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diff --git a/.gitattributes b/.gitattributes new file mode 100644 index 0000000..d7b82bc --- /dev/null +++ b/.gitattributes @@ -0,0 +1,4 @@ +*.txt text eol=lf +*.htm text eol=lf +*.html text eol=lf +*.md text eol=lf diff --git a/LICENSE.txt b/LICENSE.txt new file mode 100644 index 0000000..6312041 --- /dev/null +++ b/LICENSE.txt @@ -0,0 +1,11 @@ +This eBook, including all associated images, markup, improvements, +metadata, and any other content or labor, has been confirmed to be +in the PUBLIC DOMAIN IN THE UNITED STATES. + +Procedures for determining public domain status are described in +the "Copyright How-To" at https://www.gutenberg.org. + +No investigation has been made concerning possible copyrights in +jurisdictions other than the United States. Anyone seeking to utilize +this eBook outside of the United States should confirm copyright +status under the laws that apply to them. diff --git a/README.md b/README.md new file mode 100644 index 0000000..79ee59d --- /dev/null +++ b/README.md @@ -0,0 +1,2 @@ +Project Gutenberg (https://www.gutenberg.org) public repository for +eBook #60187 (https://www.gutenberg.org/ebooks/60187) diff --git a/old/60187-0.txt b/old/60187-0.txt deleted file mode 100644 index 6455cc9..0000000 --- a/old/60187-0.txt +++ /dev/null @@ -1,2093 +0,0 @@ -The Project Gutenberg EBook of The American Journal of Dental Science, -Vol. XIX. No. 6. Oct. 1885, by Various - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: The American Journal of Dental Science, Vol. XIX. No. 6. Oct. 1885 - -Author: Various - -Editor: F. J. S Gorgas - -Release Date: August 26, 2019 [EBook #60187] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK AMERICAN JOURNAL--DENTAL SCIENCE, OCT 1885 *** - - - - -Produced by Jwala Kumar Sista and the Online Distributed -Proofreading Team at http://www.pgdp.net (This file was -produced from images generously made available by The -Internet Archive) - - - - - - +Transcriber's Notes+ - - 1. Typos have been silently corrected. - - 2. Variations of spelling and hyphenation are as in the original. - - 3. The text version is coded for italics and the like mark-ups i.e., - (a) italics are indicated thus _italic_; (b) small-caps are indicated - thus CAPS; (c) Single image is indicated as [Illustration:] - - 4. One footnote moved to the end of book. - - * * * * * - - [Illustration: "cover-page"] - - - THE - - AMERICAN JOURNAL - - OF - - DENTAL SCIENCE - - VOL. XIX. THIRD SERIES.--OCTOBER 1885. No. 6. - - - - - ARTICLE I. - - NERVOUS ENERGY. - - BY DR. E. PARSONS, SAVANNAH, GEORGIA. - - [Read before the Georgia State Dental Society, May, 1885.] - - -GENTLEMEN--The subject I have chosen for your consideration at this, -our Annual Meeting, is "Nervous Energy, how Actuated, and its Varied -Phenomena." No one can question the importance of knowing all that can -be known about it. - -There is an invariable law by which means mind acts on matter, and it -is my purpose, in this paper, to briefly elucidate what I have learned -by reading, observation and experience on the subject. The great -advantage of meeting in council is an increase in knowledge on all -subjects in any way relating to our profession. We have many things yet -to learn that will be, when known, of great benefit to both ourselves -and the public. - -Science demands a full and free investigation of all or any causative -principle by which life is manifested, or death produced. So long as we -draw our conclusions only from appearances, we shall often be deceived -in a correct diagnosis; consequently often fail to cure diseases that -come within the legitimate bounds of our specialty. - -Proper remuneration for our services are absolutely necessary for the -respectable maintainance of ourselves and those dependent on us; but -our best men are laboring unweariedly in their endeavor to elevate our -standard throughout the world, but particularly in our own country, and -this Society can do much to help them in their onward march, developing -all possible improvements in Scientific Dentistry. - -Again, we all have a full consciousness of three things--we love, -we think, we act. But few have a scientific knowledge of the means -employed by which mind acts on matter. There are such varied forms and -circumstances controlling its development, that we need not marvel -at anything that comes within the sphere of our observation. As we -are brought face to face with almost every possible condition of -the nervous system, our opportunities for investigating the various -manifestations of nervous energy, its source and supply, may we not -equal any other specialty in solving the great problem of cause and -effect manifesting nervous energy? As the brain is the seat of all -sensation, I briefly present some of the best authenticated views -of its organization. I think you all will agree with me that it is -wonderfully constructed by Infinite Wisdom for the development of the -finite mind. In the elucidation of my subject, let us not forget the -fact that the blood has much to do with the various conditions of -the nervous system. It holds, or should contain in solution, all the -elements necessary for the growth and sustenance of every organ in the -body; it is both a receiver and a giver; it is fed from what we eat and -drink, without which it cannot perform the office intended. - - - THE BRAIN. - -The brain is divided by the septum into two lobes, right and left -sides; also, into the cerebrum and the cerebellum, front and back -sides. Phrenologists divide the lobes into about forty convolutions, -assign to each a distinct office, and by careful observation of each as -to their development, profess to know individual character, and point -out what kind of occupation one, by nature, is best fitted for. - -In 1840, Dr. Sherwood, of New York, by ingenious experiments, -demonstrated the fact that the brain has four large poles, two in the -cerebrum and two in the cerebellum, and from these proceed not only the -convolutions, but every nerve in the body. By these, and experiments -in animal magnetism, he maintained that animal magnetism is the motive -power of the human system, and without it there can be no connection -between mind and matter. - -In the Fall of 1844, I invited several of our most eminent physicians -to meet me at my office to witness some experiments in magnetism. My -subject for demonstration was a young man of unimpeachable character, -twenty-three years of age. My visitors were very skeptical on the -subject of magnetism. There had been some public exhibitions, but the -result did not satisfy them. - -I said, as the science of phrenology is ridiculed by some, I wished -first to exhibit each convolution of the brain, in a state of -exaltation, while he is as wide awake as we are. To prevent any -suspicion of collusion, I handed them a chart containing the names of -the different convolutions of the brain, and requested them to write on -paper any question or the name of the organ, for me to excite. - -The first paper had on it mirth. I placed the point of my finger over -the organ, and he immediately broke out into an uncontrollable fit of -laughter. I passed off the influence and he instantly became calm. They -asked him what he laughed at. He said he did not know; he could not -help it. - -The second paper had on it veneration. I excited the organ, and he -immediately bowed his head and assumed the attitude of the most zealous -pietist, and appeared to be in earnest prayer. - -The next paper had on it music. I excited the organ, and he immediately -commenced singing with as much earnestness as if his life depended on -it. - -The next paper had on it combativeness. I excited the organ; he -immediately doubled his fist and pitched into an imaginary enemy in the -most vigorous manner possible. - -Not to take up too much space in this paper, I will only add, we went -through with about twenty of the organs with equally marked results, -which both pleased and astonished my friends. They said they now -thought there was much more truth in the science of phrenology than -they had supposed possible. I then said you have seen the effect of -so-called animal magnetism; I will now exhibit a different phase of -it. I magnetized him in the usual way, and said he is now as oblivious -to all external impressions as if his five senses had no existence. -Examine him and satisfy yourselves. - -After a thorough examination, Dr. Richardson said he believed he could -cut off his leg and he would not feel it. I demagnetized him, which -restored him to full consciousness. They questioned him about it. He -said he did not remember anything done in that state. They then said -if it was practicable it would be a good thing in surgical operations. -They thanked me for the pleasure of witnessing the experiments, and -retired. - -To understand the different nervous conditions of patients is of vast -importance to both dentists and physicians. This cannot be attained -without close observation and experience. If the nervous temperament of -a patient is known, we shall have a key to guide us in our treatment in -every individual case. Temperament is usually divided into six distinct -classes: - -1st. Nervous bilious; 2d. Nervous sanguine; 3d. Nervous lymphatic; 4th. -Bilious nervous; 5th. Sanguine nervous; 6th. Lymphatic nervous. - -You have doubtless observed a difference in the quality of human teeth. -We usually find the best in the nervous bilious temperament, and the -poorest in the lymphatic nervous. Viciated tastes and habits do not -change the shape of the teeth when once formed, but their quality. -Science demands discrimination under varied circumstances; it is not -possible to treat all alike, and be equally successful. I shall refer -to this again below. - -I now present you with a few incidents in practice which may serve as a -basis for a better elucidation of my subject: - -1st. In the Fall of 1835, I was called to see a gentleman at eight -P. M., represented to be suffering greatly, and unable to come to my -office. I was introduced to a large man walking the floor in great -agony. Seating him in a chair, I found the left side of the face -swollen; a purple colored spot over the antrum; the first molar on the -left upper jaw filled with gold; tooth firm, but evidently devitalized. -I diagnosed the trouble to be abscess in the antrum. I extracted the -tooth; he sprung out of the chair and dropped on the floor, face -downwards, and quivered like an ox struck on the head with an ax. I -used cold water freely to his head, and soon brought him to; placed -him back in the chair; made a free passage through the front labial -socket into the antrum, and the pus flowed freely. He then laid down -on the bed much relieved; gave him a half grain of opium; waited about -twenty minutes and injected the antrum with warm green tea; directed -his head to be kept cool with cloths wet with cold water; left him with -a promise to call again in a few hours; called again about three P. -M.; was told he had been sleeping several hours; I injected the antrum -with a weak solution of nitrate of silver; saw him the next morning and -again injected the antrum with a much stronger solution of nitrate of -silver; the swollen cheek appeared almost natural; said if he needed my -service any more to come to my office. About a week later he called on -me; brought me a sack; said a few hours before that he blowed it out -through the left nostril; it was about one and a fourth-inch long, and -about the size of an ordinary goose-quill; it was soft with a leathery -like appearance; said he was all right; paid his bill; have not seen -him since. - -2d. In September, 1836, I was called by a physician to see his wife. He -said she was suffering terribly from facial neuralgia, and thought it -was caused by a tooth. She was in her eighth month of pregnancy. He had -applied the usual remedies, which gave no relief. I examined her teeth; -found both the third-molars on upper jaw decayed, and on slightly -tapping them with the handle of an instrument, the pain was greatly -increased. He said he was afraid of the consequences, in her state, of -having the teeth extracted. I told him nothing else would give relief. -She said take them out, it cannot be worse than I am now suffering. I -parted the gums from the teeth with a lance; I had barely completed -this part of the operation when she fainted; her mouth was open; I -took my forceps and extracted both teeth; brought her head forward to -prevent the blood running down her throat; we soon brought her back -to consciousness, and the first thing she said was: "I cannot have -them out." Her husband said: "Darling, they are both out." She said, -"Are they? I did not feel it; I am so glad; the pain is all gone." The -Doctor said to me--"You are a bold man: I would have stopped you if -I could, but you was too quick for me." I afterwards learned that no -serious result followed the operation. - -3d. In August, 1856, a young lady, aged about twenty, came to my office -at eight o'clock A. M. Temperament nervous, lymphatic. Said she had not -slept a wink all night. Her face was pale, hands cold, pulse feeble. -Said she had a mortal dread of having a tooth extracted. I put my -mouth-mirror into her mouth for examination, and saw the tooth caused -the trouble. In an instant she fainted. I took my forceps and extracted -the tooth, used restoratives and soon brought her to. The first thing -she said was--"I cannot have it out." I showed her the tooth. She said: -"Oh! I am so glad I did not feel it;" and left the office laughing -about it. - -4th. In the Fall of 1858 a lady called to have the two upper front -incisors filled. She appeared to be middle-aged, and apparently in good -health. On examination, the teeth were very close together--not badly -decayed, but must be separated for sufficient room to enable me to do -the work properly. Our only means, then, was either wedging or filing -them. I filed about one quarter of what was necessary, and she fainted. -I then filed as rapidly as possible while she was unconscious, and -completed this part of the operation, and used restoratives, and soon -brought her to. I gave her a glass of wine, and completed the operation -without further trouble. - -5th. In the Fall of 1874, a lady called to have a tooth extracted. -She appeared to be in good health; said she was almost distracted -with toothache; was afraid to take chloroform; was afraid as of death -without it. I said the pain would be only momentary, and would not kill -her. I extracted the tooth, and she fainted. My usual remedy in such -cases was hartshorn and cold water. Through mistake, I took up a vial -of the Essence of Gaultheria, poured a little on a handkerchief, held -it to her nose, and was surprised to see how quickly she recovered -consciousness. This prompted me to experiment with it. I concluded that -if it was a good restorative, it might be a useful preventative. - -I soon had a chance to test it. A lady called to have an ulcerated -tooth extracted. She was in delicate health: face swollen, hands cold. -She said she would like to take chloroform, but her physician said she -must not take it; she knew she would faint without it. I told her I -thought that could be prevented. I took a doily, folded it small, and -poured about a teaspoonful of the essence on it. I told her to inhale -through her nose, and exhale through her mouth. She continued this -until her brain was pretty well stimulated, and the tooth extracted. -She showed no signs of syncopy, and could hold a glass of water as -still as I could. I have not had any one to faint away in my office -since. - -In the Spring of 1874, a lady, aged about sixty, came to consult me. -She said that her teeth were so bad she could not eat any ordinary -food; had disease of the lungs; was forbidden to take chloroform. -After an examination, I told her she had eight teeth in the upper jaw -that could not possibly be made useful, and she had better have them -extracted. She said she had never had one extracted without fainting -dead away. She could not think of having more than one out at a time. -Her temperament, nervous sanguine, emaciated hands cold, pulse very -feeble. I told her if she would follow my directions I would take -them all out and she would not mind it more than one, and guaranteed -she could not faint if she tried. I explained the effect of the -wintergreen, and said it would do no more harm than a glass of good -wine. I administered the article, as before described, until her face -flushed, tears ran down her cheeks, then extracted the eighth teeth -without her closing her mouth. She asked if they were all out, and I -said yes. She said, "Is it possible?" I gave her a glass of water. It -did not show the least tremor of the nerves. She left, giving me many -thanks, saying that she felt much better than when she came into the -office. - -I could relate many more similar cases, but do not deem it necessary. -My object is to show what may sometimes be done to advantage in cases -of syncopy, and also the means of preventing it while performing a -painful operation. - -As before said, the brain is the seat of all sensation; and our -patients, no matter how nervous they are, if the brain is properly -stimulated, cannot faint--caused by the extraction of teeth. When my -patients are known to be pregnant, I always use the stimulant above -described before performing any painful operation; it always prevents -any severe shock of the nervous system when in this condition. If any -one wishes to know how to prepare the Essence, it is as follows: To one -pint of alcohol add one ounce of the Oil of Gaultheria, commonly called -Wintergreen. Shake it well and it is fit for use. - -In passing from a conscious to an unconscious state, all the -Clairvoyants I have questioned on the subject say it is affected by -a change of polarity of the sensatory organs, and the principle is -the same whether caused by animal magnetism, syncopy or anæsthetic -agents, and if only the voluntary organs are affected thereby, there -is no danger to life, but if polarity in the involuntary is reversed, -the heart ceases to beat and death is instantly the result. I was the -first in this city to administer ether for the purpose of extracting -teeth without pain. In a few cases it developed paroxysms of hysteria; -otherwise no harm was done. I have administered ether, chloroform and -gas to over two thousand persons. With chloroform, I had three cases -that barely escaped death in my chair; with gas, some after deleterious -effects followed in two cases. - -Admitting man's physical organization to be a magnetic machine, the -deaths that have occurred are easily explained, when caused by these -powerful drugs. The voluntary organs are under the control of the will, -and during our waking hours there is a constant draft on our magnetic -supply; it is best recuperated by sleep, when the will is at rest. - -The involuntary organs do not sleep until death ends our earth life. -We can readily understand that if by any cause polarity in the two -large poles in the cerebrum are reversed, the gateway by which we gain -a knowledge of things about us is closed so perfectly that physical -sensation is impossible. On the other hand, if the equilibrium between -the two large poles in the cerebellum are not well balanced, just -in this proportion some kind of ailment is the result. Let us not -forget that the will has no control over these poles, and all medicine -that does not beneficially act on them is non-curative. Now, just in -proportion as anæsthetic agents disturb their equilibrium, they are -dangerous, it makes no difference whether polarity is reversed or -destroyed; in either case the principle of life can no longer act on -the nerves by means of its intermediate; the heart ceases to beat, -and restoration is impossible. Chloroform is more easily administered -than ether or gas, and most convenient when the patient cannot come -to the office; but we should remember that many deaths have occurred -when given for the purpose of extracting teeth, and that, too, when -least expected. The public mind is more horrified at one death in the -dentist's office than twenty caused by a railroad smash-up. We have now -the means that will stimulate the nerves, greatly mitigate the pain and -not endanger either life or health. - -I have long desired a perfectly safe anæsthetic that can be -administered no matter what the condition of the patient. I am now -creditably informed that Dr. Mayo, of Boston, some eighteen months ago, -by various experiments, produced a compound article that satisfied -him was harmless. He would not put it on the market until it had been -thoroughly tested by both dentists and surgeons. All who tested its -effect and efficiency testified to its great superiority over all other -known anæsthetics for dental and minor surgical operations. It is -now only a few months since he made arrangements for its manufacture -and appliances, and put it on the market. He has named it Mayo's -Vegetable Vapor Anæsthetic. I have been using it for extracting teeth -very successfully. The nitrous oxide causes the patient, when fully -under its influence, to have very like the appearance of a corpse. The -action of this new anæsthetic does not act on the vital organs, and the -patient appears like one in a natural sleep, and, in my opinion, is -perfectly safe and without danger to life or health. - -Our patients come to us for either a preventative or curative -treatment. As before said, we are brought face to face with almost -every conceivable condition of the nervous system, and the more true -knowledge we have of it the better are we able to satisfactorily manage -them. Some come in a very excitable, and some in a very depressed -state. We need means to quiet the former and stimulate the latter. - -Again. To be fully entitled to the name of Scientific, we must know -something of the laws of life, in order that we may obey them and fight -life's battles manfully--doing justice to others and with credit to -ourselves. Life, in itself, is not creatable, but given to us with -power to properly use or abuse, the end being the creation of the -finite mind. I have explained above the means by which it acts on -matter, but as a further illustration, let me say, you drop an article -on the floor, gravitation holds it there; you desire to pick it up, how -can you do it; if you have sufficient will-power it will act on the -magnetic element, this on the nerves, these on the muscles. You stoop -down and pick it up, and probably not one in ten thousand have a single -thought about the necessary means by which you are enabled to do so, so -little do we reflect about causative principles involved in what we do. - -So far as our voluntary organs are concerned they may be compared to -a locomotive engine. They are both useless if the motive power is -wanting. To make the engine useful, steam must be generated by means -of fire and water; and to make our voluntary organs useful, animal -magnetism must be generated by means of life and the atmospheres. The -engineer controls the steam power, and human will controls the magnetic -power, and when properly applied, if the machine is in good order, -locomotion is the result in both cases. I will only add, the steam -acts on the piston heads and causes the crank to move and the wheels -to rotate. Magnetism acts on the nerves, then on the muscles, and -man moves in any direction he chooses. A dentist with a strong will, -if he uses the proper means, can more easily and favorably impress -his nervous patient than one with a weak will, and the reason is, he -imparts more of his animal magnetism, which has a stimulating effect on -the nerves of his patient. There is a magnetic sphere emanating from -both man and beast, particularly when in motion. Were it not so, no dog -could follow their tracks successfully. All pain is the result of an -obstruction of a normal flow of the magnetic current, whether caused by -disease or otherwise. - -Arsenic, applied to the nerve of a tooth, destroys its polarity, and -applied to any other nerve it is no longer capable of being actuated -by the magnetic current, without which there can be no sensation, and -death is the result. Physical endurance depends largely on the mind and -the state of the nervous system. The difference in individuals to bear -pain is marvelous; some one can have a tooth extracted and seem to care -but little about it, while others, without the use of a preventative, -appear to suffer intensely, and in some cases the operation causes -syncopy. - -In conclusion allow me to say, a vast field lies before us, and if -cultivated properly this Society will in due time reap a rich harvest, -the benefits of which cannot now be estimated. - -The grand distinction between mind and matter may be seen thus: If we -give any physical object to another, we part with it, but if we give a -new idea on any subject, we do not part with it, but in so doing its -boundaries are enlarged in our minds. - -The space occupied in briefly presenting my views on the subject I -have chosen is greater than I at first intended, but the fundamental -principles which underlie everything with which we have to do, and -the importance of fully understanding them, is my only apology for -occupying so much of your time.