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THE
DENTAL RECORD:
MONTHLY JOURNAL
OF
DENTAL SCIENCE, ART, AND LITERATURE,
D3VOTii]D TO THE INT3RE3TS OF THE PROFESSION.
Edited by
W. II. DOLAMORE, L.R.C.P., M.R.C.S., L.D.S
VOL. XVI.
J".^a^TJJ^:E^Y-ID:Bc:E:M:BE;x^, i896.
Published by
THE DENTAL MANUFACTURING COMPANY, LIMITED,
6 to lO, LEXINGTON STREET, LONDON, W. ;
AND
MANCHESTER AND DUBLIN.
I N D EX.
PAGE
*' Alveolar Abscess," Stanley Colyer, on ... ... ... ... 10
" Amalgam." R. McKay, on ... 57
''Amalgams, Notes on," by C. S. Tomes 212
Anjesthetics, Action on Isolated Nerve ... ... ... ... 141
"Anaesthesia, the next Great Advance in," by Sir B. W. Richardson 225
Anatomy, Lecture on, by W. Arbuthnot Lane ... ... ... 577
Anchoring Large Fillings ... ... ... ... ... ... 191
" Aneurism by Anastomosis on Hard Palate," by Marmaduke Shield 204
Austin, Harrold, " Effects of Specific Fevers on Mouth" ... 241
"Bacteria of Mouth," by Messrs. Goadby and Washbourn ... 301
Baldwin, H., on '' Repairing Bridges " ... ... ... ... 489
British Dental Association, Annual Meeting, Programme of
Proceedings ... ... ... ... ... ... ... 355
British Dental Association, Report of Annual Meeting ... ... 389
Buxton, Dr. Dudley, on '' Nature of Anaesthesia •' ... ... 67
" Calcification of a Widely Exposed Pulp," C. S. Tomes, on ... 209
Cataphoresis ... ... ... ... ... ... ... 842
Caush, Douglas E., on " Exostosis " 289, 337, 441
Chlorate of Potash as an Antiseptic and Germicide for the Mouth 366
Chloroform, Deaths from 183, 184, 216, 218, 282, 535
Claims for Damages following Tooth Extraction ... ... ... 281
Cocaine ... ... ... ... ... ... .. ... 190
" Cocaine," S. A. Hopkins, on 372
Cocaine and Cocaineism ... ... .. ... ... ... 4o6
College of Surgeons, Edinburgh, Pass List 280, 387
„ „ England, „ „ 312
jj „ „ New Regulations for L.D.S. ... 356
IV.
DENTAL RECORD.
College of Surgeons, Ireland, Pass List
College of Dental Surgeons, Ontario, New Buildings
Colyer, J. ¥., on •' Early Treatment of Crowded Mouths "
Colyer, Stanley, on "Alveolar Abscess"
Comer v. Gwynue ...
Crowded Mouths, Early Treatment of, by J. F. Colyer ..
Crystal Gold...
PAGE
280
525
264
10
44
264
107
Death following Tooth Extraction
" Deformity of First Temporary Incisor," Dr. T. H. Denz, on
Denz, Dr. T. H., on " Deformity of First Temporary Incisor
Dental Hospital, Birmingham, Annual Meeting
,, ,, Brighton, Annual Report
,j ,, Devon and Exeter, Annual Meeting
,, ,, Glasgow, Annual Meeting
„ „ Ireland, Opening of New Building
,, ,, London, Dinner ...
„ „ „ Annual Meeting
,, ,, „ Conversazione ...
„ „ Liverpool, Annual Meeting
,, ,, Manchester, ,, ,,
,, ,, National, Dinner
,, ,, Newcastle, ,, ,,
" Dental Histology, the Enamel Organ," Prof. Paul, on ...
Dental Prosecution, Cardiff. ..
Dentists Bill, N. S. W
Diseases of Upper Air Passages
Dundee Dental Prosecution
Douglas, J. C, on " Oral Antiseptics"
284
65
65
80
128
217
182
134
46
178
359
131
129
571
181
493
352
523
368
81
499
Editorials —
" Death during the Administration of Pental "
*' Direct Representation of the Dental Profession "
" Gold as a Filling "
" The British Dental Association Meeting "...
" The Extraction of Unerupted First Bicuspids "
" T'he New Regulation for the L. D. S. Eng."
35
449
77
888
310
353
DENTAL RECOUD. V.
