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Title: The American Journal of Dental Science, Vol. XIX. No. 6. Oct. 1885
Author: Various
Language: English
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                           AMERICAN JOURNAL


                            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

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

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

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

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

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

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.


  [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

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

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

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

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.


              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.


                      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

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

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

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.


                  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

                             ARTICLE VIII.



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

                            Editorial, Etc.

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

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.


  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
  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.,


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."


  _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,

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._

                   *       *       *       *       *

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.]

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