--_Dental Luminary._ - - - - - ARTICLE II. - - PULPLESS TEETH. - - BY DR. WILSON, OF BURLINGTON, MEMBER OF THE FACULTY OF THE DENTAL - DEPARTMENT OF THE STATE UNIVERSITY. - - [Extracts of a paper read before the Iowa Dental Association at its - late annual meeting.] - - -A pulpless tooth is not necessarily a dead tooth, but a dead tooth is, -of course, a pulpless tooth. The adjectives "pulpless" and "dead" are -not, therefore, synonymous, although frequently so used, especially -by medical writers. Let us note the marked distinction between the -two. A pulpless tooth may be a part of the living organism--a dead -tooth has its nutritive supply entirely cut off, and it is in every -sense a foreign body--it is dead and inert. The former may be restored -to health and usefulness--the latter should always be condemned as a -nuisance that cannot be abated without the use of the forceps. * * * * - -Having thus briefly called attention to the fact that the dentine and -cementine derive their vitality from independent sources--that the life -of the one is not dependent upon the life of the other--that a pulpless -tooth is not necessarily a dead tooth--we are prepared to consider, -understandingly, the subject of this paper. It may, however, seem like -presumption on the part of the writer, in thus offering the foregoing -to an intelligent body of dentists, when every student of dentistry at -the close of his junior year should fully understand the facts above -stated. But I am led to a consideration of this subject from articles -entitled, "Dead Teeth in the Jaws," that have appeared, from time to -time, during the last two years, in the New York _Medical Record_, and -as those articles come from high sources in the medical profession, -they deserve more than passing notice. The able editor of that journal, -and Dr. Samuel Sexton, a distinguished oculist and aurist of New York -City, being the principal writers referred to. - -The _Medical Record_ of October 4, 1884, contains a report from the -aural service of Dr. Sexton, entitled, "Pain in the Ears due to -Irritation in the Jaws." He describes a number of cases of otalgia in -which he found the lesion to be in diseased teeth. - -He goes on to say that "since dentistry had become such a popular -business, and diseased teeth had been so carefully retained in the -jaws, nervous diseases about the head were becoming alarmingly common." - -The same number of the above journal contained an editorial on "Dead -Teeth in the Jaws," which read as follows: "Perhaps the time is near at -hand when medical men should be themselves better informed concerning -diseases of the jaws and mouth, rather than refer the ailments of this -region to individuals whose limited knowledge of medicine does not -prevent them from 'treating' dead teeth long after their presence in -the jaws has given rise to alveolar abscesses and neuralgias more or -less painful. It would not be strange if in the course of events, the -day would soon come when all teeth without pulps, and hence in process -of more or less rapid decay, as well as those which the deposit of -tartar, or other cause, had become entirely divested of periosteal -nourishment, would be promptly condemned as unfit to remain in the -jaws, regarded in fact as foreign bodies liable to give rise, not only -to cerebral irritation and disease in the organs of special sense, -through the propagation of local disturbances in the mouth to the -regions mentioned, but to endanger likewise the general health through -purulent matter discharged into the mouth from alveolar abscesses, -to be continuously swallowed for a long time, or, indeed, in some -instances, to be absorbed and thus produce septicæmic poisoning. It is -certainly gratifying to note the establishment of instruction in oral -surgery in some of the medical schools, and it is to be hoped that this -subject will receive the attention its importance demands." - -Dr. Sexton cites the readers of the _Record_ to eight cases of otalgia -resulting from diseased teeth. I have no doubt but a majority of the -dentists before me to-day have met with almost that number of cases in -practice every week; nor do you find it a difficult thing to render -prompt relief, and that, too, in a large majority of cases, without the -use of the forceps. And I believe that I am warranted in saying that in -at least three-fourths of the cases met with in our practice, we find -the reflex pain in the ears due to exposed living pulps, and not to -"dead teeth in the jaws." - -That diseased teeth do cause reflex trouble, not only in the head, -but frequently in more remote parts of the body, is a fact well-known -to every competent dentist. I am glad that Dr. Sexton has at last -discovered the fact, that diseased teeth do frequently cause reflex -pain in the ears, and in other neighboring parts, and that alveolar -abscesses very often cause catarrhal affections of the maxillary sinus -and of the nasal passages, and that diseased teeth will endanger the -general health. It is to be regretted, however, that the doctor has -found it necessary to charge this unfortunate state of affairs to the -ignorance of dental practitioners, who are in no way responsible for -but few of the many cases met with in practice, for there can be no -doubt but a very large majority of the teeth causing the troubles above -referred to have never received any treatment whatever at the hands -of dentists, and because Dr. Sexton has discovered that in certain -cases pulpless teeth (or dead teeth as he calls them), has caused the -ailments above referred to by Dr. Sexton, there can be no doubt. Every -dentist of any considerable experience can enumerate such experiences -by the score, and the medical profession has only been too slow to -recognize the facts discovered by Dr. Sexton. - -The only difficulty with these medical gentlemen is, that they have -drawn very erroneous conclusions from the important discoveries they -have made. Their limited knowledge of the minute structure of the -dental tissue, and the source from which each derives its life, is -manifested by the erroneous statements upon which they have based their -arguments, and then after arguing from false premises, Dr. Sexton says: -"In regard to the treatment of pulpless teeth, the practice in vogue -seems the reverse of procedures founded on well-established surgical -principles." And in an editorial of the same issue we are informed that -the treatment of diseased teeth is carried, to what "the medical minds -regard as a dangerous extreme." - -That some members of our profession have been over zealous in their -efforts to save all diseased pulps alive, there can be no doubt. We -will occasionally meet with an enthusiast in our profession who will -say, "I have no use for forceps, I never extract teeth." I have heard -that statement made on the floor of the Iowa State Dental Association. - -That incurable diseased teeth should not be tolerated in the jaws -does not admit of discussion. Good common sense ought to settle that -question. And again, there are extremists who never devitalize diseased -pulps, no matter how badly exposed, but "doctor them up," and stupify -them, and then bury them in a living grave. Much evil has grown out of -this practice. - -Some one has said that to cap a badly exposed pulp is to create a -slumbering volcano, and he might well have added that such volcanoes -have but a limited time to slumber. Gentlemen, there are in our -own country ten thousand volcanoes belching forth--not pure molten -lava--but impure gases and putrescent matter of the most sickening -character. The craters to these volcanoes are not found on the mountain -top, but they are found in human mouths--in the antrum of Highmore, in -the nasal passages, and externally on the face, neck, or even on the -chest. - -When the pulp of a tooth is dead and confined within its bony walls -an outlet is sought, and must be affected for the escape of impure -gases arising from the decomposing pulp and for the putrescent matter -associated with it. When thus confined its only way of escape is -through the dental foramen, and into tissues adjacent thereto. The -pressure thus brought to bear upon the bony walls surrounding the apex -of the root will in time perforate it at its weakest point, and the -poisonous matter is forced through the opening thus formed and into the -soft tissues, which soon yield to the pressure, and the imprisoned mass -of corruption is liberated. The pain and swelling now subsides, but a -dangerous nuisance has been created. The channel formed from the apex -of the root to an external opening will not close while it is used for -the passage of foul matter and gases that will flow unceasingly from -the pulp canal. - -The remedy of course is to remove the cause, and assist nature in -affecting a cure, and to do this the pulp chamber must be opened, its -contents removed, the canals cleansed and disinfected, the abscess -healed, and the roots filled to the exclusion of all fluids and -purulent matter. But how often this is not done. How many thousands of -suffering mortals are to-day dragging out miserable lives because of -these drainage tubes emptying themselves into the oral cavity--into -the maxillary sinus or into the meatus of the nose. Such an abiding -nuisance in the mouth cannot long exist without ruining health. But how -few of the unfortunate sufferers realize the cause of their nervous -irritability, their loss of appetite, their feeling of lassitude, -their lack of energy, and their general prostration. And here let me -say, that but few, in comparison to the number of these unfortunate -sufferers seek relief at the hands of the dental practitioner. The -patient is neither sick nor well, but debilitated and "good for -nothing." The family physician is consulted, nervines and tonics are -administered, but to no avail. The septic matter is vitiating the air -that is breathed, and poisoning the food that is eaten. The saliva -that is poured into the mouth from the various glands must mingle with -this poisonous matter and carry it into the stomach. - -Sanitary means are being employed in all our cities at the present -time, in view of the cholera scourge that it is feared will sweep over -our land the coming summer. Our physicians wisely talk and write about -the baneful influences of impure water, about miasma arising from the -decomposition of vegetable matter, and about unwholesome food, and it -would be well if the public would heed their timely warnings. And as -dental practitioners, I feel that we, also have an important duty to -perform, in enlightening our patients, and the public so far as we are -able to do so, in the direction I have above indicated. - -The subject is of paramount importance, and as the opportunities come -to us in every day practice, let us not fail to impress upon the minds -of our patient (when we find it necessary to do so), the fact that a -clean mouth is essential to health. - -The agitation of this subject, by the medical profession, is a step -forward. Hitherto medical men have not given the matter the attention -its importance demanded. - -And now that this new light has dawned upon Dr. Sexton, it is not -strange that, in hastily drawing his conclusions, he should have -mingled much of error with the truths he has discovered. Possibly some -of the cases that have come under his notice may have been the result -of bad practice on the part of incompetent dental practitioners, but -to charge the dental profession with their short-comings would be a -matter of great injustice. Dr. Sexton is too hasty in his conclusions. -First, he discovered that certain pulpless teeth had caused certain -ailments, hence he condemns all pulpless teeth. He has discovered that -certain dentists have failed to treat such teeth successfully, hence he -condemns the dental profession for attempting to save teeth, it would -be equally fair to condemn the whole medical profession, because of -the incompetency of some of its members. But before dismissing the -subject of pulpless teeth, it may be well for us to examine the subject -a little more carefully from the standpoint of the medical writers -above referred to. We cannot afford to make a mistake with regard to -so important a matter. The higher a man stands in his profession, the -more serious the mistakes he makes, and the more important it is that -his practice be sound. An enthusiast or an extremist may injure a good -cause. There are such men in our ranks. - -A few years ago a prominent dentist said, "The tooth's pulp is its -soul, and it is criminal to destroy it." - -I heard another prominent dentist say, "If I find a part of the pulp -dead, I amputate the dead tissues, and save the balance of the pulp -alive." - -A dentist has just moved away from Burlington, who has been in practice -there for fifteen years, and during that time he has been using arsenic -for obtunding sensitive dentine, and he has succeeded in accomplishing -his purpose admirably. I have found in one month half a dozen filled -teeth containing dead pulps, and, of course as many alveolar abscesses -in active operation. The evils arising from such abominable methods of -practice are simply appalling. - - * * * * * - -I have less frequently met with cases where those fistulous openings -were on the neck or chest. In those cases the roots of the teeth are -usually long, and when the abscess breaks through the lower border -of the jaw, and the pus comes in contact with the soft tissues, it -follows the course of the muscles and forms a sinous as it gravitates -to some point on the neck or chest. I have known of a number of such -cases being under medical treatment for years, where the affection -was supposed to be of a strumpous nature, and the real cause was -not suspected, and in every case a rapid recovery has followed the -extraction of the offending tooth. - - * * * * * - -Gentlemen, I have no doubt but the most of you are disappointed in -the nature of this paper. I have scarcely alluded to the treatment -and filling of pulpless teeth. That had not been my purpose. But I -have wished to call attention to the fact that a large majority of -the ailments above referred to have been due to diseased teeth that -have never received any attention whatever at the hands of competent -dentists. - -That pulpless teeth and roots may be treated, filled, and preserved -in health in a majority of cases, is a settled question. Every -well-informed dentist knows that to be a fact, the distinguished Dr. -Sexton and the able editor of the _Medical Record_ to the contrary -notwithstanding.--_Iowa State Med. Reporter._ - - - - - ARTICLE III. - - DEAD TEETH IN THE JAWS. - - TRUMAN W. BROPHY, M. D., D. D. S. - - - In reply to Dr. Sexton on this subject, Dr. Brophy makes these - pertinent remarks in the journal of the American Medical Association: - - Dr. Sexton says: "The retention in the jaws of teeth which are - diseased, have become irredeemably sensitive to thermal influences, - or deprived of adequate periosteal nourishment through calcareous - formations about the roots, very frequently gives rise to nervous - diseases about the head. I am convinced that these reflected nerve - influences manifest themselves much oftener since dentistry has come - more extensively into practice during the present generation, and - greater efforts are made to retain defective teeth in the jaw." - -That diseases of the teeth are often the center from which pain is -reflected to the eyes, ears and other parts, all experienced clinical -observers must admit. But that these pathological conditions of the -teeth, from which reflected pain has its origin, can be and are -successfully treated and cured with rare exceptions, as effectually as -any other diseases, is a fact too well-established to be set aside. - -It is not possible to describe in this letter the method by which the -various diseases of the teeth are treated, but suffice it to say that -"teeth which are diseased from death of the pulp or from caries" _do -not_ "become irredeemably sensitive to thermal influences." In proof of -this statement, many thoroughly educated medical men, practicing the -specialty of dental surgery, will testify. - -"Teeth deprived of adequate periosteal nourishment, through calcareous -formations about the roots, very frequently give rise to nervous -diseases about the head." To this statement I assent, but dissent as -to the remedy not mentioned but implied, _i. e._, the removal of the -teeth. If the calcareous deposits mentioned have destroyed so much of -the pericementum and the alveolar processes as to render the teeth -very loose; if, indeed, the teeth have lost their bony support and -are retained by means of a remnant of pericementum only, they cannot, -of course, be restored to permanent health and usefulness, and their -removal is, therefore, indicated. Teeth in this condition "frequently -give rise to nervous diseases about the head." - -On the contrary, if the calcareous deposits have not destroyed the -pericementum and alveolar processes to a very great extent, the -condition is amendable to intelligent treatment and cure. In answer -to the assertion that "Reflected nerve influences manifest themselves -much oftener since dentistry has come more extensively into practice -during the present generation," I would say, that with equal propriety -it might be said that reflected nerve influences manifest themselves -more frequently since gynæcology has come more extensively into -practice. To attribute the obvious increase of nervous diseases during -the present generation to diseases of the teeth is a statement not -only "sweeping," but "overdrawn." _Much harm_ is no doubt done by some -of the modern appliances "for retention in the mouth of substitutes -for absent teeth," and the unhealthy state of the gums and contiguous -parts, established and maintained by the presence of these substitutes, -unquestionably give rise in many cases to reflected pain. - -When Dr. Sexton attempts to establish a _law_ governing the management -of diseased teeth, it must be based on more substantial grounds -than those which he presents. The case related of his patient, the -"medical man, who practices dentistry," and who was convinced that -an inflammation of one of his ears began from the time the upper -second molar of that side was treated for a diseased pulp, is simply -an assumption, on the part of the patient, that the ear trouble had -its origin from the diseased tooth, and the patient's diagnosis of -his own case seems to have been accepted by Dr. S. as conclusive. The -ear disease in this case may have emanated from the diseased tooth, -but no evidence is produced to that effect. In regard to the query as -to "whether it is safe practice to retain dead teeth in the jaws," I -would say that thousands of people in our own country have had pulpless -(not dead) teeth in their jaws many years, which are exempt from -pericemental disease, and which serve all the purposes for which teeth -were provided. To ask whether it is safe practice to retain these, -so-called, dead teeth in the jaws when they have been comfortable and -useful from ten to forty years and promise to remain so through life, -seems like a proposition too injudicious to need comment. While the -death of the pulp results in "cutting off the source of nutrition from -the dentine," it does not follow "that in a large number of instances -irritation can not be easily controlled." - -Neither does the tooth become a foreign substance. The dentine and the -enamel are, of course, no longer nourished after the death of the pulp, -but their resisting structure renders them capable of maintaining their -integrity many years after the pulp has been removed; and pericementum -will nourish the cementum and thereby retain the tooth in its alveolus -in a comfortable condition. In order, however, to thus retain the -tooth and prevent inflammation from supervening, the devitalized pulp -must be removed, the pulp canals thoroughly disinfected and filled -with a plastic material which hardens when in position. Dr. S. most -clearly exhibits his imperfect knowledge of the dental operations in -vogue when he says: "Inflammation of exposed dentine cannot surely -be entirely arrested in any case by filling the pulp cavity with any -known extraneous material, and especially is handicraft wanting to -even imperfectly protect the minute and often tortuous canals leading -down to the apical foramina of the majority of the teeth." To arrest -"inflammation of exposed dentine by filling the pulp cavity," in the -opinion of Dr. S. would seem to be most desirable. How a tissue without -nourishment and consequently without vitality can take or maintain -inflammation is beyond comprehension. The impervious filling which -I have mentioned will close the apical foramina, together with the -canal, which "in the majority of cases" _is not_ tortuous to a degree -of rendering the perfect filling of the root difficult or uncertain, -and the assertion that the dental surgeon "is able only to offer a -hopeful but uncertain prognosis in these cases" is contrary to well -established fact. There are no diseases to which mankind is heir more -scientifically and effectually cured than the diseases of the teeth in -question. - -Again: "The dead tissues of the dentine will sooner or later, most -likely, be transmitted through the tissues of the cementum to the -periosteum." Communication between the lacunæ canaliculi of the -cementum with the tubuli of the dentine is not free; indeed, it seldom -exists, hence it cannot be "that through the periosteum alone the -dentine may long derive some nourishment." - -About 22,000,000 teeth are annually extracted in the United States, and -I regret to say this enormous loss of teeth is to no small extent due -to the indifference manifested by physicians in the anatomy, physiology -and pathology of these organs. It is a fact, no one will attempt to -gainsay, that hygienic measures directed toward the preservation of the -deciduous set, if understood, are seldom recommended by the general -practitioner to the families under his charge. The premature loss of -these teeth paves the way for early lesions of the permanent set. The -pain resulting from advanced caries of the deciduous teeth, owing to -the difficulties encountered in controlling the patient, is not easily -treated; moreover, the injurious impressions thus made on the system of -the child abide through life. There is no doubt hundreds of thousands -of teeth are unnecessarily extracted each year, and then drugs are -given with a view of curing the patient of the disorders of digestion -and other abnormal conditions which follow, and which in turn arise -from imperfect mastication of food, verily for the want of teeth. - -We need to know "what's the matter" in the treatment of these "nervous -diseases about the head," as in all others, and apply a remedy which -will bring the abnormal tissues back to health. Too often, indeed, has -it happened that patients, by advice of their medical attendants, have -submitted to the loss of many, and, in some instances, to all their -teeth, in the vain endeavor to be relieved from trigeminal neuralgia. -You may ask, Why this useless loss of teeth, and all the resulting -evils? Because the advice given was not wise; the etiology of the -affection was not understood. - -There are certain pathological conditions of the teeth which have not -been mentioned in this discussion, and which give rise to reflected -pain of the eyes, ears, and other parts. - -Among these may be mentioned exostosis of the roots of teeth and -nodules of calcific matter within the pulp canals in contact with -a living pulp. The former of these conditions has been regarded -incurable, the removal of the tooth with the united bony tumor being -indicated. In favorable cases, however, this tumor may be excised and -removed without removing the tooth. The pulp nodules of calcified -deposits within the pulp chamber may be, in a large majority of cases, -successfully removed without sacrificing the tooth. - -No one approves more than I the removal of the causes of disease. -It is no more necessary to extract a tooth at the root of which an -alveolar abscess has formed than it would be to amputate a limb for -the cure of an abscess of the medullary substance of its bone. Disease -of the eye sometimes requires that it be enucleated, but the honest, -skilled ophthalmologist _would not_ remove the eye when he _knew_ he -could restore it to usefulness. The spirit of the teachings of Dr. -Sexton's articles is far from being progressive. Nor is this all; many -assertions are not based on fact, but on erroneous impressions. Our -duty to our profession and the laity is not to destroy but to save; and -while ignorance is ever working its mischief in all vocations in life, -it is not just to accept the results of such work as a basis on which -to found a law. - - - - - ARTICLE IV. - - DIAGNOSIS AND TREATMENT OF DENTRITIC CYSTIC TUMORS OF THE JAWS. - - BY JOHN S. SMITH, D. D. S., LANCASTER, PA. - - -_Diagnosis._--Cystic tumors may be confounded with other affections -which occasion swellings about the jaws, as enchrondromata, sarcomata, -and myxomata, abscesses, and the collections of fluids