Editorials — contin^ied. page
" The Recent Examination " 568
" Shock and Strain." 278
" Two Deaths from Chloroform Ana3Sihesia '' ... ... 176
*' Unsatisfactory Balance Sheets " ... ... ... ... 125
Edwards, R. on " Pain " • 537
Enamel and Dentine, Notes on, by C. S. Tomes ... ... ... 115
'' Exostosis," by Douglas E. Caush 289, 337, 441
'' Fermentation and Oral Antiseptics," J. C. Douglas, on... ... 499
Formalin as a Preservative ... ... ... ... ... ... 549
Fox, Charles James — Obituary Notice ... ... ... ... 148
General Medical Council 38,316,575
Gold and Amalgam ... ... ...^ ... ... ... ... 51
Gregson, Mr. George — Obituary Notice ... ... ... ... 81
Grayston, W. Cass, on " Treatment and Filling of Teeth " 1, 49,
97, 147 193, 249
Guttapercha... ... • ... .. ... ... ... ... 4
Harlan, Dr., on "Essential Oils" 257
Heath, Mr., on " Honeycombed and Syphilitic Teeth " 107
Honeycombed and Syphilitic Teeth ... ... ... ... 107
Howard, F. H., on " Porcelain Inlaying" ... ... ... ... 246
'* Inaugural Address," by Morton Sm ale ... ... ... ... 454
" Infiltrating Dental Osseous Tissues," Charters White, on ... 563
" Liquid Silex " by H. H. Burchard 382
McKay, R., on "Amalgam " 57
Matheson, Leonard, on " Practical Points" ... ... ... 23
Miller, Dr. W. D., on ''Transparent Zone ... ... ... 18
Miller, F., on " Should Women be Dentists? " ... ' 155
VI. DF.NTAT. RECORD.
PAGE
Naden, Percy T. — Presidential Address ... ... ... ... 5
" Nature of Anaesthesia," Dr. Dudley Buxton, on ... ... 67
New Drugs ... ... ... ... .-• ••• ..• ••• ^5
Nottin2:ham Dental Prosecution 5H3
'O'
Odontobgical Society of Great Britain, 16, 64, 113, 161, 203,
263, 300, 556
Odontological Society, Liverpool ... ... ... ... 517, 565
" Oral Hygiene," John G. Ranken on 293
Orient, Dentistry in... ... ... ... ... ... ... 478
"Origin of Mammalian Teeth," Dr. M. Tims, on 164
Osteo Fillings 2
"Pain," by R. Edwards ... 537
Paul, Prof., on " Dental Histology " ... 41)3
Plastic Fillings, Manipulation of . ... ... ... ... 201
Porcelain Crowns, Quick Method of Making ... ... ... 452
'* Porcelain Inlaying," by F. R. Howard ... ... ... ... 446
Prosthetic Dentistry ... ... ... ... ... ... 186
Pyorrhoea Alveolaris ... ... ... ... ... 189, 485
Ranken, John G., on "Oral Hygiene" 293
Reviews 285,486
Richardson, Sir B. W., on " The Next Great Advance in
Anaesthesia" ... ... ... ... ... ... ... 225
Salivary Calculus, Case of ... ... ... ... ... ... 121
Separation of the Teeth ... ... ... ... ... ,.. 250
Septicsemia following Alveolar Abscess ... ... ... ... 385
Shield, Marmaduke, on "Aneurism by Anastomosis on Haid Palate" 204
Smale, Morton — Inaugural Address ... ... ... ... 454
" Soldering in Mouth," H. Baldwin on 489
" Specific Fevers, Effects on Mo^lth," by Harold Austen 241
Students' Society, Birmingham — Presidential Address ... ... 5
Students' Society, London 32, 75, 121, 171, 275, 518, 566
Students' Supplement ... ... ... ... ... ... 419
Subluxation of Jaw ... ... ... ... ... ... ... 175
DENTAL RECOKD.
Tin Foil
Tomes, C. S., on " Calcification of a Widely Exposed Pulp"
Tomes, C. S., on '' Notes on Amalgams" ...
Tomes, C. S., on " Notes upon Enamel and Dentine "
Touch Bulbs in Dentine
" Transparent Zone in Decay," Dr. W. D. Miller, on
" Treatment and FilUng of Teeth," Notes on, by W. Cass Grayston
1, 49, 97, 147, 193, 249
Trifacial Neuralgia ... ... ... ... ... ... ... 482
Trueman, W. H. on " Advent of Dental Science in U. S. A." .. 469
Turner, John — Obituary Notice ... ... ... ... ... 144
Vll
PAGE
1
209
212
115
404
18
"' Undeveloped Mandibles," Bland Sutton, on
... 561
X Ray and its Application in Dentistry
332
'•V
The dental RECORD.
Vol. XVI. JANUARY 1st, 1896. No. 1.
®ri0tnal Cnrnmnnirations,
NOTES ON THE TREATMENT AND FILLING OF TEETH.
By W. Cass Grayston, L.D.S.
{^Continued from page 533.)
Tin Foil.
