, based on his practical experience in their use in a high-class practice, is given with candor and good sense. We are not acquainted with a book which, if followed faithfully, will do more good than this one in the matter of developing manipulative dexterity in filling teeth with gold. This cannot fail to aid the operator in producing the perfect and the beautiful. The management of every class of cavities is thoroughly explained, the shaping, forming, etc., and everything that relates to the employment of aids for successfully and expeditiously executing the work. Taking it as a whole, we do not see how any man can own the book, study it and apply it, without becoming an operator capable of inserting gold fillings that are artistically beautiful and scientifically correct. Having attained to superiority in this direction, the operator is justified in advancing his fees so that this superior work is not to be so readily obtained as inferior work of other dentists. Next to gold work, it is necessary to be skilful in the performance of crown and bridge work; this rapidly expanding branch of service calling to its performance an increasingly high order of ability. Those who have had opportunities for visiting other dentists while they were engaged on crown and bridge work, are astounded at the vast amount of inferior, almost totally worthless work done in the name of modern crown and bridge work. W^e have seen bridge work constructed and inserted wholly without regard to mechanical principles, physiological requirements or aesthetic taste; orowns that did not properly fit the convolution of the gingiva, and which did not occlude properly; dummies that were tipped with 536 THE PRACTICE BUILDER gold, allowing a space between the gold and tip into which a card the thickness of blotting paper might be inserted; this is no exaggeration. In other places we have seen crown and bridge work that was a revelation; that met every requirement of science and of art; the work of a master hand, an artist and an artisan. To become skilled in crown and bridge work, a thorough training under a skilled operator in this branch should be preceded and followed by a careful and thorough study of the subject as presented by Dr. Evans in his complete treatise, " Artificial Crown and Bridge Work," published by The S. S. White Dental Mfg. Co. The practical appli- cation of the work should be attended with judgment; the more com- plicated forms of work should be avoided; the simpler forms are safe and sure; while the complicated work may be successful in the hands of the eminent specialists, only those who have inside information know of the mortifying failures and consequent dissatisfaction that often follows. Orthodontia is a field in which few practitioners attain to great skill. This is due chiefly to lack of opportunity, and to the fact that dentists do not suf^ciently instruct their patients in the importance of the work; but partly owing to the fact that it is only recently that the subject has attracted the thoughtful attention of the profession. It is a work that requires the very highest order of artistic taste, together with great inventive talents and mechanical ingenuity. The literature of the subject is more voluminous in the journals than in the book literature, but the latter is by far the best, containing, as it does, the best wisdom, refined by experience, of the authors, who have in most instances confined themselves to this branch of work as a specialty. In text books we have Kingsley's " Oral Deformities," Guilford's " Orthodontia," Farrar's " Irregularities of the Teeth and Their Correc- tion," and Angle's " System of Regulation and Retention." Of these Guilford's " Orthodontia " is the most practical for daily use, relating as it does, to irregularities of the teeth only. Kingsley's " Oral Deformities " treats of every deformity of the teeth, mouth, and jaws, and is an exceedingly valuable book; and if the practitioner intends to do work other than relates to the correction of irregularities of the teeth, the book will be necessary. THE PRACTICE BUILDER 537 Farrar's work is in three volumes of about 800 pages each; and while much more voluminous than the others, and containing a great many illustrations and dealing with its subject most thoroughly, is not to be commended as highly as Kingsley and Guilford. Angle's system shows the many devices invented by Dr. Edward H. Angle for the correction of the various forms of irregularity, and for retaining them suitably after they have been corrected. The devices are ingenious and practical and are made ready for use without the practitioner worrying over the case. The use of the appliances is fully illustrated and made plain by comprehensive instructions. It is a neces- sary book. To attempt to do work of this kind without such reference books as we have named would be the height of folly ; every man is at his best in his books, and these are by the best men ; so that it is not only right that such works should be at hand, but it is also absolutely necessary. In plate work, especially vulcanite plate work, little or no attempt has been made at really superior work, the great point appearing to be to get the work out and the money in. Some men not only fail to give this work earnest consideration, but really dislike it, and show no dis- position to like it. It is not always easy to make a beautiful plate on either a metal or a vegetable base, and we are of the opinion that it will be to the best interest of both practitioner and patient to send this work to mechanical laboratories to be done by those who do one thing only, and consequently do that one thing well. Most men proceed to forget a large share of their knowledge of pathology and therapeutics after they leave college, and the result is that in two or three years after entering practice they are not as well qualified for this branch of work as an active practice ordinarily demands. Study and observation are necessary to the successful treatment of the various cases that present. The best and most comprehensive work on this branch is " Dental Pathology and Therapeutics," by J. Foster Flagg. Study alone fits a practitioner to deal with pathological conditions, and study alone develops his ability. The constant changes which science and investigation have made in this field, have demanded of every conscientious dentist an increasing attention to it. Post Graduate Study '■'Learning is but an adjunct to our self" Post graduate schools of medicine have been in operation for many years. The first post graduate dental school was established in Chicago by the venerable Dr. L. P. Haskell; it has been found to fill a great need. Since the introduction of vulcanite rubber into dental practice, the majority of dentists have had little or no instruction in metal plate work. The instruction given has been so incomplete, or the work has been rendered so difficult, that they have not been inclined to put it into practice. A rubber plate is so easily constructed, and the majority of persons are so easily satisfied with it — usually for the reason that it is so much cheaper than the metal plates — that dentists have not been inclined to recommend the latter work to their patients. Since the introduction of crown and bridge work, it has become a nccessitv which cannot be overlooked, for every dentist to know how to do metal work wath superior skill. Until recently it was the custom of dentists who could not do bridge work, to advise the patient to liave a partial plate inserted. The general public looks askance at the dentist who is not skilful enough to execute such work when the opportunity is presented. How shall a dentist who has been in practice for a number of years learn this work? Not by a course of instruction in a dental college, for he cannot spare the time from his practice; and even if he could, the instruction there is gained under such difficulties that he does not feel competent to undertake it. Large classes cannot be successfully handled in the college laboratory. Too much of the student's time is taken up in the lecture room, in the futile attempt to instruct him how 538 THE PRACTICE BUILDER 539 to do a mechanical operation, which cannot be and never is learned except at the work bench, under the eye of an expert. In the post graduate schools it is the plan to instruct the pupils individually, and not in classes ; no lectures are delivered, but what would be the practical or essential part of the lecture is given in telling the student not only how to do a thing, but the reason why. Step by step, the student is carried through a systematic course, first, of metal plates, full and partial, rubber attachments and soldered work. Especial attention is given to the proper selection, arrangement, and articulation of teeth; the contouring of the artificial gums, so as to restore the contour of the mouth; the proper adjustment of clasps, which seems to be so little understood. This is followed by instruction in gold crown and bridge work, and then by continuous gum work. A simple system of metal plate work, whereby sure results are accomplished with no trouble, renders the insertion of metal plates easy and in fact more satisfactory than rubber; and since the introduction of pure aluminum, there is no reason why a rubber plate should be worn for a permanent denture, in view of the fact that from its non-con- ductibility great injury is done to the mouth by the excessive absorption of the alveolar process, a condition which the older practitioners assert was not observable before the introduction of rubber, but which has been constantly seen ever since. Dr. Haskell's post graduate school is patronized by pupils from every state in the Union, Canada, Mexico, Chili, Australia, New Zea- land, Scotland, Sweden, Germany, Spain, Netherlands, India. Dr. Haskell states that many of his pupils have been from fifty-five to seventy years of age, having practiced dentistry for a life-time, but being desirous of becoming posted on the latest improvements. Many of the students enter the school direct from college with their diplomas, to take the course provided for them. A young graduate cannot do anythmg wiser than this. It places him on an equal footing with any practitioner, so far as ability is concerned, to perform work of the higher grades in prosthetic dentistry. By such instruction he is able to start into practice with the acquired experience of fifty years. It is the possession of superior skill of this kind that helps a young man to the front, by enabling him to do good work and high-grade work 540 THE PRACTICE BUILDER right from the beginning of his professional career; so that if he secures good patrons at the beginning, he can perform his work so as to meet their requirements. Besides this, the instruction given in a post graduate school is such, by reason of the pupil actually performing the work of constructing the various appliances, that he gains a confidence in himself that permits him, after entering practice, to attempt work which otherwise he would not have the confidence to attempt. The training in the general prin- ciples of prosthetic dentistry, crown and bridge work, etc., is such that the dentist performs with ease work which he had never seen done before, because of his knowledge of the principles involved ; thus, while his training comprehended the usual performances in plate work and crown and bridge work, he is capable also of doing any repair work in these lines, and of constructing devices for regulating the teeth and the making of obturators, artificial palates, etc. A young graduate, or an old practitioner, can make no better invest- ment than to take a course of instruction in a post graduate dental school. His professional training, his skill, is his capital; when he adds to that training or skill, he adds to his capital. The Dental Protective Association " In union there is strength " The Dental Protective Association of the United States was formed to contest, in a lawful and equitable manner, the patents of The Inter- national Tooth Crown Company, or any other patents relating to den- tistry, where the validity of such patents has not been fully established. After competent legal advice it was incorporated. The first object of the association is to defend the profession against the unjust demands of patentees whose claims are worthless. It is not the purpose of the Dental Protective Association to interfere with any man's legitimate business or valid patents, but to stop the enormous abuse of dental patents. Its second object is to bind the dental profession together for mutual protection, strength, and helpfulness, with a bank account and without politics. After collusion had been proved against the old rubber company, and the case had been dismissed from the Supreme Court on that ac- count, the dental profession still had to pay royalty to this company because they were powerless to defend themselves, for lack of organi- zation. The power is vested in the directors. They can sue and be sued, are accountable for the proper handling of the funds, and must take charge of the suit of any member of the association who is unjustly sued for infringement. Every member, by paying a fee of ten dollars, and assum- ing a liability of ten more, only, which latter will probably not be needed, can continue his practice undisturbed, knowing that if sued he will be furnished with the best legal talent and evidence, and be relieved of all costs and harassment of suit. It is thus seen that the largest expendi- 541 542 THE PRACTICE BUILDER ture of the association must be that of time, energy, and thought on the part of the directors, since there are no salaried officers. By-laws have been adopted, a copy of which will be forwarded to any dentist. The International Tooth Crown Company was formed by persons, not dentists, who had previously been connected with the Goodyear Dental Vulcanite Company, wliich for many years waged war on the individual dentists throughout the country. Dr. J. N. Crouse is chairman of the association. Any communica- tion addressed to him at 2231 Prairie Avenue, Chicago, will probably receive prompt attention. Fire, Life^ and Accident Insurance " // zs better to be sure than sorry " Property is a source of power and enjoyment, and it is the aim of every man to accumulate wealth; but the agents of destruction are numerous, and none is more to be feared than fire. It is an ever existing" danger, but relief from anxiety is found in a measure, by throwing all the risk upon the insvirance companies. The fact that dentists are usually located in buildings having several other occupants, and the fact that in most instances the fire is just as likely to occur in the rooms of another individual as in his own, make it doubly important to protect himself against loss by fire. In the majority of instances the greater portion of a dentist's wealth is invested in his office, and as this is his source of income, it is the part of wisdom to carry an appropriate amount of insurance on such possessions. A reliable form of insurance policy for a dentist is something as fol- lows : $1,050 On Office Furniture and Fixtures, Library of Printed Books; Laboratory of Dental Materials, Dental Operating Chairs, Office Pictures and their Frames, Stoves, Carpets, including Tools and all other articles usually found in a first-class Dental Office, not exceeding cost price. $100 On Columbia Bicycle; all while contained on the floor of a story, brick, metal roof building, situated on the west side of Street, being No thereof, in the city of Permission granted to use electric light. Permission granted to use for fuel. This form attached to policy No of the Insurance Co. of forms a part thereof. 543 544 THE PRACTICE BUILDER Life insurance, to state the case accurately and briefly, is as good an investment as a deposit in a savings bank, even though the insured lives to the average limit; while in the event of premature death it is a gift to his heirs that partakes of a special providence. Life insurance has many very important advantages over other methods of saving. It secures to the individual a substitute for the guarantee of life, which he can never have, by putting him in a condi- tion in which the advantages connected with an average length of life are assured him, and by fixing his services with reference thereto; it keeps him from touching the savings accumulated, by depriving him of control of them; it prevents him from growing negligent in his econ- omy, by making him lose all or part of what he has saved, if he fails to pay his premiums. Endowment insurance is a form of life insurance in which the insured receives the amount of the insurance if he lives until the expiration of a term of years, usually twenty. It is not always the best judgment to carry life insurance. Life insurance agents are so persistent that they often convince young men who are not financially able to carry insurance, that such is the proper thing to do. It is a fact that a large number of policies lapse every year through inability on the part of the insured to pay the premiums. These persons undertook to carry insurance when they were not financially prepared. If one fails to pay his premiums in any one of the first three years, we understand that the amounts already paid in are lost — that is so far as their applying on an endowment policy is concerned, but he would be insured for the time paid. For a young man just entering practice, provided he is unmarried, there is little reason for taking out insurance, even considering the endowment feature. During the first few years a dentist is in practice he is not able to save very much money; and what ready cash he can get together should be used to advance his business and professional interests; should, in short, be reinvested in the practice, and in this way add to its productiveness. If a man is married it is a duty to his wife to have his life insured. The moment a dentist becomes sick his income ceases; no one else can conduct his business; when he dies his family is deprived of any source of livelihood. A thinking man will not fail to protect his wife, by insuring his life for her benefit. THE PRACTICE BUILDER 545 Accident insurance is valuable to dentists according to the size of the city in which they live, because in large cities persons are oftener exposed to casualties. The danger of accidents of cable and trolley cars and from other causes, makes it a good plan for dentists to carry insurance of this kind. Dentists are considered very good risks, and rank very nearly first with accident companies, because they are so rarely exposed to accidental happenings. Few dentists are injured by accidents in their offices. Vulcanizers do not explode, as formerly they were likely to do, and there is little or no danger through infection by the instruments which he uses. Fakirs '"Knaves and fools divide the world" This word " fakir " is an Americanism that has come into popular use because of its pecuhar fitness in describing a class which thrives on the credulity of human nature, and which always seeks those persons who want something for nothing, or very near it. The dentist is made the object of more. or less attention by the fakir, not because he is supposed to be more credulous than others, nor be- cause he wants something for nothing, but because, to the popular mind, the dentist makes his money easily. The fakir's business is a cash business, and he confines his work chiefly to the smaller cities and towns. One of the most dangerous of this class is the subscription fakir. His mode of operating is as follows: He calls at the dentist's of^ce and introduces himself as the representative of the International Magazine Subscription Agency, or any other high sounding concern he may choose to name. He states that his company takes contracts with all the large publications, and agrees to increase their circulation to such and such a figure, receiving in return certain discounts. He will state, for instance, that his company has a contract with the publishers of The Dental Cosmos to increase their circulation by 5,000 copies, and for doing which they receive a large discount from the regular subscription price; and as they do not get the discount after the first year, and as the subscriber is likely to continue to take The Cosmos, the transaction proves a profitable one to the publishers. His argmnents are usually plausible and he often convinces his listener of his truthfulness. There are several legitimate subscription agencies, but they do not ofTer such large discounts, and cannot do so with class journals such 546 THE PRACTICE BUILDER 547 as those of the medical and dental professions, because the total circu- lation of these is exceedingly small compared with that of any of the popular magazines. The subscription fakir has a list of publications of every class, and he compares his very favorable rates with the regular prices and offers a discount of 33-1 J3 per cent, from the latter. Where he can secure a sub- scription to two or more journals, he will cut this considerably. Sup- pose the dentist wishes to subscribe for The Cosmos, The Dental Re- view, and The Items of Interest. The regular price for these would be $6, but the fakir will have them sent you for $3.50. If it happens that you take one of these papers, he will accommodatingly offer to let the subscription begin after your present subscription expires. Of course you must pay cash in advance in order to gain the ad- vantage of the large discount; if you demur, he will tell you that you don't have to pay him, but may send the money to The International Subscription Agency, at the home office in New York, either by money order or express order, and thus you are perfectly safe (?). Of course it makes no difference to him; he gets the money just the same. If you send it as above, his confederate cashes the order at once, and you never see the journals. If you write to the publishers of the journals, you will leceive a reply stating that they have no agents and that no one is authorized to take subscriptions to their journals except the regular dealers in dental supplies. Inquiry at the post office of the city to which money has been sent, brings the information that no such concern is known there. These individuals prey upon physicians, lawyers, dressmakers, pho- tographers, and in fact upon all professions and occupations represented by class journals. As the business is one of absolute profit, giving no returns of any kind, it is not necessary to secure many orders in each town to make it pay handsomely, and it never becomes necessary to go to the same city a second time. The fakir is usually clothed in a cheap suit of ancient pattern, and is exceedingly seedy in appearance. He carries a small satchel made of imitation alligator skin, worth when new, perhaps seventy-five cents; his eyes are usually covered by blue glasses, and taken altogether he has the appearance of one of those " ne'er-do-wells " who frequently 548 THE PRACTICE BUILDER enter the office for the purpose of seUing some trashy article. The seediness of appearance serves to disarm suspicion, and few young men can avoid subscribing for the journals when the very liberal terms are shown and the reason for giving them is made clear. Another line along which many fakirs are operating, is the alloy trade. This is particularly dangerous to the dentist, for the reason that an unsatisfactory alloy is harmful to the interests of the patient and detri- mental to the reputation of the practitioner. Failure of fillings is at all times an undesirable thing, notwithstanding it is continually taking place in the best practices, and at the hands of the most skilful operators; but when work fails through inferior material, it is a matter of exceeding great importance to the operator, and he cannot exercise too much caution in the selection of his alloys. Forming, as it does, the material which is most depended upon for the largest share of filling operations, the dentist who understands what reputation means and what is at stake when operations are performed, and who knows how much depends upon the use of good material, will realize that nothing but the best alloys are fit for use. Most of the poor alloys that find their way into dental offices are sold by travelling vendors. We do not mean to say that all those who travel handle unreliable alloys, for we know several men who have established a good paying business in the manufacture and sale of reliable dental alloys. There is no reason why an individual cannot make as good an alloy as a large manufacturer. Alloy is a staple article and one of constant every day use in every dental office. There is no dentist who does not use it, and in most practices it is employed to a greater extent than any other tooth filling material ; consequently, the salesman always has a market for his product, and if he is conscientious in the matter of giving all that he claims to give, and can induce the dentist to become a user of his product, he establishes a business that is not only very profitable but which is also likely to be permanent. The difference in the cost of raw material as used in the manufacture of dental alloys, and the selling price, is such that a handsome profit is realized. There are a great manv men going througli the country, how- ever, selling tliis and that formula allov; all sorts of claims are made for their particular alloy, and testimonials are shown in substantiation: THE PRACTICE BUILDER 549 these are often written on the typewriter, and signed by it, too. The letter-head of the person giving the testimonial is seldom shown, and if it is, the writer is so far away as to be of little use. Sometimes the salesman shows what purports to be the analysis of his alloy, by a prominent assayer, who asserts that it possesses several remarkable characteristics and testifies to the large amount of gold, silver, or plati- num which it contains. The agent dilates on the great cost of havmg this assayer do this very important work, and then shows other analyses wherein other alloys are shown up, to the great disparagement of the latter. We know of an instance where the alloy salesman misappro- priated several blank forms from an assayer's ofifice, and filled them out to suit his own convenience, and signed and receipted the bills there- for. These were shown to his customers, and apparently substantiated all the claims made for the alloy. The claims made by such travelling vendors are usually more em- phatic than those made by the representatives of regular dealers. They usually affirm that there is absolutely no shrinkage or expansion, and that the tendency to spheroiding is materially overcome by the use of the peculiar manner in which their alloy is compounded; that it mixes with a minimum amount of mercury, and hardens sufficiently in twenty minutes to take a beautiful polish, and that it retains its color in the fluids of the mouth. A sample filling is shown in the mouth which has been in — months or years, and is still as beautiful in color as the day it was inserted. The assertion is made that by use of the improved'and ex- pensive machinery employed in the cutting of their alloy, a peculiar shaving or cutting is made, which, presenting as it does a greater surface of metal to the action of the mercury, accomplishes the proper mixmg with the materials with less mercury than most alloys. Occasionally an agent has for sale an alloy which is said to contain a certain proportion of aluminum, and for this the most extravagant claims are made. These relate chiefly to the beautiful color and quick setting, together with the ability to beautifully polish at the same sitting, and the permanence with which the whiteness is retained. A satisfactory scientific explanation of the superiority of aluminum over other ingredients is not forthcoming: and if the dentist will refer to the authorities, particularly to Flagg, he w411 find that the use of 550 THE PRACTICE BUILDER aluminum is extremely questionable. The dentist should guard against the adoption of unusual innovations in the preparation of alloys. He cannot afford to experiment on his patrons. Better to adopt one of the well known standard alloys, and stick to it. The price marked upon the bottle or package may be $4.00 or near that amount; but for an order of four ounces a very liberal reduction will be given — a reduction that is usually out of all proportion to the size of the order. P>equent attempts are made to leave ten ounces, to be paid for when the salesman calls again; these should be discouraged. In our remarks on the subject of alloys we wish particularly to state that many persons are engaged in the manufacture and sale of really good alloys, who do not make or sell anything else. We wish we could say the same of all — but we cannot. Few of the things in daily use by the dentist have afforded such opportunity for misrepresentation and deception of every sort as has the local anaesthetic. For nearly ten years dentists have been the object of the most devoted attention by manufacturers of local anaesthetics for the painless extraction of teeth. For a time there was hardly a mail in which the dentist did not receive a circular soliciting him to use some one of these. A wonderful variety was offered, including the usual liquid form, together with pastes, tablets, pencils, etc., until there were hundreds of preparations upon the market. In many instances com- fortable fortunes have been made from them. Shortly after the intro- duction of the local anaesthetic, the promoters of the enterprise, seeing the avidity with which the idea was taken hold of, began the sale of ex- clusive city rights; in this there was of course a great deal more profit than in the sale of the anaesthetic, for they were really getting money for nothing, or simply for the right to use the name of the preparation, and for insuring to the user or lessee the advertising value of its name. Many of the preparations were, and are still meritorious; but, as is always the case, the market soon became flooded with hundreds of anaesthetics that were positively harmful, and dangerous to human life. The percentage of cocaine was, in many instances, greatly in excess of the amount necessary, and in consequence the danger from the use of the preparation was greatly enhanced. Indeed, the matter has been taken hold of several times by the editors of the most prominent dental THE PRACTICE BUILDER 55 1 journals, and has been made the subject of much serious comment; as it should be, because of its importance upon the status of the dental profession, and regard for the safety of patients. Several times suggestions have been made touching the necessity for legislative enactments relative to the manufacture and use of these compounds. In nearly every instance great stress has been laid upon the statement that there is no cocaine in these preparations, when it is a fact so clearly established as to make any denial unnecessary, that most, if not all local anaesthetics vended in this manner depend for their suc- cess upon the presence of a certain proportion of cocaine — usually less than one per cent. That successful local anaesthetics containing no co- caine are in daily use cannot be denied, for there are several which have for years maintained their popularity, in which not the slightest vestige of cocaine is to be found. It was not solely upon the merit of the anaesthetic that the pro- prietors depended, after the market had been gorged with the hundred or more compounds, but upon