in the antrum. -Dental alveolar abscess may be distinguished by its acute course, and -when in a chronic, condition by the discharge of its contents through -the fistula, either upon the gum, or within the oral cavity. The tumor -formed by an abscess is never so sharply definite as is the case with -cysts; with dropsy of the antral cavity the distention of the facial -wall of the jaw is more uniform than it is with cysts. - -In some cases of cystic tumors, they present so formidable an -appearance at first sight, that they may be taken for solid tumors; -especially is this so when their walls are compact and well organized, -nearly if not altogether obliterating the sense of fluctuation when -pressure is made upon them. - -Cases have come under the observation of the writer where it required -the most delicate touch to detect any fluctuation when pressure was -made upon the apex of the tumor. - -In some cases the diagnosis cannot be determined accurately until -after one or more teeth are removed that are involved with the tumor. -After such operation, a probe carried through the alveolus will -usually reveal the true condition of the lesion. One or more dead -teeth are found involved--one, however, being the rule in most cases -which have come to the notice of the writer, while two, and sometimes -three, are implicated with the tumor. The dead tooth may be easily -distinguished from the living ones by its opaque appearance. Such tooth -may be carious, and it may not. - -Primarily the dentritic cyst originates from what pathologists -call a "cold abscess," that is, an abscess which has never opened; -subsequently, having developed into a tumor. The interior of the cyst -has a fibrous lining, and being compact in structure, is the seat of -an inflammatory process. The cyst contains a pyriform fluid; it may -attain such magnitude as to invest several teeth and extend beyond the -alveolar process. The tumor is usually oval in shape, with its apex -on a line with the diseased tooth directly involved. The size of the -tumor may be as large as a hulled walnut or as small as hazel-nut; -crepitates under pressure, and feels like parchment. In cases of long -standing, considerable resorption of the alveolar process takes place, -and the teeth immediately connected will be loose; especially will this -be the case if the alveolar borders are broken; these teeth should be -removed. These tumors are found painless, as a rule. I have met with -cases, however, where an acute inflammatory condition was present, with -all the symptoms of acute periodontitis manifested. So that it could -have been readily mistaken for the pointing of an alveolar abscess. - -_Pathology._--Cysts of the jaw may be either simple or compound; -whether they be cysts of retention, exudation cysts, or extravasation -cysts belonging to the jaws, is a matter not as yet fully established. -The exudation cyst is a secretory cyst; in a generic relation, however, -it is just the opposite of the retention cyst. Serous sacs form the -foundations of the exudation cysts. "The mode of development of cysts -of the jaws," says Wedl, "has not yet been determined; it therefore -becomes necessary, in order to throw more light on the subject, to -pursue further anatomical investigations in that direction." - -Rindfleisch says: "The accumulation of the fluid is not produced -by the continuance of the normal secretion, but by an exudation -surpassing the normal measure of the serum of the blood with salts, -albumen, fibrinogenous substance, and extractives, in the most varying -proportions. The exudation cysts have little to do with pathological -new formation. Of extravasation cysts," he says, "a parenchymatous -bleeding can very well be the point of departure for the formation of -a cyst. The hemorrhagic depot can present itself primarily as a cyst, -namely, when the blood is poured out between two surfaces in themselves -smooth; for example, bone and periosteum, cartilage and perichondrium, -and thereafter remains fluid. As a cyst may also be formed when upon -the one hand the limitary parenchyma furnishes a connective tissue -membrane, upon the other hand, the blood itself is resorbed through a -series of metamorphoses up to a small remainder, and is replaced by a -clear fluid." - -The above-mentioned condition is liable to manifest itself within the -body of the jaw, the bone and periosteum, after severe mechanical -injuries to the bone, and the rupture of blood-vessels within the -parenchyma. There can be little doubt that many of the so-called -dentritic cysts of the jaws have their origin primarily from causes -brought about by falls, strokes and mechanical violence, causing -rupture of blood-vessels. It is quite true, history of cases fully -confirms such facts. - -Clinical observations leads us to believe, however, that only in cases -where the abscess does not open, we find the pathological new formation -taking place within the jaws. Pulpitis, and as has been observed, -followed by pericementitis and periodontitis, is a prolific cause of -the development of the dentritic cystic tumor. - -_Treatment._--The removal of all dead teeth involved. Other teeth -whose pulps are living may be loose, and to a casual observer appear -to be complicated, but a careful examination will reveal the fact -that they should not be disturbed but retained in their places; only -one tooth may be the offender, being a dead one which has caused the -trouble. After the removal of the cause, let it be either one or more -dead teeth or fangs of teeth, cyst walls may be punctured with a sharp -instrument, and the contents of the sac released, this being done -by carrying the instrument through the alveoli, and not through the -bony parietes of the jaw. After the contents of the sac is let out, -and the sharp spicula of bone trimmed, with engine burs, tincture of -iodine full strength may be forced into the cyst sac, by saturating -tufts of cotton-wool and allowing them to remain, again repeating -the treatment at intervals of a day. If necrosis of bone be present, -it is good practice to alternate the iodine treatment with aromatic -sulphuric acid. Cases generally yield to this treatment in from six -week to three months. I have seen cases not yielding to treatment for -nine months. There are other and shorter methods in the treatment -which perhaps some would prefer--the cutting down through the body of -the tumor, by making a crucial incision and scraping out the contents -of the sac, afterwards allowing nature to do the rest--but I do not -believe it is the best or safest way. There is surely a much greater -loss of structure, which is never restored as in the former method by -granulation, after the secreting cells have been destroyed by medicinal -applications of iodine and sulphuric acid treatment.--_Medical and -Surgical Reporter._ - - - - - ARTICLE V. - - THOROUGHNESS. - - BY L. P. DOTTERER, D. D. S. - - [Read before the South Carolina Dental Association.] - - -Though scarcely more than a novice in the vast field of Operative -Dentistry, I have gleaned sufficient experience from observation and -practice to know that THOROUGHNESS is the surest means of success. - -Just as the tillers of the soil sow their seeds, watch their crops, -and reap their harvests, so must we do our duty, advise our patients -as to the best means of preservation, and would that I could say, reap -our harvest. There has been so much written upon this subject that I -have nothing _new_ to say, but will touch upon several points, and in -giving my idea of thoroughness, as there applied, I may draw out some -discussion. - -The first step towards the preparation of the mouth for dental -operations is the removal of calculus and decayed fangs. Let this be -done in a manner that will _insure future cleanliness_, where the -proper after attention is given on the part of the patient. - -As regards the preparation and filling of cavities, there are so many -conflicting conditions, that we must be governed entirely by the case -before us; but to be thorough in our preparation, we must so shape the -cavity as to have the walls nearly plumb, uniform margin, slightly -undercut. In proximal cavities there may be a groove or pit at cervical -wall, but do not have it too near the margin, on account of its -liability to produce fracture, and consequent failure at that point. -On grinding surfaces, cut out all fissures leading into cavity, and be -careful to have no angles. - -The margin, after all, is the most important point; for just here -failure begins, especially at the cervical wall, and care should be -taken to thoroughly remove all softened structure, and aim to reach -a solid foundation. These margins should be carefully trimmed and -burnished, and thus our cavity is ready for the filling. - -We often hear practitioners decry the rubber-dam, and boast of their -skillful use of the napkin; but, gentlemen, many are the failures -consequent! For in deep proximal cavities, the dam is invaluable in -keeping guard against oozing moisture from the gums, which, without -this precaution, will flow upon the filling without our knowledge. -The dam adjusted, we proceed to form a mass of non-cohesive gold, and -where the walls are strong enough, we can continue with this material -throughout. But where cohesive gold is necessary, we should cover our -borders, as far as possible, with soft foil; for this is more adaptable -to the walls. Another advantage to be found in non-cohesive gold, is -its pliability, ease of starting, and rapidity in finishing. We should -thoroughly condense from beginning to end, whatever may be the kind of -foil used. - -Filing and finishing is too often hurried through, leaving a surplus -of material at the cervical wall, or lapping the edges--another sure -cause of failure; and every care should be directed to finish in such -way that an instrument passing over the line of demarkation cannot -detect it. After filing, we would use pumice, either on a strip of -orange-wood, or by some other convenient means, and then polish. The -same general rule holds good in amalgam work, and the main cause of -failure in these cases is that lack of thoroughness in finishing. - -In grinding surface cavities, where the enamel leading thereto is -funnel-shaped, we often introduce too much amalgam, extending it -beyond the margins of the cavity, and finishing to a fine edge. This -material, when hard and bit upon, will fracture perpendicularly around -the margins, giving the finishing a bulged appearance, and exposing a -V-shaped crack, which will invite decay. Consequently, we should remove -all surplus material, and finish at the very margin of the cavity. When -gold is used, this precaution is not so necessary, as the edges of a -gold filling will not fracture. Since we do not have to mallet amalgam, -it is natural to suppose we don't require firm margins, but this is -a mistake; and as much, or even more care should be exercised in the -preparation of a cavity for amalgam than gold, as tooth-structure seems -to waste away more rapidly from the former. - -Let our motto be, "Whatever is worth doing at all is worth doing well." -If applying arsenic or a disinfectant, cover it with gutta-percha, -for the patient may be delayed a few days longer than we anticipate; -and what is worse than removing a foul piece of cotton, and finding -the tooth in a poorer condition than we left it? If we introduce a -temporary stopping on account of exposure or frailty, let it be done -thoroughly; and after relating its importance to the patient, caution -her to return at a certain time for its removal and permanent filling. - -We must be teachers at our chairs, if we wish the public to appreciate -us, and we should instruct patients in the proper care of their teeth -by an intelligent and thorough use of the brush, pick, etc. - -Such is the importance of thoroughness in dental operations. This paper -does not half express it, but for fear of trespassing too much on your -valuable time, I commend these ideas to your criticism.--_Southern -Dental Journal._ - - - - - ARTICLE VI. - - WHAT FILLINGS SHOULD WE USE? - - DR. W. G. A. BONWILL, PHILADELPHIA. - - -When I look back at my commencement and reflect that my early practice -was founded on what the older men in authority had published and -taught, and how I feared to do other than they demanded, I shudder at -the many teeth I extracted I now know might have been saved, with even -the amalgam of that day. And I tremble at the advice _now_ given by the -authorities that _gold_ only should be used as a permanent filling. -Young men knew no better, but the older do. God forgive them, I cannot. -While I do not belong to the disciples of the new departure, _so far as -their theory is concerned_, I stand side by side with any person _who -can save teeth by plastic materials_, where gold cannot be used. Better -do this than persist with gold indiscriminately, and lose teeth, rather -than stoop to conquer with _any article_ that is _not gold_. The public -are demoralized on the subject of _gold_. "Are you not going to fill my -teeth with gold?" says nearly every new customer; "Dr. ---- would not -think of using anything else." A city operator must have more than the -usual quota of courage to stand before the societies and state "he has -been using _amalgam_ more freely of late." For the first eight years of -my practice I would not touch it, because Doctors Elisha Townsend and -J. D. White passed their anathemas on everything but gold and tin. I -worked myself nearly to death with tin to find it preserves from caries -but not from attrition. Since 1862, I have been feeling my way, and -while I think I have reared many beautiful and substantial monuments of -gold, and have perfected machinery with which to do it, yet I consume -more amalgam than ever before. - -A gold filling _properly_ impacted, with cavity judiciously prepared, -and the walls shaped as to forbid future decay, _will save_, -irrespective of the frailty of their bony structure? But as thousands -of teeth _cannot be so prepared_, both of strong and of frail -organizations, and the circumstances _cannot_ be controlled, we should -resort to something that will enable us the more surely to meet the -issue. - -To enumerate the many cases of peculiar character that forbid the use -of gold, would be too great a task. Physical impossibilities lie in the -way of every undertaking; and it is for the successful engineer, who -is well acquainted with his material, and their relative strength and -_adaptability_ for his purposes, to so use each, that his design will -be consummated, and which shall not by future wear, prove a failure. -There is a fitness in every material that experience has proven to -be specially adapted for a given work, and when this general law is -recognized and we become first-class engineers, we shall the better -see where we can adapt our materials to the work to be done, and we -can be the more certain of success, for it is founded on the logic of -mechanics and physical law. - -Where is the dentist that first lays out his design and orders -materials best adapted for specific portions of it? - -As well say everything should be made only of iron, or steel, or -wood, as that every tooth should be filled with gold; or, as _equally -ridiculous_, that the amalgam or some one of the plastic fillings -should be the only material used. - -It is not _necessary_ to found a _creed or departure_ on a law of -_incompatibility_ to tooth substance. We need not look so far into the -unknown and unknowable. We poor, short-sighted creatures must have -the tangible; not a hypothesis on a _supposed theory_. Any one with -half an eye can see just where the incompatibility is; not between gold -and dentos, but between dentos and untutored and unskilled brain and -hands to _carry out the law of adaptibility_--the correlation of forces -involved. - -One skilled in the use of the mallet, with the rubber-dam and a -substantial starting point, with walls ever so frail, can perfectly -impact and complete the work in gold filling, _provided the -surroundings are there_. But allow _one little vacuum_ between the -tooth substance and the filling, and a _capillary tube_ will be formed -to suck up _fermentable material_; and the _acid generated_ will act -on the tooth whether it be filled with gold, amalgam, oxyphosphate, or -gutta-percha. A thousand capillary tubes making porosity in the gold -or the amalgam, will not do it; but if there is one, however small, -between dentos and filling, destruction is sure.--_Transactions of the -Odontological Society of Pennsylvania._ - - - - - ARTICLE VII. - - SOME METHODS OF SEPARATING TEETH WITH WEDGES. - - BY DR. DWIGHT M. CLAPP, OF BOSTON. - -[Read at the joint meeting of the Massachusetts and Connecticut Valley - Dental Societies, held at Worcester, Mass., June, 1885.] - - -Among the many disagreeable and annoying, not to say painful, things -that patients have to suffer at the hands of dentists, nothing, -perhaps, is received with greater dread and disgust than the -announcement that the teeth must be "wedged" before filling. Some, -a small minority among us, I think, always fill without previous -separation. In regard to the necessity for it, I will enter no argument -here, but only say that personally I am a firm believer in wide -spaces between the teeth at their necks, and labor to the best of my -ability to obtain this result. It is most likely that many of you are -using the same means that I am to get the desired room for filling, -but by presenting and discussing the subject, it is possible we may -obtain some help in doing what I fear the most of us find, at times, -difficult and perplexing. For a long time rubber was about the only -thing used for separating. It has some good qualities and many bad -ones. It probably causes more pain and annoyance to the patient than -any other wedge. Its liability to slide into contact with the gum, -causing great pain and soreness, and even suppuration, has caused me -to entirely abandon its use, I am willing to admit that it may be used -successfully sometimes. The best rubber to use, if it must be used -at all, is that of which the most inelastic tubing is made, or the -erasers sold by stationers, cut into suitable shape. Wedges of wood -are well adapted to cases where the sides of teeth to be wedged are -nearly parallel, or where there is less space at the gum than at the -points of the teeth. The wedge should be about as wide as the length -of the crown, that is, it should extend from the cutting edge to the -gum, nearly. It should be so shaped and trimmed as to not irritate the -tongue or cheek. One advantage of the wooden wedge is that it is more -cleanly than tape, cotton, or silk. This same class of teeth, those -with nearly parallel sides, can be separated as successfully, and I -think with less pain, with tape. Linen tape of various widths and well -waxed is the best. It should be folded so as to be of proper width and -thickness, and then drawn into place. A sharp knife is preferable to -scissors for cutting off the ends. The tape should be thoroughly waxed, -which assists materially in getting it between the teeth, and renders -it more cleanly when left in the mouth for several days. In teeth with -cavities so situated that cotton can be crowded in with sufficient -force, this is one of the best wedges that can be used, as regards both -effectiveness and comfort. It is necessary to so place the cotton that -the force of expansion will be exerted against adjoining teeth and not -expanded within the cavity. By once changing the cotton, space enough -can generally be obtained. It is difficult to adjust and keep wedges in -place between teeth having more or less space at the gum, and touching -only at a small point near the cutting ends. It is in these cases -that ligatures of various kinds serve an admirable purpose. Take for -instance, the superior central incisors. These usually have but a small -point of contact, with considerable space between them at the gum, and -it is very difficult to put in a wedge of rubber, wood, or tape, that -will not slip up against the gum, or come out altogether. If a ligature -is used, the knots can be so tied that the string will clasp the point -of contact in such a manner as to hold it quite firmly in place. There -are many ways of making the knots; one is to pass the silk once between -the teeth, then tie a surgeon's knot; but, before drawing it up, pass -one of the ends again between the teeth, and then draw the knot so it -will wedge from the gum towards the cutting ends; draw it closely, then -finish by tying so that the last knot will be at the labial, or palatal -side of the teeth. Another way is to make a series of knots like a -chain stitch in crochet work, thus enlarging the silk for a suitable -length; draw this between the teeth and tie as before, omitting the -first knot that is drawn between the teeth. Another, and a very good -way of enlarging the ligature, is, after well waxing it, to roll a -little cotton around the silk as you would around a broach for wiping -out a root canal, and draw this between the teeth and tie the same as -when the silk is knotted. Still another method, easy of application and -very effective in almost all cases where there is a cavity in one or -both of the teeth, is to secure a pellet of cotton with the ligature. -The silk is placed between the teeth in some of the before-mentioned -ways; a pellet of cotton is forced into the cavity, projecting against -the adjoining tooth, then the silk is tied firmly around the cotton. -The swelling of the cotton and silk will make all the space necessary -between any of the front teeth with but one application. The bulging -of the cotton into the cavity or cavities, caused by tying the silk -around it will hold it securely in place. This makes by far the most -satisfactory wedge I have ever used, and, so far as I am aware, is -original with me. It is sometimes well to open the cavity slightly with -an excavator or chisel before wedging, so that the cotton will be more -readily retained. For bicuspids and molars more than one application -may be needed if much space is required. Quick wedging is sometimes -possible, and when it can be done readily is usually desirable. Teeth -that move easily may be separated sufficiently for operations by -placing a wedge at the point of contact, and another near the gum, -applying force gently with the hand, or light blows with a mallet, -first on one, and then on the other, until wedged enough. Then remove -the wedge that interferes most with the operation, leaving the other in -place. Another way that often works well with children and with teeth -that move readily, is to insert a large piece of rubber and let it -remain from fifteen to twenty minutes, when the rubber will have opened -a considerable space. A wooden wedge will keep the teeth from springing -together while the work is being done. The appliances designed by Drs. -Perry, Bogue and others, for making rapid separations, I have not -used, but hear favorable reports in regard to them. Having spoken of -rapid and semi-rapid separations, it is left only to speak of a method -which works very slowly. It applies, as a rule, to the biscuspids and -molars only. In many cases where there are large cavities between these -teeth, and often, when it is desirable that they should be filled with -what I think is very properly called a "treatment filling," it is -well to fill the entire space between the teeth with gutta-percha. In -the course of a few months the process of mastication will force the -gutta-percha toward the gum, and on removing what has not worn away the -teeth will be found well separated, the cervical margins well in view, -and the cavities in good condition for a metal filling.