Chemically pure tin foil has been used for many years for filling
teeth. Since the introduction of amalgams and other plastic
materials, it does not appear to be so much employed. It is some-
what softer than gold and is therefore more easily worked against
the walls of cavities. It is a low conductor of heat and cold, andean
therefore be placed with safety nearer the pulp than gold. Its
softness enables a filling to be more easily started than with gold,
for in an awkwardly shaped cavity, where just the cutting necessary
to fix the first pieces of gold cannot be made, one or more pellets of
tin foil will often, if wedged between the walls, remain firm and make
a good foundation, where gold similarly packed would roll about
and refuse to stay in place. On to this base of tin the gold can
be readily worked, and the filling completed. In deep cavities
particularly crown cavities, where the pulp is nearly exposed, it is often
convenient, and saves time, to pack tin foil on to the floor, and then to
build up with gold. This is quite as safe as flooring with guttapercha
or osteo. Gold can be made to adhere to tin, a. id therefore a thicker
protecting layer can often be made than is possible with the other
materials. In using tin to start gold fillings it is always inadvisable
to allow it to extend to the margins. It sometimes happens that the
tin becomes disintegrated and eaten away by the action of the oral fluids
at the cervical edge, and as this is very annoying, it is well to prevent
its happening. To make a filling entirely of tin is, except in simple
cases, more troublesome than using gold, for it possesses very little
cohesion, and is consequently usually worked by the non-cohesive
wedging principle, which with our present knowledge of the value of
contour, limits its application, and in front teeth the discoloration
of the surface of the filling, and the dark appearance that it gives to
a tooth in this position if the labial wall is at all thin, precludes its
A
2 THE DENTAL RECOBD.
use. Tin can be worked cohesively, and I have made some perfectly
cohesive fillings with it, but it is laborious, and takes up far more
time than working cohesive gold. To enable a cavity to be satisfactorily
filled with tin foil it should be thoroughly and carefully prepared,
and, given a well prepared cavity, I have never seen a.iy results from
tin, or from a combination of tin and gold, which lead me to
suppose that beyond making a tight filling it has any preservative
effect on a tooth, or that a tooth well filled with gold will not
prevent decay quite as well ; and as I have seen several cases where
tin and also the tin gold advocated by Dr. Miller has rotted at
the cervical edge, I consider its only reliable value lies in being a
convenient starter for gold, and an excellent low conducting lining
under gold.
White Cement or Osteo Fillings.
Osteo, or artificial bone, fillings are usually oxychloride of zinc
or phosphate of zinc. The oxychloride is now, comparatively speak-
ing, rarely used. It is more troublesome to work than many of the
phosphates, and must be kept perfectly dry during insertion and
carefully protected from moisture while setting by careful varnishing.
It appears to be harder than the average phosphate, but is, as a
rule, considered to be not so durable in the mouth. It often causes
pain on insertion, but is said to have a hardening effect on soft
dentine, although I cannot say I have observed this myself.
Phosphate of zinc, like the oxychloride, is in the form of a
powder (oxide of zinc) and a liquid (phosphoric acid) which are
mixed together when required in proportions sufficient to make a
paste or cement for the case in hand. A little of the liquid and a
little of the powder are placed on a glass slab, and then the powder
is gradually worked into the liquid with a spatula until the mass is
of a putty like consistency, when it should be rapidly pressed into
the cavity and the surface trimmed to shape as it sets.
There are many makes of this material on the market. Some
are very easy to mix and manipulate, others are difficult and
troublesome. Some are too sticky to be packed in a tooth one
moment, and the next are too stiff, the least addition of powder to
overcome the stickiness resulting in too rapid setting. Some prepara-
tions will work from the sticky condition to the stiff on the slab, and
as soon as they are placed in the cavity become sticky again (probably
owing to the heat of the mouth) ; there are again makes that mix
THE DENTAL RECORD. S
and work easily and give no trouble, and as the average duration of
these cements (before needing replacement) is from one to two years,
and as the '' awkward" cements do not appear to have any greater
average duration to make up for the difficulty and trouble of using
them ; it is better to confine oneself to a reliable cement that is
easy to work.
I find from an observation of osteo fillings inserted during the
the last ten years, that the cervical failure, so often alluded to, is in
my experience the exception rather than the rule. I am inclined to
think that cervical failure must usually be due to the use of cements
that are difficult to manipulate. The filling, if sticky, is probably
drawn from the cervical edge during the packing, or else owing to
the rapidity with which it sets, it either never reaches this part or
only in a crumbly condition. It is presumed, of course, that the
tooth at this part is kept perfectly dry.
Phosphate fillings possess the inestimable advantage of adhering
somewhat to the dentine (providing it is dry), consequently in
sensitive cavities there is often no necessity to cut retainage in the
sound tooth structure. The decay, if possible, should, however,
always be removed. The principal use of these fillings is in
cavities of the front teeth, when for any reason gold is contra-
indicated ; for fillings where a pulp has been capped or the roots
treated, when it is thought desirable to postpone the use of a more
permanent material ; for fixing crowns and bridges ; for lining
cavities before filling with amalgam, and for fixing inlays. It is
occasionally useful for sealing up arsenical dressings and for filling roots.