the premium offers made to induce the dentist to purchase. When the preparation is sold by the travelling agent, the ofifer usually takes the shape of a very liberal reduction in price; and we have known of an anaesthetic selling at Si. 50 per ounce being ofifered as low as 50 cents, "just for trial;" as even at that price there is a profit of no inconsiderable amount. No anaesthetics should be purchased of travelling vendors unless the purchaser is per- sonally acquainted with the salesman and has unlimited confidence in his integrity. Much damage has resulted from the use of preparations compounded by persons totally ignorant of the nature and use of the drugs entering into their manufacture. Many times the very appear- ance of the compound shows that it was carelessly put up ; sometimes quite large pieces of sediment and foreign matter plainly indicate that it has not been carefully filtered, if filtered at all. To force the sale of local anaesthetics various plans have been adopted; among which may be mentioned: The free hypodermic syringe; while the anaesthetic may be worthy of much confidence, the manufacturers give much more praise to the hypodermic syringe than they do to the preparation. Usually a syringe is given with the first trial order. A package of cement is also offered as 55: THE PRACTICE BUILDER an inducement to try an ounce. A set of teeth, either gum or plain, is a premium advertised by several concerns. Advertising cuts, specially intended to advertise the particular preparation, are sometimes given with an order for a specified amount. Glass signs for use outside of the office are offered as inducements to buy in (juantities — usually in $10.00 orders. One of the boldest and most disgraceful others ever made was that of a concern which sent out circulars offering, to anyone who would buy a certain amount, a large certificate, written in Latin, and so arranged as to look like a diploma; the manufacturers claimed that it was very finely executed, and when framed and hung upon the wall had all the appearance of a genuine diploma " which would be a very great ad- vantage to all dentists who have not a diploma, and who are not regular graduates." Again, after having sold large amounts, the ofier is sometimes made to furnish the purchaser with the formula, so that he can prepare his own anaesthetic at home, at a very great saving. Another plan was to offer a local anaesthetic which was claimed to have done wonderful things, and to give with an order for it, the book written by the owner, wherein is told everything that it is necessary to know about local anaesthetics in dental surgery. The book is advertised as bound in leather and lettered in gold, and some of the advertising matter is accompanied by a cut of the book which would lead one to think it a most voluminous and exhaustive affair; but when received it is found to be a small sixteen or eighteen page booklet, bound in leather and lettered in gold; the greater portion of the text of which is taken up with references to the particular anaesthetic of the publisher, and how to use the hypodermic needle, while absolutely nothing of any value is told about anaesthetics nor about local anaesthesia in dental surgery. Advertising fakirs are numerous and their devices are sometimes very ingenious and their arguments convincing. Most young practi- tioners throw away a great many dollars by listening to the glowing tales told by advertising solicitors. Usually the canvassing is done by a person who visits several towns or cities, and the advertising is what is known as " scheme advertising." Scheme advertising is that THE PRACTICE BUILDER 553 which permits the agent to give something away — by having the ad- vertisers pay for it; as for instance, hotel registers, hotel display direc- tories, etc. The agent approaches the dentist with a letter from the per- son to whom the advertisement (hotel register) is to be presented. The letter states that the proprietor vvould consider it a favor if the dentist would place a card in the directory, and that he (the proprietor) would in return send the hotel patronage to him. As the people who sign their names on hotel directories do not stop to look at the advertise- ments, it must be apparent that whatever is paid out is just so much money thrown away; it follows that no person of any experience will place an advertisement in mediums of this sort. Among the schemes which are used by travelling agents may be mentioned: hotel room cards, printed on cardboard or on fancy colored satin, and ornamented with more or less trinkets, upon which are printed the rules and regulations of the house, surrounded with cards of business and professional men. It is throwing money away to adver- tise in such a medium ; the circulation is limited to the number of rooms in the house, and those who see it are transients, and of no value to a dentist. Probably not one out of a hundred occupying a room ever looks at the card. Advertisements engraved on silver plate, on hotel inkstands, have the disadvantage of costliness in addition to utter worthlessness. Sometimes an agent applies with a batch of blotters which he is to distribute to the most prominent business houses, and on which he will permit advertisers to place a card, for a consideration; the considera- tion is out of all proportion to the circulation of the blotters, and the blotters are an exceedingly poor advertisement. Besides the usual hotel register, there is one richly gotten up and elegantly bound in leather, so arranged that business cards may be printed on the space between the printed pages and the edge of the binding. It makes a pretty advertisement, but it costs too much and does no good. Hotel stationery is sometimes put up in pads and advertising cards placed on the cover and blotter, and the stationery furnished free to the hotel. It is not a good way to advertise, and cannot pay. Large time-tables are hung up in hotels, showing arrival and de- 554 THE PRACTICE BUILDER parture of trains on tlic different roads; and in the post office, showing arrival anil departure of mails, etc.; around this information business cards of the various firms are placed. The charge is from five to fifteen dollars, which is too much. The cards are rarely looked at; fre(iuently the whole thing is thrown into the rubbish room at the hotels, as so many come along that if all were allowed a place the whole house might be cluttered up with them. Post oflfice guides are issued, in the shape of a pamphlet, containing information regarding foreign and domestic mails; in the centre pages, advertising cards are inserted at a charge of eight to ten dollars. An excessive charge, and an un- profitable medium. Church directories, whether in tlie form of booklets containing names of the members, or other information, are not worthy of at- tention. Fire alarm cards are not good mediums in which to advertise; the part of the card on which the real information is printed is always cut out, so that the advertising cards are destroyed. Railway maps on rollers, which the advertising agent claims are to be distributed and hung up in every post office, railroad station, and general store in the county, is another scheme. If the advertiser pays the price asked, he is foolish, for he may look a long time and not see the advertisements anywhere in the county. A scheme which attained some vogue some time since, and which is still in operation is the coupon scheme: By this plan the merchants and others, in a town or city, subscribe to the conditions of the agent by paying a stipulated amount. Every person purchasing at these stores, or having work done at the ofifice of a dentist who may be a sub- scriber to the plan, asks for a coupon-book, and for each dollar's worth of purchases receives a coupon good for five cents; as the coupons are good in several lines of business it does not take long to accumulate enough coupons to amount to several dollars. These coupons are then taken to the agent, or sent to the home office,, where they are accepted as full payment in subscription for almost any magazine or journal pub- lished. The scheme may or may not be a good one for mercantile houses, but it certainly is not good for dentists, because it is undignified and unprofessional; partaking, as it does, so much of the usual com- THE PRACTICE BUILDER 555 petitive trade methods. The plan does not last long, as the merchants soon tire of it, giving as they do a discount of five per cent, on every purchase of one dollar. The same plan, slightly modified, is sometimes employed by grocers, who permit advertisements to appear on pass books given to their patrons, and to be placed on the coupons in the pass-book. The idea is not a worthy one and should be avoided. A subscription scheme which has been and is still being worked very profitably, is the " County Atlas " scheme; sometimes it is an illustrated county history, containing portraits of the leading citizens and of the finest public buildings and private residences. No matter which it hapens to be, Atlas or History, the purpose is the same — that of securing a very high price for a volume of limited circulation and containing information that every one is already pos- sessed of, or which can be had for much less money. In most instances it is the practice of the solicitor to offer to insert half-tone reproductions of photographs of business and professional men, at from fifteen to twenty-five dollars; the sum to include a copy of the work. The subscriber signs a contract, and when the work is ready he finds that it rarely, if ever, conforms to the claims as made for it in the proof pictures. No satisfaction can be had when the agent has failed to keep his agreement, which is usually a verbal one, and there is noth- ing left but to pay the bill and avoid a law suit. The contract as signed by the subscriber merely states that he agrees to pay for one copy of the Atlas, or History; and the publisher may furnish just such an one as he sees fit, and the subscriber must take it, and charge the amount to experience. Coming now to the subject of criminal fakirs, we take first the fake beggar. He is often one who is suffering from a self-inflicted injury. Perhaps he states that he has been very seriously burned, and asks for a small sum to help him pay his doctor bill, or something to that efifect; in support of his statement he shows a paper on which several people have testified to their sympathy for him. He carefully unwraps a cloth from his arm or leg and exposes to view a hideous sore, the member raw and matterated, a sight sufiticiently convincing to induce many to give freely. The beggar causes the sore himself by deliberately apply- ing sulphuric acid; the result is in appearance a burn that is horrible 556 THE PRACTICE BUILDER to look at. and it is astoundint; to tliink that a person could do such a thing to atifortl a means by which to gain money. lUit this is a strange world, as some worthy has sagely remarked. Another beggar enters the office, cleanly and neatly dressed per- haps, but nevertheles-s a beggar. He shows a wounded leg or arm, and states that while pursuing his studies in the — medical, dental, or phar- maceutical school some chemicals exploded, inflicting the injury. He shows a letter, written on the stationery of the institution, and signed apparently by a member of the faculty, and he succeeds in most in- stances in securing some aid. As he confines his attention chiefly to physicians, dentists, and druggists, it is not necessary for him to call on many to receive a handsome profit for his day's work. The peculiar nature of his misfortune is something that is entirely familiar to anyone who has pursued either of the above professions, because all have dur- ing their college course been compelled to study chemistry, and know that not infrequently a student loses the sight of an eye or is otherwise harmed by the accidental explosion of chemicals. The young man states that the medical attention necessary, and the loss of time through inability to work has cost him the savings of years; and if he does not raise an amount sufficient to defray his expenses for the next college term he will be unable to graduate, and thus the ambition of a lifetime will be crushed. He is usually a young man of intelligence, and tells his tale with apparent honesty. His credentials are generally forged, and when he presents them he should be politely but firmly informed that you have no money for him. Sometimes a beggar will apply, requesting money, and when told that he should go to the county officials for help, or to any one of the charitable organizations in nearly every town, he replies that he has already done so but they cannot do anything but help him to the county line. The dentist should answer that this is enough, and that he has no right to ask for anything more. The " masonic widow " is also a fake, in many instances, as she has nothing to show to prove that she is a masonic widow. She usually has for sale some trifling article of no value, and as she asks but a small fee for it, it is probably best to buy in order to get rid of her. We now call attention to several fakes which are operated generally THE PRACTICE BUILDER 557 in the large cities, but some of them are used in the smaller towns. Among the first of these are the fictitious charitable institutions; for several years these sharks that live off the public have solicited for hospitals, missions, and churches that have never existed. The average man does not know whether or not there is any Ebenezer Baptist Church, and when appealed to in the name of this imaginary church he may respond, but his money will go no further. Probably there never was, and never will be a church of that name. There are some twenty purely fictitious charitable institutions, all with high-sounding titles, that have defrauded the public with great success. Sometimes two coffee-colored individuals enter, and unload a few pocketfuls of documents, printed slips, forms, indorsements, and peti- tions headed with the name of a more or less prominent citizen. The colored worthies state that they are collecting money for an Afro- Methodist Church, to be built in the Indian Territory, and they would like to receive a donation of five dollars from the person addressed. If the person demurs, the colored gentlemen will argue in the interest of their case, and if the intended victim is unrelenting, they will show an- other printed form whereon the person may subscribe a donation of fifty or twenty-five cents. Any thoughtful man would of course make mental note of the fact that it would be well for the Afro-Methodist Church if they asked for donations near at home instead of sending solicitors to distant states. The next class is that of institutions not worthy : Some two or three swindlers take out a charter for a benevolent order, or for some labor organization. Any one can secure a charter by the payment of a small fee. Armed with this, and a subscription list, the swindlers make the rounds. Perhaps they induce some well-known men to contribute. These names appear to be a guaranty of the worthiness of the enter- prise. Solicitors talk plausibly, and are persistent in their demands. Often enough they secure money. Much of the swindling of this kind is perpetrated in the name of " labor." The solicitors prove that they represent a " chartered " organization, in which the word " labor " ap- pears prominently. They tell the business man that unless he shows a friendly disposition he will not be favored by the " workingmen," and thus by hints of boycott they obtain subscriptions. It is estimated by 558 THE PRACTICE BUILDER an information bureau, that in one year, in the city of Chicago, $100,000 is fraudulently collected in the name of labor. Not one cent of this money ever reaches any bona fide labor organization. Soliciting on commission: Suppose that some worthy club, charit- able institution, or benevolent order decides to give an entertainment of some kind. Immediately it is approached by the men who make a business of selling tickets on commission. Usually they ask a com- mission of fifteen to twenty-five per cent, on all sales. Often enough, armed with the authority of some reputable organization, thev go to well-known corporations and business men to sell these tickets. The purchaser says he is willing to buy ten, twenty or even fifty tickets, but as he has no use for them, he does not take the tickets, and merely gives his money in the form of a donation. In such a case the money does not go to the organization. The solicitor merely accounts for tickets placed in his hands. Even when the tickets are sold and de- livered, the purchaser does not know that 25 per cent, of his money is going to the man who sells the tickets. Private militia organizations: There are a number of these organiza- tions in most of the large cities; some of them worthy in themselves, but they have been used to further the interests of swindlers. Business men and others subscribe directly and indirectly to the support of these organizations, supposing that they are a part of the state militia, and are subject to call in case of riot or other public disturbance. The alleged representative of one of these private military companies col- lected $5,000 during the strike period of 1894 in Chicago, although the company was not in service at any time and was not subject to the call of the National Guard. Support more than sufficient: A man may open a mission, and start out to collect money for the support of the work. He is his own treasurer and bookkeeper, and is accountable to no church or other organization for the money placed in his hands. There have been cases in which these missions have collected and misappropriated money. Fictitious clubs and societies: Of these there are a hundred or more, and new ones with the most elaborate titles are springing up. A few smart men invent a name for a club, have i.ooo tickets printed, at a cost of $2.00, and they are ready to do business with the public. In some THE PRACTICE BUILDER 559 cases these men have been arrested with satchels full of tickets, and it has been shown that they have engaged no park for the proposed " picnic," and that they are the only members of the so-called " club; " yet it has been impossible to convict them. Fraudulent publications: There are solicitors who take money for phantom publications. One successful operator gets out fifteen books or " registers," each under a different title, but the only difference be- tween them is the cover. He has one book and fifteen different kinds of covers. This may or may not be fraud, but it is something that would interest advertisers. The advertising " certificate," regarding which warning is given, is a very smooth swindle: A solicitor calls on an advertiser, and by offering liberal terms, induces him to put an advertisement in his pub- lication. " Now," says the solicitor, " I want you to certify that you have taken this advertisement, and what the price is, so I can make my report to the publisher." The certificate is harmless. It reads : To THE Publishers : This is to certify : That the undersigned has this day Paid for advertising ordered inserted in the department of your pubHcation, edition of headings amounting to the sum of $ Dollars, as per contract shown payable after publication. Name, Collector, Street. Dist. Manager, 189— As shown in the illustration, this certificate can be cut in two pieces so that the right hand piece will read : This is to certify that the undersigned has this day ordered inserted in the edition of headings amounting to Dollars, payable after publication. Name, Collector, Street. Dist. Manager, i8q — 56o THE PRACTICE BUILDER The solicitor, in first filling out the certificate, places the amount in dollars to the left of the sheet so that it is cut off, leaving the space in front of the word " dollars " to be filled in with any amount. The signer has no duplicate of the original certificate. His signature is there. The guileless gentleman who comes in to collect on the con- tract knows nothing about the original agreement. And there you are. To THE Publishers. This is to certify : That the undersigned has this Paid for advertising day ordered inserted in the department of your publi- edition of headings amounting cation, to the sum of $ . _ Dollars. as per contract payable after publication. Collector. Name, Dist. Manager. 189 — _ Street. There are sharks and swindlers operating in the names of widows, old soldiers, and crippled brakemen. They give street addresses, and in(|uiry reveals the fact that in three-fourths of the cases the street numbers belong to vacant lots. One of the boldest swindlers was that of a man who started a manual training school, on paper, and collected money until he saw the jail yawning for him; then he adopted a more cautious plan, and leased a lot, and on that lot placed a corner-stone. This stone was the begin- ning of the St. Paul's Evangelist Methodist Church. He put the stone there as an evidence of good faith, to demonstrate that he meant busi- ness. He collected money on the strength of his sanctimonious manner and oily conversation. The corner-stone is still there. The St. Paul's Evangelist Church will not be constructed for some time, at least not until the self-sacrificing j\Ir. Lenox, late of Chicago, serves out his term in a Canadian penitentiary. It has been said, and there is a great deal of truth in it too, that half the people in the world live to swindle, and the other half live to be swindled. There is one thing to do that is alwavs safe; viz.: Not to give to THE PRACTICE BUILDER 561 beggars, no matter how urgent their appeals; ninety-nine times out of a hundred they are totally unworthy. Where a person asking aid is a resident of the town or city, and sufficient evidence of his worthiness is produced, it may be proper to help; but usually the only occupation of a beggar is begging. It is best to show at once that you have nothing to give. It sounds very pitiful, of course, to hear of seven small children, no work, a sick wife, and a broken leg; but when you stop and think that it is a lie, it is not so bad, after all. The variety of stories that are told would fill a book, and it may sometimes seem hard to keep from helping the applicants; but when you consider that they are making more money, by less work, than you are, you may understand your position in the matter. If a dentist were to stop and calculate how much money he gives away in a year to fakirs, etc., he would be very much surprised at the total. Refrain from subscribing to the hundred and one clap-trap schemes that are constantly being presented. In most instances you get no more for your money than if you bought from a dealer, and you run the chance of being swindled, or being caught by a contract which does not tell the whole story. So when a man comes in and shows you a prospectus of a beautifully illustrated book, in 278 parts, at so much per part; or has an advertising scheme that is going to do wonders, tell him you haven't the money nor the inclination to accept; and that if you had the money, your inclination would be to keep it. The Use and Abuse of Credit " He that dies pays all debts " Commercial credit is the name of that trust which is reposed in men because of their character and resources. It is an estimate of abihty, and of the disposition to fulfill business engagements; it confers pur- chasing power to command the industry or the capital of others. Credit is the opposite of money, for it pays nothing. Debt is a thing to be paid, and money is the thing that pays. But the value which at- taches to a person's word, the skill and experience he has acquired, and the relations he has established must surely be considered in some sense as capital. The man who buys with money uses the realized profits of the past. If he buys upon credit, he utilizes the present value of a future payment. He promises to pay a sum of money, and gives the creditors a right of action against him if he fails to pay; this is the legal basis of credit. If by the lapse of time, or by a bankrupt law, he is legally discharged, the obligation is not thereby extinguished. The creditor is merely denied the use of the law to enforce his claim. Credit neither creates nor destroys capital ; it merely transfers to the debtor the property of the creditor, and one is plus only as much as the other is viinus. Credit is a tax upon labor, because prices on credit are higher than for cash. Those who take credit, and pay, are charged to make up losses from those who take credit and do not pay. The good are the insurers of the bad, and cash discounts show the cost of credit; no one becomes bankrupt who does not owe; credit is, therefore, a cause of bankruptcy. Credit favors extravagance and speculation ; it is easy to risk money which has cost neither labor nor self-denial, but which is evidenced merely by a promise to pay hereafter. Social econo- 562 THE PRACTICE BUILDER 563 mists know that a family which buys its supphes on credit spends much more than if it pays cash. Credit stimulates demand and raises prices; yet it is often a bless- ing to the sick or unemployed workman, because it enables him to draw upon the future for his necessities. Credit pays capital for permitting itself to be employed in produc- tion, and transfers it from hands that cannot use it, to hands that can. It enables those who have industry, but no capital, to enjoy the ad- vantage of both, and to move commodities over the civilized world from producer to consumer. Without credit, the present business of the world could not be trans- acted; not all the gold ever taken from the earth could perform its service. It constructs railways, opens mines, improves farms, and builds houses; it is the soul of commerce, an agent and promoter of civiliza- tion wherever human energies can be exerted. Credit is the fruit of a settled condition, and was therefore unknown in the early stages of society. It has succeeded the primitive periods of barter, and appears only when the observance of contracts is enforced by public authority. Wise and beneficent credit follows the largest per- sonal liberty, but is opposed to every form of misrule and anarchy and flourishes best under the wing of Strong and secure government. It is estimated that from ninety to ninety-five per cent, of the world's present business is transacted upon credit. Daniel W^ebster declared that " credit has done more, a thousand times, to enrich na- tions, than all the mines of the world." Real, or metallic money, coined by public authority, is the standard measure of values ; and denotes itself an exchangeable value equal to that of the amount of labor required to mine and coin it. It is, therefore, not only a measurer or medium of exchange, but an object of exchange, like other products of labor and capital. It is this intrinsic property which insures absolute confidence in it, without which there is sure to be confusion and distress. One of the chief causes of the panic of 1893 was, that while gold and silver were equal in legal tender qualities, their relative value was unstable. The price of the thing, which is its trade or commercial value, may fluctuate according to demand and supply; money is also subject to 564 THE PRACTICE BUILDER constant oscillations between plenty and scarcity, but it is supposed to stand still while prices of other things move. As a gold dollar is a unit of value, we cannot think of it as worth more or less than a dollar. Its pulsations of commercial value are not registered in itself, but in the prices of staple commodities; increase their supply, and they become cheaper; increase the relative quantity of money and they tend to rise in price. If business stagnates, less money is needed; consequently it becomes more abundant, with an easy rate of interest which encour- ages enterprise and advancing prices. Perhaps the wealthy actually handle less money than the poorer classes, because they deal chiefly by credit. They exchange the title to money. They deposit checks in bank, and draw checks upon it. The principal function of the bank is to transfer credits from one account to another, and it neither receives nor pays out much cash relatively to the amount of its transactions. It has been said that the bulk of current money is used by those who are too poor or too little known to obtain or to utilize credit. Credit must rest upon some substantial foundation, some absolute stable measure and representation of value; and to furnish this is the function of money. Every debt implies a credit, and all the debts are equal to all the credits. If all those who apply to the dentist for credit had all the money they needed, and could pay for their work promptly, the financial aspects of the practice of dentistry would be vastly improved. Many have entered the profession in the last ten years, actuated by no other mo- tives than mere financial considerations, only to be gloriously unde- ceived after a few years of inside experience. Dentists, and professional men, generally, are recognized as being notoriously poor business men. Dentists, especially, throw heart and soul into an ambition to excel in the technic branches, and into a study of " ologies." This breeds a neglect of the business side of the question. This should not be, but it is. No matter how skilful a man may be, if he does not know how to turn his skill not alone into professional distinction, but into dollars and cents, he will be a failure in both, because both are necessary to personal advancement. Without the finance necessary for his aims his success is but a success of esteem; but with both financial and professional capital, the success is founded on a surer and more permanent basis. THE PRACTICE BUILDER 565 It would be difficult to determine whether the lack of financial abil- ity on the part of dentists is caused by intense application to the study of the great unsolved questions of dentistry, which begets indifference to the money side of the question, and dwarfs the commercial spirit, or whether those practitioners never had any commercial spirit, and sought dentistry as a means of further developing their scientific at- tainments. It is a fact patent to any one familiar with the emoluments of the profession, that a very large number of dentists reach old age without a competency such as should reward every man who has spent a lifetime in a vocation so exacting. Many of those who die have lived in straightened circumstances during the later years of their lives. Many once prominent in the pro- fession, have been in their later years taken care of by charitable in- stitutions, or in secret society homes. This is indeed a sad ending to a brilliant career, and all young men should look forward with the determination to evade such a one. It is a reminder of the necessity of making hay while the sun shines. The dentist's market value decreases, except in a few exceptional cases, as years advance; younger and more vigorous men are rapidly taking the places of those who, a short time since, were in possession of large and exclusive practices. This matter deserves most thoughtful consideration, because of the numerous in- stances of men who have reached three score years and ten, or even four score years, and who are compelled to continue in active practice when they should be able to pass the sunset of life in the enjoyment of the fruits of their years of toil. This subject is of vital interest to every dentist in the world. A man who has worked all his life in the service of humanity