--_Archives of -Dentistry._ - - - - - ARTICLE VIII. - - COCAINE. - - WALTER W. ALLPORT, M. D., D. D. S., OF CHICAGO, ILL. - - -The introduction of cocaine as a local anæsthetic, and the more general -use of peroxide of hydrogen (H_{2}O_{2}) in the treatment of dental and -oral diseases, are the principal advance made in the medical department -of this practice during the year for which this report is made. - -The two forms of cocaine which have been most generally used in surgery -are the hydrochlorate and the oleate. - -In operations in the mouth, involving the mucous membranes, together -with the immediately subjacent tissues, these preparations have -proven so efficient there is little question of its value as a local -anæsthetic in such cases. But its action on deeper structures, such -as involve the roots of teeth, is so uncertain as to render its -practicable benefits questionable in the operation of extraction. -In the surgical treatment of pockets caused by pyorrhea alveolaris, -the anæsthetic effect of this agent is often so great as to render -this sometimes very painful operation comparatively painless, and -its employment in such cases should rarely be dispensed with. In the -treatment of hypersensitive dentine, as well as in the removal of -tooth-pulps, its action as an anæsthetic has, under some circumstances, -seemed to be all that could be desired. But in far the greater number -of cases it has proved of little practical value. More recently, -however, a new form of cocaine, known as the citrate, has been -introduced in Germany by Merck, and is now being manufactured by -McKesson & Robbins, of New York. In a series of experiments, conducted -by Dr. John S. Marshall, of Chicago, it has been shown that for -operations on sub-mucous tissues, or in the extraction of teeth, it -seems to possess no special advantages over the preparations previously -named. But when applied to dentine or the pulp, its action--though not -always positive--seems to be more reliable, especially on the dentine, -and gives promise of better results. Under favorable conditions it -produces anæsthesia of the parts in from five to ten minutes, and the -duration of the effect is of sufficient length to afford time for -the preparation of the cavity. This effect has, in some cases been -prolonged for more than an hour. The pulp has been extirpated without -pain after the drug has been applied in from three to twelve minutes. - -If the citrate of cocaine be kept in solution for more than three -or four days it decomposes and loses its active properties. As -introduced by Mr. Merck for dental purposes, it is made into pills by -incorporating it with gum tragacanth dissolved in glycerine, each pill -containing 1/8 grain of the citrate. In this form it keeps well. A pill -is applied to the sensitive cavity and covered with a cotton pledget, -moistened in tepid water. It should be allowed to remain from five to -twelve minutes, when--if at all--the desired result is produced. In -twenty per cent. of the cases where this remedy has been employed it -has proven unsuccessful, but it is hoped that this percentage will be -reduced by a better knowledge of the drug and the improved methods of -its preparation and use. - -With this in view, and at the suggestion of Dr. Marshall, McKesson & -Robbins are now manufacturing granules containing one-sixteenth of -a grain of the citrate of cocaine, without glycerine or any other -saccharine excipient, so that the obtundent may act more promptly -than it can in the presence of sugar.--_Address at American Medical -Association._ - - - - - Editorial, Etc. - - -UNIVERSITY OF MARYLAND, DENTAL DEPARTMENT.--The fourth Annual session -of this institution opened with a much larger number of matriculates -than ever before in its history, and the number is so rapidly -increasing that the present class of seniors and juniors bids fair to -be larger than any preceding one. - -The reputation of this school has never been sullied by the graduation -of students for fees irrespective of professional ability, and the -consequence of such a course as has been steadily pursued since its -organization, has been to give a professional standing to its diploma -which that of no other dental school excels. The present class consists -of representatives from all parts of this country, and also Germany, -France, South America, Canada, and even Turkey. Many states of this -country are largely represented, such as New York, Georgia, Virginia, -Pennsylvania, South Carolina and Maryland especially, and also the New -England states, while nearly every other state is represented. - -Students who have passed a session at other dental schools have entered -on a second session at the University of Maryland, Dental Department, -to complete their course of study and receive its diploma, and not -one of the hundreds of students who have attended a course in this -institution, has ever gone elsewhere to graduate. In matriculating the -present class, the resolutions adopted by the National Board of State -Dental Examiners have been strictly adhered to, and many applicants -of this country and Europe have been refused admission who desired to -make their attendance obligatory on graduation after ONE session's -attendance. - -The Infirmary and Laboratory practice is not excelled in size if -equalled by that of any other dental school, and the records will -show hundreds of gold fillings credited to the individual practice of -students for both the regular winter and summer sessions. No other -school can offer greater facilities for practical instruction, nor -present more complete equipment as to building and appliances than -this Dental Department. Dental practitioners are cordially invited to -visit the University and inspect the specimen work of its graduating -classes deposited in the museum. Large and valuable contributions from -all parts of this country and also from Europe are almost daily being -received for the Museum, which will compare favorably with that of any -other dental school for valuable pathological specimens, which are also -utilized for illustrating the lectures of each course. - - * * * * * - -CORRESPONDENCE.--The following letter was received from a prominent -dental practitioner of Georgia for publication: - - AUGUSTA, Sept. 30th, 1885. - - EDITOR "AM. JOURNAL OF DENTAL SCIENCE": - - DEAR SIR: According to my knowledge of the proceedings of the - organizations known as the "National Board of Dental Examiners," and - the "National Association of Dental Faculties," it was determined that - no dental school would be regarded as reputable that did not after - June, 1885, require TWO FULL SESSIONS OF FIVE MONTHS EACH IN SEPARATE - YEARS FOR GRADUATION. The only exceptions made being those who after - graduation in medicine had passed one year in the study and practice - of clinical dentistry, and also those who had attended a previous - session at a reputable dental school. I believe that the American - Dental Association also adopted the same rule. Am I not correct? - I therefore ask how it is that the dental school of Vanderbilt - University is permitted to offer graduation at the close of but one - session, to a student of this city who has passed one session only, - and that very irregularly, at the Georgia Medical College? I also ask - how the same school can offer similar inducements to another - student from Edgefield, South Carolina, as I understand it has done, - and yet be declared reputable? Was it for the purpose of permitting - such violations of the rules adopted by the different organizations - referred to, that the "National Association of Dental Faculties" - allowed the dental school of Vanderbilt University to abstain from - becoming a member of that Association for the present year, and - accorded to its Dean the privileges of the floor at its late meeting - in Chicago? I cannot see why some schools should be compelled to - conform to a rule that others may violate with impunity, and I think - that the State Boards of Dental Examiners of both my own state and - South Carolina should investigate the matter and act accordingly. - - Respectfully, &c., - - "JUSTICE." - -We can only reply to the above letter by stating that several students -who as we had learned from their preceptors, intended to matriculate -in the Dental Department of the University of Maryland, on discovering -that they would be required to attend two sessions in the institution, -had, we are informed, been induced to go to Vanderbilt by the promise -of graduation on one session's attendance. - - EDITOR OF "AM. JOURNAL OF DENTAL SCIENCE." - - - - - Bibliographical. - - - _A Series of Questions Pertaining to the Curriculum of the Dental - Student._--Embracing Dental Histology, Dental Pathology, Dental - Surgery, Dental Prosthesis, Dental Metallurgy, Dental Materia Medica - and Therapeutics, Anatomy, Physiology and Chemistry. By Ferdinand J. - S. Gorgas, A. M., M. D., D. D. S., University of Maryland. Publishers: - W. K. Boyle & Son, Cor. Baltimore and St. Paul Streets, Baltimore, Md. - 1885. Price, $1.50. - -This work comprises leading questions on all the branches belonging to -the course of study pursued by the dental student, and its object is to -facilitate the study of dental science and its collateral sciences. - -Some years ago the author published a small work embracing in an -abridged form, questions on Dental Science, and the favor with -which it was received by the students of his class, was such as to -rapidly exhaust the limited edition, and induce him to prepare, when -opportunity offered, a more complete series of questions embracing the -entire curriculum of the dental student, and even that of the medical -student so far as related to Anatomy, Physiology and Chemistry. - -The present work, therefore, is the result of such an intention, and is -presented with the hope that it may accomplish the object for which it -has been prepared. - - * * * * * - - _Practical and Analytical Chemistry._--Being a Complete Course in - Chemical Analysis. By Henry Trimble, Ph. G., Professor of Analytical - Chemistry in the Philadelphia College of Pharmacy. Illustrated. - Publishers: P. Blackiston, Son & Co., Philadelphia. 1885. Price, - $1.50. - -The object of this excellent work is to place before the student of -pharmacy and medicine a compact course of analytical chemistry. - -The distinguished author believing that the study of Qualitative -Analysis should be preceded by some practical experience such as -relates to the preparation of the important gases and a few of the -salts, devotes Part First to the consideration of Hydrogen, Chlorine, -Hydrochloric Acid, Oxygen, Nitrogen, Ammonia, Nitric Acid, Carbon -Dioxide and the preparation of such salts as Potassium Chloride, -Potassium and Sodium Tartrate, Ammonium Nitrate and Oxalate, Calcium -Phosphate, Magnesium Sulphate, Carbonate and Oxide, Aluminium -Hydrate, Ferrous Sulphate, Ferric Sulphate and Hydrate, Copper -Sulphate and Lead Acetate. Part Second is devoted to Qualitative -Analysis, and Part Third to Quantitative Analysis, together with a -description of apparatus, and the processes of filtration, evaporation, -crystallization, ignition, etc. The work extends over nearly one -hundred pages, and is a valuable text-book for the student. - - * * * * * - - _Chemical Problems._--By Dr. Karl Stammer. Translated from the second - German edition, with explanations and answers, by W. S. Hoskinson, A. - M., of Wittenberg College, Ohio. Publishers: P. Blackiston, Son & Co., - Philadelphia. 1885. Price, 75 cents. - -The text is in the form of questions to which answers are given at -the end of the volume, which comprises one hundred and nine pages. -Part First relates to the recognized elements, and Part Second to -approximate ratios, temperature, atmospheric pressure and mixed -problems, making a compact and useful text-book for the study of -chemical problems. - - * * * * * - - _Quiz Questions._--Course on Dental Pathological and Therapeutics, - Philadelphia Dental College. Prof. J. Foster Flagg, D. D. S. - Answered by William C. Foulks, D. D. S. Third edition, Revised and - Enlarged. Publishers: The S. S. White Dental Manufacturing Company, - Philadelphia, New York, Boston and Chicago. - -This excellent series of questions and answers on Dental Pathology -and Therapeutics is again offered to the dental profession as a work -of reference in daily office practice, and is the only book that -contains in a condensed and practical form the facts and principles -of these subjects, as enunciated by Professor Flagg. Commencing with -General Principles, these questions and answers relate to Deciduous -Teeth, Pathological Dentition, Lancing, Permanent Teeth, Dental -Caries, Sensitive Dentine, Galvanic Action, Pulp Protectors, Obtunding -Applications, Pulp Capping, Pathological Conditions of Pulp, Dental -Exostosis, Malformed Teeth, Periodontitis and Alveolar Abscess, the -whole constituting a work of great value to all engaged in the practice -of dentistry. The work is interleaved with blank pages for notes, etc., -and gotten up in a neat and excellent style. We take great pleasure -in commending this treatise as a valuable adjunct to the regular -text-books of the profession. - - - - - Monthly Summary. - - -PEROXIDE OF HYDROGEN.--_Dr. W. W. Allport, Chicago._--The peroxide of -hydrogen (H2 O2), though not a new remedy, has only within the last few -years gained much prominence in the treatment of surgical diseases. -One of its uses in dental and oral surgery is in blind or deep-seated -abscesses, such as arise from roots of diseased teeth. As the tendency -of pus is always downward, when these cases occur in the lower jaw it -is not infrequent that the abscess, if left to itself, and sometimes -even after the tooth is extracted, will point through the external -tissues at the lower margin of the jaw, and occasionally downward -between the muscles of the neck, and open at various points, even as -low down as the clavicle. The usual treatment is to extract the tooth -and evacuate the pus through the alveolus, but it often happens that -the formation of pus and the continuance of suppuration is not checked, -and the abscess points, or is opened through the external tissue of the -face or neck, leaving, when healed, a disfiguring scar. - -By injecting peroxide of hydrogen into such abscesses before they point -through the external tissues, this serious disfigurement can usually -be averted, and the suppurative process is materially shortened. It -is also a valuable aid for the evacuation of the purulent contents of -the antrum of Highmore, in catarrhal and suppurative inflammations, -and especially where the sinuses are divided into two or more pockets -by bony septi. These cases are often protracted by the inability of -the surgeon to perfectly evacuate them. But with this preparation it -becomes a simple matter after access has been gained to the cavity -by the extraction of a tooth or the perforation of its external wall -in the proper place at the juncture of the cheek with the alveolar -border. A free opening must always be made for the escape of the -contents, in order to avoid pressure from the rapid evolution of -gas. Two or three applications of a dram each is usually sufficient to -completely empty the sac. - -It is used with the most gratifying results in the treatment of -pyorrhea alveolaris, and is an invaluable agent in treating pulpless -teeth, as by its action all decomposed matter from the pulp chamber and -dentinal tubuli is readily ejected, thereby removing the most frequent -cause of discoloring of this class of teeth, of inflammation of the -peridontal membrane, as well as alveolar abscesses. - -The efficacy of peroxide of hydrogen depends on the case with which -it is decomposed into oxygen and water. Pus is one of the many -substances which causes this decomposition. Hydrogen peroxide acts -first chemically and then mechanically. When the decomposition takes -place the oxygen is set free and escapes from a liquid to a gaseous -form; this expansion of the gas distends the pus cavity, and as it -escapes from the orifice, it carries much of the pus with it, and -its application should be repeated till all purulent accumulations -are evacuated. The liberated oxygen, being in a nascent or active -condition, rapidly oxidizes the products of suppuration, and destroys -many of the micro organisms of suppuration.[A] Hence it is a -disinfectant and anti-septic. - -Finally, peroxide of hydrogen, after its decomposition, leaves no -material in the system which is foreign to the system, and it is, -therefore, one of the most efficient and harmless disinfectants -and anti-septics that can be used, in all forms of purulent -inflammation.--_Address at American Medical Association._ - - * * * * * - -ALCOHOLIC PARALYSIS.--The immediate and transient effects of an -excessive quantity of alcohol upon the human nervous system, whether -they are manifested in the form of drunkenness, or of delirium tremens, -or of an acute attack of insanity, are well-known. Scarcely less -evident are the effects produced upon the nervous system by a less -excessive, but a more prolonged, abuse of alcoholic drinks. These -effects may be manifested either in a general failure of physical and -mental power, or in a form of disease closely resembling progressive -paralytic dementia, or in various forms of chronic insanity, or in -epilepsy, or in neuralgia, or in paralysis. In the acute form of -alcoholic poisoning, no change in the structure of the nervous system -has been found, except that the meninges in common with the internal -organs and the mucous membranes are the seat of a very decided -injection and slight exudation. In the chronic form of alcoholism, a -number of pathological changes have been discovered in the nervous -system, which, however, vary greatly in different cases. - -Of late years the paralysis which results from the abuse of alcohol -has been accurately described by numerous observers, and the attempt -has been made to discover the lesion of the nervous system which is -associated with this form of paralysis. Two cases which are reported by -Dr. Henry Hun, of Albany, in the _American Journal of Medical Sciences_ -for April, 1885, are typical examples of this disease, and contribute -to a better understanding of it. - -Dr. Hun has collected the recorded cases of alcoholic paralysis, and -from their study he holds that we are justified in regarding it as a -special form of disease with the following symptoms: After a number -of cerebral and gastric disturbances due to the alcoholic poisoning, -the symptoms of the disease proper commence with neuralgic pains -and paræsthesiæ in the legs, which gradually extend to the upper -extremities, and which are accompanied at first by hyperæsthesia, later -by anæsthesia, and in very severe cases by retardation of conduction -of pain. Along with these symptoms appears a muscular weakness, -which steadily increases to an extreme degree of paralysis, and is -accompanied by rapid atrophy and by great sensitiveness of the muscles -to pressure and passive motion. Both the sensory and motor disturbances -are symmetrically distributed, and the paralysis attacks especially -the extensor muscles. In addition to these motor and sensory symptoms, -there is also a decided degree of ataxia. The tendon reflexes are -abolished and vaso-motor symptoms, such as ɶdema, congestion, etc., are -usually present. Symptoms of mental disturbance are always present in -the form of loss of memory and in transient delirium. - -The lesion is in all probability a degeneration of the peripheral nerve -fibres and of the nerve cells in the cerebral cortex, together with -a chronic congestion or inflammation of the pia mater. This lesion -explains well the symptoms, although it is curious that alcohol should -not attack the spinal cord, but only the highest and lowest part of -the nervous system, if one may so call the cortex of the brain and the -terminal branches of the peripheral nerves.--_Detroit Lancet._ - - * * * * * - -NOURISHING THE TISSUES OF THE TEETH.--Dr. Frank Abbott says: For a -number of years past I have entertained the views that there was -some difficulty existing not due to an insufficiency of lime-salts, -which occasions so many faulty and imperfectly formed teeth. With -that idea in view I have advised exercise in the open air and other -kinds of treatment for some patients which would favorably affect -their digestion. That the food ordinarily taken contains sufficient -lime-salts to form and to sustain the teeth I have no doubt (except in -cases of extreme anemia, during gestation and lactation). I believe -the fault is beyond that. There is a lack of proper nourishment of the -tissues, due to imperfect digestion, which depends again on the proper -"nerve tone." I believe this to be the real cause of the difficulty. It -is reasonable to suppose that any _tonic_, whether taken in the form of -exercise in the open air, or in any other form, which affects favorably -other portions of the body, will affect the teeth favorably as well. -When we have _ascertained the functions of the great nerve-centers_, -and those functions are assured, then we will probably have more -perfectly formed teeth.--_Items of Interest._ - - -[Footnote A: See Gradle on "Bacteria and the Germ Theory of Disease," -pp. 39 and 151.] - - - - - -End of the Project Gutenberg EBook of The American Journal of Dental -Science, Vol. XIX. No. 6. 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Thus, we do not -necessarily keep eBooks in compliance with any particular paper -edition. - -Most people start at our Web site which has the main PG search -facility: www.gutenberg.org - -This Web site includes information about Project Gutenberg-tm, -including how to make donations to the Project Gutenberg Literary -Archive Foundation, how to help produce our new eBooks, and how to -subscribe to our email newsletter to hear about new eBooks. - diff --git a/old/60187-0.zip b/old/60187-0.zip Binary files differdeleted file mode 100644 index 8044ebe..0000000 --- a/old/60187-0.zip +++ /dev/null diff --git a/old/60187-h.zip b/old/60187-h.zip Binary files differdeleted file mode 100644 index d054f01..0000000 --- a/old/60187-h.zip +++ /dev/null diff --git a/old/60187-h/60187-h.htm b/old/60187-h/60187-h.htm deleted file mode 100644 index f52dc74..0000000 --- a/old/60187-h/60187-h.htm +++ /dev/null @@ -1,2322 +0,0 @@ -<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" - "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> -<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> - <head> - <meta http-equiv="Content-Type" content="text/html;charset=UTF-8" /> - <meta http-equiv="Content-Style-Type" content="text/css" /> - <title> - The Project Gutenberg eBook of The American Journal of Dental Medicine by Dr. E. Parsons, Savannah, Georgia. - </title> - <link rel="coverpage" href="images/cover.jpg" /> - <style type="text/css"> - -body { - margin-left: 10%; - margin-right: 10%; -} - - h1,h2,h3 { - text-align: center; /* all headings centered */ - clear: both; -} - -p { text-indent: 2em; - margin-top: .51em; - text-align: justify; - margin-bottom: .49em; -} -.p1 {text-indent: 0em} - -.cb {text-align:center;text-indent:0%;font-weight:bold;} -.u {text-decoration: underline;} - -hr.tb {width: 35%;} -hr.chap {width: 65%} - -.pagenum { /* uncomment the next line for invisible page numbers */ - visibility: hidden; - position: absolute; - left: 92%; - font-size: smaller; - text-align: right; -} /* page numbers */ - -.center {text-align: center;} - -.right {text-align: right;} - -.smcap {font-variant: small-caps;} - -.large {font-size: 125%;} - -.caption {font-weight: bold;} - -div -.chapter { - page-break-before: always; - text-align: center; - page-break-inside: avoid; -} - - -/* Images */ -.figcenter { - margin: auto; - text-align: center; -} -.figcenter .bord { - margin: auto; - text-align: center; - max-width: 100%; -} - -/* Transcriber's notes */ -.transnote {background-color: #E6E6FA; - color: black; - font-size:smaller; - padding:0.5em; - margin-bottom:5em; - font-family:sans-serif, serif; } - -.space-below {margin-bottom: 2.5em;} - -/* Footnotes */ -.footnote {border: dashed 1px; - margin-left: 10%; - margin-right: 10%; - font-size: 0.9em;} - -.footnote .label {position: absolute; right: 84%; text-align: right;} - -.fnanchor { - vertical-align: super; - font-size: .8em; - text-decoration: - none; -} - - </style> - </head> -<body> - - -<pre> - -The Project Gutenberg EBook of The American Journal of Dental Science, -Vol. XIX. No. 6. Oct. 1885, by Various - -This eBook is for the use of anyone anywhere in the United States and most -other parts of the world at no cost and with almost no restrictions -whatsoever. You may copy it, give it away or re-use it under the terms of -the Project Gutenberg License included with this eBook or online at -www.gutenberg.org. If you are not located in the United States, you'll have -to check the laws of the country where you are located before using this ebook. - -Title: The American Journal of Dental Science, Vol. XIX. No. 6. Oct. 1885 - -Author: Various - -Editor: F. J. S Gorgas - -Release Date: August 26, 2019 [EBook #60187] - -Language: English - -Character set encoding: UTF-8 - -*** START OF THIS PROJECT GUTENBERG EBOOK AMERICAN JOURNAL--DENTAL SCIENCE, OCT 1885 *** - - - - -Produced by Jwala Kumar Sista and the Online Distributed -Proofreading Team at http://www.pgdp.net (This file was -produced from images generously made available by The -Internet Archive) - - - - - - -</pre> - - -<hr class="chap" /> -<div class="transnote"> -<p class="cb">Transcriber's Notes</p> -<p>1.Typos were silently corrected.</p> -<p>2.The "cover-page" is developed and placed in public domain as well "Table of Contents" added by the Transcriber.</p> -</div> - -<div class="figcenter bord"> -<a name="i_title.jpg" id="i_title.jpg"></a> - <img src="images/i_title.jpg" - alt="" width="320" height="420" /> - <div class="caption"></div> -</div> -<p class="space-below"><span class="pagenum"><a name="Page_241" id="Page_241">[Pg 241]</a></span></p> - - - -<p class="cb"><span class="large smcap">Table of Contents</span></p> - -<p class="p1 center"> -<!-- Autogenerated TOC. Modify or delete as required. --> - -<a href="#ARTICLE_I">ARTICLE I.</a><br /> -<a href="#ARTICLE_II">ARTICLE II.</a><br /> -<a href="#ARTICLE_III">ARTICLE III.</a><br /> -<a href="#ARTICLE_IV">ARTICLE IV.</a><br /> -<a href="#ARTICLE_V">ARTICLE V.</a><br /> -<a href="#ARTICLE_VI">ARTICLE VI.</a><br /> -<a href="#ARTICLE_VII">ARTICLE VII.</a><br /> -<a href="#ARTICLE_VIII">ARTICLE VIII.</a><br /> -<a href="#Editorial_Etc">Editorial, Etc.</a><br /> -<a href="#Bibliographical">Bibliographical.</a><br /> -<a href="#Monthly_Summary">Monthly Summary.</a><br /> -<a href="#Footnotes">Footnotes</a><br /> - -<!