Wherever it is possible the rubber dam should be used, so as to
exclude all moisture. A phosphate filling will become perfectly
hard in water, but it is generally considered advantageous to
varnish the surface. Chloropercha soon dries, and is as useful as
anything for this purpose. A phosphate filling saves a tooth
probably better than any other material, with the exception of
guttapercha. It is rarely that cavities are as accurately prepared
and such care taken with the edges as where gold is skilfully used,
and yet it is exceptional to find a tooth filled with either phosphate
or guttapercha decaying at the margins as long as the filling remains
intact. Nay, more than this, the filling may become worn down
somewhat without any decay taking place. It is only when it is
considerably worn that the tooth is again attacked. Now take a gold
A 2
4 THE DENTAL RECORD.
filling, and instead of making it flush with the margins leave it
depressed, and with the enamel projecting, like the average osteo
after a year's wear, and how long, no matter how carefully the gold
might be smoothed, would any dentist expect it to last ? As before
mentioned, the fluids of the mouth appear to attack the weakest
part, viz., the osteo, and to leave the enamel intact. Arguments
based on single cases are of very little value, but the following as an
experience is interesting. More than ten years ago I replaced two
large osteo fillings on the mesial surfaces of two upper centrals.
Since then I have regularly replaced these fillings every eighteen
months or two years. No decay has again attacked these surfaces,
nor have the margins required recutting during this time. Decay
has attacked the distal surfaces, and also the laterals and cuspids,
and they have been filled and refilled when necessary with osteo and
guttapercha. In no case has decay again taken place in or at the
edges of the cavities. The fact that it is dissolved away so surely,
and the fact that patients will not, as a rule, present themselves for
regular examinations so as to have these fillings replaced in time
greatly reduces their value as tooth savers and leads many dentists
to use gold in doubtful cases.
Guttapercha.
The guttapercha specially prepared for filling teeth is a very
valuable material if judgment is exercised in its use. The softer
kinds as coverings for dressings are most useful, and the harder, or
more permanent preparations, if used in small cavities not exposed
to the force and friction of mastication, probably give better results,
taking one case with another, than any other material.
Small cavities in the front teeth are readily filled with this material
and it will usually last some few years. Sometimes guttapercha
rots in the mouth ; usually (although the surface may become soft
and apparently porous and not very sightly) it only fails from down-
right mechanical wear. A medium or large sized cavity in a front
tooth is better filled with osteo (when gold is contra-indicated), but in
all cases where the cavity does not extend either to the lingual or
labial surface, the guttapercha will last longer and is easier to replace.
Small pin head sized holes on approximal walls of bicuspids and
molars should usually be filled with guttapercha under any circum-
stances. For instance, if a pin head hole is discovered in this
THE DENTAL RECORD. 0
position, and after much time and trouble is filled with gold, decay will
usually attack the margins within a year or two, whether this is due
to difficulties of manipulation or the absence of free edges I am not
prepared to say, but I should always expect a guttapercha filling to
last here longer than a gold filling, and it can if necessary be replaced
in a very short time. Even the most ardent contourist and believer
in the necessity for free edges would not think it right to cut away
all the side of a tooth and hollow out its interior in order to
convert a minute cavity into a magnificient contour filling.
Guttapercha shrinks slightly, and although lining the cavity with
copal ether varnish or resin dissolved in chloroform is said to
prevent this, the fact remains that leaky guttapercha fillings usually
save teeth until the material is considerably worn. It is considered
that leakage in a filling is a very bad thing, and that absolute
moisture-tightness is one of the most, if not the most important,
factor in preserving a tooth. With the record of guttapercha before
us, it appears doubtful if slight leakage is of very great importance^
providing it does not cause chipping of the edges, or discoloration of
the tooth. i
Many labial, buccal and lingual cavitiei may also be satisfactorily
filled with guttapercha. A cavity for this material should have a
general retaining shape, and, consequently, a little more cutting is
usually needed than for osteo, but owing to the smallness of the cavities
generally filled with guttapercha, the preparation is as a rule rapidly
effected. It is also a very valuable material for filling root canals.
Dissolved in chloroform it is known as chloropercha, and is an
excellent protecting varnish for osteo fillings, and, in connection with
cotton wool, for covering dressings. For filling all cavities (not too
much exposed to mastication) where a clasp or band or part of a
plate will be in contact with the filling, guttapercha seems to answer
better than anything else. »
(7b he continued?)
PRESIDENTIAL ADDRESS.*
By Percy T. Naden, L.S.A., L.D.S.
Gkntlemkn, — In commencing my address I must first ihank the
Members of this Society for the honour they have conferred on me
by electing me as their President.
* Presidential Address, delivered at the Annual Meeting of the Birmingham
Dental Students' Society, October 31st, 1895.