should be able, when old age comes, to pass the remainder of his days in ease; the service which dentistry does for the human family should entitle its members to this. To see an old man toiling day by day at the nerve-racking operation of filling teeth, after having be- come the victim of all the infirmities of age, is a pitiable sight. These serve as lessons to all young men entering the profession, and a careful consideration of the matter at the very beginning of their careers may prove of much benefit. It is well for the young practitioner to remember that all of dentistry does not consist in knowing how to do the great variety of operations which he may be called upon to per- 566 THE PRACTICE BUILDER form, — to fill teeth beautiluUy. to treat diseased conditions with suc- cess, and to put on artificial crowns and bridges. A close attention, as well, to the most minute details of the practice is absolutely necessary in order to secure the benefits of our toil, and this is but supplementary to the operative skill, the mechanical abilit\-, or the mental attainments. This .may be distasteful to the man of high professional attainments who loves to spend his time in the investigation of the tissues, or in any one of the various lines of study that invite the attention of the student; but the conditions of the time demand that attention be given to these things; we live in a commercial age; no calling or profession can ignore this side of the question. It is absolutely necessary to conduct a practice upon business prin- ciples from the very beginning, especially if one enters practice where he is not acquainted with the business reputation of those who first be- come his patrons. The business methods of nearly all professional men. including den- tists, are altogether too loose; and this lack of attention is becoming more prevalent. In order to meet his own obligations promptly, and thus to maintain his credit, it is incumbent upon him to collect his out- standing accounts promptly when they become due; and he must allow no sentimental consideration to stand in the way. It is necessary for a dentist to maintain his credit inviolable; and to do this he must seldom ask for credit, and in so refraining from asking, he soon attains a repu- tation for probity and honor which begets confidence. In the system of rendering his accounts the dentist must be governed to some extent by the custom which prevails in his locality; but where this custom is unbusinesslike it will be necessary for him to establish more effective means in order to maintain his position as a dentist who is not in practice for love or pleasure. A bill should be rendered not later than the first of the month following the completion of the work ; and when the work is completed on the last of the month this should not in the least afTect the time. He should make his patrons realize that his practice is conducted on business principles; and no sensible patron will take ofifense at the prompt rendering of a bill when it is known that it is a business rule of the practice, and that all are treated alike, irre- spective of condition or creed. THE PRACTICE BUILDER i6^ There are many reasons why an account should be rendered promptly. When allowed to run a long time, people pay it with great reluctance. This is not only true in a general business, but it is par- ticularly true of dentistry. The value of the work lessens in the patient's mind, as the account grows in age. He is impressed with the worth of the work immediately it is completed, and for a short time thereafter, especially if the operation was a tedious one, requiring great skill and patience; and he has no objection to paying a reasonable fee then, whereas, if the bill were allowed to run, he would consider it large in proportion to the time that had passed. When the patient has had several sittings, which have tried him as thoroughly as they have tried the operator, he comprehends fully the amount of time, labor, and edu- cated skill necessary to the performance of any given operation. This is likely to be forgotten when the dentist neglects to send the bill for some time, and the bill is then apt to be considered excessive. There is no valid reason why a dentist should give credit, and there should be no excuse for asking him to do so. There is, in fact, less reason why a dentist should give credit, than for one in any other line of work, pro- fessional or otherwise. The very nature of his duties, and of the ma- terials which he employs, are such that large credits are obstacles to financial success, and consequently to professional success. The den- tist's work requires the use of large quantities of gold and silver, and ex- pensive materials of every class, and many dealers make it a rule to sell gold and silver for cash only, or to send notices to dentists ordering these metals that no time is allowed on the purchase. There is scarcely an operation performed in dentistry into which the use of these metals does not enter largely; so it is readily seen that in extending credit a dentist is giving time on something for which he himself must pay, whether the patient does or not. If the patient does not pay, the dentist loses his time, and is also paying for the privilege of putting gold and silver into the patient's teeth. If the amount of the accounts that are not collectable by dentists were added together for one year, the sum total would be an amount sufficient to found a home that would keep old and indigent dentists, in a manner equal to their position, for the remainder of their natural lives. This is a serious matter — this one of giving credit — and the 568 THE PRACIICE BUILDER sooner the present custom of extending credit indiscriminately is abolished, the better it will be for the dentist and for the paying class of patronage. A man who loses little or nothing each year will become a better dentist, and he will enter into his work with greater satisfaction to him- self and to his clients. Being known as liberal in granting credits, tends to promote losses by bad debts, and to saddle undesiral)le patrons upon a practice. As a rule, the dentist who enforces pronii)t pa\-ment is the more respected, and he loses little, if any, good patronage by it. There are, of course, times and cases when it is humane and ex- pedient to show forbearance to a dilatory debtor; but the account that is perpetually in arrears, and can never be brought to a balance merits little consideration, and is a good one to throw overboard. It is clients of this kind who avoid the patient and confiding dentist whom they owe, and sneak into other dental ofifices and pay cash for their work. When a dentist begins practice in a locality that is strange to him, as is the case with a great majority of young practitioners, he is likely to encounter more or less of the class of people who do not care to pay for their work, or for anything else. To this class the new dentist is just the easy mark they have been looking for. Before he came they had patronized every other office in town, and had been dunned and dunned until the dentist and his collector gave up in weariness and disgust. The new dentist thinks he is getting along nicely, because he is getting patronage from the very start; but in after years he realizes that the dead-beats come without invitation, and the really desirable class are won by reason of superior merit ; they do not come at first, sometimes it is two or three years before they decide to change. To know to whom to give credit, and who to refuse is a matter which requires a keen insight into human nature and a peculiar ability to read character from the face of the individual. Nearly every one has some idea of an honest face and of one that is crafty and dishonest, and such knowledge stands one in good stead in a profession wdiere one is brought into constant contact with hundreds of personalities. It is not always easy to tell which of those who first patronize a den- tist are of the class usually denominated " dead-beats; " but before one has been a resident in his city long he will find out by hearsay. If he is THE PRACTICE BUILDER 569 wise, he will quietly take counsel with some friend, and thus will be told the names of those who do not pay for anything; when these individuals apply for services he can indicate that his terms are cash upon comple- tion of the work. We strongly advise the use of appointment cards in the beginning of practice, which are got up in the form here shown: Appointment with Dr. A. B. Blank .o'clock In this office the cash system has been adopted. Payment required at the end of each appointment. Bad debts are thus avoided, for which the paying class do not have to settle. Giving an appointment card of this kind to persons who are notori- ous for not paying their just debts, will at least set them to thinking; and when the first appointment is finished, a courteous and expectant attitude just at the right moment will often suffice to cause the patient to make a voluntary statement with reference to the payment for the work. " How much will it be, Doctor? " The dentist replies, stating the amount. " Shall I pay now, or wait until the work is all done? " " It is customary for me to collect the amount of each appointment, as I do not keep any book accounts." " I didn't think to bring my pocket-book with me, as I did not know your rules. Well, I am to come Thursday, am I?" " Yes." "All right, I'll be here Thursday at nine o'clock. Good morning Doctor." When one evades the moment of paying at the conclusion of an ap- 5;o THE PRACTICE BUILDER pointment, especially when it is stipulated on the appointment card that the terms are cash, the dentist knows that the patient is deliberately prevaricating; and unless he has positive evidence to the contrary, he may know that he belongs to the non-paying class and should at once make inquiry. Upon confirmation of his suspicions he should write to the person, if the work is of an expensive character, requiring sev- eral appointments, or if it demands the use of much gold, as follows: Mrs. J. Smith, Dear Madam: As indicated on my appointment cards, my terms are cash at the conclusion of each appointment. It will not be convenient for me to fulfill my engagement for next Thursday until the last one is paid for, bill for which is herewith enclosed. Yours truly, A. B. Blank. We do not advise the use of these letters where the dentist is likely to be mistaken ; but he must use them without the slightest hesitation when he knows the person to be of the " dead-beat " class, for he will never be able to collect one cent if he finishes the work. He has noth- ing to lose by sending the letter, and he has nothing to gain by having such patrons; for their influence is worth nothing to him, because they liave none, and if he keeps them on his books and attempts to collect the account they will tell people that his work is not good, and in every way attempt to damage his reputation. It would be much better to keep them quiet than to have them making disparaging statements. Another manner of avoiding payment when work is completed is as follows: The patient about to depart after the work is finished, says: '"' I'll be up in a few days and settle for this. Doctor." A few days is rather indefinite, it may be meant to express either two or three days, or it may mean a month. A dentist should always be ready for such things; he should always have a ready tongue for these people. If they endeavor to evade pay- ment in such a manner, the dentist should not hesitate to checkmate them. He should say promptly, and without the slightest show of timidity, " My terms are cash at the close of appointments, and if it is convenient for you I should appreciate payment, as I do not keep any book accounts." If the person still evades payment with an excuse, THE PRACTICE BUILDER 571 a bill should be sent not later than the second day thereafter, and if the person fails to pay attention to it, one after another of the forms for let- ters which appear in this chapter should be sent at short periods, and the account finally placed in the collector's hands, as indicated farther on. If the person calls and pays and indicates his displeasure at your sending notices, give him to understand that you conduct your practice on simple business principles; that you aim to give your patrons your best services, and that to do so you must receive that evidence of ap- preciation which is accompanied by prompt payment, as that is the least a patron can do. If he becomes angry, tell him that it is not usually necessary for you to employ such methods, as your practice, being com- posed of the better class of citizens, is such that you are rarely called upon to do any dunning; and that money does not do you any good while it is owing to you. State that the patron has your time, work and material, and that you have nothing in return for it, and that it is not necessary for those who do not conform to your rules to patronize you. You are a young man, just starting out, and you cannot afford to have any undesirable patrons. You must be dignified and firm in your statements and show that you do not fear the loss of his patronage. Sometimes a lady, after having had work performed will say: " J\Ir. Smith will call and settle for this." She will say this, even after you have been given the impression that the work will be paid for on com- pletion. There is but one thing to do in these cases. You have been deliberately deceived, and must take prompt action to secure the ac- count. You should show^ your displeasure at such methods by send- ing the bill the same day, accompanied by one of the letter forms shown in the pages which follow. A practice must be kept free from the ag- gravations which this class of patronage causes. The sooner a dentist gets a reputation for prompt action with these people, the better it will be for him. If he is not firm in ridding himself of them he will soon find that it gets whispered about that he is easy, and they all gravitate toward him. While he is doing work for such people they will make him believe, or think they make him believe, which is just the same so far as their purpose is concerned, that they consider him such a superior dentist and that they are so pleased with their work. After the work is finished and the dentist sends his bills and endeavors to procure pay- ment, he finds that the tune has changed. 572 THE PRACTICE BUILDER Instead of being such a skilful dentist, he is referred to as a poor workman; his work is said to be very unsatisfactory, and his charges exorbitant. In this way more harm is done to the dentist than if he had never seen the patient at all. If the dentist knows these persons when they present themselves to him for an r-ipointment, he will save himself a great deal of unnecessary work and the cost of the material by stating that his appointment book is filled up close for two months ahead and that it will be impossible for him to do the work before that time. If they do not see the point he can tell them the same story when they ap- ply again, and he will not be troubled with them any more. This is just where some dentists make their mistake; they think it is the proper thing to always be busy, and do not look far enough ahead to see that the}', instead of the patient, may be paying for the work and material. This is very poor judgment; it would be much better not to work at all than to work for some one who is not going to pay. There is no glory in working for the mere sake of appearing busy. Every dentist knows that the occupation of a person has something to do with his credit; that is to say, persons in certain businesses and pursuits are recognized as worthy of credit. Those who, for instance, practice in rural communities, know that it is usually safe to extend credit to farmers. While their requirements in the matter of dental service call for the simpler operations and the use of the least expensive materials, they are usually ready with their cash when the work is done; and if they state that they would like a little time in which to pay. they will speak about it before the work is begun. But where plate work is to be done, we most emphatically advise the practitioner to be cautious in giving credit. The collection of accounts for plate work is the most diflficult of all. \\"hen a dentist makes a plate, and receives his pay for it, he hears little if anything of it, one way or another; but if he allows the person to wear it without having paid, he will have trouble in collecting his bill. The patient will complain that it hurts; that it feels loose; that the teeth are too long, and too short; too broad, and too narrow; too dark, and too white; too thin, and too thick; that they can't bite a hatchet, as Mrs. Jones can. It is better to state plainly but firmly that you will THE PRACTICE BUILDER. 573 not, under any circumstances, permit a set of teeth to leave your office until they are paid for in full; state to the patient that you cannot do it, that to do so would invite your ruin, that you are engaged in a pro- fession and that your work is not like a business where the proprietor has capital, for you have none. State that you cannot make a practice of ■extending credit, as it would only take a few sets to amount to a hun- dred dollars, and you cannot afford to have accounts standing out as you have to pay for the material yourself; that the dealers do not allow you time, and consequently you cannot do so, no matter how much you w^ould like to favor any one. If you are convinced that the person in- tends to pay, it is proper to have him sign the combined note and bill form which is illustrated in this chapter. Saloon-keepers, and men engaged in work that is not enviable, will usually be found reliable and prompt in payment; in fact they seldom ask for credit, and when they do will pay more promiptly than some long-faced sanctimonious and parsimonious persons. Ministers, when settling their accounts, will sometimes ask if you allow the usual discounts to clergymen. Look them squarely in the face and say: " I try to do just as good work for ministers as I do for anyone, for which I charge a similar fee with no discount. If the work is worth anything at all, it is worth just what I ask for it and not one cent less/' If you intend to have a sliding scale of fees you may as well give up all hope of ever receiving a proper appreciation for your work. Occasionally persons will apply for work and state that they are artists, or that they are engaged in this or that work, or have a store, and they would like to have the dentist take some of their work, in part pay- ment, or take a portion of the bill out in trade. If the dentist does this he is foolish; it is not only unnecessary for him to do it, but if he does the transaction will result in dissatisfaction to the patron and to him- self. If he does the work and renders his bill for it, stating that so much is cash and the balance to be in work or goods, the patient is more than likely to claim that he understood the dentist was to take the entire bill out in exchange, and an unpleasant argument may ensue. Where the patient is a merchant there is no satisfaction in this sort of dealing. We know of dentists who do it ; but when the bills are rendered the amounts are put up, to forestall the merchant; then the merchant tacks onto the 574 THE PRACTICE BUILDER bill to get even, and so on until they give up the plan, which they will certainly do, if they are sensible business men. When this subject is broached it is best for the dentist to say that it is not customary for him to do work on those conditions, and that he is rarely if ever requested to do so. He should state that his practice is composed of a class representing the more prominent citizens, and that his time is always engaged ahead, and for these reasons it is not neces- sary for him to do work on such conditions; but that, if he had some open time on his hands, and did not have anything else to do he would be glad to accommodate the person; but that not being the case at present, he does not think he can do it. He should know, however, that these persons come to him probably because they believe him to be the most skilful dentist, or one of the most skilful, and if he is tactful he can manage to avoid doing the work on the lines suggested by the patient and yet will secure it anyway. Sometimes a man will say, when his work is finished: " Well, Doc- tor, when you want anything in my line come in and see me and we'll just let this go until you want something." You must be ready for these people. Answer right back: "All right; when I want something in your line I'll drop in, but I'll have the cash ready in my hand to pay for it when I get it." If he laughs it off, send him a bill in a few days, just as if you had never heard what he said about your calling in. In every town there are some men who have everything in their wives' names. These men are usually unreliable; and when the dentist knows this beforehand he should never undertake to perform a line of work that requires cither time or material of an expensive nature, but should state plainly before beginning the work just what the expense is likely to be and what his terms are for payment; these people will in- variably attempt to avoid payment ; we have never known it to fail ; it makes no difference even if they do mingle in the best society, that they wear the most stylish clothes, or that they attend the most fashionable church. The bill must be sent within two days after the work is com- pleted, if they have not settled when the work is done; and even if they pay part and say that they will pay the rest " in a few days," you must give no attention to the promise but send a bill for the balance, and if THE PRACTICE BUILDER 575 prompt payment is not made send it again within a week. This shows them that you mean business, and that you are familiar with their tac- tics. Let no sentiment interfere with this matter. You are not working for the mere sake of packing gold into the cavities of any one's teeth, and you need not care whether these people like your methods, or not. To collect your account is your only purpose, and if they do not like your style they can go somewhere else. They are of no benefit to your prac- tice, and to let them know that you are firm in your demands for pay- ment will protect you from having large accounts against them on your books. If your practice is already good, numbering among your patrons some of the more prominent citizens, you need not fear losing the patronage of those persons who owe you: they will not care to be known as patronizing another dentist, because some one may casualty mention the fact to you, which would bring out an explanation; and they would prefer to continue with you rather than to allow it to become known that they were dismissed because they did not pay for their work. When you are cognizant of the fact that the property is all in the wife's name, and the husband does not respond after you have sent the bill, send a second bill to his wife. If the cash is not forthcoming in ten days, address one of the letter forms to her personally; and if payment is not made within a reasonable time, which should not exceed one month, place the account in the hands of a collector as suggested in this chapter. When a servant girl applies for work, and the bill will amount to over ten dollars, you should find out by whom she is employed; this need not be done directly, but can be ascertained when making the examination and putting the address down on the examination blank; and reference to the directory will show who the employer is when the patient does not volunteer the information. The appointment card should be sufficient to convey to the patient the fact that payment is ex- pected when the work is done; and if no mention of payment is made by her when an approximate estimate of the cost is given, the operator may proceed with the work, and if payment is not made when com- pleted the bill should be sent promptly to the address; if no attention is given to it, the bill should then be sent to the employer, with a note ex- plaining that the account has been sent to the servant, without response; that you gave credit because of the well-known reliability of the em- 576 THE PRACTICE BUILDER plover, and that you would greatly appreciate prompt payment or a satisfactory explanation from the servant. If payment is not forthcom- ing, place the account in the hands of a collector as suggested, after hav- ing sent the letters as shown in the forms given. When you do work for a physician, or for any member of his family, and no reference is made to the settlement of the account, the work should be completed, and, if you know the physician to be short of money, do not push the account; send a bill once or twice, but do not use any of the special forms except the first card, and you should not continue to send the bill, it being suflficient to let him know what the amount is. The influence of physicians is very valuable to dentists; not that they may send him patrons, as physicians cannot openly re- commend persons to go to any particular dentist, but may, by references and complimentary remarks indicate a preference; and these, from a person engaged in the healing art, are most valuable commendations. Wait until the physician gets ready to pay, and do not show by your actions or words that you think anything about the bill; if he speaks to you about it, say: '' Aly dear Doctor, that account doesn't worry me, and 1 don't want you to let it worry you." This is tact. You may need a friend some day and this one may stand you in good stead. Influence is a wonderful factor in professional success. Get all of it you can. You cainiot have too much. You can use it all. Even if you allow the doctor's account to run over a year or more, always bear in mind to keep on good terms with him and he will eventually be the cause of your receiving enough extra patronage to more than make up for the amount of his bill. There is another class of patronage somewhat similar to that of the physician. It is that of the prominent citizen who is perpetually short of money. He is a jolly good fellow and numbers every man, woman, and child in the town among his friends; he knows everybody and everybody knows him. He circulates among the very best people in the town, and when he speaks a good word for anyone it is remembered. If he comes to your office to have work done, do it; no matter how ex- pensive it is, do it, and do it promptly: send the bill once or twice but do not attempt to hurry the collection. He will come to you, and will send his family to you, because he thinks you are the best dentist; you THE PRACTICE BUILDER 577 can have no greater compliment than his patronage. For him to be seen in your office is one of the best advertisements you can have; it will add to your professional reputation to have the members of his family for your patrons, and to have it known that you are patronized by this class. They will always speak in the warmest terms, provided they are satisfied with your work; and their commendations are always made in quarters and to persons that form the most desirable clients. Let them pay when they get ready, and if they take two or three years in doing it, don't worry. You will be more than repaid by their good will and by the hearty outspoken favorable comments upon you and your work. A man must use sense and judgment in all things, and he must surely realize that the influence of such patrons is worth a great deal. Another class, and the most aggravating that a dentist can have any- thing to do with, consists of those who were born and reared in poverty and who have, by usury and other close practices, attained a comfort- able position in life and yet continue to exercise their close-fisted prac- tices. When they call to have work done they will show the cloven foot right on the start. You will find out that your client has a bump of acquisitiveness about the size of a goose egg; also, the bumps of combativeness and firmness are very well developed. The gentleman will introduce his wife to you, and state that he wants you to do whatever work may be necessary, and that when the work is right he will pay for it. He will say, perhaps, that he has never been satisfied with the work done by other dentists, and that he wants you to undertake this work and warrant satisfaction; and when he is satisfied that the work is all right he will pa:y you, and he may even go so far as to say that if it is not satisfactory or does not suit him he will not pay for it. Right here the dentist must show that his bumps of self-esteem and firmness are just as prominent as those of the prospective patient. He will state, in the first place, that he is a professional man; that he is a professional man by having given time, money, and earnest study to his work; that he has nothing to sell, but that his professional services are for hire, for which, when rendered, he expects to be paid; that his prac- tice is composed altogether of persons of the better sort and that he has never been called upon to warrant his ability to do this or that particular 578 THE PRACTICE BUILDER thing. State that a profession is different from a business; that when a man buys something at a store he can return it and get his money, but when he appHes to a lawyer for advice, or to a physician for a prescrip- tion, or to a dentist for services he must pay for them, whether those services meet his approval or not ; and that a dentist must be remuner- ated after having given those services, together with the expensive materials entering into the work demanded. Explain that it is cus- tomary for the dentist to do the very best that is in him, and that it will be necessary for his patient to accept the same conditions that other- patrons do, viz.: prompt payment in full immediately the work is com- pleted, which means as soon as the plate, bridge, or filling may be in- serted. These grasping people must be treated in just this manner, abso- lutely without regard to their social or financial position ; and this un- derstanding must be had on the start, and not after the work is done. Sometimes they are so small that they will send a check for an amount that does not wholly liquidate the bill, and will write on the face of it in ink, " Payment in full to — " (whatever the date may be). The dentist should call personally, or send a letter stating that the amount is not ac- ceptable in full liquidation, and that inasmuch as the work was per- formed promptly and according to your best skill you demand full pay- ment; and that the person is at liberty to seek his dental services else- where in the future, as you do not care to be bothered with such patrons. You may think that we advise an air of independence in these mat- ters that is too firm, and that it would not be policy for a young man to use such measures; but they are just the measures the young man must use, and the very ones that will command respect from these people and save him much unnecessary work and trouble. Deficiency in this re- spect renders a man too humble, and the people take him at his own estimation; if he lacks firmness, he is imposed upon time after time, and having no confidence in himself, no one else will have any in him. A knowledge of temperaments is a very great aid in studying the varying types that present themselves to the attention of a dentist. It helps to determine whether you should use persuasive methods, or if it is better to use their own tactics to collect an account. It is w^ell to let THE PRACTICE BUILDER 579 these grasping people know that you don't care how public the matter becomes, because you are in the right and cannot be damaged by the publicity. When sending out a bill for the first time to a patron enclose it with a card like the one shown : From and after this date my practice will be conducted upon the usual business principles, which require monthly settlements of all accounts. A. B. BLANK Smithton, Ohio Jan. 1, 1898 This card should be printed on the very best quality of bristol board, in black ink, and the card should measure about five by three inches. Once is sufficient to let them know that you expect prompt payment when the work is completed. It is not necessary to again call attention to the matter unless a year or more elapses before more work is done. If the person is known to have good credit, but is not prompt in pay- ment and does not respond to the bill, at the beginning of the second month after the work is completed the following letter should be sent: John Smith, Dear Sir: Large obligations, which must soon be met, make it necessary for me to request the settlement of all accounts. Trusting it will be convenient for you to pay, I am, with much respect. Yours truly, A. B. Blank. 