-- End Autogenerated TOC. --> - -</p> - - - -<div class="chapter"> -<h1>THE<br /> -AMERICAN JOURNAL<br /> -OF<br /> -DENTAL SCIENCE<br /> -</h1> -<p class="center"><span class="smcap">Vol. xix. Third Series.</span>—OCTOBER 1885. No. 6.</p> -</div> - -<hr class="chap" /> - - - - -<div class="chapter"> -<h2><span class="large"><a name="ARTICLE_I" id="ARTICLE_I">ARTICLE I.</a></span><br /><br /> -NERVOUS ENERGY.</h2> -</div> - -<p class="cb">BY DR. E. PARSONS, SAVANNAH, GEORGIA.</p> - -<p class="center">[Read before the Georgia State Dental Society, May, 1885.]</p> - - -<p><span class="smcap">Gentlemen</span>—The subject I have chosen for your consideration -at this, our Annual Meeting, is "Nervous Energy, how Actuated, and its -Varied Phenomena." No one can question the importance of knowing all -that can be known about it.</p> - -<p>There is an invariable law by which means mind acts on matter, and it -is my purpose, in this paper, to briefly elucidate what I have learned -by reading, observation and experience on the subject. The great -advantage of meeting in council is an increase in knowledge on all -subjects in any way relating to our profession. We have many things yet -to learn that will be, when known, of great benefit to both ourselves -and the public.</p> - -<p><span class="pagenum"><a name="Page_242" id="Page_242">[Pg 242]</a></span></p> - -<p>Science demands a full and free investigation of all or any causative -principle by which life is manifested, or death produced. So long as we -draw our conclusions only from appearances, we shall often be deceived -in a correct diagnosis; consequently often fail to cure diseases that -come within the legitimate bounds of our specialty.</p> - -<p>Proper remuneration for our services are absolutely necessary for the -respectable maintainance of ourselves and those dependent on us; but -our best men are laboring unweariedly in their endeavor to elevate our -standard throughout the world, but particularly in our own country, and -this Society can do much to help them in their onward march, developing -all possible improvements in Scientific Dentistry.</p> - -<p>Again, we all have a full consciousness of three things—we love, -we think, we act. But few have a scientific knowledge of the means -employed by which mind acts on matter. There are such varied forms and -circumstances controlling its development, that we need not marvel -at anything that comes within the sphere of our observation. As we -are brought face to face with almost every possible condition of -the nervous system, our opportunities for investigating the various -manifestations of nervous energy, its source and supply, may we not -equal any other specialty in solving the great problem of cause and -effect manifesting nervous energy? As the brain is the seat of all -sensation, I briefly present some of the best authenticated views -of its organization. I think you all will agree with me that it is -wonderfully constructed by Infinite Wisdom for the development of the -finite mind. In the elucidation of my subject, let us not forget the -fact that the blood has much to do with the various conditions of -the nervous system. It holds, or should contain in solution, all the -elements necessary for the growth and sustenance of every organ in the -body; it is both a receiver and a giver; it is fed from what we eat and -drink, without which it cannot perform the office intended.</p> - -<p><span class="pagenum"><a name="Page_243" id="Page_243">[Pg 243]</a></span></p> - - -<h3>THE BRAIN.</h3> - -<p>The brain is divided by the septum into two lobes, right and left -sides; also, into the cerebrum and the cerebellum, front and back -sides. Phrenologists divide the lobes into about forty convolutions, -assign to each a distinct office, and by careful observation of each as -to their development, profess to know individual character, and point -out what kind of occupation one, by nature, is best fitted for.</p> - -<p>In 1840, Dr. Sherwood, of New York, by ingenious experiments, -demonstrated the fact that the brain has four large poles, two in the -cerebrum and two in the cerebellum, and from these proceed not only the -convolutions, but every nerve in the body. By these, and experiments -in animal magnetism, he maintained that animal magnetism is the motive -power of the human system, and without it there can be no connection -between mind and matter.</p> - -<p>In the Fall of 1844, I invited several of our most eminent physicians -to meet me at my office to witness some experiments in magnetism. My -subject for demonstration was a young man of unimpeachable character, -twenty-three years of age. My visitors were very skeptical on the -subject of magnetism. There had been some public exhibitions, but the -result did not satisfy them.</p> - -<p>I said, as the science of phrenology is ridiculed by some, I wished -first to exhibit each convolution of the brain, in a state of -exaltation, while he is as wide awake as we are. To prevent any -suspicion of collusion, I handed them a chart containing the names of -the different convolutions of the brain, and requested them to write on -paper any question or the name of the organ, for me to excite.</p> - -<p>The first paper had on it mirth. I placed the point of my finger over -the organ, and he immediately broke out into an uncontrollable fit of -laughter. I passed off the influence and he instantly became calm. They -asked him what he laughed at. He said he did not know; he could not -help it.</p> - -<p><span class="pagenum"><a name="Page_244" id="Page_244">[Pg 244]</a></span></p> - -<p>The second paper had on it veneration. I excited the organ, and he -immediately bowed his head and assumed the attitude of the most zealous -pietist, and appeared to be in earnest prayer.</p> - -<p>The next paper had on it music. I excited the organ, and he immediately -commenced singing with as much earnestness as if his life depended on -it.</p> - -<p>The next paper had on it combativeness. I excited the organ; he -immediately doubled his fist and pitched into an imaginary enemy in the -most vigorous manner possible.</p> - -<p>Not to take up too much space in this paper, I will only add, we went -through with about twenty of the organs with equally marked results, -which both pleased and astonished my friends. They said they now -thought there was much more truth in the science of phrenology than -they had supposed possible. I then said you have seen the effect of -so-called animal magnetism; I will now exhibit a different phase of -it. I magnetized him in the usual way, and said he is now as oblivious -to all external impressions as if his five senses had no existence. -Examine him and satisfy yourselves.</p> - -<p>After a thorough examination, Dr. Richardson said he believed he could -cut off his leg and he would not feel it. I demagnetized him, which -restored him to full consciousness. They questioned him about it. He -said he did not remember anything done in that state. They then said -if it was practicable it would be a good thing in surgical operations. -They thanked me for the pleasure of witnessing the experiments, and -retired.</p> - -<p>To understand the different nervous conditions of patients is of vast -importance to both dentists and physicians. This cannot be attained -without close observation and experience. If the nervous temperament of -a patient is known, we shall have a key to guide us in our treatment in -every individual case. Temperament is usually divided into six distinct -classes:</p> - -<p><span class="pagenum"><a name="Page_245" id="Page_245">[Pg 245]</a></span></p> - -<p>1st. Nervous bilious; 2d. Nervous sanguine; 3d. Nervous lymphatic; 4th. -Bilious nervous; 5th. Sanguine nervous; 6th. Lymphatic nervous.</p> - -<p>You have doubtless observed a difference in the quality of human teeth. -We usually find the best in the nervous bilious temperament, and the -poorest in the lymphatic nervous. Viciated tastes and habits do not -change the shape of the teeth when once formed, but their quality. -Science demands discrimination under varied circumstances; it is not -possible to treat all alike, and be equally successful. I shall refer -to this again below.</p> - -<p>I now present you with a few incidents in practice which may serve as a -basis for a better elucidation of my subject:</p> - -<p>1st. In the Fall of 1835, I was called to see a gentleman at eight -P. M., represented to be suffering greatly, and unable to come to my -office. I was introduced to a large man walking the floor in great -agony. Seating him in a chair, I found the left side of the face -swollen; a purple colored spot over the antrum; the first molar on the -left upper jaw filled with gold; tooth firm, but evidently devitalized. -I diagnosed the trouble to be abscess in the antrum. I extracted the -tooth; he sprung out of the chair and dropped on the floor, face -downwards, and quivered like an ox struck on the head with an ax. I -used cold water freely to his head, and soon brought him to; placed -him back in the chair; made a free passage through the front labial -socket into the antrum, and the pus flowed freely. He then laid down -on the bed much relieved; gave him a half grain of opium; waited about -twenty minutes and injected the antrum with warm green tea; directed -his head to be kept cool with cloths wet with cold water; left him with -a promise to call again in a few hours; called again about three P. -M.; was told he had been sleeping several hours; I injected the antrum -with a weak solution of nitrate of silver; saw him the next morning and -again injected the antrum with a much stronger solution of nitrate<span class="pagenum"><a name="Page_246" id="Page_246">[Pg 246]</a></span> of -silver; the swollen cheek appeared almost natural; said if he needed my -service any more to come to my office. About a week later he called on -me; brought me a sack; said a few hours before that he blowed it out -through the left nostril; it was about one and a fourth-inch long, and -about the size of an ordinary goose-quill; it was soft with a leathery -like appearance; said he was all right; paid his bill; have not seen -him since.</p> - -<p>2d. In September, 1836, I was called by a physician to see his wife. He -said she was suffering terribly from facial neuralgia, and thought it -was caused by a tooth. She was in her eighth month of pregnancy. He had -applied the usual remedies, which gave no relief. I examined her teeth; -found both the third-molars on upper jaw decayed, and on slightly -tapping them with the handle of an instrument, the pain was greatly -increased. He said he was afraid of the consequences, in her state, of -having the teeth extracted. I told him nothing else would give relief. -She said take them out, it cannot be worse than I am now suffering. I -parted the gums from the teeth with a lance; I had barely completed -this part of the operation when she fainted; her mouth was open; I -took my forceps and extracted both teeth; brought her head forward to -prevent the blood running down her throat; we soon brought her back -to consciousness, and the first thing she said was: "I cannot have -them out." Her husband said: "Darling, they are both out." She said, -"Are they? I did not feel it; I am so glad; the pain is all gone." The -Doctor said to me—"You are a bold man: I would have stopped you if -I could, but you was too quick for me." I afterwards learned that no -serious result followed the operation.</p> - -<p>3d. In August, 1856, a young lady, aged about twenty, came to my office -at eight o'clock A. M. Temperament nervous, lymphatic. Said she had not -slept a wink all night. Her face was pale, hands cold, pulse feeble. -Said she had a mortal dread of having a tooth extracted. I put my -mouth-mirror into her mouth for examination, and saw<span class="pagenum"><a name="Page_247" id="Page_247">[Pg 247]</a></span> the tooth caused -the trouble. In an instant she fainted. I took my forceps and extracted -the tooth, used restoratives and soon brought her to. The first thing -she said was—"I cannot have it out." I showed her the tooth. She said: -"Oh! I am so glad I did not feel it;" and left the office laughing -about it.</p> - -<p>4th. In the Fall of 1858 a lady called to have the two upper front -incisors filled. She appeared to be middle-aged, and apparently in good -health. On examination, the teeth were very close together—not badly -decayed, but must be separated for sufficient room to enable me to do -the work properly. Our only means, then, was either wedging or filing -them. I filed about one quarter of what was necessary, and she fainted. -I then filed as rapidly as possible while she was unconscious, and -completed this part of the operation, and used restoratives, and soon -brought her to. I gave her a glass of wine, and completed the operation -without further trouble.</p> - -<p>5th. In the Fall of 1874, a lady called to have a tooth extracted. -She appeared to be in good health; said she was almost distracted -with toothache; was afraid to take chloroform; was afraid as of death -without it. I said the pain would be only momentary, and would not kill -her. I extracted the tooth, and she fainted. My usual remedy in such -cases was hartshorn and cold water. Through mistake, I took up a vial -of the Essence of Gaultheria, poured a little on a handkerchief, held -it to her nose, and was surprised to see how quickly she recovered -consciousness. This prompted me to experiment with it. I concluded that -if it was a good restorative, it might be a useful preventative.</p> - -<p>I soon had a chance to test it. A lady called to have an ulcerated -tooth extracted. She was in delicate health: face swollen, hands cold. -She said she would like to take chloroform, but her physician said she -must not take it; she knew she would faint without it. I told her I -thought that could be prevented. I took a doily, folded it small,<span class="pagenum"><a name="Page_248" id="Page_248">[Pg 248]</a></span> and -poured about a teaspoonful of the essence on it. I told her to inhale -through her nose, and exhale through her mouth. She continued this -until her brain was pretty well stimulated, and the tooth extracted. -She showed no signs of syncopy, and could hold a glass of water as -still as I could. I have not had any one to faint away in my office -since.</p> - -<p>In the Spring of 1874, a lady, aged about sixty, came to consult me. -She said that her teeth were so bad she could not eat any ordinary -food; had disease of the lungs; was forbidden to take chloroform. -After an examination, I told her she had eight teeth in the upper jaw -that could not possibly be made useful, and she had better have them -extracted. She said she had never had one extracted without fainting -dead away. She could not think of having more than one out at a time. -Her temperament, nervous sanguine, emaciated hands cold, pulse very -feeble. I told her if she would follow my directions I would take -them all out and she would not mind it more than one, and guaranteed -she could not faint if she tried. I explained the effect of the -wintergreen, and said it would do no more harm than a glass of good -wine. I administered the article, as before described, until her face -flushed, tears ran down her cheeks, then extracted the eighth teeth -without her closing her mouth. She asked if they were all out, and I -said yes. She said, "Is it possible?" I gave her a glass of water. It -did not show the least tremor of the nerves. She left, giving me many -thanks, saying that she felt much better than when she came into the -office.</p> - -<p>I could relate many more similar cases, but do not deem it necessary. -My object is to show what may sometimes be done to advantage in cases -of syncopy, and also the means of preventing it while performing a -painful operation.</p> - -<p>As before said, the brain is the seat of all sensation; and our -patients, no matter how nervous they are, if the brain is properly -stimulated, cannot faint—caused by the<span class="pagenum"><a name="Page_249" id="Page_249">[Pg 249]</a></span> extraction of teeth. When my -patients are known to be pregnant, I always use the stimulant above -described before performing any painful operation; it always prevents -any severe shock of the nervous system when in this condition. If any -one wishes to know how to prepare the Essence, it is as follows: To one -pint of alcohol add one ounce of the Oil of Gaultheria, commonly called -Wintergreen. Shake it well and it is fit for use.</p> - -<p>In passing from a conscious to an unconscious state, all the -Clairvoyants I have questioned on the subject say it is affected by -a change of polarity of the sensatory organs, and the principle is -the same whether caused by animal magnetism, syncopy or anæsthetic -agents, and if only the voluntary organs are affected thereby, there -is no danger to life, but if polarity in the involuntary is reversed, -the heart ceases to beat and death is instantly the result. I was the -first in this city to administer ether for the purpose of extracting -teeth without pain. In a few cases it developed paroxysms of hysteria; -otherwise no harm was done. I have administered ether, chloroform and -gas to over two thousand persons. With chloroform, I had three cases -that barely escaped death in my chair; with gas, some after deleterious -effects followed in two cases.</p> - -<p>Admitting man's physical organization to be a magnetic machine, the -deaths that have occurred are easily explained, when caused by these -powerful drugs. The voluntary organs are under the control of the will, -and during our waking hours there is a constant draft on our magnetic -supply; it is best recuperated by sleep, when the will is at rest.</p> - -<p>The involuntary organs do not sleep until death ends our earth life. -We can readily understand that if by any cause polarity in the two -large poles in the cerebrum are reversed, the gateway by which we gain -a knowledge of things about us is closed so perfectly that physical -sensation is impossible. On the other hand, if the equilibrium between -the two large poles in the cerebellum are not well<span class="pagenum"><a name="Page_250" id="Page_250">[Pg 250]</a></span> balanced, just -in this proportion some kind of ailment is the result. Let us not -forget that the will has no control over these poles, and all medicine -that does not beneficially act on them is non-curative. Now, just in -proportion as anæsthetic agents disturb their equilibrium, they are -dangerous, it makes no difference whether polarity is reversed or -destroyed; in either case the principle of life can no longer act on -the nerves by means of its intermediate; the heart ceases to beat, -and restoration is impossible. Chloroform is more easily administered -than ether or gas, and most convenient when the patient cannot come -to the office; but we should remember that many deaths have occurred -when given for the purpose of extracting teeth, and that, too, when -least expected. The public mind is more horrified at one death in the -dentist's office than twenty caused by a railroad smash-up. We have now -the means that will stimulate the nerves, greatly mitigate the pain and -not endanger either life or health.</p> - -<p>I have long desired a perfectly safe anæsthetic that can be -administered no matter what the condition of the patient. I am now -creditably informed that Dr. Mayo, of Boston, some eighteen months ago, -by various experiments, produced a compound article that satisfied -him was harmless. He would not put it on the market until it had been -thoroughly tested by both dentists and surgeons. All who tested its -effect and efficiency testified to its great superiority over all other -known anæsthetics for dental and minor surgical operations. It is -now only a few months since he made arrangements for its manufacture -and appliances, and put it on the market. He has named it Mayo's -Vegetable Vapor Anæsthetic. I have been using it for extracting teeth -very successfully. The nitrous oxide causes the patient, when fully -under its influence, to have very like the appearance of a corpse. The -action of this new anæsthetic does not act on the vital organs, and the -patient appears like one in a natural sleep, and, in my opinion, is -perfectly safe and without danger to life or health.</p> - -<p><span class="pagenum"><a name="Page_251" id="Page_251">[Pg 251]</a></span></p> - -<p>Our patients come to us for either a preventative or curative -treatment. As before said, we are brought face to face with almost -every conceivable condition of the nervous system, and the more true -knowledge we have of it the better are we able to satisfactorily manage -them. Some come in a very excitable, and some in a very depressed -state. We need means to quiet the former and stimulate the latter.</p> - -<p>Again. To be fully entitled to the name of Scientific, we must know -something of the laws of life, in order that we may obey them and fight -life's battles manfully—doing justice to others and with credit to -ourselves. Life, in itself, is not creatable, but given to us with -power to properly use or abuse, the end being the creation of the -finite mind. I have explained above the means by which it acts on -matter, but as a further illustration, let me say, you drop an article -on the floor, gravitation holds it there; you desire to pick it up, how -can you do it; if you have sufficient will-power it will act on the -magnetic element, this on the nerves, these on the muscles. You stoop -down and pick it up, and probably not one in ten thousand have a single -thought about the necessary means by which you are enabled to do so, so -little do we reflect about causative principles involved in what we do.</p> - -<p>So far as our voluntary organs are concerned they may be compared to -a locomotive engine. They are both useless if the motive power is -wanting. To make the engine useful, steam must be generated by means -of fire and water; and to make our voluntary organs useful, animal -magnetism must be generated by means of life and the atmospheres. The -engineer controls the steam power, and human will controls the magnetic -power, and when properly applied, if the machine is in good order, -locomotion is the result in both cases. I will only add, the steam -acts on the piston heads and causes the crank to move and the wheels -to rotate. Magnetism acts on the nerves, then on the muscles, and -man moves in any direction he chooses. A dentist with a strong will, -if he uses the proper means,<span class="pagenum"><a name="Page_252" id="Page_252">[Pg 252]</a></span> can more easily and favorably impress -his nervous patient than one with a weak will, and the reason is, he -imparts more of his animal magnetism, which has a stimulating effect on -the nerves of his patient. There is a magnetic sphere emanating from -both man and beast, particularly when in motion. Were it not so, no dog -could follow their tracks successfully. All pain is the result of an -obstruction of a normal flow of the magnetic current, whether caused by -disease or otherwise.</p> - -<p>Arsenic, applied to the nerve of a tooth, destroys its polarity, and -applied to any other nerve it is no longer capable of being actuated -by the magnetic current, without which there can be no sensation, and -death is the result. Physical endurance depends largely on the mind and -the state of the nervous system. The difference in individuals to bear -pain is marvelous; some one can have a tooth extracted and seem to care -but little about it, while others, without the use of a preventative, -appear to suffer intensely, and in some cases the operation causes -syncopy.</p> - -<p>In conclusion allow me to say, a vast field lies before us, and if -cultivated properly this Society will in due time reap a rich harvest, -the benefits of which cannot now be estimated.</p> - -<p>The grand distinction between mind and matter may be seen thus: If we -give any physical object to another, we part with it, but if we give a -new idea on any subject, we do not part with it, but in so doing its -boundaries are enlarged in our minds.</p> - -<p>The space occupied in briefly presenting my views on the subject I -have chosen is greater than I at first intended, but the fundamental -principles which underlie everything with which we have to do, and -the importance of fully understanding them, is my only apology for -occupying so much of your time.—<i>Dental Luminary.</i></p> - -<hr class="chap" /> - -<p class="space-below"><span class="pagenum"><a name="Page_253" id="Page_253">[Pg 253]</a></span></p> - - - - -<div class="chapter"> -<h2><span class="large"><a name="ARTICLE_II" id="ARTICLE_II">ARTICLE II.</a></span><br /><br /> -PULPLESS TEETH.</h2> -</div> - -<p class="cb">BY DR. WILSON, OF BURLINGTON, MEMBER OF THE FACULTY OF THE DENTAL -DEPARTMENT OF THE STATE UNIVERSITY.</p> - -<p>[Extracts of a paper read before the Iowa Dental Association at its -late annual meeting.]