6 THE DENTAL RECORD.
This evening I intend to say a few words on the importance of
a proper appreciation by the public of the value of keeping the teeth
in a healthy and efficient condition. I shall touch upon dental
hygiene, and upon the appointment of dental surgeons to public
institutions, including the Army and Navy. The greater number ( f
the people of this country do not seem, as yet, to be impressed with
the necessity of having the mouth periodically examined and
thoroughly overhauled ; and in many cases they never think of
interviewing the dentist until they are forced to do so by their
sufferings. Now, I understand that this statement does not hold
good for every country ; in the United States I believe it is more
general to have a dental examination about every three months. I
think there is no doubt that a large number of people are deterred
from a visit to the dentist by a vivid recollection of a painful inter
view which they had with him years ago. On enquiry, it will be
often ascertained that the patient went to have a tooth extracted
and chanced to consult an unqualified man, who had undergone no
special course of dental education. 1 have heard patients exclaim
that "they did not believe in the filling of teeth," and proceed to
narrate that they have had teeth filled, and that the stopping either
came out or caused them so much pain after the insertion of the
fining, that the tooth had to be extracted in the end. Now that a
thorough course of dental training is compulsory, the incompetent
practitioner should die out; this result has not been attained, for up
to the present time we occasionally hear of the art of dentistry being
tampered with, even by hairdressers. I am here reminded of an
incident which occurred in the practice of a brother professional, who
is well known to me. This dental friend of mine told me that one
day a nurse girl brought three children to his rooms. On seating in
the chair the first one to be attended to he asked the youngster to
open his mouth, when the nurse exclaimed : " Oh, I didn't brin^
him to have his teeth seen to, I brought him to have his hair cut."
But, to continue my subject, there is another reason why dental
treat»nent is too often deferred. I refer to the fact that there are
some people who unfortunately are of an exceedingly neurotic
ttmperament, and on whom the slightest operation will cause
intense pain. Such individuals require greater care and patience on
our part. It may sometimes be thought that, because a tooth is
affected with caries to a slight extent only, there must necessarily
be Httle or no pain attending its preparation for filling. We know
by experience, however, that the amount of pain does not depend
upon the size of the cavity. It must be borne in mind, therefore,
that if such cases as these are not dealt with by using all possible
gentleness our nervous patients may take advantage of our skill as
a last resource only. Of course, we must be able to discriminate
between actual pain and a make-belief of suffering.
When we consider the number and gravity of the affections
arising from an unhealthy state of the mouth, the urgent necessity
for a stricter attention to this particular part of our organism
becomes evident. I will here mention some of these affections, the
causation of which we can directly trace to the teeth. Let us take
THE DENTAL RECORD. 7
a few examples : — (a) Neuralgia, after defying medical treatment, is
often found to yield when brought under the care of the dental
surgeon. (3) Dyspepsia is sometimes traceable either to an
unhealthy mouth or to insufficient means for the proper mastication
of the food. As a sequel of dyspepsia gastric ulcer sometimes
arises. (c) Epithelioma of the lips, cheek, or tongue has frequently
been traced to constant irritation from the jagged edge of a tooth.
(d) Trismus occurs in . connection with diseased or impacted
conditions of the wisdom teeth, (e) Fits have also been mentioned
as resulting from dental trouble. Again, there are instances quoted
in which forms of (/) Paralysis are found to give way to dental
treatment.
I should like to give the details of a somewhat peculiar
case, which came under my notice when I occupied the post of
House Surgeon to this Hospital. I don't think I can do better than
give you the history of the case from some notes which I look at the
time. C. J., aged 26 years, had an attack of measles when one year
and eight months old, since that time her right arm and hand had
(so she said) been paralysed. When I saw her muscular wasting
was marked from elbow to wrist, but not so marked from elbow to
shoulder. The affected limb was considerably shorter than the
corresponding limb. She could not move the paralysed arm, which
was fixed to the side. She had ether at this hospital, and twelve
carious teeth were extracted. A fortnight after this the patient told
us that she was recovering the use of her arm and hand, and four
or five weeks after the operation she could raise her arm above the
head ; before the operation this was quite impossible. As this
satisfactory result was arrived at about a month or five weeks after
the extraction of the teeth, it is reasonable to suppose that the
patient would recover, to a great extent, the use of the limb. This
was most probably a case of infantile paralysis, and I should say the
removal of the teeth acted as a strong counter-irritant to the nerve
endings, thereby producing a beneficial effect ; for we know how
extensively the nerves of the limb may be affected by apparently
trifling causes. An instance of this sort was given in a paper read
at one of the meetings of this Society last session. It was a case
recorded by Brown-Sequard, in which a boy had a bit of gravel
imbedded in the ball of the toe. Every time he trod on the ground,
he had a reflex convulsion. On clipping away the irritated skin a
cure was effected.
Passing on to the next point in my paper, we find that researches
instituted in order to discover the predisposing causes of caries, have
established beyond doubt the fact that not the least important of
our duties is to pay special attention to hygienic measures, and to the
quality of the food-stuffs to be consumed. Now, we know that the
^malle^ the quantity of lime salts that is absorbed by a tooth during
the process of its development the softer it is, and the more liable it
is ti> give way to the ravages of decay. In support of this, we have
rhe results of the careful and exhaustive investigations of Dr. Rose,
of Freiburg, who proved that the drinking of water poor in lime,
and also the consumption of food poor in lime, produce an influence
8 THE DENTAL RErORD.
which is unfavourable to the healthy structure of the teeth. It is
also proved that the eating of a soft sticky wheat-bread is a very
active cause of decay ; this being brought about by the large
quantity of acids wliich are formed by saliva-mixtures with bread.