58o THE PRACTICE BUILDER Usually persons of good intentions will respontl to this letter without much delay. The bill should be sent for one or two months without card or letter, but the best plan is to send twice or three times during the month, on the tenth and twentieth, besides the tirst. This is just and proper, and it is just exactly what is done by methodical business men. A dentist has just as much reason to be methodical in the collec- tion of his accounts as any other business man. When no attention is paid to either letters or bills, or to the card just shown, it is proper to enclose the card printed according to the form here shown : Notice As indicated upon the cards that accompany bills, it is customary to render bills at the end of month following com- pletion of operations, prompt payment of which is expected. We trust you will give this your early attention, thus saving the expense of collection. Respectfully, A. B. BLANK This card should be the same size as the one already shown, printed on the same high quality of white bristol, in black ink, using De Vinne, Ronaldson, Elzivir, Gushing, Jenson, or Roman type. Where the dentist has a boy assistant, or a girl assistant, it is proper to send either to collect the bills after they have been sent by mail once or twice. Prompt payment is thus secured, because many neglect to send money in payment of bills, who will pay at once w-hen the assistant calls personally. Where no assistant is employed, and the debtor per- THE PRACTICE BUILDER 581 sistently refuses to pay attention to notices and letters, the following note should be mailed: John Smith, Dear Sir: I attended promptly to your work, and I ask a return of courtesy. Respectfully, A. B. Blank. This letter makes John a little bit ashamed of himself, and he is likely to pay at once and apologize for his backwardness in coming forward. Another form which is very effective is the following: John Smith, Dear Sir: I shall have special need for an amount of money on the 15th inst., and I should consider it a favor if you will oblige me with the amount of your account before that date. Yours truly, A. B. Bl.ank. Such a request courteously made will cause any fair-minded person to exert himself in your behalf, and he will endeavor to have the amount ready. Another effective manner of rendering bills is to make out the second bill with the same date as the first and mark it " duplicate,'' or •" 26. bill," " 3d bill," " 4th bill," and so on, always keeping the first date on, which impresses the debtor with the age of the account. To those who habitually throw bills aside when sent, it is proper, at a time when you have an especial expense to meet, to drop a note stat- ing that you will need funds on a certain date, and give your reasons for making so pressing a request. With a delinquent, use the phrase " Amount now on the books, $ — ;"' or "Balance still on the books S — ," on the bill, and enclose a brief note stating that his account is greatly overdue, or that it is now the oldest account on the books, and ask him to oblige you by calling and settling. This will induce him to call and make an explanation, or to pay a portion of the bill which otherwise might remain unpaid for months. It is best not to itemize accounts, but put in the amount of the bill without items ; but of course have the items on day book and ledger so that thev mav readilv be referred to if necessary. When you have 582 THE PRACTICE BUILDER rendered a bill to a grasping person, and he sends you a check that does not fully liquidate the account, write as follows: John Smith, Dear Sir: I am in receipt of your check for $ . This amount is not acceptable to me in full liquidation of your account. The bill as submitted by me is reasonable and just, and I have afforded you ample time for its consideration. I ask simply that you accord me the same treatment I extended you. Very respectfully, A. B. Blank. You must remember that business is business, and should always be regarded as such. You must be clothed and fed, and must support those dependent upon you, just as other people do. Let no false deli- cacy or politeness break up the business part of your profession, or in- terfere with money matters, or prevent your knowing where sentiment ends and business begins. The practice of dentistry is the work of your life; it is as honest, useful, and legitimate a branch of human industry as any on the face of the globe, and no one earns his living more fairly, nor often more dearly, than the hard-working dentist; and both common sense and vital neces- sity require that you should try to provide properly for yourself and for those dependent on your labors for their support. This you cannot do unless you have a business system, for upon system depends both your professional and financial success. Xo man is at his best when handicapped by poverty, and no one can practice dentistry with clearness and effect if his mind and spirits be depressed by the debts he owes, and those that others owe him. The grocer, the tailor, the dental dealer, all must be paid. Wrinkled purses make wrinkled faces. If you do not send your bills promptly, people will think you do not believe in prompt collecting, or that you do not depend altogether on your practice for support, or that you do not need the money nearly so much as they do; consequently they will be more careful than you have been. The nearer your financial arrangements approach the cash sys- tem, the better it will be for yourself and family. It is wise to have " Folio — " on your bill heads, and to insert the THE PRACTICE BUILDER 583 number of ledger page in the blank, to show the patient that it is on the books and that you see the account often. If you do not look after accounts while they are still young you may be glad to take a good deal less in settlement, and to do this weakens your claim. Many patients will quit employing you to escape an old claim, and then to hide from their surprised neighbors the true cause, will trump up some falsehood and give you a bad name to prevent others from employing you and thereby possibly learning the true reason for their change. Before you have practiced long you will find that your welfare will depend not upon how much you book, but upon how much you collect; and that if you never insist upon the payment of your fees you can never separate the wheat from the chaff. When patients ask how much their bills are, or how much they are indebted for this or that service, always reply with courteous prompt- ness and decision " five dollars," or " ten dollars," or " fifty cents," or whatever else the amount may be, large or small; and if you are careful to avoid prefacing or following this reply with other words, most people •will in the embarrassment of the moment proceed to pay without objec- tion ; whereas if you add more words it will weaken your claim in their minds, or impress them with the belief that you have no settled charge, .and will furnish them with a pretext to show surprise or contend for a reduction. When one does demur at the amount, show your amaze- ment and be prepared at once to defend or explain the justice of the ■charge. Take your fees for honest services whenever tendered. Patients will often ask: " Doctor, when shall I pay you? " or " Shall I pay you now?" A good plan is to answer promptly: "Well, I take money whenever I can get it; if you have it you may pay it now, as it will leave no bones to pick;" or, "Short payments make long friends;" or, " Prompt pay is double pay, and causes the dentist to think more of his patients," or something to that efifect. Never give such answers as, " Oh, any time will do," or " It makes no difference when," or you will soon find it to be very expensive modesty. Patients will occasionally dispute the correctness or justness of your charges. If a bill is not correct, correct it at once, and willingly, with such an expression of regret at the error as may be judicious; if. 584 THE PRACTIC£ BUILDER however, it be correct and just, do not allow yourself to be brow-bcatcn into the position that it is otherwise; when payment is made on an ac- count always insist on giving a receipt, but never under any circum- stances give a receipt before you have the cash in your hand. Do not give a receipted bill as a compliment to a minister, or to anyone else, because if you do they can delay payment as long as they please. It makes no difference how much confidence you have in anyone's hon- esty, it is not business and it is not sense. Here is a trick that has been played with a receipt: the work having been completed, the patient says: " Make out my bill, Doctor, and I'll pay you. You make out the bill and receipt it, expecting payment, and he will walk out, saying: " I'll call in this afternoon with the money." Having received the receipted bill, he can call in when he gets good and ready. Therefore, when you are asked to make out a bill, do so, and hand it to the person, saying: " Fifteen dollars, please," and don't say a word before or after these words. If he pays you say, " Just hand me the bill a moment, please, and I will receipt it," but if he says " I'll call in an hour and pay you," he holds no receipt and you have nothing to worry about. If you have given a receipted bill before payment, and think it pos- sible he intends to keep the receipt as evidence of payment, write a letter inclosing a bill for a larger amount ; as, for instance, if you gave a receipted bill for fifteen dollars, send one for twenty dollars, not men- tioning the fact that the other was fifteen dollars, and the debtor will immediately call your attention to the fact that the amount should be fifteen dollars. Of course you will mention in the letter that you in- advertently gave a receipt; then, when the statement is made that the amount should be fifteen dollars, you can hold that as evidence that the bill is not paid. When you are in dispute about an account, or when a patron re- fuses to pay you for your work and you have in mind the purpose of suing him, consider well both his own and your side of the question before putting the matter in the hands of an attorney. It will seldom pay you to sue people, even though your suits be successful; it is, gen- erally speaking, undesirable to begin litigation to enforce your claims, THE PRACTICE BUILDER 585 except under very aggravating circumstances or to maintain your repu- tation and self respect. Professional men, whether physicians or den- tists, who go to law frequently to recover fees generally lose more in the end than they recover, because prejudice is excited and enemies of the most active kind made. Honest poverty should not be pursued in the courts. When a person pays all of an account but ten or fifteen dollars, or when a check is sent which does not fully liquidate the bill, and you have sent the letters as suggested in this article, it is best to put your pride in your pocket, no matter how aggravating the circumstances; unless the person is contemptible and notoriously grasping, when, if you have a strong case, sue him, and, if necessary, carry the case up. You can find out if your case is sustained by reference to " Rehfuss's Dental Jurisprudence," wherein cases of every possible nature are fully cited. In the selection of an attorney for the collection of accounts it is well to remember that your consulting attorney is not the person for these duties, because his interest lies in the favorable influence and friendly feeling of the general public; to render accounts to your pa- tients would likely be hurtful to his professional and business interests; few attorneys ca;"e to engage in collecting home accounts, as their politi- cal aspirations or professional practice may be affected by the ill-feel- ing engendered because of prodding habitual delinquents. Select some- one whose specialty is collecting. A good, honest collector, one who possesses judgment and sufficient tact to wake up hard customers, and get money on an easy installment or other plan from reluctant and dilatory debtors without irritating them and converting them into active enemies, will be found very useful, and quite necessary if you be too tender or too high-spirited to allow a direct transfer of remuneration from old friends or refined patients, or if you have no time or are an indifferent collector yourself. Having only business transactions with patients, his interviews with them are business exclusively and he can persevere in his efforts to collect to a degree that you would find un- pleasant and humiliating. Many thoroughly honest people are too poor to pay honest bills, and if you allowed their accounts to accumu- late they would be unable to pay the whole, even if they wished; con- 586 THE PRACTICE BUILDER sequently you would place them in a position of embarrassment. Hav- ing a collector prevents this and keeps one's financial department in a healthy condition. It also tends to stimulate those who are habitually slow of payment, and at the same time sifts out undesirable patients and erases their names from your list before they run their bills very high. Most collectors have specific arrangements under which they en- gage to collect accounts, charging usually ten per cent, of the amount; where great difficulty has been had in collecting from particularly no- « torious customers, they sometimes receive more than ten per cent. If dentists would furnish each other with blacklists, containing the names of all those indebted to them who have by their actions shown themselves unworthy of credit, they would be mutually benefited, and would save many hours' labor and a good many dollars' worth of mate- rial. A scheme recently placed in operation, and of which we believe there are two or three representatives, is that which protects business and professional men from persons who make a business of leaving one store as soon as their credit is gone, and running an account with an- other house. One of these corporations is called The Interstate Collec- tion Agency and Information Bureau, and the other The American Collection Agency. These incorporations engage to give information as to the reliabil- ity of any person, by means of lists carefully revised at short intervals; it is only necessary to look over the list and find if the name of the applicant is there, and if he is said to be indebted to half a dozen busi- ness men and one or more dentists or physicians, an explanation is in order. The cost of these arrangements is about fifteen dollars per year, and the charge for collection of the bad accounts is twenty-five per cent. These persons, having no other business but collecting, it is fair to pre- sume that they do it properly. The fear that their names will be given publicity by these lists will keep many persons from holding back what they know to be the dentist's rightful dues. When a person has had a line of work done and you know nothing about either his ability or intentions to pay, and he has said nothing about the fee or whether or not he would be ready to pay when the work is completed, but waits until about to leave the ofiBce before men- THE PRACTICE BUILDER 587 o o H X H in c « f ^ § CD > f- ^i^ ti^ t^ se 'ij rJ c 5^ ?3 ^ 6^ ^ ^ ^ ^> ag down the bot- n came in sight of •ith. There was a the hilltops, across ng through, ilong I saw where lad idled away the he short grass or great wall. I now and when within mouth of the can- i\)t 200 yards away side of the valley tly for perhaps 50 after the manner elk was standing a sentry at a dun- a fine view of him 1st the sunlit slope IS resembling the He seemed to be larticular, but just nteresting to turn - close at hand. .e deep gloom, at , I levelled the targets. But it ,. ves and deepen- jermit me to get a nake a sure thing must reach a low ad, and over which t as much as pos- spmewhat on the TO EXCHANGE— A reputable den- tist will exchange high-grade dental work for first-class tailoring. Address " Dentos," Tribune Office. TO EXCHANGE— Dentist will ex- change dental work for piano. Ad- dress X. Y. Z., Herald Office. TO EXCHANGE— Downtown dentist .will exchange best dental work for a good typewriter. Address H., 207 Rec- ord Office. TO EXCHANGE— Dentist will ex- change his services for a high-grade bicycle of this year's pattern. Address offers to M., 187 Enquirer Office. TO EXCHANGE— Dentist will per- form high-grade work in exchange for real estate. Address O. P. H.. Rec- ord Office. TO EXCHANGE— Reputable practi- tioner in dentistry will insert best bridge work for oil painting. Address P. O. Box 227, City. TO EXCHANGE— A dentist will ex- change a due bill, good for $150, for carpeting, painting, and wall papering. Dentist O. K., Herald Office. TO EXCHANGE— A due bill for $100 worth of dental work, at the office of a reputable, high-class dentist, to ex- change for tailoring, dressmaking, or will sell for $80 cash. A., 22 Tribune Office. TO EXCHANGE— Dentist will give dental work in exchange for music lessons for his daughter, or for instruc- tion in French. Dentine, Leader Of- fice. TO EXCHANGE— Dentist wishes to exchange dental work for groceries, or what you have to offer. Address " Aurum," Times Office. I to strike somewher I that I had gained got to alter my ca' \ ing at the top ol j A simple thing to rific results ! I The powder ch i grains, yet that lit ' tween those walls, sound crashing aga yon and reboundir I wall to wall, as I i ball. I looked up come tumbling a' [ withstood the sho :.t the disturbanc bounding awaj', w; fainter, till it seen: wall between this and came roarinj Then, rolling past, valley, where it fii died away, like th^ ing thunder storm. But what of the t that something hac seemed bending ui his head as if in watched, expecting full minute he see deliberately walkr What with the elk, I had neglec Before I could p' the chamber the t yon. I followed going a long dista the marshalling of' ther pursuit, but fai of my game. Returning to t' broke in on the r amined for ma*-' dark to make :. detect a crimson stem the elk had ' With this I was hoping the light me in possession o As I made my w depressed at the but as I thought oi my spirits lighter buoyancy. For v these great plains, and glorious poss" In the morning miles, by blood spl 598 THE PRACTICE BUILDER he is likely to be looked upon as a rather commonplace individual; and this mode of living is not likely to attract anyone to his office, and it does not give him an opportunity for making acquaintances. Young practitioners generally find it convenient to engage board at a fashion- able private boarding house, because thus they are brought into contact with persons of a select class, and make many acquaintances that will likely prove of great benefit. After having made the accjuaintance of all the desirable persons at the house, and having secured them as patrons, many dentists make it a rule to at once change their boarding place to another equally fashionable house. This plan is not to be commended, as it does not look well in a professional man. It is a favorite method, however, with many dentists, especially in the largest cities. It has proved so profitable, indeed, to some, that they have been able to have a home of their own in a very few years. When a dentist has acquaintances and friends in the city in which he engages in practice, he may, besides sending the announcement forms we have illustrated in this chapter, and also in the chapter headed " Introduction to the Public," send them copies of " The American Dental Instructor," and in the same mail a polite note with his com- pliments. It may be said that there are several mediums for publicity for the young practitioner; these are: Society, which may be sub-divided into General Society and Fraternal Society ; the Church, and church or re- hgious societies; and advertising. These have been fully discussed in the chapters upon " The Church," " Social Diversion," and " Adver- tising." How to Hold Patronage " 6^1?/ what you can, and what yoti get hold " It is one thing to be able to attract the patronage of a desirable class, and quite another to retain their patronage. Dentists are con- stantly reminded of this by the fact that they are receiving, in their practice, many who have but recently been the patrons of other dentists, and by realizing that many of their own patrons have sought dental services elsewhere. It is true of both medicine and dentistry that patients change from one practitioner to another frequently; indeed, many persons in the habit of receiving dental services frequently, do not patronize the same dentist twice. The worth of a dental practice depends upon its permanency; and the fact that its patrons do not continue as clients operates against the reputation of the practitioner. It is, or should be, a matter of pride to every dentist to know that his practice is a permanent one, based upon the confidence which his patients have in him. In nearly all practices new patrons are being received, and old ones being lost to other dentists. If, instead of these old patrons being lost their patronage could be jetained, the advantage can readily be seen; for with their patronage is their influence, and influence is one of the most powerful factors in the upbuilding and upholding of a dental prac- tice. Either men do not know how to retain patronage, or, if they do, they do not apply the means. In the beginning, all the patients must necessarily be new patrons to the dentist; but, as time rolls by and the dentist becomes more and more interested in the active duties of his practice, there are not so many new patrons applying as there were in the earlier days. There 599 Goo THE PRACTICE BUILDER certainly is some reason for this. Often it is due to the fact that as the dentist becomes more absorbed with his professional work, he pays less attention to those little details upon which depend the growth of the practice. He forgets to use many little things that in the beginning were productive of much good in the way of attracting patronage. These may have been either in relation to the manner of the man, or to methods employed in extending patronage, factors of appearance or personal bearing, or a failure to keep in close touch with his patrons. Financial success in dentistry is said to be based on the number of friends a dentist may have, and his professional success upon the esteem in which he may be held by the members of his profession. The first part of this statement may or may not be true. A dentist may have a very large number of friends, but these friends may be patrons of some other practitioner. His financial success depends upon the close atten- tion which he devotes to the details of his practice, constantly, wiiether he has a very large circle of acquaintances or not. By keeping the best interests of his patients in view, he makes them his friends, and by his constancy he may have more friends in less time than other dentists possessed of the greatest ability. One of the most important factors toward retaining patrons is clean- liness. Those who have left other dentists have often stated that they changed because the last dentist was not cleanly. To always wash the hands before working for the patient is one of the most important mat- ters of personal deportment. It is absolutely essential that the nails are carefully trimmed, and that there is not the least evidence of un- eleanliness beneath them. Patients have sometimes reported that the dentist did not cleanse the instruments after he finished working, and that he introduced them into the mouths of others without having first cleansed them and placed them in an antiseptic bath. People are fully aware of the great variety of individuals for whom a dentist is called upon to work, and many are in constant fear of infection from unclean instruments, whether forceps or operating instruments, such as lances, excavators, broaches, and others, that might make wounds of the gum. There can be no better offset to this fear than to place the instruments in the steriHzer, in the presence of the patient, not in an ostentatious way, but in the most matter-of-fact manner. This will be commented upon THE PRACTICE BUILDER 6oi by the patient to his or her friends and cannot but redound to the credit of the dentist. The personal appearance of the dentist, whether in the offiice or on the street, should always be maintained above criticism. Failure to observe this requirement has caused loss of patrons. Attire that is slov- enly, soiled, or that shows long wear should be avoided. Members of all the professions understand the need for the observance of neatness, and dentists, especially, by reason of the fact that they are called upon to work for ladies more than for anyone else, are liable to criticism by members of the fair sex, who are known to be the sharpest critics of men's dress, and who are the first to commend a dentist for neatness of appearance. Young men are more thoughtful in this respect than their elders. Many men appear to give very little attention to their per- sonal appearance after they have reached forty years, and soon become so careless in this respect that it is remarked. Sometimes men give little attention to the details of their practice, after they have been in pos- session of a good clientele for some years, and get into such a con- tented, self-satisfied condition, that they are willing to let others set the pace. And when a man gets into this condition he is on the back- ward track. This condition is best described by the word " stagna- tion." Stagnation in a professional man means professional oblivion. Aggressive and progressive men succeed, but those who are con- tent to let others lead the way rarely accomplish anything worthy of note. A dentist cannot get a large practice by letting it run itself, nor by neglecting to give the closest attention to all details, not only of the professional, but of the business side as well. It is the lack of atten- tion to these things that is responsible for old-established practices get- ting to a standstill in the matter of attracting patronage. The causes for which patrons leave dentists may sometimes be triv- ial, but this is all the more reason for giving close attention to the little things; and it will be found generally that the men who give attention to the little things will give attention to the things that are of great importance. It is a matter of principle rather than of dogma. A den- tist's associations, the company he keeps, will have an effect on his practice. Avoid, therefore, associating with aimless idlers and those who bear a merited stigma, and are looked upon as unworthy by the 6o2 THE PRACTICE BUILDER people of the town or neighborhood, persons who are notoriously de- ficient, or whose hopes and ambitions have been bhghted or wrecked by intemperance, or their good names otherwise tarnished by their own misconduct. On the contrary, let your associations be, as far ac possible, with professional brethren and people of genuine worth. Pre- fer to spend your unoccupied moments in your office with your refer- ence books and dental journals, or in rational conversation with high- minded friends, or other dentists, or at dental society meetings, to loung- ing around drug stores, hotel bars, saloons, club-rooms, cigar stores, billiard parlors, barber shops, or corner groceries, with lazy fellows, who love doing nothing, frivolity, and dissipation; and do not go out riding with such persons, or to the horse races, or to join the throng at the baseball game. No one ever conceives a more exalted opinion of a professional man by fraternizing with him at such places, or in seeing him in such company. Unfortunate acquaintances have been the ruin of many a promising young dentist; therefore, select your associates with great care, and do not let your office be a lounging place or a smoking room for would-be horsemen, dog fanciers, baseballers, politicians, chatty blockheads, or others whose time iiaiigs heavily on their hands. The public look upon dentists as public characters, earnest, sober, studious men, with scientific tastes and temperate habits, who have been singled out and set apart for a lofty purpose, and as socially, mentally, and morally worthy of an esteem not accorded to such people, or even to ordinary citizens engaged in the private business of life. The idle jokes, childish amusements, boyish gambols, commonplace gabbl;:, and tone of thought common to lightminded people, do not harmonize with the studies, tastes, and desires of worthy dentists, and, moreover, tend to weaken or destroy the faith of the public, which is so essential in our work, for on no profession does faith have such influence as on ours. You, as a dentist, are public property, and the pul)lic. and espe- cially the female portion of it, with eyes like a microsope. will take cog- nizance of your associations and of a thousand other little facts regard- ing you. Every circumstance of your appearance in dress, manners, actions, Avalk, speech, conversation, habits, where you are to be found when not professionally engaged, etc., will be closely observed in order to THE PRACTICE BUILDER 603 arrive at a true verdict, more especially in the early years of your career. The question will never be asked whether you were graduated from this or that college, but it will be, " Is he a good dentist? " As a dentist is not supposed to have use for more than one set of operating appliances, this one set should always be of good quality. Experienced operators buy instruments that are heavily plated, and that have smooth handles. Those that are " Knurled " or roughened in any way are hard to keep clean, and will be found much discolored after having been used a year or two, while the smooth-handled instru- ments will retain their new appearance for many years. A dentist should have all the necessary instruments, and all the de- vices that save time in operating, or that prevent or lessen pain; but he should not unwisely buy all the instruments that are presented to his notice, for many of them are little needed and are expensive. A dentist who hopes to retain any class of patronage, whether of the highest and most desirable element of society or any other, should not liave two prices for one kind of work; nor should he intimate that he makes two grades of plate-work, one at twelve dollars and one at fifteen dollars, for