</p> - - -<p>A pulpless tooth is not necessarily a dead tooth, but a dead tooth is, -of course, a pulpless tooth. The adjectives "pulpless" and "dead" are -not, therefore, synonymous, although frequently so used, especially -by medical writers. Let us note the marked distinction between the -two. A pulpless tooth may be a part of the living organism—a dead -tooth has its nutritive supply entirely cut off, and it is in every -sense a foreign body—it is dead and inert. The former may be restored -to health and usefulness—the latter should always be condemned as a -nuisance that cannot be abated without the use of the forceps. * * * *</p> - -<p>Having thus briefly called attention to the fact that the dentine and -cementine derive their vitality from independent sources—that the life -of the one is not dependent upon the life of the other—that a pulpless -tooth is not necessarily a dead tooth—we are prepared to consider, -understandingly, the subject of this paper. It may, however, seem like -presumption on the part of the writer, in thus offering the foregoing -to an intelligent body of dentists, when every student of dentistry at -the close of his junior year should fully understand the facts above -stated. But I am led to a consideration of this subject from articles -entitled, "Dead Teeth in the Jaws," that have appeared, from time to -time, during the last two years, in the New York <i>Medical Record</i>, and -as those articles come from high sources in the medical<span class="pagenum"><a name="Page_254" id="Page_254">[Pg 254]</a></span> profession, -they deserve more than passing notice. The able editor of that journal, -and Dr. Samuel Sexton, a distinguished oculist and aurist of New York -City, being the principal writers referred to.</p> - -<p>The <i>Medical Record</i> of October 4, 1884, contains a report from the -aural service of Dr. Sexton, entitled, "Pain in the Ears due to -Irritation in the Jaws." He describes a number of cases of otalgia in -which he found the lesion to be in diseased teeth.</p> - -<p>He goes on to say that "since dentistry had become such a popular -business, and diseased teeth had been so carefully retained in the -jaws, nervous diseases about the head were becoming alarmingly common."</p> - -<p>The same number of the above journal contained an editorial on "Dead -Teeth in the Jaws," which read as follows: "Perhaps the time is near at -hand when medical men should be themselves better informed concerning -diseases of the jaws and mouth, rather than refer the ailments of this -region to individuals whose limited knowledge of medicine does not -prevent them from 'treating' dead teeth long after their presence in -the jaws has given rise to alveolar abscesses and neuralgias more or -less painful. It would not be strange if in the course of events, the -day would soon come when all teeth without pulps, and hence in process -of more or less rapid decay, as well as those which the deposit of -tartar, or other cause, had become entirely divested of periosteal -nourishment, would be promptly condemned as unfit to remain in the -jaws, regarded in fact as foreign bodies liable to give rise, not only -to cerebral irritation and disease in the organs of special sense, -through the propagation of local disturbances in the mouth to the -regions mentioned, but to endanger likewise the general health through -purulent matter discharged into the mouth from alveolar abscesses, -to be continuously swallowed for a long time, or, indeed, in some -instances, to be absorbed and thus produce septicæmic poisoning. It is -certainly gratifying to note the establishment of instruction<span class="pagenum"><a name="Page_255" id="Page_255">[Pg 255]</a></span> in oral -surgery in some of the medical schools, and it is to be hoped that this -subject will receive the attention its importance demands."</p> - -<p>Dr. Sexton cites the readers of the <i>Record</i> to eight cases of otalgia -resulting from diseased teeth. I have no doubt but a majority of the -dentists before me to-day have met with almost that number of cases in -practice every week; nor do you find it a difficult thing to render -prompt relief, and that, too, in a large majority of cases, without the -use of the forceps. And I believe that I am warranted in saying that in -at least three-fourths of the cases met with in our practice, we find -the reflex pain in the ears due to exposed living pulps, and not to -"dead teeth in the jaws."</p> - -<p>That diseased teeth do cause reflex trouble, not only in the head, -but frequently in more remote parts of the body, is a fact well-known -to every competent dentist. I am glad that Dr. Sexton has at last -discovered the fact, that diseased teeth do frequently cause reflex -pain in the ears, and in other neighboring parts, and that alveolar -abscesses very often cause catarrhal affections of the maxillary sinus -and of the nasal passages, and that diseased teeth will endanger the -general health. It is to be regretted, however, that the doctor has -found it necessary to charge this unfortunate state of affairs to the -ignorance of dental practitioners, who are in no way responsible for -but few of the many cases met with in practice, for there can be no -doubt but a very large majority of the teeth causing the troubles above -referred to have never received any treatment whatever at the hands -of dentists, and because Dr. Sexton has discovered that in certain -cases pulpless teeth (or dead teeth as he calls them), has caused the -ailments above referred to by Dr. Sexton, there can be no doubt. Every -dentist of any considerable experience can enumerate such experiences -by the score, and the medical profession has only been too slow to -recognize the facts discovered by Dr. Sexton.</p> - -<p>The only difficulty with these medical gentlemen is,<span class="pagenum"><a name="Page_256" id="Page_256">[Pg 256]</a></span> that they have -drawn very erroneous conclusions from the important discoveries they -have made. Their limited knowledge of the minute structure of the -dental tissue, and the source from which each derives its life, is -manifested by the erroneous statements upon which they have based their -arguments, and then after arguing from false premises, Dr. Sexton says: -"In regard to the treatment of pulpless teeth, the practice in vogue -seems the reverse of procedures founded on well-established surgical -principles." And in an editorial of the same issue we are informed that -the treatment of diseased teeth is carried, to what "the medical minds -regard as a dangerous extreme."</p> - -<p>That some members of our profession have been over zealous in their -efforts to save all diseased pulps alive, there can be no doubt. We -will occasionally meet with an enthusiast in our profession who will -say, "I have no use for forceps, I never extract teeth." I have heard -that statement made on the floor of the Iowa State Dental Association.</p> - -<p>That incurable diseased teeth should not be tolerated in the jaws -does not admit of discussion. Good common sense ought to settle that -question. And again, there are extremists who never devitalize diseased -pulps, no matter how badly exposed, but "doctor them up," and stupify -them, and then bury them in a living grave. Much evil has grown out of -this practice.</p> - -<p>Some one has said that to cap a badly exposed pulp is to create a -slumbering volcano, and he might well have added that such volcanoes -have but a limited time to slumber. Gentlemen, there are in our -own country ten thousand volcanoes belching forth—not pure molten -lava—but impure gases and putrescent matter of the most sickening -character. The craters to these volcanoes are not found on the mountain -top, but they are found in human mouths—in the antrum of Highmore, in -the nasal passages, and externally on the face, neck, or even on the -chest.</p> - -<p>When the pulp of a tooth is dead and confined within<span class="pagenum"><a name="Page_257" id="Page_257">[Pg 257]</a></span> its bony walls -an outlet is sought, and must be affected for the escape of impure -gases arising from the decomposing pulp and for the putrescent matter -associated with it. When thus confined its only way of escape is -through the dental foramen, and into tissues adjacent thereto. The -pressure thus brought to bear upon the bony walls surrounding the apex -of the root will in time perforate it at its weakest point, and the -poisonous matter is forced through the opening thus formed and into the -soft tissues, which soon yield to the pressure, and the imprisoned mass -of corruption is liberated. The pain and swelling now subsides, but a -dangerous nuisance has been created. The channel formed from the apex -of the root to an external opening will not close while it is used for -the passage of foul matter and gases that will flow unceasingly from -the pulp canal.</p> - -<p>The remedy of course is to remove the cause, and assist nature in -affecting a cure, and to do this the pulp chamber must be opened, its -contents removed, the canals cleansed and disinfected, the abscess -healed, and the roots filled to the exclusion of all fluids and -purulent matter. But how often this is not done. How many thousands of -suffering mortals are to-day dragging out miserable lives because of -these drainage tubes emptying themselves into the oral cavity—into -the maxillary sinus or into the meatus of the nose. Such an abiding -nuisance in the mouth cannot long exist without ruining health. But how -few of the unfortunate sufferers realize the cause of their nervous -irritability, their loss of appetite, their feeling of lassitude, -their lack of energy, and their general prostration. And here let me -say, that but few, in comparison to the number of these unfortunate -sufferers seek relief at the hands of the dental practitioner. The -patient is neither sick nor well, but debilitated and "good for -nothing." The family physician is consulted, nervines and tonics are -administered, but to no avail. The septic matter is vitiating the air -that is breathed, and poisoning the food that is eaten.<span class="pagenum"><a name="Page_258" id="Page_258">[Pg 258]</a></span> The saliva -that is poured into the mouth from the various glands must mingle with -this poisonous matter and carry it into the stomach.</p> - -<p>Sanitary means are being employed in all our cities at the present -time, in view of the cholera scourge that it is feared will sweep over -our land the coming summer. Our physicians wisely talk and write about -the baneful influences of impure water, about miasma arising from the -decomposition of vegetable matter, and about unwholesome food, and it -would be well if the public would heed their timely warnings. And as -dental practitioners, I feel that we, also have an important duty to -perform, in enlightening our patients, and the public so far as we are -able to do so, in the direction I have above indicated.</p> - -<p>The subject is of paramount importance, and as the opportunities come -to us in every day practice, let us not fail to impress upon the minds -of our patient (when we find it necessary to do so), the fact that a -clean mouth is essential to health.</p> - -<p>The agitation of this subject, by the medical profession, is a step -forward. Hitherto medical men have not given the matter the attention -its importance demanded.</p> - -<p>And now that this new light has dawned upon Dr. Sexton, it is not -strange that, in hastily drawing his conclusions, he should have -mingled much of error with the truths he has discovered. Possibly some -of the cases that have come under his notice may have been the result -of bad practice on the part of incompetent dental practitioners, but -to charge the dental profession with their short-comings would be a -matter of great injustice. Dr. Sexton is too hasty in his conclusions. -First, he discovered that certain pulpless teeth had caused certain -ailments, hence he condemns all pulpless teeth. He has discovered that -certain dentists have failed to treat such teeth successfully, hence he -condemns the dental profession for attempting to save teeth, it would -be equally fair to condemn the whole medical profession, because of -the incompetency of some of<span class="pagenum"><a name="Page_259" id="Page_259">[Pg 259]</a></span> its members. But before dismissing the -subject of pulpless teeth, it may be well for us to examine the subject -a little more carefully from the standpoint of the medical writers -above referred to. We cannot afford to make a mistake with regard to -so important a matter. The higher a man stands in his profession, the -more serious the mistakes he makes, and the more important it is that -his practice be sound. An enthusiast or an extremist may injure a good -cause. There are such men in our ranks.</p> - -<p>A few years ago a prominent dentist said, "The tooth's pulp is its -soul, and it is criminal to destroy it."</p> - -<p>I heard another prominent dentist say, "If I find a part of the pulp -dead, I amputate the dead tissues, and save the balance of the pulp -alive."</p> - -<p>A dentist has just moved away from Burlington, who has been in practice -there for fifteen years, and during that time he has been using arsenic -for obtunding sensitive dentine, and he has succeeded in accomplishing -his purpose admirably. I have found in one month half a dozen filled -teeth containing dead pulps, and, of course as many alveolar abscesses -in active operation. The evils arising from such abominable methods of -practice are simply appalling.</p> - -<hr class="tb" /> - -<p>I have less frequently met with cases where those fistulous openings -were on the neck or chest. In those cases the roots of the teeth are -usually long, and when the abscess breaks through the lower border -of the jaw, and the pus comes in contact with the soft tissues, it -follows the course of the muscles and forms a sinous as it gravitates -to some point on the neck or chest. I have known of a number of such -cases being under medical treatment for years, where the affection -was supposed to be of a strumpous nature, and the real cause was -not suspected, and in every case a rapid recovery has followed the -extraction of the offending tooth.</p> - -<hr class="tb" /> -<p><span class="pagenum"><a name="Page_260" id="Page_260">[Pg 260]</a></span></p> - -<p>Gentlemen, I have no doubt but the most of you are disappointed in -the nature of this paper. I have scarcely alluded to the treatment -and filling of pulpless teeth. That had not been my purpose. But I -have wished to call attention to the fact that a large majority of -the ailments above referred to have been due to diseased teeth that -have never received any attention whatever at the hands of competent -dentists.</p> - -<p>That pulpless teeth and roots may be treated, filled, and preserved -in health in a majority of cases, is a settled question. Every -well-informed dentist knows that to be a fact, the distinguished Dr. -Sexton and the able editor of the <i>Medical Record</i> to the contrary -notwithstanding.—<i>Iowa State Med. Reporter.</i></p> - -<hr class="chap" /> - - - - -<div class="chapter"> -<h2><span class="large"><a name="ARTICLE_III" id="ARTICLE_III">ARTICLE III.</a></span><br /><br /> -DEAD TEETH IN THE JAWS.</h2> -</div> - -<p class="cb">TRUMAN W. BROPHY, M. D., D. D. S.</p> - - -<p>In reply to Dr. Sexton on this subject, Dr. Brophy makes these -pertinent remarks in the journal of the American Medical Association:</p> - -<blockquote> - -<p>Dr. Sexton says: "The retention in the jaws of teeth which are -diseased, have become irredeemably sensitive to thermal influences, -or deprived of adequate periosteal nourishment through calcareous -formations about the roots, very frequently gives rise to nervous -diseases about the head. I am convinced that these reflected nerve -influences manifest themselves much oftener since dentistry has come -more extensively into practice during the present generation, and -greater efforts are made to retain defective teeth in the jaw."</p></blockquote> - -<p>That diseases of the teeth are often the center from<span class="pagenum"><a name="Page_261" id="Page_261">[Pg 261]</a></span> which pain is -reflected to the eyes, ears and other parts, all experienced clinical -observers must admit. But that these pathological conditions of the -teeth, from which reflected pain has its origin, can be and are -successfully treated and cured with rare exceptions, as effectually as -any other diseases, is a fact too well established to be set aside.</p> - -<p>It is not possible to describe in this letter the method by which the -various diseases of the teeth are treated, but suffice it to say that -"teeth which are diseased from death of the pulp or from caries" <i>do -not</i> "become irredeemably sensitive to thermal influences." In proof of -this statement, many thoroughly educated medical men, practicing the -specialty of dental surgery, will testify.</p> - -<p>"Teeth deprived of adequate periosteal nourishment, through calcareous -formations about the roots, very frequently give rise to nervous -diseases about the head." To this statement I assent, but dissent as -to the remedy not mentioned but implied, <i>i. e.</i>, the removal of the -teeth. If the calcareous deposits mentioned have destroyed so much of -the pericementum and the alveolar processes as to render the teeth -very loose; if, indeed, the teeth have lost their bony support and -are retained by means of a remnant of pericementum only, they cannot, -of course, be restored to permanent health and usefulness, and their -removal is, therefore, indicated. Teeth in this condition "frequently -give rise to nervous diseases about the head."</p> - -<p>On the contrary, if the calcareous deposits have not destroyed the -pericementum and alveolar processes to a very great extent, the -condition is amendable to intelligent treatment and cure. In answer -to the assertion that "Reflected nerve influences manifest themselves -much oftener since dentistry has come more extensively into practice -during the present generation," I would say, that with equal propriety -it might be said that reflected nerve influences manifest themselves -more frequently since gynæcology has come more extensively into -practice. To attribute the obvious increase of nervous diseases during -the present<span class="pagenum"><a name="Page_262" id="Page_262">[Pg 262]</a></span> generation to diseases of the teeth is a statement not -only "sweeping," but "overdrawn." <i>Much harm</i> is no doubt done by some -of the modern appliances "for retention in the mouth of substitutes -for absent teeth," and the unhealthy state of the gums and contiguous -parts, established and maintained by the presence of these substitutes, -unquestionably give rise in many cases to reflected pain.</p> - -<p>When Dr. Sexton attempts to establish a <i>law</i> governing the management -of diseased teeth, it must be based on more substantial grounds -than those which he presents. The case related of his patient, the -"medical man, who practices dentistry," and who was convinced that -an inflammation of one of his ears began from the time the upper -second molar of that side was treated for a diseased pulp, is simply -an assumption, on the part of the patient, that the ear trouble had -its origin from the diseased tooth, and the patient's diagnosis of -his own case seems to have been accepted by Dr. S. as conclusive. The -ear disease in this case may have emanated from the diseased tooth, -but no evidence is produced to that effect. In regard to the query as -to "whether it is safe practice to retain dead teeth in the jaws," I -would say that thousands of people in our own country have had pulpless -(not dead) teeth in their jaws many years, which are exempt from -pericemental disease, and which serve all the purposes for which teeth -were provided. To ask whether it is safe practice to retain these, -so-called, dead teeth in the jaws when they have been comfortable and -useful from ten to forty years and promise to remain so through life, -seems like a proposition too injudicious to need comment. While the -death of the pulp results in "cutting off the source of nutrition from -the dentine," it does not follow "that in a large number of instances -irritation can not be easily controlled."</p> - -<p>Neither does the tooth become a foreign substance. The dentine and the -enamel are, of course, no longer nourished after the death of the pulp, -but their resisting structure renders them capable of maintaining their -integrity<span class="pagenum"><a name="Page_263" id="Page_263">[Pg 263]</a></span> many years after the pulp has been removed; and pericementum -will nourish the cementum and thereby retain the tooth in its alveolus -in a comfortable condition. In order, however, to thus retain the -tooth and prevent inflammation from supervening, the devitalized pulp -must be removed, the pulp canals thoroughly disinfected and filled -with a plastic material which hardens when in position. Dr. S. most -clearly exhibits his imperfect knowledge of the dental operations in -vogue when he says: "Inflammation of exposed dentine cannot surely -be entirely arrested in any case by filling the pulp cavity with any -known extraneous material, and especially is handicraft wanting to -even imperfectly protect the minute and often tortuous canals leading -down to the apical foramina of the majority of the teeth." To arrest -"inflammation of exposed dentine by filling the pulp cavity," in the -opinion of Dr. S. would seem to be most desirable. How a tissue without -nourishment and consequently without vitality can take or maintain -inflammation is beyond comprehension. The impervious filling which -I have mentioned will close the apical foramina, together with the -canal, which "in the majority of cases" <i>is not</i> tortuous to a degree -of rendering the perfect filling of the root difficult or uncertain, -and the assertion that the dental surgeon "is able only to offer a -hopeful but uncertain prognosis in these cases" is contrary to well -established fact. There are no diseases to which mankind is heir more -scientifically and effectually cured than the diseases of the teeth in -question.</p> - -<p>Again: "The dead tissues of the dentine will sooner or later, most -likely, be transmitted through the tissues of the cementum to the -periosteum." Communication between the lacunæ canaliculi of the -cementum with the tubuli of the dentine is not free; indeed, it seldom -exists, hence it cannot be "that through the periosteum alone the -dentine may long derive some nourishment."</p> - -<p>About 22,000,000 teeth are annually extracted in the United States, and -I regret to say this enormous loss of<span class="pagenum"><a name="Page_264" id="Page_264">[Pg 264]</a></span> teeth is to no small extent due -to the indifference manifested by physicians in the anatomy, physiology -and pathology of these organs. It is a fact, no one will attempt to -gainsay, that hygienic measures directed toward the preservation of the -deciduous set, if understood, are seldom recommended by the general -practitioner to the families under his charge. The premature loss of -these teeth paves the way for early lesions of the permanent set. The -pain resulting from advanced caries of the deciduous teeth, owing to -the difficulties encountered in controlling the patient, is not easily -treated; moreover, the injurious impressions thus made on the system of -the child abide through life. There is no doubt hundreds of thousands -of teeth are unnecessarily extracted each year, and then drugs are -given with a view of curing the patient of the disorders of digestion -and other abnormal conditions which follow, and which in turn arise -from imperfect mastication of food, verily for the want of teeth.</p> - -<p>We need to know "what's the matter" in the treatment of these "nervous -diseases about the head," as in all others, and apply a remedy which -will bring the abnormal tissues back to health. Too often, indeed, has -it happened that patients, by advice of their medical attendants, have -submitted to the loss of many, and, in some instances, to all their -teeth, in the vain endeavor to be relieved from trigeminal neuralgia. -You may ask, Why this useless loss of teeth, and all the resulting -evils? Because the advice given was not wise; the etiology of the -affection was not understood.</p> - -<p>There are certain pathological conditions of the teeth which have not -been mentioned in this discussion, and which give rise to reflected -pain of the eyes, ears, and other parts.</p> - -<p>Among these may be mentioned exostosis of the roots of teeth and -nodules of calcific matter within the pulp canals in contact with -a living pulp. The former of these conditions has been regarded -incurable, the removal of the<span class="pagenum"><a name="Page_265" id="Page_265">[Pg 265]</a></span> tooth with the united bony tumor being -indicated. In favorable cases, however, this tumor may be excised and -removed without removing the tooth. The pulp nodules of calcified -deposits within the pulp chamber may be, in a large majority of cases, -successfully removed without sacrificing the tooth.</p> - -<p>No one approves more than I the removal of the causes of disease. -It is no more necessary to extract a tooth at the root of which an -alveolar abscess has formed than it would be to amputate a limb for -the cure of an abscess of the medullary substance of its bone. Disease -of the eye sometimes requires that it be enucleated, but the honest, -skilled ophthalmologist <i>would not</i> remove the eye when he <i>knew</i> he -could restore it to usefulness. The spirit of the teachings of Dr. -Sexton's articles is far from being progressive. Nor is this all; many -assertions are not based on fact, but on erroneous impressions. Our -duty to our profession and the laity is not to destroy but to save; and -while ignorance is ever working its mischief in all vocations in life, -it is not just to accept the results of such work as a basis on which -to found a law.