On the other hand, it has been demonstrated that course brown
bread is much less likely to be a factor in the production of decay,
inasmuch as it requires the muscles of mastication to be used with
considerable force ; and as a consequence of this increase in the
action of the jaws a larger flow of saliva results, and any remnants
of bread which may cling to the teeth are to a great extent washed
away. Coarse brown bread has a beneficial action mechanically, for
it ■ helps to keep the teeth clean, thereby taking the place of the
toothbrush; and we find that it assists to maintain the mucous
membrane of the gums in a healthy condition. In order to prove
the relative value of the different kinds of bread, so far as they can
assist in influencing the structure of a tooth, it will be necessary to
point out that dentine contains 72 per cent, of inorganic matter, and
of this 66*7 per cent, is calcium phosphate. Enamel contains
96-41 per cent, of inorganic matter, and of this 89*82 per cent, is
calcium phosphate and fluoride. Now, whole meal bread is richer
than white in phosphates ; for we find that white bread contains
of mineral matter 0*7 per cent., and whole meal bread con
tains ]*7 per cent. These salts are largely made up of earthy
phosphates and alkaline phosphates. Alkaline phosphates probably
combine with lime in the system to form the important calcium
phosphate.
It is my intention now to proceed to the consideration of the
appointments ot dental surgeons to public institutions These
appointments, in my opinion, are still far too few. Although a town
may possess a dental hospital, nevertheless, I contend that an
institution, like our General Hospital, should have a duly qualified
man on the staff, to attend solely to troubles connected with the
teeth ; for such troubles do frequently complicate cases in the
medical and surgical wards. In a certain number of paid appoint-
ments which are open to us, we are expected to give up a large
amount of time (indeed, this is necessary if the work is to be carried
out conscientiously^, but often the remuneration for our services is
quite inadequate when compared with similar medical appointments.
What I should sugges': with regard to these salaried positions is
thai the remuneration should be sufficient to make it possible for us
to give plenty of time to the patients, thus ensuring the best kind of
Work.
I shall now dwell on the advisability of appointing dental officers
in the Army and Navy. It has always appeared to me that there is a
certain amount of inconsistency in the facts, that before passing
recruits into the services special attention is paid to the number
and condition of the testh, but that after enlistment no further
notice is taken, except when a complaint of odontalgia is made, when
the offending tooth is extracted.
Fillings, I believe, are rarely inserted, although materials such as
amalgams and gold can be obtained, together with scaling instru-
THE DENTAL RECORD. ' V
ments, from the head-quarters of the district. No hard-and-fast-line
is laid down in the regulations regarding dental efTiciency of an
intending recruit, but all is left to the discretion of the surgeon.
The rule usually followed is this : that if at least half of the teeth
remaining in the jaws are in good order and are fairly evenly
distributed, the man would be accepted. It has been found from
the experience of Surgeon Captain Saw, who is at present stationed
in this city, and to whom I am much indebted for the kindly way in
which he answered my enquiiies, that men recruited round large
manufacturing towns have bad teeth, especially in Lancashire ; but
it is satisfactory to learn he considers that in Birmingham the teeth
are very good indeed. From returns made on this subject out of
891 rejections in this district only two were due to defects and
deficiency of teeth. I also made enquiries with a view to discover-
ing whether there were any disadvantages attending the appointment
of dental surgical officers to the services. And from what I could
gather, the difficulties to cope with would be : first of all the
expense ; and, secondly, the practice of malingering, which it is
feared would be frequently resorted to. It was stated that the men
would make a pretence of suffering toothache, with the idea of
evading duties, fatigues and punishments. Another point suggested
is that the men's time would be wasted. I was informed that in
India ro per cent, of the men composing a regiment were always in
hospital, and the additional absence of men reporting sick from
various causes, either to be relieved from toothache or undergoing
dental operations, would so materially reduce the number of soldiers
at drill as to be a serious matter. On the other hand we hear that
odontalgia was prevalent to such a degree amongst the officers of the
Chitral Force during the late war that Sir Robert Low has advised
the Government in all future expeditions to appoint a staff of
dentists with a principal dental officer attached to the headquarters
staff. I understand that the Indian subordinate medical department
consists of Eurasians (these are half-castes, being a mixture of
Europeans and Asiatics), who take the place of the medical staff
corps, who are non-commissioned officers. The members of this
subordinate medical department receive two years' medical education
at the expense of the Government. These men do most of the
teeth extractions, and by practice become very skilful. In this
connection, it is interesting to know that in the days of the old
muzzle-loading guns, when greased cartridges were used, teeth
in the front of the mouth were a necessity. This, of course,
arose from the fact that in order to load a rifle the end of the
cartridge was bitten off, the powder it contained was poured
down the barrel of the gun, and then the. bullet and paper
cartridge case were rammed down above it. Men who were
deficient in front teeth were not received into the army, and those
men who were in the army and did not find it to their liking,
adopted the plan of knocking out their front teeth in order to
obtain their discharge.