instance, because people will at once become suspicious, and mentally, and sometimes openly, accuse him of double dealing. Besides, it is not compatible with the best results professionally. One grade of work will demand the closest attention and be productive of the best results, because those who may see the second grade may judge the dentist by it and consider it to be representative of his best skill. This applies to all the work, operating as well as bridge work and plate work. Close attention to one grade of work, and that the highest the oper- ator is capable of performing, is sure to bring good results, and it is the only way by which a reputation of an enduring character can be secured. Close attention should be paid to every issue of the dental journals. It is not enough that the dentist note carefully the original communica- tions, but he should, as well, read carefully the proceedings of the dental societies, for here only can any subject be seen from every point. The library of reference books should be added to as requirements make themselves felt, and attention should be given to selecting books (3o4 im- PKACTICE BUILDER that are eminently practical and that have a bearing on the everyday work of the office. When in doubt concerning diseases or conditions that are not fully understood, the books should be depended upon rather than the dental journals. The modes of treatment will be found more reliable and the subjects are treated more understandingly, and usually by persons better (lualified to treat of such matters than those whose articles are published in the dental journals. After a good list of books bearing upon the technical operations of dentistry has been collected, the scientific knowledge of the dentist should be extended by the study of such as relate to conditions not definitely understood and to the pursuit of such questions as are open to discussion. The theory of yesterday is the practice of to-morrow; the practice of to-day is the theory of yesterday. No dentist need fear that he will be classed as a theorist because he devotes his spare mo- ments to his professional cultivation, because practitioners in dentistry do no work that is really theoretical ; their work is practical ; it is nearly all hand-work, guided by intellect, and usually the higher the intel- lectual attainments the greater will be the manipulative dexterity, with proper practice. Many dentists fail to hold some patrons because they do not tact- fully manage the important question of extending credit and of collect- ing promptly. There is a great deal of sentiment about this matter, and the sooner the dentist disabuses his mind of it the better will it be for him. In the very beginning of his professional career he should settle this point so that there shall be no deviation. Somewhat related to the subject of credit is that of fees. The den- tist who expects to retain patronage cannot practice double dealing in this respect, and charge one class one fee and another class another fee. The really desirable clients are willing to pay good fees for good work, and there should be no attempt to curry favor with an inferior class by doing work for its members at lower rates than those which are charged other and more desirable people. If a dentist has a good class of patronage and charges good fees for his work, this form of appreciation will make him ambitious to excel himself, and the stand- ard of his work is likely to be raised because of the fact that his patrons- are ever ready to pay what he deems proper compensation. THE PRACTICE BUILDER 605 Dentists should keep a set of books, and record all operations per- ■formed. If an advertising practice is conducted, and the practitioner is in possession of a class of patronage above the average, he will read- ily realize that this patronage was not secured by the advertising, but by his own reputation, and he will be wise if he discontinues his adver- tising and holds his high-class patronage, and adds to it by such pro- fessional qualifications and the employment of such ethical methods as shall insure to him a continuance of the same. This patronage is more satisfactory and more enduring by far than all the advertising practice in the world, because it depends upon people who are not attracted by cheapness and special inducements. If an advertising practice is conducted upon those undesirable plans which we have mentioned in the chapter on advertising, let the pro- prietor at once depart from the timeworn and doubtful forms of pub- lic announcement and substitute therefor advertisements more in keeping with the dignity of dentistry. Attention should be given to printed matter. In the chapter on '" Printing," a broad hint has been given that good printing can be made a valuable aid toward gaining publicity, without the use of ex- pedients that may be called advertising. To this end we have shown all the latest and most desirable type faces, and all borders and orna- ments which are applicable to the uses of the dentist. Business furniture and labor-saving devices, together with such devices as aid in the classification of professional information, will facilitate the routine duties of a practice. The typewriter commends itself especially for such uses as have been indicated, and can be made one of the essentials in such work as attention to records and examina- tions, and also special communications with reference to anything con- nected with appointments, or other matters. The presence of a type- writer in a professional man's office makes the place look as if the person were a man of business, and the tone of his correspondence is made prosperous and up-to-date. A typewriter in an office, on a pri- vate desk, anywhere that writing, thinking, or planning is done, is an evidence of energy, acumen, and push. For typewritten letters indi- cate large interests, create a good impression, inspire confidence, and help make business. More business means more money, and the prac- CoC THE PRACTICE BUILDER titioner delegates the minor details of his practice to others, or employs assistants and finds time for attending to the more important matters himself. His means for making money broaden and he becomes a busy man. Before proceeding further in the discussion of the things that are necessary in order that the dentist may hold his patronage, it is proper to say that, with all his close attention to the details of his professional work and close application to the building of the practice, the need for proper amusement and recreation must not be lost sight of. Close application, without recreation, dulls the perception and blunts mental activity to such an extent that the greatest good is not received from the mind. An occasional day's sport with rod or gvm, or a summer trip, or an evening at the theatre, a change of occupation, or alternative of labor with ease of any kind, will work off nervousness and act as a refresh- ment; break the worries, frets, tumults, jarring, and cares of practice, vary the monotony of life, subdue mental tension, remove brain weari- ness, soften the ups and downs, soothe mental excitement and nervous strain, conduce to health and longevity, and actually make you more philosophical and a better dentist. Many dentists, in the eager pursuit of business, foolishly postpone all relaxation from one time to another, intending to give up some of the hardest of their work and worst of their privations, and to fall back on their reputation for skill and experience, and to take life easy, indulge in diversions, social amenities, and pleasure when they get older — in the autumn of life — when the hair grows gray, and do not seek enjoyments until they lose all taste for them, till they care for nothing and are fit for nothing but work, work, work. To retain patronage permanently, the same close, careful attention to each individual case must be given to-day, to-morrow, and the day after. The same care, the same endeavors to excel self must character- ize every operation that is performed. It makes no difference whether the work is such as calls for the exhibition of the highest scientific attainments, or whether it is a simple operation demanding little prac- tice or knowledge, it should receive the same attention that it would if the fee were large, the patient a prominent person, and the manipula- THE PRACTICE BUILDER 607 tions demanded the greatest possible dexterity. It is a deviation from this straight and narrow path that leads young professional men to the back rows in the esteem of patrons. Neglect, however slight, is sure to bear fruit in dissatisfaction to the patient and mortification to the dentist. To prevent such occurrences the cure is, never to begin. Perhaps, at first, the dentist may be guilty of only slight remissness of duty in the performance of his work, and he may be to a certain extent the victim of slignt accidental happenings in his operating. Undue haste to finish work, for fear he may be considered slow; some- times he may chance to check the enamel while malleting a gold filling, and he will perhaps, instead of retrimming the cavity border, proceed Avith the filling by permitting the gold to extend be} ond the cavity borders, and then finish it down in the hope that a perfect adaptation has been secured. Although he may take some pride in filling teeth with gold and prefer this work to any other that he does, and spend more time in giving the final polish to a gold filling than to any other, yet he may not think it worth while to give an adequate amount of time and care to preparation of the cavity margins, and may not prop- erly cut them away to solid tooth substance, and symmetrically shape and smooth them to perfect borders. He may be guilty of the same disregard in treating the enamel margins of molars and bicuspids, and may not thoroughly drill out all cavities of decay that extend into fissures. When he has pulp-canal work to do, and has several patients waiting, instead of devoting to this work all the time and attention which its importance demands, he either permits portions of the un- extirpated pulp to remain, or is careless in sterilizing and cleansing the roots, or employs such materials for filling the roots as are easily in- serted. He sees roots of teeth that have been comfortable for years without any filling material in them, and he has seen other cases where supposedly carefully filled roots have given serious trouble; and he may finally succeed in convincing himself that it doesn't make much dif- ference whether the roots are filled carefully or not, and that trouble is just as likely to ensue when the most painstaking work is done, as when it is done in a haphazard, devil-may-care manner. Perhaps he argues to himself that the time given to the minutiae of detail in the treatment of pulpless teeth is time and labor thrown 6o8 THE PRACTICE BUILDER awav. He believes, too, that pulp-canal work is not paid for as well, according to the time demanded to do the work thoroughly, as other operations which do not require the same careful attention, and which, when done, are not likely to cause any uneasiness to patient or dentist. When these ideas become firmly fixed in his mind he is likely to advise the extraction of teeth, which, if carefully treated, might be saved and restored to usefulness and comfort for many years. Again, in the fill- ing of cavities that do not require canal work, he learns early in his practice that amalgam is desired by his patients largely, because the cavities are in " back teeth and won't show," and because it is a great deal cheaper. To do gold work demands that the operator be pos- sessed of an artistic temperament, in which the commercial remunera- ation is a minor consideration, and, in his opinion, this is not compatible with making money rapidly. He knows that he can make more money, and in less time, if he uses amalgam, and he does not advise the use of gold in cavities wdiere it would be appropriate; and, having started to do a line of amalgam work for a person, he does not care to switch ofif and insert a gold filling. He does gold work so rarely that his fingers do not follow the dic- tates of his brain as once they did, and he realizes that his dexterity in its manipulation is on the wane. By continually shirking gold work, and especially those complicated cases in which good operators revel, he feels no stimulation in attempting and successfully performing them, until he eventually becomes a back number, whose professional career is blighted, and takes his place in the back rows with those whose highest achievements are plate work and amalgam filling. While he is going on in this way, someone calls for whom he has put in a carelessly inserted filling; one of those, perhaps, which he mal- leted over the cavity borders to conceal the enamel which he fractured into powder by careless malleting, and he cannot escape the fact that it is leaking badly and is so darkened and discolored around the cav- ity that it is most unsightly. " It is decaying around the filling," he says, " but the filling is all right." He removes the filling and inserts another one, for which he cannot charge as much as he did for the first, and sometimes, by reason of the impaired condition of the tooth caused by the ravages THE PRACTICE BUILDER C09 of decay around the filling, he cannot charge anything. Perhaps he enters into an artful dissertation on the softening of tooth structure, and dilates at length upon the causes which produce such effects on gold or other fillings, and the patient may be satisfied that the condition of the teeth was not the result of faulty manipulation on his part. But the experience is repeated in the case of other patients, and he is confronted with filling after filling that is faihng at the cervical bor- der, or with those that have become loosened, and he is brought face to face with the indisputable fact that these fillings did not have suffi- cient anchorage. This may not cause him any great anxiety, from the fact that in most instances he may be able to repair them. Never- theless, he sees that if he had given these cavities careful, deliberate, thorough preparation ; had cleaned them thoroughly of every portion of decay, and had made good undercuts and grooves extending the l:»orders beyond the line of decay to firm foundations, and had secured perfectly beveled borders, these fillings would not have returned to him loose, leaking, or with recurrent decay. To add to his mortifica- tion and discomfiture, patients present themselves with a frequency that humiliates him, suffering from the effects of his careless or negli- gent treatment of pulpless teeth. With faces swollen almost beyond recognition, and suffering the tortures of the damned with teeth that throb with an intensity that is maddening, with heavy eyes that show the loss of sleep, and with nerves enfeebled by the soul-racking torture of toothache that unmans the most vigorous, they present pitiable ex- amples of his unskilfulness. Extracting is nearly always demanded by the patient, and his faith in the efficacy of dental operations suffers a marked relapse, and he thereafter neglects his teeth because of this. He begins, in addition to his filling failures, to be confronted with continual repetitions of the conditions we have pictured which super- vene upon the formation of abscesses. He dreads to see a patient enter the office for whom he has filled a pulpless tooth, so frequently is he brought to face the disastrous results of his treatment. The practice of dentistry becomes to him a horrible nightmare, for the longer he practices the more frequent become his failures; not alone in treating cases, but in filling operations and every other class of work as well: for, if he was careless in one thing, he was careless in all that he did. 6io THE PRACTICE BUILDER Those who were his friends and patrons have had tlieir confidence in him weakened by tlic frequency of his faikires and the periodic neces- sity for attempts at explainins^ them. His reputation has deteriorated until he never receives the patronage of the better class of business and professional men, and the most desirable members of the fair sex have long since deserted him. In the early days of his practice he was ambitious for success and had entertained bright day-dreams of con- quest. His parents and friends had great hopes for him, and expected him to make a name for himself; but by his shiftlessness he has spiked liis own guns, and feels that he could do better in any other place than where he has been practicing, because then he would not be confronted by his failures. He has realized too late that if he had done right on the start his position might be a very different one. If in the beginning of his practice he had devoted to each operation his very best thought and his very best work, making thoroughness his only aim. he would have acquired great skill. Having become habituated to using his best efforts, and never for any reason slighting his work, it would have become second nature with him to do only the very best he knew how. He would never have been bothered with those exasperating cases of recurrence of decay from faulty preparation of cavities, and from injury to the enamel borders, due to careless malleting. Having devoted the best and most conscientious work of his brain and hand to the treatment of pulpless teeth, he would not have been abashed, humbled, confused, humiliated, and dumfounded by the repe- tition of failures from his almost criminal neglect. His patients' faces would have reflected their inward satisfaction and pride in him, instead of being distorted and wearing the agonized expression of pain and anguish. A dentist's mistakes are a constant reminder to him of his poor work. They are a constant reminder to the patient, and the patient is a thorn in the flesh by referring friends away from the dentist who did their own work. The mistakes of doctors are buried in the grounrl: the mistakes of lawyers are dangled in the air: but the mistakes of dentists stare them in the face, a constant reminder of cprel^ccirss. unskjlfulness, and disregard for the demands of scientific dentistry. THE PRACTICE BUILDER 6ll The man who possesses and retains a high-class practice is ever ready to learn and benefit by the results of recent investigation, that his knowledge may be increased and his value to his patrons enhanced thereby. Cautious, yet not so sceptical as to be unbelieving, and not so impressible that oversanguineness lets a new fad run away with his better judgment, he will not allow the latest fad to influence him to such an extent that he will abandon a well-established mode of prac- tice. He is not the first by whom the new is tried, nor yet the last to lay the old aside. He will never deem himself so wise that he is beyond learning from even the most humble member of his profession. '■ For never yet hath one attained To such perfection, but that time, and place. And use have brought addition to his knowledge; Or made correction, or admonished him That he was ignorant of much which he Had thought he knew, or led him to reject What he had once esteemed of highest price." A great deal of tact is necessary to successfully handle the different classes who seek the services of the dentist. Some dentists are pos- sessed of a personality and a manner that is engaging to one class, and that is not at all pleasing to another. Here is seen the need of an inti- mate knowledge of temperamental attributes, and an understanding" of the likes and dislikes of human nature. No man should employ a fawning manner to secure the good opinion of anyone, but a polite and gracious exterior is the possession of every person of breeding and wealth; and it cannot, surely, be out of place for a dentist, in whom^ above all things, gentleness is expected. Partiality should not be shown, but those who show the greatest appreciation of the dentist's work should be repaid for their apprecia- tion by the operator's most earnest efforts to please. Dental practices, with very few exceptions, depend for patronage^ as do medical practices, upon a mixed constituency. People of every grade are attracted to this dentist or that one by belief in his superior ability, and not for the possession of any traits of bearing, or other attributes that do not form a part of his professional learning. When boys or young men come to you for assistance for their 6l2 THE PRACTICE BUILDER baseball clubs, or their library, and the like, give somctliing and give it freely, and without the slightest evidence of a dislike to do so. Be cheerful in making the subscription. If a little boy or girl comes to sell a concert ticket, buy it laughingly. If ladies ask you for a donation to aid the heathen or to help buy a carpet for their church, for the relief of someone afflicted, or to take space in the programme for their church entertainment, be sure to give willingly; for contributions of this sort not only do good to others, but often prove to be a judicious professional investment for self. Were you to growl and, with length- ened visage, say " No! " all would unite in calling you " Old Stingy! " and ever after avoid you. Remember that three-fourths of the population are children, and that every effort should be made to gain their confidence, and to hold it by gentle treatment and careful attention to such work as they may have done. Children are growing up all the time, and often their preference for this or that dentist has much weight with the older members of the family. IVIany dentists have, by reason of an engaging manner with children, built up and retained practices which they otherwise might not have been able to do in the same length of time. Cultivate the younger patrons of the practice, and take an interest in their studies and enter fully into the subjects and ambitions that interest them. Children like to know that dentists are just the same as other people, and that they have the same thoughts, and that their sole aim in life is not to hurt people and to think only of microbes and bones and nerves. While operating at the chair a solicitous demeanor must be pre- served — a demeanor which does not change and become offensively familiar by reason of the fact that the patient has been a patron of the office for some time. Some dentists have a way of becoming famil- iar with patients to the extent that they discuss personalities and events of a social character which should not be talked of between dentist and patient. Wit, as an accomplishment of a dentist, is out of place. It is un- becoming in a man whose leisure hours are supposed to be spent in scientific studies and serious thoughts. Many dentists have lost patronage because they permitted unskilled THE PRACTICE BUILDER 613 assistants to attempt work for which they were unfitted, and which, having caused trouble, weakened the patient's confidence in the prac- titioner. Boy assistants should not be allowed to do operating of any kind, with the possible exception of cleaning teeth. Never, under any circumstances, should an assistant be permitted to " treat teeth," nor to do canal work, nor any work demanding intricate processes or a knowledge of pathology and therapeutics. If an assistant fractures a tooth in attempting to extract it, and great difficulty is experienced in removing the unextracted portions, the patient will not soon forget the experience and will condemn the dentist for permitting the assistant to attempt such work. A patient who has left one dentist may become a very active testimonial to another, and it should be the aim to per- sonally superintend the work that is done, whether the operation is a trivial or an important one. If a drill is accidentally broken off in a root-canal, an accident which is likely to happen to even a careful operator, the dentist will feel better to know he did it himself than that it was done by the assistant. A dentist who entrusts work to his assistant is likely to be considered as one who does not think that dental work is very important, and that he can let his assistant do it and charge as much as if he did it himself. There are two very potent reasons why some men lose patronage. One reason is that the work is faulty. Some dentists, after having se- cured a good reputation, depend upon that reputation, which may have been secured because of a high standard of skill carefully sustained, but which became, by reason of increasing patronage demanding faster work and more of it, so affected by the lesser degree of attention which it received that the output of the office no longer compared with its former work. This could have been remedied by advancing the fees, but many dentists fear to do this. It would be much better to do so, get more money for less work, and keep the mark at a high standard, than to let the quality of the work deteriorate through an inability to serve a large clientele as well as a smaller number of persons could be served. As soon as reports become current that the work of a dentist does not equal his former output, and that he does not take as much care 6i4 THE PRACTICE BUILDER as he did at first, these will be circulated by people who do not person- ally know anything about the matter. Some irresponsible individual may remark that " They say he is getting careless," with as much assurance as if they really knew this from personal knowledge and observation. Nothing could be more harmful than that such stories should become current, and the only way to prevent it is to keep the work up to the operator's best standard. It is a great deal easier to l)uil(l up a new practice than to restore one that has been allowed to deteriorate through poor work. A dentist has always to bear in mind that he may not be judged by all the work that he does, but that one simple little operation may be judged as a sample of his quality. The work, therefore, that is done for a servant girl should be as carefully done as that which is performed for the person of great wealth and refinement. Many times persons are influenced to patronize a certain dentist because he has done good work for a servant in the household. The other reason for loss of patronage is that the dentist is com- mented upon unfavorably because of his conduct toward women. This may be because of an attitude lacking respect in his conduct toward women generally, or it may be the result of reports of more or less notorious relations with them. Nothing could be more harmful to an unmarried dentist than that such reports gain circulation. A report of this nature, whether true or not, will cling to the victim of it so persistently that it will be eradicated with difficulty. The far-reaching effects of such reports can readily be imagined. Their efifect upon the patronage of the office cannot but be immediate and permanent. In the first place, there are few men who would care to trust their wives to the professional care of a dentist whose disregard of the proprieties is a matter of notoriety. Men do not care to have their daughters go to a dentist about whom shady stories are told, and mothers will be sure to send their daughters somewhere else. Such things have a way of leaking out, and when they do they will prove damaging influences operating against retaining or attracting patron- age; in fact, the result is that they will repel patronage. The fact that so great a proportion of the patronage of a dental practice is composed of women, should indicate to any dentist that to THE PRACTICE BUILDER 615 retain such patronage his conduct should be above reproach in this regard. There is a time and place for everything, and the dentist who forgets the foundation upon which his practice is based forgets some- thing that should be uppermost in his memory. Be careful, therefore, never to go beyond the bounds of decorum in conversing with mem- bers of the opposite sex. "Scandal is like a pinch of lampblack; there is no limit to the blackening it may do." " Scandals fly on eagle's wing." Immoral conduct is never more out of place than in a professional man, and in none does it meet with more open condemnation by the public. A low-minded dentist, who indulges in double entendres, coarse ambiguities, vulgar jokes, jocular innuendoes, and indelicate anecdotes about the sexes with other men or with coarse women, even though he poses as a gentleman, is sure to be shunned, and the reason therefor made the subject of gossip and passed from one to another in social whispers, till it reaches the purest and best of the community. Thought- ful people of both sexes everywhere rightfully regard such libertines as being far more amenable to criticism, and far more dangerous to admit into the bosoms of their families, than rough-mannered believers in social purity, who gamble, drink, or swear. If you employ a local anaesthetic or gas for the extraction of teeth without pain, be careful that you do not, in your close attention to this work, gain the reputation of being a tooth extractor. To a high-class practice this is a dangerous reputation. It is a most undesirable one for a man of high ideals, and who takes delight in the performance of work demanding really superior skill, such as bridge work and other high-grade operations. If you make special efforts to gain an extract- ing patronage, you will find that people think you are a " tooth-puller," and that you do not do other kinds of work, and you may often be asked by patients " if you make artificial teeth? " As if they really thought you might not possibly do this class of work. If your office becomes overrun with people of the lower classes, servant girls and poor people generally, who do not usually have any other work done than the removal of teeth which are aching and troublesome, you may find that generally the better class of people will be seen less and less 6i6 THE PRACTICE BUILDER frequently, until finally you may have none of that patronage; and those who formerly were your patients may come to class you as hav- ing degenerated in ability and may not care to entrust to you work which is difficult and expensive. Be careful not alone to avoid cultivating an extracting patronage, but also be careful in the selection of local anesthetics, and do not keep constantly changing to every new scheme that is presented. So many of these local ansesthetics are short-lived and unworthy of confidence that care should be observed in purchasing them. Accidents happening in the office are hurtful to the reputation of the practitioner, and cause patrons to go elsewhere. Some of the acci- dents which happen in dental offices might easily be averted, but many cannot be avoided. Care must be observed in drilling cavities, and in running the engine so that the gums are not lacerated; and in the use of canal-reamers, and drills, so as not to break them off, necessitat- ing tedious and sometimes fruitless labors in attempting to remove them. Other accidents in the use of strips and disks might be avoided by careful attention to duty. Never hold instruments, such as excavators, in one hand, while operating with the other; as one hand is usually held near the mouth to keep the lips apart, the instruments may be so near the eye of the patient as to frighten him. Other accidents, such as the careless use of carbolic acid or other medicaments, when spilled upon the face of a patient, will neither be forgiven nor forgotten. Permitting the engine to run after the bur is removed from the tooth and letting the bur become entangled in the dress of the patient will anger her, so that remarks of an uncomplimentary nature may be made about the dentist for his carelessness. Do not permit your friends, no matter how intimate they may be, to loiter around your office. Be firm in this respect. Some dentists have as acquaintances good-natured individuals whose time is not wholly employed, who make a practice of loafing in the laboratory or reception-room. If these persons should not be held in esteem by the people of the community, their presence can but reflect upon the dentist. The greater proportion of those who seek the services of dentists THE PRACTICE BUILDER 617 are ladies, and when they go for consultation do not like to find other persons present. It is for this reason that the custom of giving ap- pointments is most satisfactory to our patrons. Patients, especially ladies, do not feel at ease if they know that a third person is present, who has no connection with the office, and if the individual is seen as often as they call, they will prefer to go to another dentist. Do not permit anyone to become an habitue of your office ; do not allow rela- tives, even near relatives, to use your office as a lounging place. The peculiar and confidential nature of a dentist's business is such that himself and no other should be present during the performance of operations or during the preliminary or ensuing transactions. Request your wife, if you are married, not to get in the habit of calling at your office during your office hours. She may meet her social friends there, and the meetings, under the circumstances, may not be especially pleasing to the patients. Observation of such little matters are especially helpful to the dentist, besides permitting him to employ his spare moments with profit to himself in some satisfactory manner. In consulting text-books and journals, avoid relying on antiquated books and back volumes of journals as guides in so progressive a science as dentistry. New investigations and rapid progress render new text-books essential to those who would keep up with the dental world and maintain the skilled readiness and self-reliance which the con- sciousness of being fully posted on new instruments, methods, and improvements naturally inspires. Never allow yourself to be biased too quicklv nor strongly in favor of new unsettled theories, based on physiological, microscopical, chem- ical, or other experiments, especially when offered by the over-zealous to establish their own conclusions or preconceived ideas, or by those who have identified themselves with the latest dental fad. Also, do not allow yourself to be led too far from the practical branches of your I)rofession, into histology, pathology, microscopic anatomy, bacterio- mania, comparative dental anatomy, biology, psychology, and analo- gous subjects, that merely create a fondness for the marvellous: because it is likely to impair your practical tendency and give your mind a wrong bias, and your usefulness as a practicing dentist will almost surely diminish. 