</p> - -<hr class="chap" /> - - - - -<div class="chapter"> -<h2><span class="large"><a name="ARTICLE_IV" id="ARTICLE_IV">ARTICLE IV.</a></span><br /><br /> -DIAGNOSIS AND TREATMENT OF DENTRITIC CYSTIC TUMORS OF THE JAWS.</h2> -</div> - -<p class="cb">BY JOHN S. SMITH, D. D. S., LANCASTER, PA.</p> - - -<p><i>Diagnosis.</i>—Cystic tumors may be confounded with other affections -which occasion swellings about the jaws, as enchrondromata, sarcomata, -and myxomata, abscesses, and the collections of fluids in the antrum. -Dental alveolar<span class="pagenum"><a name="Page_266" id="Page_266">[Pg 266]</a></span> abscess may be distinguished by its acute course, and -when in a chronic, condition by the discharge of its contents through -the fistula, either upon the gum, or within the oral cavity. The tumor -formed by an abscess is never so sharply definite as is the case with -cysts; with dropsy of the antral cavity the distention of the facial -wall of the jaw is more uniform than it is with cysts.</p> - -<p>In some cases of cystic tumors, they present so formidable an -appearance at first sight, that they may be taken for solid tumors; -especially is this so when their walls are compact and well organized, -nearly if not altogether obliterating the sense of fluctuation when -pressure is made upon them.</p> - -<p>Cases have come under the observation of the writer where it required -the most delicate touch to detect any fluctuation when pressure was -made upon the apex of the tumor.</p> - -<p>In some cases the diagnosis cannot be determined accurately until -after one or more teeth are removed that are involved with the tumor. -After such operation, a probe carried through the alveolus will -usually reveal the true condition of the lesion. One or more dead -teeth are found involved—one, however, being the rule in most cases -which have come to the notice of the writer, while two, and sometimes -three, are implicated with the the tumor. The dead tooth may be easily -distinguished from the living ones by its opaque appearance. Such tooth -may be carious, and it may not.</p> - -<p>Primarily the dentritic cyst originates from what pathologists -call a "cold abscess," that is, an abscess which has never opened; -subsequently, having developed into a tumor. The interior of the cyst -has a fibrous lining, and being compact in structure, is the seat of -an inflammatory process. The cyst contains a pyriform fluid; it may -attain such magnitude as to invest several teeth and extend beyond the -alveolar process. The tumor is usually oval in shape, with its apex -on a line with the diseased tooth<span class="pagenum"><a name="Page_267" id="Page_267">[Pg 267]</a></span> directly involved. The size of the -tumor may be as large as a hulled walnut or as small as hazel-nut; -crepitates under pressure, and feels like parchment. In cases of long -standing, considerable resorption of the alveolar process takes place, -and the teeth immediately connected will be loose; especially will this -be the case if the alveolar borders are broken; these teeth should be -removed. These tumors are found painless, as a rule. I have met with -cases, however, where an acute inflammatory condition was present, with -all the symptoms of acute periodontitis manifested. So that it could -have been readily mistaken for the pointing of an alveolar abscess.</p> - -<p><i>Pathology.</i>—Cysts of the jaw may be either simple or compound; -whether they be cysts of retention, exudation cysts, or extravasation -cysts belonging to the jaws, is a matter not as yet fully established. -The exudation cyst is a secretory cyst; in a generic relation, however, -it is just the opposite of the retention cyst. Serous sacs form the -foundations of the exudation cysts. "The mode of development of cysts -of the jaws," says Wedl, "has not yet been determined; it therefore -becomes necessary, in order to throw more light on the subject, to -pursue further anatomical investigations in that direction."</p> - -<p>Rindfleisch says: "The accumulation of the fluid is not produced -by the continuance of the normal secretion, but by an exudation -surpassing the normal measure of the serum of the blood with salts, -albumen, fibrinogenous substance, and extractives, in the most varying -proportions. The exudation cysts have little to do with pathological -new formation. Of extravasation cysts," he says, "a parenchymatous -bleeding can very well be the point of departure for the formation of -a cyst. The hemorrhagic depot can present itself primarily as a cyst, -namely, when the blood is poured out between two surfaces in themselves -smooth; for example, bone and periosteum, cartilage and perichondrium, -and thereafter remains fluid. As a cyst may also be formed when upon -the one hand the limitary<span class="pagenum"><a name="Page_268" id="Page_268">[Pg 268]</a></span> parenchyma furnishes a connective tissue -membrane, upon the other hand, the blood itself is resorbed through a -series of metamorphoses up to a small remainder, and is replaced by a -clear fluid."</p> - -<p>The above-mentioned condition is liable to manifest itself within the -body of the jaw, the bone and periosteum, after severe mechanical -injuries to the bone, and the rupture of blood-vessels within the -parenchyma. There can be little doubt that many of the so-called -dentritic cysts of the jaws have their origin primarily from causes -brought about by falls, strokes and mechanical violence, causing -rupture of blood-vessels. It is quite true, history of cases fully -confirms such facts.</p> - -<p>Clinical observations leads us to believe, however, that only in cases -where the abscess does not open, we find the pathological new formation -taking place within the jaws. Pulpitis, and as has been observed, -followed by pericementitis and periodontitis, is a prolific cause of -the development of the dentritic cystic tumor.</p> - -<p><i>Treatment.</i>—The removal of all dead teeth involved. Other teeth -whose pulps are living may be loose, and to a casual observer appear -to be complicated, but a careful examination will reveal the fact -that they should not be disturbed but retained in their places; only -one tooth may be the offender, being a dead one which has caused the -trouble. After the removal of the cause, let it be either one or more -dead teeth or fangs of teeth, cyst walls may be punctured with a sharp -instrument, and the contents of the sac released, this being done -by carrying the instrument through the alveoli, and not through the -bony parietes of the jaw. After the contents of the sac is let out, -and the sharp spicula of bone trimmed, with engine burs, tincture of -iodine full strength may be forced into the cyst sac, by saturating -tufts of cotton-wool and allowing them to remain, again repeating -the treatment at intervals of a day. If necrosis of bone be present, -it is good practice to alternate the iodine treatment with aromatic -sulphuric acid. Cases generally yield to this treatment in from six -week to three months. I have seen cases not yielding to treatment for -nine months. There are other and shorter methods in the treatment -which perhaps some would prefer—the cutting down through the body of -the tumor, by making a crucial incision and scraping out the contents -of the sac, afterwards allowing nature to do the rest—but I do not -believe it is the best or safest way. There is surely a much greater -loss of structure, which is never restored as in the former method by -granulation, after the secreting cells have been destroyed by medicinal -applications of iodine and sulphuric acid treatment.—<i>Medical and -Surgical Reporter.</i></p> - -<hr class="chap" /> -<p><span class="pagenum"><a name="Page_269" id="Page_269">[Pg 269]</a></span></p> - - - - -<div class="chapter"> -<h2><span class="large"><a name="ARTICLE_V" id="ARTICLE_V">ARTICLE V.</a></span><br /><br /> -THOROUGHNESS.</h2> -</div> - -<p class="cb">BY L. P. DOTTERER, D. D. S.</p> - -<p class="center">[Read before the South Carolina Dental Association.]</p> - - -<p>Though scarcely more than a novice in the vast field of Operative -Dentistry, I have gleaned sufficient experience from observation and -practice to know that <span class="smcap">THOROUGHNESS</span> is the surest means of -success.</p> - -<p>Just as the tillers of the soil sow their seeds, watch their crops, -and reap their harvests, so must we do our duty, advise our patients -as to the best means of preservation, and would that I could say, reap -our harvest. There has been so much written upon this subject that I -have nothing <i>new</i> to say, but will touch upon several points, and in -giving my idea of thoroughness, as there applied, I may draw out some -discussion.</p> - -<p>The first step towards the preparation of the mouth<span class="pagenum"><a name="Page_270" id="Page_270">[Pg 270]</a></span> for dental -operations is the removal of calculus and decayed fangs. Let this be -done in a manner that will <i>insure future cleanliness</i>, where the -proper after attention is given on the part of the patient.</p> - -<p>As regards the preparation and filling of cavities, there are so many -conflicting conditions, that we must be governed entirely by the case -before us; but to be thorough in our preparation, we must so shape the -cavity as to have the walls nearly plumb, uniform margin, slightly -undercut. In proximal cavities there may be a groove or pit at cervical -wall, but do not have it too near the margin, on account of its -liability to produce fracture, and consequent failure at that point. -On grinding surfaces, cut out all fissures leading into cavity, and be -careful to have no angles.</p> - -<p>The margin, after all, is the most important point; for just here -failure begins, especially at the cervical wall, and care should be -taken to thoroughly remove all softened structure, and aim to reach -a solid foundation. These margins should be carefully trimmed and -burnished, and thus our cavity is ready for the filling.</p> - -<p>We often hear practitioners decry the rubber dam, and boast of their -skillful use of the napkin; but, gentlemen, many are the failures -consequent! For in deep proximal cavities, the dam is invaluable in -keeping guard against oozing moisture from the gums, which, without -this precaution, will flow upon the filling without our knowledge. -The dam adjusted, we proceed to form a mass of non-cohesive gold, and -where the walls are strong enough, we can continue with this material -throughout. But where cohesive gold is necessary, we should cover our -borders, as far as possible, with soft foil; for this is more adaptable -to the walls. Another advantage to be found in non-cohesive gold, is -its pliability, ease of starting, and rapidity in finishing. We should -thoroughly condense from beginning to end, whatever may be the kind of -foil used.</p> - -<p>Filing and finishing is too often hurried through, leaving a surplus -of material at the cervical wall, or lapping<span class="pagenum"><a name="Page_271" id="Page_271">[Pg 271]</a></span> the edges—another sure -cause of failure; and every care should be directed to finish in such -way that an instrument passing over the line of demarkation cannot -detect it. After filing, we would use pumice, either on a strip of -orange-wood, or by some other convenient means, and then polish. The -same general rule holds good in amalgam work, and the main cause of -failure in these cases is that lack of thoroughness in finishing.</p> - -<p>In grinding surface cavities, where the enamel leading thereto is -funnel-shaped, we often introduce too much amalgam, extending it -beyond the margins of the cavity, and finishing to a fine edge. This -material, when hard and bit upon, will fracture perpendicularly around -the margins, giving the finishing a bulged appearance, and exposing a -V-shaped crack, which will invite decay. Consequently, we should remove -all surplus material, and finish at the very margin of the cavity. When -gold is used, this precaution is not so necessary, as the edges of a -gold filling will not fracture. Since we do not have to mallet amalgam, -it is natural to suppose we don't require firm margins, but this is -a mistake; and as much, or even more care should be exercised in the -preparation of a cavity for amalgam than gold, as tooth-structure seems -to waste away more rapidly from the former.</p> - -<p>Let our motto be, "Whatever is worth doing at all is worth doing well." -If applying arsenic or a disinfectant, cover it with gutta-percha, -for the patient may be delayed a few days longer than we anticipate; -and what is worse than removing a foul piece of cotton, and finding -the tooth in a poorer condition than we left it? If we introduce a -temporary stopping on account of exposure or frailty, let it be done -thoroughly; and after relating its importance to the patient, caution -her to return at a certain time for its removal and permanent filling.</p> - -<p>We must be teachers at our chairs, if we wish the public to appreciate -us, and we should instruct patients in the proper care of their teeth -by an intelligent and thorough use of the brush, pick, etc.</p> - -<p>Such is the importance of thoroughness in dental operations. This paper -does not half express it, but for fear of trespassing too much on your -valuable time, I commend these ideas to your criticism.—<i>Southern -Dental Journal.</i></p> - -<hr class="chap" /> -<p><span class="pagenum"><a name="Page_272" id="Page_272">[Pg 272]</a></span></p> - - - - -<div class="chapter"> -<h2><span class="large"><a name="ARTICLE_VI" id="ARTICLE_VI">ARTICLE VI.</a></span><br /><br /> -WHAT FILLINGS SHOULD WE USE?</h2> -</div> - -<p class="cb">DR. W. G. A. BONWILL, PHILADELPHIA.</p> - - -<p>When I look back at my commencement and reflect that my early practice -was founded on what the older men in authority had published and -taught, and how I feared to do other than they demanded, I shudder at -the many teeth I extracted I now know might have been saved, with even -the amalgam of that day. And I tremble at the advice <i>now</i> given by the -authorities that <i>gold</i> only should be used as a permanent filling. -Young men knew no better, but the older do. God forgive them, I cannot. -While I do not belong to the disciples of the new departure, <i>so far as -their theory is concerned</i>, I stand side by side with any person <i>who -can save teeth by plastic materials</i>, where gold cannot be used. Better -do this than persist with gold indiscriminately, and lose teeth, rather -than stoop to conquer with <i>any article</i> that is <i>not gold</i>. The public -are demoralized on the subject of <i>gold</i>. "Are you not going to fill my -teeth with gold?" says nearly every new customer; "Dr. —— would not -think of using anything else." A city operator must have more than the -usual quota of courage to stand before the societies and state "he has -been using <i>amalgam</i> more freely of late." For the first eight years of -my practice I would not touch it, because Doctors Elisha Townsend and<span class="pagenum"><a name="Page_273" id="Page_273">[Pg 273]</a></span> -J. D. White passed their anathemas on everything but gold and tin. I -worked myself nearly to death with tin to find it preserves from caries -but not from attrition. Since 1862, I have been feeling my way, and -while I think I have reared many beautiful and substantial monuments of -gold, and have perfected machinery with which to do it, yet I consume -more amalgam than ever before.</p> - -<p>A gold filling <i>properly</i> impacted, with cavity judiciously prepared, -and the walls shaped as to forbid future decay, <i>will save</i>, -irrespective of the frailty of their bony structure? But as thousands -of teeth <i>cannot be so prepared</i>, both of strong and of frail -organizations, and the circumstances <i>cannot</i> be controlled, we should -resort to something that will enable us the more surely to meet the -issue.</p> - -<p>To enumerate the many cases of peculiar character that forbid the use -of gold, would be too great a task. Physical impossibilities lie in the -way of every undertaking; and it is for the successful engineer, who -is well acquainted with his material, and their relative strength and -<i>adaptability</i> for his purposes, to so use each, that his design will -be consummated, and which shall not by future wear, prove a failure. -There is a fitness in every material that experience has proven to -be specially adapted for a given work, and when this general law is -recognized and we become first-class engineers, we shall the better -see where we can adapt our materials to the work to be done, and we -can be the more certain of success, for it is founded on the logic of -mechanics and physical law.</p> - -<p>Where is the dentist that first lays out his design and orders -materials best adapted for specific portions of it?</p> - -<p>As well say everything should be made only of iron, or steel, or -wood, as that every tooth should be filled with gold; or, as <i>equally -ridiculous</i>, that the amalgam or some one of the plastic fillings -should be the only material used.</p> - -<p>It is not <i>necessary</i> to found a <i>creed or departure</i> on a law of -<i>incompatibility</i> to tooth substance. We need not look so far into the -unknown and unknowable. We poor, short-sighted creatures must have -the tangible; not a hypothesis on a <i>supposed theory</i>. Any one with -half an eye can see just where the incompatibility is; not between gold -and dentos, but between dentos and untutored and unskilled brain and -hands to <i>carry out the law of adaptibility</i>—the correlation of forces -involved.</p> - -<p>One skilled in the use of the mallet, with the rubber-dam and a -substantial starting point, with walls ever so frail, can perfectly -impact and complete the work in gold filling, <i>provided the -surroundings are there</i>. But allow <i>one little vacuum</i> between the -tooth substance and the filling, and a <i>capillary tube</i> will be formed -to suck up <i>fermentable material</i>; and the <i>acid generated</i> will act -on the tooth whether it be filled with gold, amalgam, oxyphosphate, or -gutta percha. A thousand capillary tubes making porosity in the gold -or the amalgam, will not do it; but if there is one, however small, -between dentos and filling, destruction is sure.—<i>Transactions of the -Odontological Society of Pennsylvania.</i></p> - - -<hr class="chap" /> -<p><span class="pagenum"><a name="Page_274" id="Page_274">[Pg 274]</a></span></p> - - - - -<div class="chapter"> -<h2><span class="large"><a name="ARTICLE_VII" id="ARTICLE_VII">ARTICLE VII.</a></span><br /><br /> -SOME METHODS OF SEPARATING TEETH WITH WEDGES.</h2> -</div> - -<p class="cb">BY DR. DWIGHT M. CLAPP, OF BOSTON.</p> - -<p class="center">[Read at the joint meeting of the Massachusetts and Connecticut Valley -Dental Societies, held at Worcester, Mass., June, 1885.]</p> - - -<p>Among the many disagreeable and annoying, not to say painful, things -that patients have to suffer at the hands of dentists, nothing, -perhaps, is received with greater dread and disgust than the -announcement that the teeth must be "wedged" before filling. Some, -a small minority among<span class="pagenum"><a name="Page_275" id="Page_275">[Pg 275]</a></span> us, I think, always fill without previous -separation. In regard to the necessity for it, I will enter no argument -here, but only say that personally I am a firm believer in wide -spaces between the teeth at their necks, and labor to the best of my -ability to obtain this result. It is most likely that many of you are -using the same means that I am to get the desired room for filling, -but by presenting and discussing the subject, it is possible we may -obtain some help in doing what I fear the most of us find, at times, -difficult and perplexing. For a long time rubber was about the only -thing used for separating. It has some good qualities and many bad -ones. It probably causes more pain and annoyance to the patient than -any other wedge. Its liability to slide into contact with the gum, -causing great pain and soreness, and even suppuration, has caused me -to entirely abandon its use, I am willing to admit that it may be used -successfully sometimes. The best rubber to use, if it must be used -at all, is that of which the most inelastic tubing is made, or the -erasers sold by stationers, cut into suitable shape. Wedges of wood -are well adapted to cases where the sides of teeth to be wedged are -nearly parallel, or where there is less space at the gum than at the -points of the teeth. The wedge should be about as wide as the length -of the crown, that is, it should extend from the cutting edge to the -gum, nearly. It should be so shaped and trimmed as to not irritate the -tongue or cheek. One advantage of the wooden wedge is that it is more -cleanly than tape, cotton, or silk. This same class of teeth, those -with nearly parallel sides, can be separated as successfully, and I -think with less pain, with tape. Linen tape of various widths and well -waxed is the best. It should be folded so as to be of proper width and -thickness, and then drawn into place. A sharp knife is preferable to -scissors for cutting off the ends. The tape should be thoroughly waxed, -which assists materially in getting it between the teeth, and renders -it more cleanly when left in the mouth for several days. In teeth with -cavities so situated<span class="pagenum"><a name="Page_276" id="Page_276">[Pg 276]</a></span> that cotton can be crowded in with sufficient -force, this is one of the best wedges that can be used, as regards both -effectiveness and comfort. It is necessary to so place the cotton that -the force of expansion will be exerted against adjoining teeth and not -expanded within the cavity. By once changing the cotton, space enough -can generally be obtained. It is difficult to adjust and keep wedges in -place between teeth having more or less space at the gum, and touching -only at a small point near the cutting ends. It is in these cases -that ligatures of various kinds serve an admirable purpose. Take for -instance, the superior central incisors. These usually have but a small -point of contact, with considerable space between them at the gum, and -it is very difficult to put in a wedge of rubber, wood, or tape, that -will not slip up against the gum, or come out altogether. If a ligature -is used, the knots can be so tied that the string will clasp the point -of contact in such a manner as to hold it quite firmly in place. There -are many ways of making the knots; one is to pass the silk once between -the teeth, then tie a surgeon's knot; but, before drawing it up, pass -one of the ends again between the teeth, and then draw the knot so it -will wedge from the gum towards the cutting ends; draw it closely, then -finish by tying so that the last knot will be at the labial, or palatal -side of the teeth. Another way is to make a series of knots like a -chain stitch in crochet work, thus enlarging the silk for a suitable -length; draw this between the teeth and tie as before, omitting the -first knot that is drawn between the teeth. Another, and a very good -way of enlarging the ligature, is, after well waxing it, to roll a -little cotton around the silk as you would around a broach for wiping -out a root canal, and draw this between the teeth and tie the same as -when the silk is knotted. Still another method, easy of application and -very effective in almost all cases where there is a cavity in one or -both of the teeth, is to secure a pellet of cotton with the ligature. -The silk is placed between the teeth in some of the before-mentioned<span class="pagenum"><a name="Page_277" id="Page_277">[Pg 277]</a></span> -ways; a pellet of cotton is forced into the cavity, projecting against -the adjoining tooth, then the silk is tied firmly around the cotton. -The swelling of the cotton and silk will make all the space necessary -between any of the front teeth with but one application. The bulging -of the cotton into the cavity or cavities, caused by tying the silk -around it will hold it securely in place. This makes by far the most -satisfactory wedge I have ever used, and, so far as I am aware, is -original with me. It is sometimes well to open the cavity slightly with -an excavator or chisel before wedging, so that the cotton will be more -readily retained. For bicuspids and molars more than one application -may be needed if much space is required. Quick wedging is sometimes -possible, and when it can be done readily is usually desirable. Teeth -that move easily may be separated sufficiently for operations by -placing a wedge at the point of contact, and another near the gum, -applying force gently with the hand, or light blows with a mallet, -first on one, and then on the other, until wedged enough. Then remove -the wedge that interferes most with the operation, leaving the other in -place. Another way that often works well with children and with teeth -that move readily, is to insert a large piece of rubber and let it -remain from fifteen to twenty minutes, when the rubber will have opened -a considerable space. A wooden wedge will keep the teeth from springing -together while the work is being done. The appliances designed by Drs. -Perry, Bogue and others, for making rapid separations, I have not -used, but hear favorable reports in regard to them. Having spoken of -rapid and semi-rapid separations, it is left only to speak of a method -which works very slowly. It applies, as a rule, to the biscuspids and -molars only. In many cases where there are large cavities between these -teeth, and often, when it is desirable that they should be filled with -what I think is very properly called a "treatment filling," it is -well to fill the entire space between the teeth with gutta-percha. In -the course of a few months the process of mastication will force the -gutta-percha toward the gum, and on removing what has not worn away the -teeth will be found well separated, the cervical margins well in view, -and the cavities in good condition for a metal filling.