Before concluding my address, through which I fear I have
wandered in a somewhat desultory manner,, let me call your attention
10 THE DENTAL RECORD.
to an incident which recently happened, and which no doubt most
of you have read of in the newspapers. I am glad, however, to say
it is in no way connected with the professors of our art. A barber
in the Strand, London, was summoned for extorting money. It was
stated that he had notices of dentistry hung up in his shop, and that
by persuasion his customers sometimes allowed him to scale their
teeth, for which operation he charged the not very moderate fee of
four pounds ! I have no doubt most of the practitioners in this city
would only be too happy if they could get a similar fee ; but, as I
am credibly informed, each of them has a conscience which is not
elastic enough to allow him to attempt such a charge. It was
brought out in the evidence that one old gentleman was charged
five pounds for this operation, and not only did this venturesome
barber deal in dental scaling, but also in scales chromatic, for he also
bullied the poor old gentleman into buying a musical box !
Fortunately the status of our profession has much improved
since the compulsory examination has been the law, and now a
much better class of men adorn our ranks. Still, as in every other
walk of life, we must find some black sheep ; and the general public
has not quite got rid of the idea that we are associated with either
mountebanks or barbers. It is within my recollection that a lady
was located on a piece of land at the back of New Street Station,
gaily extracting teeth, while the cries of her victims were drowned
by the alluring strains of a brass band. But let us hope that all
these will soon be things of the past, and that our profession will
occupy a position second to no other branch of medical art, and that
quacks and mountebanks will never be found in its ranks again.
This much desired end can be distinctly furthered by the
co-operation of the younger members of the profession, and their
determination not to be connected with 'any unprofessional or
undignified methods of practice. By such means, we should obtain
the confidence and respect of all branches of medical science, as well
as of the general public.
ALVEOLAR ABSCESS.*
By Stanley Colyer, L.D.S. Eng.
Alveolar abscess is one of the affections which is both common
to man and the lower animals. In the majority of cases connected
with animals the abscess runs its course unabated, so in them it is a
much UiOre serious complaint than in man.
As an example that animals are sometimes treated I may cite the
case recorded by Mr. Bland Sutton of the celebrated elephant Jumbo,
who, in a fit of rage, broke both his tusks off just within their
* A paper read before the Students' Society of the Dental Hospital of London.
THE DENTAL RECORD. 11
alveoli. In due course, around each, arose abscesses which, after two
attempts, were skillfully opened by Mr. Bartlett with a probe three feet
in length. The sagacious animal, appreciating the relief which it had
received, allowed the abscess to be washed out and permitted the
one round the other tusk to be opened without flinching. But,
as I said, the majority of animals go untreated. Several examples
are furnished by the kangaroos, who contract abscess from fracture
of their procumbent lower incisors. *' Kangaroos," to quote the
same author, '' like animals of even high moral pretensions, have
domestic differences which occasionally lead to unpleasant conse-
quences." In the encounter the tips of the incisors are broken, the
exposed pulps inflame, suppurate, and lead to alveolar abscess, which
in some cases terminates in death from absorption of septic
matter. There are several other equally interesting cases, as
the beautiful case of skulls in the Odontological Society's Museum
proves.
Turning now to alveolar abscess as it affects man, we find that
morphologically it may be divided into two distinct classes —
(i) Those which arise either within the substance of the
periosteum or between it and the cementum.
(2) Those which occur in the tissue outside the periosteum.
Adopting the nomenclature of Mr. Dolamore, I shall refer to the
former as sub-periodontal, to the latter as extra-periodontal. The
sub-periodontal includes the majority of chronic abscesses. Their
position on the root is variable, they may be situated anywhere, but
around the apex is the usual seat. The infection comes as a rule
from a septic pulp, either dying or dead, and is carried either by the
blood vessels or lymphatics, if there be any, to a spot on the
periosteum, where it becomes arrested. If the condition of the tissue
be favourable to their growth, they speedily multiply, giving off
ptomaines, which irritate and set up an inflammation in the part.
Now the inflammation and its results are directly regulated by three
conditions : — (i) The resisting power of the tissues ; (2) The
duration of its action ; (3) The intensity of the cause. For instance,
a strong healthy man will rapidly recover from a blow on the shin,
whilst in a syphilitic man it may lead to a chronic periostitis, the
inflammatory material of which may undergo ossification or break
down and form pus ; so it is with the periodontal membrane. The
duration of the action is most important, a slight irritant acting
12 THE DENTAL RECORD.
some time will probably be productive of inflammatory fibrous
tissue ; it also lowers the vitality of the tissue, so that any increase in
the intensity of the cause will lead to a rapid breaking down of
the tissues.