6i8 THE PRACTICE BUILDER Economy is a good thing to practice in dentistry. For a dentist there is really only one kind of economy, and that is to have the best — not the second best, but the best; the best office, the best instruments, and the best material that money can buy. In the performance of work which requires the use of the rubber-dam, some dentists are in the habit of using the same piece of rubber twice, after having washed it. Some place the rubber-dam in an envelope bearing the name of the patient, and use it again when that patient presents again for services. Rubber-dam is usually a comparatively cheap article, in daily use, and there is very little saved by such a custom. Patients are likely to think that a person who will be so economical is likely to scrimp a little in the amount and quality of the material used in filling teeth. When they see the holes in the rubber, showing that it has been used once before, they may make no comment, but there lingers in the mind a feeling of dissatisfaction that may not be effaced for a long time. They may remark the circumstance to a third person who is not a patron of the office, and the person may be prejudiced against the dentist and go to someone else to have work done that would amount to more than the entire cost of all the rubber-dam used in the office for several years. Use napkins sparingly. Perhaps there is nothing which the dentist uses in the mouths of patients, that gives rise to such a multitude of fears as these little pieces of cloth; knowing, as they do, that the same napkin has perhaps been used in the mouths of fifty other persons. No matter how great may have been the care taken in washing them, patients dread them and do not like to have them used in their mouths. This is an indication of a proper dislike, and those who understand human nature are aware of the fact that such hints are worth taking. Substitute for the napkins the new absorbent rolls as supplied by the dental dealers, and throw them away after use. Thus your patients will be saved the temporary worry and dissatisfaction incident to the use of the linen napkins. Failure to hold patronage may be due to neglect in the performance of the simple operations and more usual routine w^ork. The following points may be of benefit to many operators: Be careful to remove all calculus, and properly care for the gums. All operators are not thor- ough in this respect. All the calculus should be removed from beneath THE PRACTICE BUILDER 619 the gums, and all that is adherent to the proximate surfaces of the teeth. Before building up the lost portion of a tooth, study carefully the lines of occlusion, so that it will be built up in proper form, not too high and not too low. Be careful to keep approximate fillings dry until thoroughly pol- ished, finally finished, and closely examined to see that there is no filling material overhanging the margins or anything that would invite caries. When it is observed that tooth-substance is being worn away adjacent to fillings on the occlusal surface, the filling should be ground away to correspond with such wearing away. In long filling operations, where a large mass of gold is introduced into a tooth, the blood may be driven from the peridental membrane, and the root of the tooth is thus driven more closely into its alveolar cell. The filling when finished may just escape occluding with its an- tagonist. When the blood again returns to the peridental membrane, the tooth may be apparently elongated, the filling will strike and the patient will complain of a sore tooth, or the filling may suffer a severe strain. Be careful to adapt contour fillings to the w^alls of the tooth all the way up. In approximate fillings in molars and bicuspids the tooth and filling may be worn and expose a portion of the wall in which the fining was not closely adapted, and the filling will leak. One of the reasons why some dentists hold the regard as well as the patronage of their clients, is because they know the needs of the patients so well from the patients' point of view, that they keep in close touch with them and by so doing get the best results from their friendly influence. This consists in taking the patients into the confi- dence of the dentist, to a certain extent, and by letting them know things which patients are not usually instructed in by their dentist, and thus winning their admiration and confidence. It is a well-known fact that dentists do not sufficiently consider the duty which they owe to their patients, in appropriately instructing them in all the matters relating to the teeth which they have a right to be informed upon. This cannot be conveniently done orally at the chair, and the usual treatises upon the subjects are not prepared in a manner to be easily understood by those who read them. 620 THE PRACTICE BUILDER This is the purpose wliich " The American Dental Instructor " is intended to fulfill. It tells the things which the patients wish to know; it answers the questions which they ask every day, and it tells, as well, the things which they would like to ask, but which they hesitate to do because of the delicate nature of some of the questions upon which they are most anxious to receive information. In no other popular treatise is such really desirable information conveyed to those for whom they are prepared. A copy of " The American Dental Instructor " should be sent to each i)atient who applies to have work done, a day or so after the pa- tient has received the appointment card at the office. The booklet should be sent in a white envelope of good cpiality, having the name of the dentist on the tlap at the back, in small type, preferably what is known as Light-faced Lining (jothic. To make its reception more effective and to insure its being read, the dentist should have the assist- ant send in the same mail a letter somewhat after the form here shown. The letter should be written on the typewriter and should be upon the best stationery: Miss M. D. Waite, Dear Mkss: I have taken the libert}' of sending you. in this mail, under separate cover, a copy of my booklet, " The American Dental Instructor." In this booklet are answered all the questions which dentists are asked every day. and all the subjects are treated which it is proper for my patients to be instructed upon. I trust that you will read it through carefully, and if you think it does not tell everything that should be told, or if there are any questions that should be treated that do not appear, I should be grateful to you if you would call my attention to them. Very respectfully yours, A. B. Blank. D.D.S. Patients appreciate such thoughtfulness on the part of the dentist. They are likely to be very favorably impressed with the subject matter of the booklet, and with the truthfulness of the statements made therein, and to become more careful in noting the condition of the teeth and attending to them promptly, and thus cooperate in bringing about an ideal condition of affairs for the dentist. Exposed pulps would be un- known, and treating pulpless teeth would becom: rarer and rarer. THE PRACTICE BUILDER 621 The dentist would be able to give his patient better services and to receive better appreciation therefor. A copy of the booklet should also be sent to all who have at any time been patrons of the office, and the result cannot but be favorable to the dentist. Frequently the booklet is seen by a friend or visitor at the home of the recipient, and that person is thereby induced to be- come a patron of the dentist whose name it bears. If those who have had teeth removed, and who are undecided whether they shall have a temporary plate inserted, or who are not posted as to the different bases upon which artificial teeth are constructed, or to anyone who has made inquiries concerning artificial teeth, there should be sent a copy of the booklet " Artificial Teeth." Patients are less well informed upon this subject than upon any other matter in dentistry, and this booklet presents the information needed in a most concise and clear manner. It should be sent under letter postage, just as " The American Dental Instructor " is sent. To those persons who have one or more teeth missing, thus indi- cating that bridge work should be inserted, or whose natural teeth are in such condition that crowns should be adapted, should be sent a copy of the booklet, " Interesting Facts About Crown Work and Bridge Work in Dentistry." This is a subject that is not at all understood by the majority of persons, many of whom, if they had a proper under- standing of what it is, how it is made, how inserted, and the special claims for its superiority over other forms of artificial substitution, and its permanence when adapted, would be quick to have such work done. It is something that cannot easily be explained at the chair, and which when explained from the text-books and engravings therein serves only to confuse the patient. In the booklet mentioned the matter is terse and plain, so that no one can fail to understand the principles upon which bridge work depends. It is uniform in style and size with the other booklets. When a patient, of a member of his family, is known to have irreg- ular teeth, and especially if such teeth affect the personal appearance of the individual, a copy of the booklet on that subject should be sent — " Irregularities of the Teeth ; How They are Corrected." This book- let should be sent to the children and younger members of the family, 622 THE PRACTICE BUILDER because it will impress upon them the importance of caring for the teeth when they have a tendency to becoiiie irregular. " The Children's Dental Instructor " is a booklet similar in char- acter and design to the others of the series, but its purpose is to incul- cate within the minds of the younger patients an appreciation of the teeth, and to influence them in cooperating with the family dentist in using a grain of prevention rather than an ounce of fillings. In this way, by use of such an instructor, children are so habituated to the propriety of dental service that the custom becomes an established one which they will follow and appreciate throughout their lives. While they are children is the best time to indelibly impress upon them the importance which attaches to the care of the teeth, and to the benefits that are to be derived from the proper attention to them in childhood. All the booklets mentioned are uniform in size and style, are artisti- cally printed and bound, and are supplied in lots of lOO to 10,000 at very reasonable prices. Read the chapter on " Instructors." Sometimes the polishing of a filling takes half as long as the inser- tion. Sometimes, by reason of the particles of gritty substance still remaining between the teeth, it is not practicable to give the highest finish at the first sitting. It will, therefore, be found much better to make an after appointment, on which to give the final polish. This may be done by the lady assistant, after she has received a thorough training in the work, and the operator will thus be saved the time it w^ould take to do it personally, and at the same time be sure that the filling is so perfectly finished, by personally examining it, that there will be no likelihood of failure at the margins. A day or so after the gold filling is inserted the lady assistant should mail to the patient a card like that shown in Form A. In a busy practice, where time is valuable, and it is necessary to have as little delay as possible caused by waiting for amalgam fillings to harden, a similar card should be used. If amalgam fillings were treated as carefully as gold ones are, there would be no occasion for removing them and refilling the teeth, as is often the case. Amalgam is the most abused of all the filling materials. Fillings are inserted w'ithout preparing the cavities as carefully as those in which gold is inserted, and receive no other smoothing than the burnisher imparts; THE PRACTICE BUILDER 623 Form A Smithton,. Having had gold fillings inserted in the teeth, is requested to call _.- at o'clock, that same may be polished and examined to see if they are perfect. A. B. BLANK, D. D. S. 10 Howe Block Appointment Card. Polishing Gold Fillirgs SO that when the filling hardens it often has an appearance very similar to that which might have been expected had a plasterer's trowel been used to give it a smooth surface.' Oftentimes the manipulation which is necessary to remove the surplus around the margins and cervical bor- Form B Smithton , 1 89- Having had teeth filled with amalgam, is requested to call at o'clockjto per- mit of the work being polished and carefully examined. A. B. BLANK, D.D.S. 10 Howe Block Appointment Card. Polishing Amalgam Fillings 624 THE PRACTICE BUILDER dor affect the integrity of the filhiig at these poiiit>. If it were trinmiLtl so as to occhide properly, and finished a few days afterward, and given a high pohsh by use of disks and powders, its permanence would be greatly cniianced. The borders could be trimmed and polished as per- fectly as the finest gold fillings. A card similar to the one for gold filling should be used, and the work may be done by the lady assistant. Cement fillings require greater care than amalgam, and because of the liability to " drag " when being finished, the teeth should be filled as smoothly as possible at the filling appointment and the cement Form C Smithton, 189- Is requested to call at o'clock that the cement fillings inserted may be carefully polished and examined. A. B. BLANK, D.D.S. 10 Howe Block Appointment Card. Polishing Cement Fillings then covered with melted paraflfine wax as suggested by Dr. Bonwill, or with one of the preparations that are suitable for the purpose, such as chloro-percha, or rubber varnish, or cavitine. the rubber-dam being kept in position until the filling is sufficiently hard to dismiss the pa- tient. A few days afterward a card similar to those sent for gold and amalgam should be mailed to the patient. When the patient presents, the filling will be so dense that it can be carefully polished and its permanence thereby greatly added to. It is proper that bridge work should be examined at frec|uent inter- vals, that its condition may be ascertained and that (if the bridge piece THE PRACTICE BUILDER 625 should have inaccessible spaces or interstices which are apt to cause uncleanliness) it may be appropriately cleansed. The natural teeth demand care, and all forms of artificial dentures require attention to secure their cleanliness and thus preserve the health of the adjacent Form D Smithton, 189- Will please call at o'clock to have Crown and Bridge-Work examined and put in order. A. B. BLANK, D.D.S. 10 Howe Block Appointment Card. Examining Bridge-Work tissues. Upon the maintenance of cleanliness depends in a large degree the permanence and satisfaction of such work. Self-cleansing spaces are often improperly formed, and thus become receptacles for particles of food debris, instead of preventing their accumulation. Besides the use of an appropriate dentifrice or antiseptic preparation, a suitably formed brush should be prescribed. The patient should be advised to use floss silk to pass through the apertures around the necks of teeth to remove accumulations of food. Besides these measures the crowns and bridges should be examined and thoroughly cleansed by the dentist at regular intervals. All the crown work and bridge work cases should be selected from the record books by the lady assistant, and entered in a special book labelled " Crown and Bridge Work." The name of the patient, crown or bridge piece, size of piece, and date of in- sertion should be indicated: 626 THE PRACTICE BUILDER Name Kind Size jsg/J'd Exaniiiied | Kcpuiied Ames, Mrs. H. B. 86 Peiiii. Ave. Bridge 4 teeth 92 3/15 9/20 93 2/10 1 94 8/2 2/15 1 9.5 lo/io 4/5 96 3/7 10/15 97 2/io FaciiiR replaced ist. Bi. 14K. Solder. Cruwii and Bridge Work Hxaiiiination Kcgi&Icr Another card tliat is sometimes of value is that whicli is sent to patients who have had teeth removed preparatory to the insertion of a plate, and who, instead of calling on the dentist at the end of three or four montlis, neglect to call, and in some instances go without teeth for a year or more, and by so doing make it all the more difficult to acctistom themselves to the use of artificial teeth when they are in- serted, and at the same time permit the lips to shrink to such an extent that when the plate is inserted the mouth has a tight, drawn expression. The card is likely to cause the patient to call and see about having the teeth made, and, if the plate is made, to become accustomed to the use of the teeth sooner, and the dentist has the money for his work. A form for the card is shown herewith : Form E Smlthton, 189- Will please call so that the condition of the gums may be ascertained. A. B. BLANK, D.D.S. Howe Block Appointment Card. Examining Gums Cement, as a filling material, is in daily use by thousands of prac- titioners, and the purposes which it is intended to subserve are varied. THE PRACTICE BUILDER 627 It is used often in the temporary teeth of children and again in their permanent teeth when these are not strong enough to warrant metal fillings; and in the teeth of young ladies, in such cases as the dentist deems best for the appearance of the patient and the safety of the teeth. Cement lasts for a long time in the mouths of some persons, and for a comparatively short time in the mouths of others. The use of some cement is attended with better results than others. Cement has its special uses, yet few have faith in its lasting qualities to such an ex- tent that they would term it a " permanent filling." Most practitioners have observed that cement is not well liked by patients in whose teeth it has been used. This is due largely to the fact that the dentist has not impressed upon the patient the fact that it is usually employed for a specific use, and that no intention is gen- erally entertained of using such filling as a permanent stopping. He does not explain that cement does not last as do other fillings, and that it is no reflection on the dentist's skill that they do not. Dentists do not have the time to explain just why this or that filling material is used in this or that tooth. If the patient could be made to understand that cement is used for the patient's own good, when it would be easier to use some other material, he might appreciate the point; but it is difficult to present the matter understandingly to pa- tients. If the reader will reflect for a moment, he will remember that of the new patrons who employ him he will find that, with those who are accustomed to dental service, there may be several cement fillings, which are in poor condition. Often the patient states that the preceding dentist had inserted cement, or " bone," or " white " fillings, and may indicate that the same was not perfectly satisfactory. In a great many instances patients leave dentists for no other reason than this. If the dentist had stated that the filling was not so reliable as metal, but that circumstances forbade the use of the latter, he might have retained the patient. It is an injustice to the dentist that patients leave him for such reasons, especially when they do so without knowing that he did the best thing possible for the teeth under the circumstances. This does not, however, prevent them from leaving; the dentist should have some means of ascertaining the condition of the teeth, and to insure the in- C28 THE PRACTICE BUILDER tegrity of the filling, and at the same time protect himself against loss of patronage if the filling should prove unsatisfactory. There is only one way to do this eflfectively, and that is to examine the cement fillings personally and to thus ascertain their condition. This is done by keep- ing a close record of all, as suggested in the chapter on " Records." The lady assistant takes from the record of filling operations the name of every patient in whose teeth there are cement fillings, and enters them in a suitably ruled book marked " Cement Fillings," showing first the name, then the date on which the filling was originally inserted, then the date of the examination. If the fillings are all right it is only necessary to mark after the last date, "O.K."; but if they are worn and require additional cement to bring them up flush with the cavity borders, this should be done either at this or some subsequent appoint- ment. For instance: Cement Filling Examination Register Where the practitioner holds a first-class clientele composed of pa- tients appreciative of his efforts to save the teeth, he will make a charge for adding to or refilling with the cement; but where this is not prac- ticable he will not make a charge for the work, unless it be a merely nominal one. By this means the dentist is enabled to judge of the value and per- manency of the various cements, while at the same time he retains the patronage of those in whose teeth cement has been used. This book should of course be so ruled as to allow of several examinations being made serially, so that the names will not have to be transferred to another portion of the book. The form of the card is shown on next page. One of the most important considerations in the matter of holding patronage is that which keeps the dentist at appropriate intervals in close touch with his patrons, and which afifords him opportunity for knowing just what the condition of their teeth may be, and thus fore- THE PRACTICE BUILDER 629 seeing the need for the performance of filHng or other operations be- fore such become imperative. The patient is apprised of the condition of the teeth long before he would be made aware of it himself, either from seeing the cavities or from experiencing sensitivity of the dentine. The advantages of such periodical examinations will be apparent to every practicing dentist. In the first place, they induce the patient to come at a time when the teeth are just beginning to decay, and thus enable the dentist to fill them more thoroughly and with less pain, and Form F Smithton, 189. Had cement fillings inserted , at which time it was suggested that you call again at the expiration of months to permit of examining them and to renew them, if necessary, without further charge. A. B. BLANK, D.D.S. 10 Howe Block Appointment Card. Examining Cement Fillings complicated cavities become less and less frequent. The fillings are alwa3^s smaller and are more easily inserted. Pulp trouble will rarely be observed, and will not be present at all in the cases of those who present themselves regularly in response to the dentist's requests. A high-class patronage is thus induced, and the patients are educated to a proper appreciation of the earnest efforts which the family dentist makes in their behalf to assure to them comfort and satisfaction. The effect upon the practice cannot but be beneficial. The patient becomes impressed with the care and attention which his dentist takes in his work, and he says to himself: " This is the dentist I have been looking for, and this is the one that I am going to stick to! " It shows to the patient that this dentist does not stop with the mere filling of the tooth 630 THE PRACTICE BUlEDER and the receiving of the fee, but that he proposes to give to his patrons his professional attention after the fiUings are inserted, and to watch them and give the patient warning that the teeth may again need atten- tion. The form of the Examination Card is shown herewith: Form G Smithton, 189 Is requested to call and have the teeth examined so that any necessary attention may be given them A. B. BLANK, D.D.S. 10 Howe Block (over) Exaniination Appointment Card What the Patient should d for himself. What the Dentist does for him. Upon these two propositions depend the saving of the teeth. There is no fee for examining the teeth of my regular patrons. Back of Examination Appointment Card THE PRACTICE BUILDER 63 1 To make the use of this examination card more effective, and to assure to the dentist the confidence of every class of patrons in accept- ing the innovation of its use, there should be sent to each person in the same mail with the card a letter which explains its purpose, and the duty of the patient in complying with it and thereby cooperating with the dentist in securing to his patients the best service. The letter should be typewritten and should read somewhat after the manner here shown: Miss Anna Walker, Dear Miss: I am sending you in this mail my dental examination card. The purpose of this card is twofold. By its use I propose to ascertain the condition of the work which I have done, and also to observe the condition of the teeth of my patrons, so as to relieve them of all uneasiness with reference to the state of the dental apparatus. In this way I hope to take such good care of them that they need never be apprised of the necessity for dental work by the dis- turbance which usually warns them that it is time to consult the family dentist. By examining the teeth frequently the need for filling can be seen before they have given their owners trouble, the work will be much more painlessly performed, and the fillings will be smaller than when the teeth are neglected. If there is no work to be done you will be so informed, and can then be relieved of worry through fear that the teeth may need attention. I trust that you will co-operate with me in aiming to secure the good results which I have indicated. Very respectfully, A. B. Blank, D.D.S. The card and the letter should be sent in separate envelopes. It will be apparent to many that these cards being sent, as they are, several days previous to the time set for the examination, the patient may forget that he has an appointment. To prevent this a " Reminder Card " is used. This is sent the afternoon of the day preceding that on which the teeth are to be examined, and thus the time is so im- pressed upon the patient's mind that in very few cases will there be failure to respond. The form for the " Reminder Card " is shown on next page. To conduct this feature of the practice which is comprehended in the various forms of examinations suggested, demands the most com- plete system in handling, so that it will not interfere with the routine duties of the dentist and will not demand his time in attending to the cards. It will therefore be a part of the lady assistant's duty to attend 632 THE PRACTICE BUILDER Form H Reminder Card Is reminded of Dental examination appointment at o'clock. 