—<i>Archives of -Dentistry.</i></p> - -<hr class="chap" /> -<p><span class="pagenum"><a name="Page_278" id="Page_278">[Pg 278]</a></span></p> - - - -<div class="chapter"> -<h2><span class="large"><a name="ARTICLE_VIII" id="ARTICLE_VIII">ARTICLE VIII.</a></span><br /><br /> -COCAINE.</h2> -</div> - -<p class="cb">WALTER W. ALLPORT, M. D., D. D. S., OF CHICAGO, ILL.</p> - - -<p>The introduction of cocaine as a local anæsthetic, and the more general -use of peroxide of hydrogen (H<sub>2</sub>O<sub>2</sub>) in the treatment of dental and -oral diseases, are the principal advance made in the medical department -of this practice during the year for which this report is made.</p> - -<p>The two forms of cocaine which have been most generally used in surgery -are the hydrochlorate and the oleate.</p> - -<p>In operations in the mouth, involving the mucous membranes, together -with the immediately subjacent tissues, these preparations have -proven so efficient there is little question of its value as a local -anæsthetic in such cases. But its action on deeper structures, such -as involve the roots of teeth, is so uncertain as to render its -practicable benefits questionable in the operation of extraction. -In the surgical treatment of pockets caused by pyorrhea alveolaris, -the anæsthetic effect of this agent is often so great as to render -this sometimes very painful operation comparatively painless, and -its employment in such cases should rarely be dispensed with. In the -treatment of hypersensitive dentine, as well as in the removal of -tooth-pulps, its action as an anæsthetic has, under some circumstances, -seemed to be all that could be desired. But in far the greater number -of cases it has proved of little practical value. More recently, -however, a new form of cocaine, known as the citrate, has been -introduced in Germany by Merck, and is now being manufactured by -McKesson & Robbins, of New York. In a series of experiments, conducted -by Dr. John S. Marshall, of Chicago, it has been shown that for -operations on sub-mucous tissues, or in the extraction of teeth, it -seems to possess no special advantages over the preparations previously -named. But when applied to dentine or the pulp, its action—though not -always positive—seems to be more reliable, especially on the dentine, -and gives promise of better results. Under favorable conditions it -produces anæsthesia of the parts in from five to ten minutes, and the -duration of the effect is of sufficient length to afford time for -the preparation of the cavity. This effect has, in some cases been -prolonged for more than an hour. The pulp has been extirpated without -pain after the drug has been applied in from three to twelve minutes.</p> - -<p>If the citrate of cocaine be kept in solution for more than three -or four days it decomposes and loses its active properties. As -introduced by Mr. Merck for dental purposes, it is made into pills by -incorporating it with gum tragacanth dissolved in glycerine, each pill -containing 1/8 grain of the citrate. In this form it keeps well. A pill -is applied to the sensitive cavity and covered with a cotton pledget, -moistened in tepid water. It should be allowed to remain from five to -twelve minutes, when—if at all—the desired result is produced. In -twenty per cent. of the cases where this remedy has been employed it -has proven unsuccessful, but it is hoped that this percentage will be -reduced by a better knowledge of the drug and the improved methods of -its preparation and use.</p> - -<p>With this in view, and at the suggestion of Dr. Marshall, McKesson & -Robbins are now manufacturing granules containing one-sixteenth of -a grain of the citrate of cocaine, without glycerine or any other -saccharine excipient, so that the obtundent may act more promptly -than it can in the presence of sugar.—<i>Address at American Medical -Association.</i></p> - -<hr class="chap" /> -<p><span class="pagenum"><a name="Page_279" id="Page_279">[Pg 279]</a></span></p> - -<p><span class="pagenum"><a name="Page_280" id="Page_280">[Pg 280]</a></span></p> - - - - -<div class="chapter"> -<p class="cb"><span class="large"><a name="Editorial_Etc" id="Editorial_Etc">Editorial, Etc.</a></span></p> -</div> - - -<p><span class="smcap">University of Maryland, Dental Department.</span>—The fourth -Annual session of this institution opened with a much larger number -of matriculates than ever before in its history, and the number is so -rapidly increasing that the present class of seniors and juniors bids -fair to be larger than any preceding one.</p> - -<p>The reputation of this school has never been sullied by the graduation -of students for fees irrespective of professional ability, and the -consequence of such a course as has been steadily pursued since its -organization, has been to give a professional standing to its diploma -which that of no other dental school excels. The present class consists -of representatives from all parts of this country, and also Germany, -France, South America, Canada, and even Turkey. Many states of this -country are largely represented, such as New York, Georgia, Virginia, -Pennsylvania, South Carolina and Maryland especially, and also the New -England states, while nearly every other state is represented.</p> - -<p>Students who have passed a session at other dental schools have entered -on a second session at the University of Maryland, Dental Department, -to complete their course of study and receive its diploma, and not -one of the hundreds of students who have attended a course in this -institution, has ever gone elsewhere to graduate. In matriculating the -present class, the resolutions adopted by the National Board of State -Dental Examiners have been strictly adhered to, and many applicants of -this country and Europe have been refused admission who desired to make -their attendance obligatory on graduation after <span class="smcap">ONE</span> session's -attendance.</p> - -<p><span class="pagenum"><a name="Page_281" id="Page_281">[Pg 281]</a></span></p> - -<p>The Infirmary and Laboratory practice is not excelled in size if -equalled by that of any other dental school, and the records will -show hundreds of gold fillings credited to the individual practice of -students for both the regular winter and summer sessions. No other -school can offer greater facilities for practical instruction, nor -present more complete equipment as to building and appliances than -this Dental Department. Dental practitioners are cordially invited to -visit the University and inspect the specimen work of its graduating -classes deposited in the museum. Large and valuable contributions from -all parts of this country and also from Europe are almost daily being -received for the Museum, which will compare favorably with that of any -other dental school for valuable pathological specimens, which are also -utilized for illustrating the lectures of each course.</p> - -<hr class="tb" /> - -<p><span class="smcap">Correspondence.</span>—The following letter was received from a -prominent dental practitioner of Georgia for publication:</p> - -<blockquote> - -<p class="right"> -<span class="smcap">Augusta</span>, Sept. 30th, 1885.</p> - -<p><span class="smcap">Editor "Am. Journal of Dental Science"</span>:</p> - -<p><span class="smcap">Dear Sir</span>: According to my knowledge of the proceedings of -the organizations known as the "National Board of Dental Examiners," -and the "National Association of Dental Faculties," it was determined -that no dental school would be regarded as reputable that did not -after June, 1885, require <span class="smcap">TWO FULL SESSIONS OF FIVE MONTHS EACH -IN SEPARATE YEARS FOR GRADUATION</span>. The only exceptions made being -those who after graduation in medicine had passed one year in the -study and practice of clinical dentistry, and also those who had -attended a previous session at a reputable dental school. I believe -that the American Dental Association also adopted the same rule. Am -I not correct? I therefore ask how it is that the dental school of -Vanderbilt University is permitted to offer graduation at the close of -but one session, to a student of this city who has passed one session -only, and that very irregularly, at the Georgia Medical College? I -also ask how the same school can offer similar inducements to #/<span class="pagenum"><a name="Page_282" id="Page_282">[Pg 282]</a></span> -it has done, and yet be declared reputable? Was it for the purpose -of permitting such violations of the rules adopted by the different -organizations referred to, that the "National Association of Dental -Faculties" allowed the dental school of Vanderbilt University to -abstain from becoming a member of that Association for the present -year, and accorded to its Dean the privileges of the floor at its late -meeting in Chicago? I cannot see why some schools should be compelled -to conform to a rule that others may violate with impunity, and I -think that the State Boards of Dental Examiners of both my own state -and South Carolina should investigate the matter and act accordingly.</p> - -<p class="right"> -Respectfully, &c., <br /> -"<span class="smcap">Justice</span>."<br /> -</p></blockquote> - -<p>We can only reply to the above letter by stating that several students -who as we had learned from their preceptors, intended to matriculate -in the Dental Department of the University of Maryland, on discovering -that they would be required to attend two sessions in the institution, -had, we are informed, been induced to go to Vanderbilt by the promise -of graduation on one session's attendance.</p> - -<p class="right"> -<span style="margin-left: 1em;"><span class="smcap">Editor of "Am. Journal of Dental Science."</span></span><br /> -</p> - -<hr class="chap" /> - -<p><span class="pagenum"><a name="Page_283" id="Page_283">[Pg 283]</a></span></p> - - - - -<div class="chapter"> -<p class="cb"><span class="large"><a name="Bibliographical" id="Bibliographical">Bibliographical.</a></span></p> -</div> - - -<blockquote> - -<p><i>A Series of Questions Pertaining to the Curriculum of the Dental -Student.</i>—Embracing Dental Histology, Dental Pathology, Dental -Surgery, Dental Prosthesis, Dental Metallurgy, Dental Materia Medica -and Therapeutics, Anatomy, Physiology and Chemistry. By Ferdinand J. -S. Gorgas, A. M., M. D., D. D. S., University of Maryland. Publishers: -W. K. Boyle & Son, Cor. Baltimore and St. Paul Streets, Baltimore, Md. -1885. Price, $1.50.</p></blockquote> - -<p>This work comprises leading questions on all the branches belonging to -the course of study pursued by the dental student, and its object is to -facilitate the study of dental science and its collateral sciences.</p> - -<p>Some years ago the author published a small work embracing in an -abridged form, questions on Dental Science, and the favor with -which it was received by the students of his class, was such as to -rapidly exhaust the limited edition, and induce him to prepare, when -opportunity offered, a more complete series of questions embracing the -entire curriculum of the dental student, and even that of the medical -student so far as related to Anatomy, Physiology and Chemistry.</p> - -<p>The present work, therefore, is the result of such an intention, and is -presented with the hope that it may accomplish the object for which it -has been prepared.</p> - -<hr class="tb" /> - -<blockquote> - -<p><i>Practical and Analytical Chemistry.</i>—Being a Complete Course in -Chemical Analysis. By Henry Trimble, Ph. G., Professor of Analytical -Chemistry in the Philadelphia College of Pharmacy. Illustrated. -Publishers: P. Blackiston, Son & Co., Philadelphia. 1885. Price, $1.50.</p></blockquote> - -<p>The object of this excellent work is to place before the student of -pharmacy and medicine a compact course of analytical chemistry.</p> - -<p>The distinguished author believing that the study of Qualitative -Analysis should be preceded by some practical experience such as -relates to the preparation of the important gases and a few of the -salts, devotes Part First to the consideration of Hydrogen, Chlorine, -Hydrochloric Acid, Oxygen, Nitrogen, Ammonia, Nitric Acid, Carbon -Dioxide and the preparation of such salts as Potassium Chloride, -Potassium and Sodium Tartrate, Ammonium Nitrate and Oxalate, Calcium -Phosphate, Magnesium Sulphate, Carbonate and Oxide, Aluminium -Hydrate, Ferrous Sulphate, Ferric Sulphate and Hydrate, Copper -Sulphate and Lead Acetate. Part Second is devoted to Qualitative -Analysis, and Part Third to Quantitative Analysis, together with a -description of apparatus, and the processes of filtration, evaporation, -crystallization, ignition, etc. The work extends over nearly one -hundred pages, and is a valuable text-book for the student.</p> - -<hr class="tb" /> -<p><span class="pagenum"><a name="Page_284" id="Page_284">[Pg 284]</a></span></p> - -<blockquote> - -<p><i>Chemical Problems.</i>—By Dr. Karl Stammer. Translated from the second -German edition, with explanations and answers, by W. S. Hoskinson, A. -M., of Wittenberg College, Ohio. Publishers: P. Blackiston, Son & Co., -Philadelphia. 1885. Price, 75 cents.</p></blockquote> - -<p>The text is in the form of questions to which answers are given at -the end of the volume, which comprises one hundred and nine pages. -Part First relates to the recognized elements, and Part Second to -approximate ratios, temperature, atmospheric pressure and mixed -problems, making a compact and useful text-book for the study of -chemical problems.</p> - -<hr class="tb" /> - -<blockquote> - -<p><i>Quiz Questions.</i>—Course on Dental Pathological and Therapeutics, -Philadelphia Dental College. Prof. J. Foster Flagg, D. D. S. -Answered by William C. Foulks, D. D. S. Third edition, Revised and -Enlarged. Publishers: The S. S. White Dental Manufacturing Company, -Philadelphia, New York, Boston and Chicago.</p></blockquote> - -<p>This excellent series of questions and answers on Dental Pathology -and Therapeutics is again offered to the dental profession as a work -of reference in daily office practice, and is the only book that -contains in a condensed and practical form the facts and principles -of these subjects, as enunciated by Professor Flagg. Commencing with -General Principles, these questions and answers relate to Deciduous -Teeth, Pathological Dentition, Lancing, Permanent Teeth, Dental -Caries, Sensitive Dentine, Galvanic Action, Pulp Protectors, Obtunding -Applications, Pulp Capping, Pathological Conditions of Pulp, Dental -Exostosis, Malformed Teeth, Periodontitis and Alveolar Abscess, the -whole constituting a work of great value to all engaged in the practice -of dentistry. The work is interleaved with blank pages for notes, etc., -and gotten up in a neat and excellent style. We take great pleasure -in commending this treatise as a valuable adjunct to the regular -text-books of the profession.</p> - -<hr class="chap" /> - -<p><span class="pagenum"><a name="Page_285" id="Page_285">[Pg 285]</a></span></p> - - - - -<div class="chapter"> -<p class="cb"><span class="large"><a name="Monthly_Summary" id="Monthly_Summary">Monthly Summary.</a></span></p> -</div> - - -<p><span class="smcap">Peroxide of Hydrogen.</span>—<i>Dr. W. W. Allport, Chicago.</i>—The -peroxide of hydrogen (H2 O2), though not a new remedy, has only within -the last few years gained much prominence in the treatment of surgical -diseases. One of its uses in dental and oral surgery is in blind or -deep-seated abscesses, such as arise from roots of diseased teeth. As -the tendency of pus is always downward, when these cases occur in the -lower jaw it is not infrequent that the abscess, if left to itself, -and sometimes even after the tooth is extracted, will point through -the external tissues at the lower margin of the jaw, and occasionally -downward between the muscles of the neck, and open at various points, -even as low down as the clavicle. The usual treatment is to extract the -tooth and evacuate the pus through the alveolus, but it often happens -that the formation of pus and the continuance of suppuration is not -checked, and the abscess points, or is opened through the external -tissue of the face or neck, leaving, when healed, a disfiguring scar.</p> - -<p>By injecting peroxide of hydrogen into such abscesses before they point -through the external tissues, this serious disfigurement can usually -be averted, and the suppurative process is materially shortened. It -is also a valuable aid for the evacuation of the purulent contents of -the antrum of Highmore, in catarrhal and suppurative inflammations, -and especially where the sinuses are divided into two or more pockets -by bony septi. These cases are often protracted by the inability of -the surgeon to perfectly evacuate them. But with this preparation it -becomes a simple matter after access has been gained to the cavity -by the extraction of a tooth or the perforation of its external wall -in the proper place at the<span class="pagenum"><a name="Page_286" id="Page_286">[Pg 286]</a></span> juncture of the cheek with the alveolar -border. A free opening must always be made for the escape of the -contents, in in order to avoid pressure from the rapid evolution of -gas. Two or three applications of a dram each is usually sufficient to -completely empty the sac.</p> - -<p>It is used with the most gratifying results in the treatment of -pyorrhea alveolaris, and is an invaluable agent in treating pulpless -teeth, as by its action all decomposed matter from the pulp chamber and -dentinal tubuli is readily ejected, thereby removing the most frequent -cause of discoloring of this class of teeth, of inflammation of the -peridontal membrane, as well as alveolar abscesses.</p> - -<p>The efficacy of peroxide of hydrogen depends on the case with which -it is decomposed into oxygen and water. Pus is one of the many -substances which causes this decomposition. Hydrogen peroxide acts -first chemically and then mechanically. When the decomposition takes -place the oxygen is set free and escapes from a liquid to a gaseous -form; this expansion of the gas distends the pus cavity, and as it -escapes from the orifice, it carries much of the pus with it, and -its application should be repeated till all purulent accumulations -are evacuated. The liberated oxygen, being in a nascent or active -condition, rapidly oxidizes the products of suppuration, and destroys -many of the micro organisms of suppuration.<a name="FNanchor_A_1" id="FNanchor_A_1"></a><a href="#Footnote_A_1" class="fnanchor">[A]</a> Hence it is a -disinfectant and anti-septic.</p> - -<p>Finally, peroxide of hydrogen, after its decomposition, leaves no -material in the system which is foreign to the system, and it is, -therefore, one of the most efficient and harmless disinfectants -and anti-septics that can be used, in all forms of purulent -inflammation.—<i>Address at American Medical Association.</i></p> - -<hr class="tb" /> - -<p><span class="pagenum"><a name="Page_287" id="Page_287">[Pg 287]</a></span></p> - -<p><span class="smcap">Alcoholic Paralysis.</span>—The immediate and transient effects of -an excessive quantity of alcohol upon the human nervous system, whether -they are manifested in the form of drunkenness, or of delirium tremens, -or of an acute attack of insanity, are well known. Scarcely less evident are -the effects produced upon the nervous system by a less excessive, but -a more prolonged, abuse of alcoholic drinks. These effects may be -manifested either in a general failure of physical and mental power, or -in a form of disease closely resembling progressive paralytic dementia, -or in various forms of chronic insanity, or in epilepsy, or in -neuralgia, or in paralysis. In the acute form of alcoholic poisoning, -no change in the structure of the nervous system has been found, -except that the meninges in common with the internal organs and the -mucous membranes are the seat of a very decided injection and slight -exudation. In the chronic form of alcoholism, a number of pathological -changes have been discovered in the nervous system, which, however, -vary greatly in different cases.</p> - -<p>Of late years the paralysis which results from the abuse of alcohol -has been accurately described by numerous observers, and the attempt -has been made to discover the lesion of the nervous system which is -associated with this form of paralysis. Two cases which are reported by -Dr. Henry Hun, of Albany, in the <i>American Journal of Medical Sciences</i> -for April, 1885, are typical examples of this disease, and contribute -to a better understanding of it.</p> - -<p>Dr. Hun has collected the recorded cases of alcoholic paralysis, and -from their study he holds that we are justified in regarding it as a -special form of disease with the following symptoms: After a number -of cerebral and gastric disturbances due to the alcoholic poisoning, -the symptoms of the disease proper commence with neuralgic pains -and paræsthesiæ in the legs, which gradually extend to the upper -extremities, and which are accompanied at first by hyperæsthesia, later -by anæsthesia, and in very severe cases by retardation of conduction -of pain. Along with these symptoms appears a muscular weakness, -which steadily increases to an extreme degree of paralysis, and is -accompanied by rapid atrophy and by great sensitiveness of the muscles -to pressure and passive motion. Both the sensory and motor disturbances -are symmetrically distributed, and the paralysis attacks especially -the extensor muscles. In addition to these motor and sensory symptoms, -there is also a decided degree of<span class="pagenum"><a name="Page_288" id="Page_288">[Pg 288]</a></span> ataxia. The tendon reflexes are -abolished and vaso-motor symptoms, such as ɶdema, congestion, etc., -are usually present. Symptoms of mental disturbance are always present -in the form of loss of memory and in transient delirium.</p> - -<p>The lesion is in all probability a degeneration of the peripheral nerve -fibres and of the nerve cells in the cerebral cortex, together with -a chronic congestion or inflammation of the pia mater. This lesion -explains well the symptoms, although it is curious that alcohol should -not attack the spinal cord, but only the highest and lowest part of -the nervous system, if one may so call the cortex of the brain and the -terminal branches of the peripheral nerves.—<i>Detroit Lancet.</i></p> - -<hr class="tb" /> - -<p><span class="smcap">Nourishing the Tissues of the Teeth.</span>—Dr. Frank Abbott says: -For a number of years past I have entertained the views that there was -some difficulty existing not due to an insufficiency of lime-salts, -which occasions so many faulty and imperfectly formed teeth. With -that idea in view I have advised exercise in the open air and other -kinds of treatment for some patients which would favorably affect -their digestion. That the food ordinarily taken contains sufficient -lime-salts to form and to sustain the teeth I have no doubt (except in -cases of extreme anemia, during gestation and lactation). I believe -the fault is beyond that. There is a lack of proper nourishment of the -tissues, due to imperfect digestion, which depends again on the proper -"nerve tone." I believe this to be the real cause of the difficulty. It -is reasonable to suppose that any <i>tonic</i>, whether taken in the form of -exercise in the open air, or in any other form, which affects favorably -other portions of the body, will affect the teeth favorably as well. -When we have <i>ascertained the functions of the great nerve-centers</i>, -and those functions are assured, then we will probably have more -perfectly formed teeth.—<i>Items of Interest.</i></p> - -<p class="cb"><span class="large"><a name="Footnotes" id="Footnotes"><span class="u">Footnotes</span></a></span></p> - -<div class="footnote"> -<p><a name="Footnote_A_1" id="Footnote_A_1"></a><a href="#FNanchor_A_1"><span class="label">[A]</span></a> See Gradle on "Bacteria and the Germ Theory of Disease," -pp. 39 and 151.</p> -</div> - - - - - - - - -<pre> - - - - - -End of the Project Gutenberg EBook of The American Journal of Dental -Science, Vol. XIX. No. 6. 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