10 Howe Block A. B. BLANK, D.D.S. Reminder Card to all the points indicated in the system of examination. For this purpose she will take the names of all those who have at any time had operatintj of any kind done, and will transfer these names to a ruled book to be known as the " Examination Register " (for sale by the American Dental Publishing Co.). The names are arranged in the book, which should not be used for any other purpose. The patient's name is first shown, and in the next space the date the card is sent, then the date shown on the examination card for the examination of the teeth, and the next space should show the date on which the " Re- minder Card " is sent. If the patient calls, this should be shown by an appropriate mark. If it is found that some filling must be done, and the patient expresses a desire to have it done, the date on which the appointment falls should be shown in the next space. After the w-ork is done the appointment date should be checked by an appropriate mark. The appearance of the book is shown herewith: Bowen, Alice 22 Hope Street Sent 96 10/22 Appointment 11/2 Reminder Card 11/12 Appt. for Work 11/22 Form of Examination Register THE PRACTICE BUILDER 633 This ruled book is not all that is necessary. A most necessary adjunct is the " Desk File." For this purpose no other file equals that supplied by the American Dental Publishing Co. This has been de- scribed in the chapter on " Office Business Fittings." We will suppose that the month is November, as indicated in the form illustrating the ruling of the " Examination Register." The lady assistant will have the names of all the patients transferred to the " Examination Register," ready to put the cards into use; the names and addresses of the patients will be shown, and also the last date upon which the patient had work done. The cards will then be taken and the date inserted upon which the examination is to be made, and a note made in the.appointment book to that effect. The reminder card is made out at the same time. All the cards having been made out for people whose teeth are to be examined in November, both " Examination " and " Reminder Cards " are placed in the desk file in the month marked November. When November becomes the current month the cards are placed in the date of the index which corresponds to the dates on which the cards are to be sent, which should be about ten days before the date indicated on the card for the appointment, and the " Reminder Cards " are put in the date just preceding that on which the examination is made. Thus, when the assistant comes in in the morning, she examines the desk file and encloses the cards which are to be sent out for that day in their appropriate envelopes, and mails them; and when the date arrives upon which the Reminder Card is to be sent she mails that also. The desk file has its pages ruled so that any note can be made on it with reference to the business of that day. The effectiveness of this entire system of examination depends upon the thoroughness with which the dentist has instructed his patrons; and we would earnestly advise every one to first send to each patient a copy of " The American Dental Instructor " and the letter which accompanies it, before introducing the examinations. The gradual inculcation of the purpose of examining the teeth, by previously in- structing the patients through the booklet mentioned, will prove more effective than to use the cards without the booklet, and the impression made upon the patient is much more lasting and convincing. After 634 THE PRACTICE BUILDER giving to his patrons the information concerning his methods of con- ducting a dental practice, which would be indicated by the use of the various booklets, letter forms, and examination cards, he can more readily and with no noticeable opposition raise his fees, and thus the standard of his work. The patient having been impressed with the method and system which characterizes the conduct of a dental practice which is operated after such a thoroughly business-like manner, after having been made acquainted with the various booklets, and business forms used in the chapter on " Compensation," can more easily be approached with the letter form which is used to indicate the raise in fees, and which is shown in the chapter above named. This letter should be typewritten. The patronage of the practice will be of such a quality that the prac- titioner can afford to lose all of that class that would be opposed to paying more than they have been accustomed to. All those persons to whom the latter portion of the letter referred to will apply, ma) take offence at the statements made, and if so the dentist may consider himself well rid of them; while the other and more desirable element of the practice will know just why those non-paying persons no longer patronize the dentist. In this way the culling of the practice may be accomplished without affecting the cash receipts for the year adversely, because the advance will more than make up for the loss of those persons whose patronage is undesirable. The dentist should feel no hesitancy in dismissing those whose patronage is undesirable, or who are for any reason not acceptable as clients. The fact that they do not pay is one of the principal rea- sons for intimating that the patronage of some people is not wanted. Again, members of the dcvii-jiiondc, especially when they patronize one office to such an extent that it may be said to have all the patron- age of that class, should not be encouraged, as it cannot be beneficial to the practice. Before attempting to put into systematic use any of the plans ad- vised in this chapter, the reader will be wise if he first familiarizes him- self with all that bears upon their use as is shown in the chapters on " Records," " Compensation." " Office Business Fittings." " Type- writer and Its Uses in Dentistry," " Lady Assistants," " Use and THE PRACTICE BUILDER 635 Abuse of Credit," etc. A proper comprehension of the appHcation to the various uses for which they are intended can only be had by read- ing these, because they bear a very intimate relation to the points con- sidered in this chapter. That their continued use from year to year will raise the dentist in the esteem of his patrons no one can deny, and that he can continue in the practice of his profession, relieved of the worry of such details, will be readily apparent to every reader of this book. Without real ability as a dentist, these plans cannot be of real or lasting benefit, but to those who are possessed of great dexterity as operators, and who give proper care and attention to the other branches of their work, the use of these plans will give not only professional supremacy but financial gains of no inconsiderable extent. Relieved of the duties involved in the conduct of the business side of his work, the dentist will be enabled to devote more time to research and study, to attending meetings of those dental societies which in- terest him, to presenting appropriate papers for the discussion of the members, to the cultivation of professional ability, and the strengthen- ing of professional connections by the articles which are published in the various dental journals. The practice of dentistry becomes less and less tedious, and is not accompanied with the narrowness which characterizes the conduct of practices of the undesirable class, which have none of the mediums by which to attract and retain a high class clientele. All of the " Examination Record Books," files, etc., treated of in this chapter, and all of the card forms illustrated, together with minute instructions, are prepared after the direction of the author and can be had of the " American Dental Publishing Co." They are specially ruled and neatly bound, and the name of each book is stamped on the back. They are uniform in size and make a very attractive appearance. Cor- respondence solicited. How to Get New Patrons '■ liijiucnce is invaluable " When first entering upon the practice of his profession all the patrons of the dentist are new patrons; but after he has been in prac- tice for a few years, nearly all those for whom he performs services are his regular patrons, who come as occasion demands to have such work done as may be required; and there are fewer who are strangers to him than was formerly the case. In some practices it becomes un- usual to receive the patronage of a person who is not a member of one of the families already on the books; this is especially true of the ex- clusive practices in the large centres of population. It may be that the dentist has received his share of those who form the dental constituency in his particular neighborhood, his share of those who are in the habit of regularly seeking dental service; and it may also be that he does not pay the same attention to the mediums by which patronage may be attracted. Close attention to actual per- formance of the work itself, and having sufficient work to engross his close attention, often for three weeks in advance, busy practitioners cannot give attention to those details which extend the business in- terests of the practice; a dental practice being the result of the indi- vidual effort of one man, upon whose ability and whose personal super- vision of work most persons depend, and who patronize him because of this. Many men become, by years of attention to their professional duties, inattentive to the details of practice as they improve from year to year. To think that because a man has made a good reputation he can there- fore rest on his oars, is a very fallacious idea. The man who has earned a reputation has to work just as hard thereafter to hold the de- 636 THE PRACTICE BUILDER 637 sirable clientele which he may have attracted; he must maintain the standard of work upon which his reputation is founded; and to do this, he is compelled to give as close attention as ever, for he is always liable to have his work compared with that of others and criticised more freely than if it were the work of a less prominent person. After having gained an average practice, it may be difficult to make it larger, because to do so may mean to attract patronage from other dentists or to attract those who do not as yet form a part of the denfal constituency. This is no easy matter, in a practice conducted upon ethical principles; and when it is considered, too, that other dentists are exerting themselves in the same manner. The highest grade of work, conscientiously maintained year in and year out, is always a powerful factor in influencing the patronage of those who are desirable clients. Every dentist should remember that one filling may be judged as a sample of his ability; that when he inserts the filling he does not know who will be impressed with its artistic appearance, or who may ob- serve that it lacks in beauty or in correctness; that one small filling may be the means of ultimately attracting a large amount of patronage, or of repelling it, and he cannot tell which of a thousand fillings it may be; therefore he must give equal attention and skill to each, so that it makes no difiference which one is observed; all will be good and equally worthy of praise. The means by which new patronage is attracted are dependent upon the dentist himself. It must be because of some inherent force of the individual, the man himself who does the work, that people will be at- tracted to him. People who have never patronized a dentist who is in full practice are attracted to him in the first place because he is reputed to be skil- ful and stands well in his profession, in short, because he has gained what all are striving for, reputation. Another feature that attracts patronage is to be always well dressed — neat and prosperous looking. Another quality of attractiveness in a dentist is affability, and a social side to his nature. The gift of making friends is a very valuable one. A pompous, or cold, or cheerless, heartless, or indifferent manner toward people; or a studied or sanctimonious isolation from them 638 THE PRACTICE BUILDER socially; or failure to recognize would-be friends on the street or else- where, as if from a lofty independence, or as if they were inferior mortals, often gives unmeant ofifcnce. A dentist who cannot in some way make friends and awaken faith in himself cannot fail to fail. The reputation of being a " very nice man " makes friends of everybody, and is, with many, even more potent than skill. To be both affable in manner and skilful in action makes a very strong combination, one that is apt to waft its possessor up to the top wave of professional suc- cess. If his manners and conversation are of the gentle, soft, and tender kind, that win and conciliate rather than repel children, it will be fortunate, and u ill probably put many a dollar into his pocket that he would not otherwise have received. The social side of his nature should therefore be cultivated, and he should extend his fraternal connections as a most important con- sideration in his social and professional life. I5ecause he has a large practice he should not disregard this point, or some one else may gain the patronage of one or more of his most desirable families. Some dentists make it a practice to go to the seashore every season, and while there to make themselves acquainted with the members of the families from their own city who may possibly become patrons. They evidently consider the expensive summer resort to be profitable so long as it brings desirable patronage upon the return to the city. It will be found hurtful to the business interests of the practice to become identified with politics; for politics, even when honorably pursued, are injurious to a dentist's prospects. Besides escaping many anxious hours and bitter disappointments, he can in the long run make ten friends and ten dollars by being no man's man. and calmly sticking to his profession, while he is making one of either in the pol- luted waters of party politics. Avoid also the expression of radical views, and do not display political or religious emblems, portraits, etc., about the office, because these relate to personal sentiments; being emphatically a public man, and his office a public place, not for any special class, but for every faith and party, no matter what shade of partisan or sectarian pictures may be displayed, they w ill surely be repugnant to some, and in this and other matters fairly open to criticism, it is a wise maxim to respect THE PRACTICE BUILDER 639" lat he was waving en man, seemingly ition with the ut- saw him fall, and nat the bullet had '»ove the brisket, i enough to slip Jge in the lower i matter encasing ahead of my pres- imbed to the upper \c, across which I on coming to the of which we had own into its shad- . sliding down its crable point. The 1 depth — near 200 id, though the sun was deep twilight jAg down the bot- n came in sight of .ith. There was a the hilltops, across iig through. long I saw where ■ad idled away the he short grass or great wall. I now and when within mouth of the can- ii:t 200 yards away side of the valley t\y for perhaps 50 after the manner elk was standing a sentry at a dun- a fine view of him 1st the sunlit slope IS resembling the He seemed to be (articular, but just nteresting to turn ,* close at hand. iC deep gloom, at , I levelled the targets. But it ,.ves and deepen- jermit me to get a nake a sure thing must reach a low ad, and over which t as much as pos- somewhat on the RAILROAD MAN INJURED. John Wash, an employee of the B. & O. R.R., was hurt at the freight yards to-day, sustaining a fracture of the jaw. He was taken to the dental office of Dr. A. B. Blank, where the fracture was re- duced and an appliance adjusted to re- tain it in position. RUNAWAY— TEETH KNOCKED OUT. Yesterday, while William Henry, driv- er of the delivery wagon for Russell Brothers, grocers, was driving across the Lake Shore Railroad tracks, the horses were frightened by a switch-en- gine, became unmanageable, and ran away. Henry was thrown violently from the wagon, and in the fall several teeth were knocked out and the nose broken. Dr. J. P. Jayne was called, and, after relieving the injured man's suffering, he was taken to the doctor's office. He was afterward taken to the dental office of Dr. A. B. Blank, the teeth replaced and secured in position. The nose was brought into proper posi- tion and supported by a suitable appli- ance. Mr. Henry is resting easily and will recover without disfigurement. HEMORRHAGE. Lizzie West, a domestic in the home of A. W. Peters, had -a tooth extracted last Tuesday, and the extraction was followed by a profuse hemorrhage, which could not be gotten under con- trol by use of the usual simple reme- dies. After continuing for three days, the girl became so weak from loss of blood that Dr. Howe, the family phy- sician, and Dr. Blank were sent for. The extracted tooth was replaced and by use of a compress and medicines the hemorrhage was gotten under control. to strike somewher that I had gained got to alter my ca ing at the top oi A simple thing to- rific results ! The powder ch grains, yet that lit tween those walls, sound crashing aga. yon and reboundir wall to wall, as L ball. I looked up come tumbling a' withstood the sho at the disturbanc bounding away, w;- fainter, till it seerr wall between this and came roarinj Then, rolling past, valley, where it fi' died away, like th' ing thunder storm But what of the e that something hac seemed bending u; his head as if in watched, expecting full minute he see deliberately walkr . What with the elk, I had neglec Before I could p' the chamber the t yon. I followed going a long dista the marshalling of_ ther pursuit, but fai' of my game. Returning to t' broke in on the i amined for ma--' dark to make 1. detect a crimson stem the elk had ' I With this I was I hoping the light c me in possession o- I As I made my w depressed at the but as I thought oIj my spirits lighter buoyancy. For v these great plains, and glorious poss' In the morning miles, by blood spl 640 THE PRACTICE BUILDER public opini^on. Difference in religion or politics has often prevented the employment of dentists or caused patrons to leave them, and the obtrusion of unpopular political views has marred the prospects of many; besides, what is popular to-day may be unpopular to-morrow; therefore, the dentist should keep his heart and his office open to all denominations and to all parties. Failure to be at the office promptly in the morning has caused loss of patronage. People who seek a dentist early in the morning, because of suffering, will not wait and prolong their suffering for the sake of having any particular dentist. What they want is relief, and they will go on till they find a dentist who is in his office. J-Yequent hunting and fishing trips are likely to cause a loss of patronage, for if a patient is suffering and must have relief, and goes to another dentist, and there finds out that he is skilful, gentle, and care- ful, and that he gives relief, they are likely to be impressed and to go to him in the future. Be careful in this respect towards other dentists, and when the patient of another applies to you because of the temporary absence or sickness of the family dentist, do such work as may be necessary to relieve the suffering and let them return to the family dentist without anything being done which could be in any way construed as dis- paraging to the other practitioner. Be careful not to turn patients over to a specialist, when you are fully capable of doing the work skilfully and rapidly yourself; because in performing special operations with skill and celerity you achieve a form of publicity which is priceless, and which may attract patronage w^orth hundreds of dollars. Men are likely to turn operations of this class over to specialists, because of the time which it is necessary to devote to them and which they think they cannot give. But when an operation is to be done which should be referred to a specialist, and which does not come within the province of every-day routine prac- tice, such cases should by all means be recommended to the care of the specialist that the patient may receive the superior skill which at- taches to specialism. Those operations which are characterized as " emergencies " are often helpful in attracting patronage. A person is hurt in a railway, THE PRACTICE BUILDER 641 announced to hid patientd tkat he had zetutned from ibew Hjozk, wheze he had been puzduing dtuaied zelattna to the Latedt tnoded of Operating, and Grown and cB ridge ^ork 1220 Sim Street dT^ay the cFizdt Announcement form. Should be upon double sheet 642 THE PRACTICE BUILDER runaway, or other accident, and as a resnlt a fracture of either of the jaws is sustained, or some damage is done to the teeth. He may be taken to a dentist's, or the dentist may be called to take charge of the case so far as the dental injuries may be concerned. If the case is one where there is a fracture, and the dentist succeeds in performing the necessary work with skill, a very favorable opinion of his professional ability is thereby gained. Sometimes in cases of dental hemorrhage the dentist is not called, but the services of a physician sought; but if the hemorrhage does not subside after the use of the usual remedies, the dentist may be called in; and if the trouble is controlled under his treatment he is Ukely to be considered a person of superior ability. When physicians are called to treat such cases they are not at all averse to receiving such publicity as is afiforded by the columns of the daily papers, although the Code of Medical Ethics is much more rigid than that prescribed for the guidance of dentists. It is customary for physicians to have a notice similar to the samples shown on page 639 in- serted in the daily papers. Whether to use these pufif notices, must rest with the practitioner. If physicians in the same town are not in the habit of using them it would probably be better that the dentist should not. Personal notices wdiich convey news are sought by the papers and are not considered unethical, when they relate to the departure of the dentist for another city for a special purpose, or when he returns, just as the doings of others are recorded, who are not members of any profession. Sometimes after a dentist has been in practice for a few years, he finds that he is losing patronage. It will in many instances be found that clients have gone to other dentists because they have been attracted by favorable reports concerning their superior ability. A younger practitioner may have located in the community, and because of the real or supposed possession of more up-to-date methods he may gain patrons from the old established practitioners. If the older practi- tioner lacks familiarity with the more recently accepted ideas in prac- tice, he will find it to his advantage to enter the office of a prominent practitioner in a large city for a period, to study the methods of such operators, or to enter a post-graduate school. Many of the regular THE PRACTICE BUILDER 643 T>r. ^. B. BLANK announces to his patients and friends that his office is now completely refitted with modern dental appliances, and appropriately refurnished throughout. Philadelphia If] Elm St. February the First Announcement form. Should be upon double sheet 644 THE PRACTICE BUILDER colleges of dentistry have in addition to their usual course of lectures a special session for graduates who feel the need for more recent knowl- edge. It does not take more than four or five weeks of time, and the expense is light comparatively and is well repaid. When he does go, it is proper for him to make an announcement in the paper, either in the form of a card or in the personals. The personal news item is the preferable form. Something like the follow- ing will be found appropriate; Dr. A. B. Blank left to-day for New York, where he will take a special course in the latest modes of dental practice. Dr. A. B. Blank left to-day for Chi- cago, where he will study with a prom- inent Chicago dentist, who has attained great skill in certain branches of den- tistry. Likewise when he returns to his practice he should have a " per- sonal " in the paper, which should read somewhat as follows : Dr. A. B. Blank, who has for some time been in New York studying the latest developments in dental science, has returned to the city. Dr. A. B. Blank has returned from Chicago, where he was associated with an eminent dentist of that city. Upon returning to the practice, and to get the full benefit of his special study in a professional and financial sense, he should mail to each patient an announcement form similar to that shown on page 641. It may be engraved, or it may be set in light face lining gothic. It should be printed upon a double sheet of best quality paper and should be sent under letter postage. It is proper for the dentist to have the same sort of personal men- tion which the physician receives, when he attends the meetings of his THE PRACTICE BUILDER 645 dental society, or when he delivers an address upon subjects kindred to his profession. Physicians are in the habit of permitting and en- couraging notices of this kind. Some samples are shown herewith : Dr. A. B. Blank left to-day for Springfield, where he will attend the meeting of the Illinois State Dental So- ciety. Dr. A. B. Blank returned from Springfield last night. Dr. Blank read a paper on "The Care of Children's Teeth," which received high praise from those present. The doctor reports that the meeting was largely attended by representative den- tists. These will afiford an idea of the manner in which notices appear. They are always in the personal columns of the paper, and never as separate news items. Besides these newspaper notices, the dentist should, if the address is upon a subject which is sufficiently devoid of technical terms to be interesting to his patrons, have it reprinted in good style and copies sent to his patrons; by so doing his patrons are brought into closer touch with him, and their confidence in him is augmented because they may thus see for themselves that he is progressive. Keep in mind the influence and good will of physicians, and do everything to maintain friendly relations with them. Influence is one of the most powerful factors which a dentist can have, and is especially valuable in aiding him to gain new patrons. A kindly word spoken by persons of wealth or position, indicating their preference for a certain physician or dentist, is given great weight because of their prominence. Druggists can recommend a great many patrons to a dentist in the course of a year, and it should be the aim of the practitioner to do all in his power to return the kindnesses by referring as many customers to the druggist as possible. Be especially careful to cultivate the good will of the children and 546 THE PRACTICE BUILDER Dr. A. B. BLANK has returned from Chicago, where he received a full course of instruction at the Hasl^ell Post-Graduate School of Prosthetic Dentistry. Dr. Blanl^ is prepared to perform all operations of this class according to the standard which prevails in the large cities. 1227 Elm St. December, 1595 Aanouncemcnt form. Should be upon double sheet THE PRACTICE BUILDER 647 to treat them with every consideration that would be accorded grown people. Be just as careful of the little boys as of the little girls, and do •everything to gain their confidence and to retain it; and never be guilty of deceiving them in any way, either with reference to operat- ing or extracting, as to the painfulness of operations or how work is to be done. Take the little ones into your confidence, and by so doing as they grow up they will esteem you as a friend and their influence will be valuable. The home life of a dentist will do much towards influencing the patronage of those with whom the members of his family may be on terms of social intimacy. A dentist whose home shows the possession of refined and artistic taste, and whose wife is a person of refinement, and whose home life is indicative of happiness and contentment will by these means attract the patronage of a very desirable element. If at any time you make any notable changes in the furnishing of your ofifice you should send out to your patrons an announcement to that efifect; this is especially important if the office has been allowed to run down, and no longer presents an inviting appearance. The announcement form should be something like that shown on page 643. When the practitioner has taken a course of instruction in a dental college, either post-graduate or other, he should let his patrons know this by use of the announcement form shown on page 646. Do not accept a young man or boy as a student in your office be- cause he has influential friends, or friends who will patronize you on his account. People do not usually patronize a dentist because some young fellow whom they know is employed or is studying there. When a patron is kind enough to recommend another person to you as a superior and reliable dentist, let him know that you appre- ciate the favor. If a patient calls for work, and says to you that Mrs. H. H. Hollins has spoken so highly of you that she decided that she would have you do her work too, you should promptly send a note of acknowledgment of the favor. The following letter will show the general form: 6^8 THE PRACTICE BUILDER A. B. BLANK, D.D.S., Howe Block Smithton, Dec. 2, J898 Mrs. H. H. Hollins, Dear Madam: I was consulted to-day by Mrs. Arthur Dixori, and in the course of our conversation I learned incidentally that Mrs. Dixon had been recommended to nie by you, and that you had done me the honor to praise my work highly. Permit me to express to you my gratitude for your kindness in compli- menting my work to Mrs. Dixon, and for referring the lady to me. Thanking you again, 1 have the honor to be, With much respect, Yours truly, A. B. BLANK. THE PRACTICE BUILDER 649 By this courtesy you indicate to Mrs. Hollins that you appreciate the honor which she has done you, and that you value the high opinion in which she holds you. If you were not to do this, she might not again go to the trouble of recommending her friends to you. Remember that patience is one of the greatest virtues a dentist can have, and that it may be the one virtue that may attract to him much patronage. Patience is an especially desirable character m the treat- ment of lady patients, and it will hold patronage and attract new patronage, where the possession of the highest professional abilities, coupled with the lack of patience, in other dentists fails to add to their practice or reputations. Conduct your practice on the basis of conservatism; this will com- mend you not alone to the layman but to the professional man as well; by being conservative you will never promise great results for your work, and you will never be charged with not equalling your claims for it. Remember that plate work and bridge work, especially plate work, demands as close attention as the most exacting operative pro- cedures; and that a good reputation for doing plate work will attract the patronage of all those persons who are nearing middle life, be- cause it is usually at that period that plate work is needed; having secured the influence of these, the younger members of the family are likewise gained, because the elders pay the bills, and if their work is satisfactory, they will send those who are dependent upon them to the same dentist. Be careful to have the lady assistant keep strict watch on the mail- ing of the booklets, and see to it that she sends out those on "' Irregu- larities of the Teeth," and " The Children's Dental Instructor," to every family where such may properly be sent; and see to it that she is per- fectly familiar with the business details of the practice, so that she can write out all the letter forms shown in the chapters where such letters appear, without suggestions from her employer. Let the business of every body else alone; attend earnestly to your own; don't buy what you don't need ; put every hour to advantage and study to make your leisure hours useful; think twice before foolishly spending a dollar; remember you will have another to make for it, and should you spend as fast as you make, you need only hope for a tread-mill existence; 650 THE PRACTICE BUILDER look after your business largely in a spirit of light-heartedness; look after accounts closely and regularly; if you find an error trace it up and keep stirring close accounts; should a streak of misfortune come upon you, retrench, work harder, but don't fly the track; confront difficulties with unflinching perseverance and good humor, and they will disappear like fog before the sunshine. Because you have been placed in possession of all the money-making, money-saving facts, timely hints, workable plans, and proven methods which this book contains, and which you have practically applied and found good in your practice, and which may have extended your reputation profes- sionally and added to your wealth financially, do not lose your head, and do not think that you are too good a dentist for such a little town — if vou should happen to live in a small city — and do not think it is beneath vour aims and aspirations to continue in practice in such a community; do not think that you can go to a large city and take hold of a large practice at once, securing to yourself the wealthiest and most desirable people ; bear in mind that these people already have a good dentist, and that they will not change for many, many years to a new and untried man; remember that it is just as honorable, and in many instances just as profitable, and in many instances much more profit- able, to practice dentistry in one of the smaller places than in the larger ones; remember that dentists in the smaller cities are the social equals of any of the pedple in their town, and that in the larger cities, except where they are the possessors of great wealth, they are subject to a form of social ostracism; bear in mind that the dentists who have made great reputations and gained wealth have, in most instances, been :;he residents of the smaller towns, and that the distinction won in the larger cities is usually of a temporary and unsubstantial nature. Julius Caesar was a wise man and a profound thinker; he said, " I would rather be the first man in a small town than the second in a large city." Try hard to be the first dentist in your own town; in doing this you gain all the professional esteem and moneyed worth that is to be had in the practice of dentistry; you could not do more than this if you practiced in the largest city in the world. Short Sixes " Short and sweet " See to it that your engine burs are always sharp and clean. Read the dental journals closely in spare moments and by so doing keep in touch with all the good new things. Read the advertising pages as carefully as the others. Keep your finger-nails clean and properly trimmed. *** Be careful to keep your breath pure. ^% Don't smoke in your office during office hours. Don't smoke on the street. Have your office as carefully and as tastefully furnished as if it were a parlor. Don't gossip with your patients. Don't mention the name of one patient to another. 651 652 THE PRACTICE BUILDER Don't talk shop at the dinner table, and head off a tendency to da so on the part of another. *** Don't exhibit specimens of your work. Don't brag about your practice, the quality of your patronage, the size of your fees or the amount of your income. *** Don't hang about the street door of your office during the daytime or in the evening after office hours. Employ your spare moments in study. *** Don't permit your lazy, shiftless friends to hang around your office. Permit no loafing. *** Stick to your office. Be there when people call for you. Don't close the office to go to the ball-game. *** Don't criticise other dentists. People will think more of you if you keep your mouth shut. If you cannot say anything good of a per- son, say nothing. *** Don't get discouraged. Cultivate worthy friendships. Be content. Read. Wait. Compel recognition. *** Be friendly with other dentists. Strive to bring about amicable relations with them. *** Don't be afraid to lose a patient. Peflets of Gold " Diminutive nuggets " Attend to details. Be prompt in all things. *** *** Do not be ever ready to make acquaintances. *** Be polite to all — rich and poor Pay your debts promptly. *** *** Use every leisure moment for improvement. *** Treat every child as if he were a grown person. He will be some day, and he will remember you. *** Don't go to church for the sake of being the last person in, and thus attract attention. 653 654 THE PRACTICE BUILDER Avoid intoxicating liquors, *** Never advertise extracting free of charge. Charge something for everything you do. Make your operations thorougli, then make them beautiful. *** Strive first to become a good operator, then to become a rapid one. Join a good dental society. Marry a good woman and have your own home. t** Extracts " I have gathered a posie of other men's flowers, and nothing but the thread that binds them is mine own " There is nothing so helpful to a young man as encouragement. This is as true in dentistry as elsewhere. The road to dental glory is not smooth; it is filled with dangerous places. Many are the discourage- ments encountered by the way. Really helpful, stimulating talks, such as those which we introduce herewith, cannot but instil enthusiasm into the hearts of all who read them. They are mostly selected from the writings of Dr. T. B, Welch, whose editorials have long been a source of keen enjoyment to all his readers. They have occupied (and we hope will continue to occupy for many, many years) a unique position in the periodical literature of the profession. Dr. Welch has a quick per- ception of all that is of interest to young men, and his editorials are always read with the greatest delight by his thousands of admirers. Pleasant Street vs. Dingy Lane What say you to moving over into Pleasant Street? They are getting along there much better than in your old Dingy Lane. It is a bright, cheerful place over there, and they pay us well for our work. You will not get sleepy and tired with the rest over there, and spiders and mildew do not thrive. I am told it is a good place for business, a sure cure for blues and dyspepsia. You find plenty of fun and nuggets of gold over there, and dentists look sleek and fat, while on Dingy Lane they are no- ticed for being lank and lean. It must be a good place to live, over in Pleasant Street, for it is a place for the nip and gay, and their pockets are filled with money for bright tradesmen and professional experts. No unskilled workman need apply. 655 656 THE PRACTICE BUILDER Conic, wake up, wash up, dress up, and move over there. Never mind your old shoes nor your old clothes nor your truck. They don't use old trash over there. Sell them and all your rusty old tools to the junk dealer, and buy new. And be sure to select the best, and the most tasty patterns, and to make \ our office inviting and cosey. Be sure and call on Mr. Public Opinion on the way. He will pay all your reasonable bills if you are worthy, and insure your business besides. And don't forget, on your way over, to stop into the tailor's and buy a professional suit of clothes, and a new hat and a good cigar — beg par- don, smoking is at a discount over there, and breaths scented with stale beer. Dentists on Pleasant Street must be as sweet and clean in body and mind as a woman. And be sure to leave your coarse language and ill manners behind — the demand is for refinement and good taste and gentlemanly conduct. Your very office must be as neat and clean and presentable as a lady's parlor. With all this you will not need to tell the people you are a good dentist; they will take it for granted till you disprove it by betraying ignorance, and by blunders. By all means, don't put a placard on your coat, or advertise cheap dentistry. Here they want good work, and for this they are willing to pay good prices. And be sure you keep up to the music of progress. Enthusiasm Oh, for enthusiasm! If we w^ould have success we must go through this world all on fire. A man with only one idea, all aglow with enthu- siasm, will accomplish more than a ripe scholar w'ith a thousand grand thoughts hidden away in pigeon holes. We allow ourselves to be too much tied up with red tape — hedged about with too much propriety — subjects of too much formality, con- servation, and restriction. Away with your icebergs, though they glisten beautifully! Give us 7nen, with a warm, genial inspiring nature; intelligence, but with intense passion; aggressive, daring, venturing their lives on success. Such men will find their place somewhere, somehow, sometime, THE PRACTICE BUILDER 657 though they make it in sacrifice and strife; they will find their work, though they find it all written over with " failure," and they will find success, though they themselves fail many times. It is fun to see enthu- siasts brush against the pigmies and clear away the rubbish, and make an oasis of the most unpromising places. It matters not whether they are let loose in a wilderness or into *' an overcrowded profession," they will find success. I can see them now as they push by all obstacles and op- position, and make a palace where was only a cabin, and success where were only the ashes of the defeated. Oh, for enthusiasm, which makes all the world bow to our purposes and speeds us on our way! Poverty Poverty is no crime. It need be no disgrace. It is seldom a hin- drance to material, social and intellectual success. It is often a blessing, a help, a legacy, to be coveted for its necessity in prompting industry, and frugality and genius. Search the annals of the past, or look into the great business present, and see who are the learned among the professions, the skilful among the trades, the successful everywhere. Do they not come from the hut of poverty? Are there many from the mansions of the rich? Wealth pampers; poverty feeds on the substantial. Riches fawn and flatter; poverty sends its children into the school of necessity. Af- fluence brings forth indolence, weakness, and efifeminacy ; poverty forces daring, bravery, heroism. The son of wealth seeks popularity by extravagance, foppery and self-indulgence; the son of poverty by industry, economy and cleanly habits. In brief, to be " born with a silver spoon in the mouth " is to lie in the cradle of indolence, to be reared in the atmosphere of enervation and to be propped up by the crutches of uncertain support, ending in beggary and misery; while the stimulant of poverty is the mother of invention, the developer of genius and the promoter of thrift which is sure to bring forth an honorable standing, a happy home and an abundant success. 658 THE PRACTICE BUILDER The Thriftless, Shiftless Dentist Ob, do not loaf about in that way! Why squander your time in shiftless idleness while there is so much to do? It is childish. Xo wonder you do not get on in your business better. Who will patronize a lazy, loose-jointed, thriftless dentist? He is sure to be a bungler. Patients of intelligence and money had rather pay double for their work to a thrifty dentist, for he is sure to be skilful and abreast of the times. Get out of your dirty shell and straighten up. It is astonishing how much a little soap and backbone and enterprise will do. The world needs you and your work, and pays well for what you do, if it is what it should be. But neither you, nor anything you can do, will be accepted while you are gaping and yawning in your shirt-sleeves. Sluggishness and shiftlessness are stamped on your very countenance, dress and work. Your contentment in such a low-level existence is worse than the pig in the sty, satisfied with enough to eat and a bed to grunt on. He will keep himself clean, if you give him a chance, but you keep neither yourself nor anything about you clean. He is good for something when fatted, but you are a nuisance, fat or lean, dead or alive. But worse than this; you remind me of some great overgrown hogs I had once. I could not fatten them. Do my best, they would remain lank and lean and raw-boned. They had actually become too lazy and degenerate to fatten. I turned them out into the woods, and said : " There, root, hog, or die." They did not die, they rooted, and the very work and scanty diet gave them good digestion and condition. In the Wrong Office " I guess we've got into the wrong office," said a lady to her com- panion. As the dentist came into the reception-room and asked what he could do for them, the lady replied: " I only want my teeth looked at, to see what they may need." This done, and tliev left. THE PRACTICE BUILDER 659 " It's no use, Lizzie," said the one who had come to have work done, " I could not have allowed that man to w^ork in my mouth. He was too dirty, and did you notice what a smell the office had, and how shiftless everything looked? " " Yes," said her companion, " there was nothing inviting, and much that was repulsive. Suppose you go over to my dentist? " They went. Here everything was neat and clean; the dentist was well dressed and polite, and everything was attractive. As soon as he could leave his patient, there in the chair, he came to them. Greeting his old patient pleasantly, he asked what he could do for her friend. They were detained till his first patient was dismissed, when he conducted his new patient to the chair. After two hours' work she was dismissed with an appointment for another day. Is this an exceptional instance? We believe not. Somewhat similar instances occur frequently. Appearances go a great way with all of us, and still more with the w^omen. They judge almost by instinct what a dentist is by what they see about him ; by the very atmosphere he carries with him. The Price of Work "At the prices I get," said one dentist to another^ " I can't afiford to do such work as you turn out." " At the prices I get," said the other, " I can't afford to do such work as you do ; I could not get my prices, and I would demoralize my busi- ness. I do everything as well as it is possible to do it, and then charge accordingly. But tell me, why do you not do such work as I do, and get my prices? " " I can't make people believe my work is worth such prices as you get." " But you admit you don't do such work, and, therefore, how do you know that your patients would not be willing to pay first-class prices for first-class work? In fact, how do you know you could do such work?" " Oh, I think I could do it if I tried." " You certainly are to blame for not doing your best, and you are not alone in your blameworthiness." 66o THE PRACTICE BUILDER " I haven't the gift of gab you have, nor the fine surroundings, nor the rich, aesthetic class of patients to cater to that you have." There are two things that mainly determine the market prices of our time and work. First, our estimate of it; second, its intrinsic value. There are dentists who injure their business by too highly estimatii g its value, or by thinking a high price will mean to their customers a high grade of work; others put their prices too low, because they have not sufficient faith in their ability, or they are too anxious for work, or when much work comes they gradually lower the standard of its quality. The greatest mistake a dentist can make is in not constantly doing the very best he can. Even this may not be the best another can do. It may not be in him. Then he must be content with corresponding prices. The public are better judges of the quality of work than some of us give them credit for. It is not blarney that wins, but good work. Our Office Appearance Do you really believe the dentist's character, reputation and skill; his dignity, learning and moral worth; his influence, thrift and success, and his finances, fees and social standing can be discerned by the ap- pearance of his office? This is the gauge by which we judge other dentists, and by which they judge us, and by which our visitors judge us; yes, and it is the gauge by which we shall judge ourselves and our own office, if we judge ourselves as others judge us. Of course, there are exceptions, but it is generally a just verdict. Suppose yourself for a moment to be a stranger to your own office. Knock at the door and peep in. What is the picture? Of thrift or decay? Is it the appearance of neatness, precision and skill or of slovenliness, confusion and sloppiness? Are the surroundings those of a professional gentleman, or of a crude, unkempt, careless tinker? Does it invite the aesthetic, refined and well-to-do class, or is it a becoming place for the shiftless, careless, stingy, who are the leavings of other dentists? Does it look like an office which invites those that trust you, or who come to be trusted? those who come for the best work, or for the lowest prices? THE PRACTICE BUILDER 66l That chair — always the object of the first attention — is it neat and clean, or clumsy and dirty? And the cuspidore and instruments, and everything about the office — are they bright and orderly, or rusty and repulsive? And how about the reception-room — is it well kept and tidy, fresh and sweet, or are cobwebs on the ceiling, dirt on the windows, and litter everywhere? Is the atmosphere pure and inviting, or repulsive and stale? And what you see in your office you will see in yourself, for usually a dentist carries his office appearance on his back; yes, and the kind of patients he has, and prices he gets, and work he does. Well, are you satisfied with what you see? No? Then I venture that others are not satisfied with you, and that your best friends are not satisfied with you, and that they may stay away because they are not satisfied with either you or your office. If you think I am too harsh Vv'ith you, take a stroll around to a half dozen other offices, and see how my gauge fits them, and then be assured it just as well fits you. And what will you do about it? Let all these suggestions pass unim- proved? If you are wise, they will do you good — you and your business. Good Books By all means have a good library. Good books are like the company of good people — so emphatically so that we are known by the company we keep with books, as with persons. But like company generally, if we would profit by them we must not be satisfied with their company simply, nor by their being mere orna- ments to tickle our vanity. We have been astonished to see how little some folks know of the character of their library. They have been har- boring strangers all their lives, simply for the dignity and the good ap- pearance of their company. Of course, all books are not to be committed to memory, nor to be used as text books. A cursory acquaintance with some is sufficient; others we should study with much thoroughness and method. There are many lighter books that are hardly essentials, but take us in pleasant 662 THE PRACTICE BUILDER nooks and bowers, and are rest and recreation. Their perusal is like an avocation, to lighten our vocation. Thus, to be well-grounded, intelligent, and happy in character and agreeable and useful in all the moods and modes of life, we need a great variety of book company, and we should revel in them through many devious paths. Of course those pertaining to our business should be first in impor- tance and place, but others also must be now and then taken in our inti- mate companionship. We must sometimes follow them out of our beaten path to the fields and woods, and in unaccustomed places and studies. Make no excuse for illiteracy. Extensive reading takes time, but it is the busiest and most successful men who have time for comprehen- sive and varied reading. Don't Fret Do not fret because you have not all you could wish, or all others have. The happiest time a man has is while he is climbing. The most substantial things grow slowly. If, therefore, you are a lit- tle better off in knowledge, skill and position this year than you were last year, and last year than the year before, and have the prospect that this gradual improvement will continue, you are like the beautiful de- velopment of childhood — in the most enjoyable period of life. Those who have commonly and constantly everything they can de- sire have few luxuries; for luxuries are rarities not easily obtained. Give the poorest and most abject person a ray of ambition, and you have given him what will make him a king, if he will follow that ray out in its brightening. Though at first only a ray, that ray will become a sharp instrument of light penetrating his very soul, and out will flow his very soul, blazing and shining and burning its way right through the world. In his inspiration he gives his life, and in giving his life to the world, he becomes himself a heaven of light and life, and love and joy. Stop fretting and regretting, and catch a ray of this light, and hold it, and follow it. Be satisfied though you can get but a glimpse of it. THE PRACTICE BUILDER 663 The full light of the perfect day is not given at once. It would be dazzling, and blinding and confusing. Receive the faint gray in the east as a harbinger; delight in the far distant, beautiful arrows of light as forerunners of splendor to come; en- joy the gorgeous coloring of the eastern sky as the dancing angels pre- saging the glorious orb. But even the full-born morning is not like the noonday brightness. That is a beautiful figure of the Christian's path, and is much like the path of the successful man generally. Its light is represented as at first faint, but sufficient to give hope and inspiration; following it, it "grows brighter and brighter even to the perfect day.". And it is so penetrating that we become ourselves " burning and shining lights." Let us be patient, and courageous, and persevering; constantly, wisely, skilfully using the light we have, it will increase gloriously. Economy . It is not so much the amount we earn and spend that makes us poor or rich as how we keep our accounts. Some keep no accounts, and, therefore, never know where they are; others keep their books so loosely that it would puzzle a Philadelphia lawyer to decipher them. But some- times we see a man who by his very air and manners is such a model of punctuality, method, and correctness, that he is an accountbook of him- self. Such gentlemen are always before-handed, not, perhaps, because they make more, or spend less than those who are hind-handed, but be- cause, like those who are governed by forethought instead of hind- thought, they know how to keep their books. The credit side has always a little more weight than the debit side, mainly because they make their money before they spend it, and never spend all they have. Then, too, they have the little knack of having what they earn in their own pockets, instead of in the pockets of those they have worked for. They never have duns, because they never owe any one, and they never have bad debts because they never trust. " Never? " " Oh, well, hardly ever! " (564 "^^^^ PRACTICE BUILDER It is singular how customers know and confide in such dentists. They inspire confidence by the confidence they have in themselves, and the confidence they have that you will honor the confidence they have in you. You know they are cash men, and expect their customers to be. They are not stern, or exacting, or penurious. Oh, no; they are as suave and obliging and confiding as women; you would not for the world impose on their confidence. It would be cruel to ask to be trusted. When your work is done, such a man passres you your receipted bill so promptly and so politely that you know it is only a gentle hint for you to press the button of your purse. Another thing is wondrous strange — the work of such a dentist is always better tiian the work not paid for in a twelvemonth. If you owed him you would rather forget him than recommend a , neighbor to visit him, and avoid him yourself when you wanted more work done. So w'e repeat, it is not so much what we earn and spend that makes us poor or rich as how we keep our accounts. The Successful Man The successful man is he who by the greatest good gives the greatest happiness to the greatest number. He wipes from the cheek of sorrow the tear of grief. He stands w'here chilly, biting winds blow hard on him, if perchance he may shield some tender fellow-creature from its blast. He steps aside in the gutter to raise again to its feet some fallen form. He prattles with infancy, smiles on youth, firmly grasps the hand of middle life, and smooths the wrinkles of old age. He lifts the help- less, cheers the despondent, weeps with the bereaved, and rejoices with the light of heart. He gives to the needy, censures the niggard, spurns the miser, and bitterly resents the affectations of the insincere. He plants in every human heart the fragrant flower of hope, and nourishes it with the perfume of his own happiness. He believes in love, in charity, in friendship, in companionship; and, above all, he has an abiding faith in his fellow-man. He is a firm believer in the ultimate good of human- ity, and his own life forms the strongest evidence in favor of this belief. He sees something good in the character of the vilest son of Adam, but is not beyond believing in the possibility of a weakness in a reputed THE PRACTICE BUILDER 665 Sampson of morals. He wishes for the best, but is prepared for the worst. The successful man is not he who lives simply for the greed of gain — •who sees nothing in life save the accumulation of dollars and dimes. The Croesus of Wall Street, the prince of the bull-pit in the Chicago Board of Trade, the bonanza king of the West, or the men who make financial Europe tremble with the touch of a pen, are not successful un- less they have elements in their lives other than those which claim the at- tention of the world. The statesman, standing before the lawmakers of the land and sway- ing the destinies of a nation by the force of his eloquence, is envied for his genius and ability; and yet his life, as measured by the one crucial test of all, may be a failure worse than that of the humblest citizen of the 4omain. The preacher, poised before his flock, and pointing out the way for them to tread, may miss the way himself. The lawyer, doctor, artist, author, actor, all may win renown in the world and yet fall short of that which constitutes success. To be successful, a man must be happy; for in all the weight of argu- ment there is no one truth which so well stands the test of time and ex- perience as this which says that " happiness is the greatest good." A man may be renowned and ruined — he may be rich and wretched. He may stand erect with a smile to the world and fall to his knees weep- ing in the quiet of his own closet. And after all, the success of a man's life is measured more by the in- fluences which surround him in the routine of his every-day experience than by any other criterion. Let me tell you who the really successful man is. It is he who, as a boy, was cherished by the love of a noble mother; who, as a young man, was absorbed by the love of a loyal girl; who, ever after, is sustained by the love of a tender wife. It is he who gathers around him the comforts of a home, who tastes the sweets of domestic happiness. It is he who feels around his neck the clinging, thrilling arms of children, who feels on his own roughened cheek the soft and velvety cheek of his babe. It is he around whose heart the precious tendrils twine, and in whose soul are sown the seeds of love 666 THE PRACTICE BUILDER which sweeten life and add a fragrance to tlie time when nature dons the " sere and yellow leaf." The successful man is he who loves and is loved from the rosy dawn of life's new morn, through the heat and bur- den of the mid-day sun, till at last his sleepy eyelids are kissed to rest by the cooling winds from nature's night of death. Dual Characters We have a few dual characters in the profession. With their ordi- nary friends at the chair they are urbane and smiling; in the labc ratory thev are rough and gruflf. In their professional character they are aes- thetic and refined; when they throw off their professional coats they are low and ungentlemanly. In public assemblies and social gatherings they seem to be as pure as ladies; in the gatherings with their zhums thev are vulgar and profane. In their reception-rooms their pictures and books are elevating and instructive; in their private apartments the walls speak of vulgar passions and depravity. They pass for ladies' men, and would not defile the tips of their fingers in their company; pri- vately they revel in an atmosphere of beer and tobacco. Yet a man of high standing in the profession declares that "A man's private character is his own ; it is with his professional character we have to do; that, being acceptable, we have no business to look behind the curtain." Success Before you succeed, and especially when you fail, many will call you a fool; if you succeed, they will call you a genius. So that a prominent difference between the fool and the genius is failure or success. Be willing to be called a fool many times, if finally you can be called a genius. Men Who Accomplish The difference between men who accomplish astonishing tasks and those who do nothing, is that one uses the time at his command, while * THE PRACTICE BUILDER 667 the other wastes it; one husbands his resources, while the other dissi- pates them; one is aggressive, the other neutral. The Difference Joe Evans was a great, burly, sleepy, loose-jointed fellow. At the dental college he was a foot-ball for the whole school. All had the privi- lege of kicking him about, just for the fun of the exercise. When he opened a dental office he was not improved in his appear- ance or manners. He was the same coarse, gaunt, slouchy boy, given to slang, lawlessness and vulgarity. He would have been an entire failure but for his acknowledged skill; for with all his defects he was a genius. Feople would patronize him in spite of his uncouth ways. His smoking, too, was specially objectionable. But as for that, his breath smelt of stale beer quite as much as of nasty tobacco. Of course, his ofHce and instruments and his whole surroundings were of the same sort. He was the antipodes of sentimentalism. He was as gruff and un- mannerly toward the " weaker sex," as he was specially pleased to call them, as he was toward his chums. He was almost a woman hater, which his friends believed accounted for much of his lawlessness and want of business ambition. True it is that love, and the object of love, makes or breaks many a young man, and the want of this tender senti- ment makes an unkempt, ill-mannered, lawless fellow. He was fond of games, horse-racing and field sports, and was " hail fellow well met " with boys generally. Even with his dental office on hand, business or no business, he must have a day off occasionally, and sometimes a night, too ; and these nights were spent in the greater dissi- pation. Of course, he had chosen for his location the poorer part of the city, for he had sense enough to know he could not thrive in the better circles. All at once Joe Evans fell in love. Yes, he did ; he fell in love all over. The awful malady seized every part of his nature and upset him terribly. And, what is singular, the object of his love was a little, delicate creature, the most directly opposite to himself in every way. It was just laughable to see them walking together — he a great, strapping, awkward, dis- 668 THE PRACTICE BUILDER jointed fellow, six feet three, taking long, heavy, ungainly steps, and she, tripping along by his burly side, hardly knowing how to behave herself. Joe Evans died. " To let " was on his office door. His chums mourned his loss, and so did his numerous clubs. The beer saloons and tobacco joints also mourned him, and his patrons did, for they could no longer have good work done at half price. " That is a straight, spruce, dignified-looking gentleman with that vivacious, intelligent lady in the dress circle," said I to a friend at a social gathering. " Yes," was the response, " he is a modest and refined gentleman and extremely enterprising. He and his wife are often the centre of attrac- tion. They are specially gifted at the piano. Both are expert players and singers. They are new-comers and in every way acceptable." While in the aristocratic section of the city of C I was desirous ' of having the tartar taken ofT my teeth. Surely, any dentist could do this. But I was particular, and making inquiry of a business man for the best dentist in the city, he said: " I can direct you to just your man. He is the favorite of every one, and is specially skilful." What was my surprise to find this was our old friend, Joe Evans! No, not Joe, he was dead; but Dr. Joseph R. Evans, a professional gentle- man, every inch of him, in appearance and manners. The love of a pure, lovely, intelligent woman had transformed him into another man. He and his lovely wife were those we met at the entertainment. No wonder we did not know him there. She had so thoroughly drawn him out of his past life, and so enamored him with all that is good and true, refined and aesthetic, that he was a noble man. His gentleness, suavity and genuine kind-heartedness had changed his whole nature and made him the favorite of his profession. I asked him what could have possibly made such a wonderful change. He replied: " Only a determination to be, in my habits and charac- ter, as good as my wife."