It is necessary to realise these facts, or else we cannot possibly
understand the condition met with — termed abscess sac — which
certainly implies that the sac is a necessary part of an abscess, which
it is not. For, as it has been ably pointed out, where suppuration
occurs between bone and periosteum, there cannot possibly be an
abscess sac. Now, if you examine these sacs, you will find that they
are of three kinds, those which are merely granulomata, the result
of a productive inflammation ; those which are the centre of
inflammation, the result in the first place of a productive inflamma-
tion with a subsequent increase in the intensity of the irritant or
diminution of the resistance of the tissues ; those which do contain
pus, in an enlarged and distended periosteum. Whether this last
variety consists always of broken down granulomata, or whether the
periosteum has been distended and thickened relatively with the
increase in volume of the pus I am unable to tell you. Of the
second class, the extra-periodontal, they are I think most frequently
caused more artificially, by the forcing of septic matter through
the apex by force from above either during mastication or by
instruments. They, as a rule, assume the acute variety. As I
have said, the most frequent cause of abscess is inoculation of the
tissues from a septic pulp ; this is by no means the only cause.
There are many others, both predisposing and exciting ; thus, we
have rheumatism, giving rise to an affection called acute rheumatic
periostitis, which is described by Senftleben as frequently attacking
healthy and robust individuals with good teeth after severe cold,
commencing with a violent toothache along one side of the jaw;
there is high fever and the other signs of inflammation are present ;
pus is apt to form and necrosis is a frequent consequence. Influenza
also has an important bearing upon abscess. It is said that after
an epidemic of it there is an epidemic of periostitis, one or two
cases of abscess are reported subsequent to it. Impacted wisdoms
and pyorrhoea both predispose to abscess, and, lastly, we have that
class called idiopathic, called so because their pathology is unknown.
The symptoms vary in intensity and character according to the
stage in which we consider them. In the early stages it is difficult
THE DENTAL RECORD. 13
to distinguish it from periostitis. The tooth is tender, raised in
its socket, and loose. There is but little swelHng, but considerable
pain of a dull throbbing character, due to the tension of the pus within
the bone, which is worse in strong healthy men. Later on, owing
to pressure, the osteoblasts take on osteoclastic functions, the bone is
absorbed, and the pus escapes, leading to considerable increase of
swelling and decrease of the pain. Soon the pus points, and the
gum or skin over it, deprived of its blood supply, sloughs, and it is
enabled to escape. During all this time the usual symptoms of
pyrexia have been present, namely a quick pulse and a high
temperature, a furred tongue and a hot and dry skin, scanty and
high coloured urine, a general feeling of malaise. I have only
found one case in which the temperature was accurately recorded,
so that I shall take the liberty to repeating it. It was a case under
the care of Dr. Marshall, in which the patient was confined to bed
for 26 days, the primary cause being an abscess in connection with
a right lower wisdom. Before the tooth was extracted the pulse
varied between lOO — ii 6, and the temperature between loo'i — 104*8.
After extraction pulsefell to 96 and temperature to 103. Examination
with a probe showed the abscess cavity to extend four and a-half
inches down the neck. He treated the case by injecting into the
cavity half an ounce of hydrogen peroxide every four hours, and
the temperature fell one degree each day for the next three days.
Owing, however, to the pain caused by the evolution of the oxygen,
the patient refused the treatment, there was an immediate rise
of temperature and increased pulse rate. She was again
induced to go under the same remedy and I believe eventually got
well.
Treatment — There are two methods — the radical and the con.
servative. We should adopt the former when the utility of the
tooth does not warrant an attempt to save it, and nearly always in
the case of children. And with regard to children I would impress
upon you the fact that they require rest, now sleep is rest, and any-
thing which deprives them of it will deprive them of that which is
essential for their growth. " Repair," says Hilton, " is the repetition
of growth. The interruption of rest by local disease occurring to
persons in the middle period of life does not cause the same
exhaustion and wasting as in the young. They bear the loss of
sleep better, because their constitution has to sustain the stress of
14 THE DENTAL RECORD.
repair only, not of both development and repair, as in the child." It
is a significant fact that children who sleep well grow well, children
who sleep badly grow badly. It rests between this fact and the
possible subsequent irregularity of the teeth which course we should
adopt. The conservative method is indicated in teeth either
serviceable for use or appearance. It consists in evacuating the
pus, either through the root or through the sinus, rendering the
whole aseptic. The sinus will granulate up and the tooth must be
filled. General treatment is indicated in all cases. I have
purposely discussed the treatment scantily that I might have the
more time to enumerate and describe as far as possible the more
important complications.
Fisttilce.—ThQ direction of the pus is variable, but subject, more
or less, to constant rules. It usually points on a level with apex of
the tooth, so that you will see, if the apex is below the sulcus, it will
probably point outside the mouth, if it is above the sulcus inside
the mouth. In connection with laterals, second bicuspids and first
molars, it may point in the palate ; with canines, in the nasal fossa ;
with second bicuspids and first molars, in the antrum ; with lower
incisors and bicuspids, on the chin ; with lower wisdoms at the angle
of the jaw, or, as in the case I have just quoted, and in that classical
one of Salter, just above the clavicle. Nicolai records a case where
the cause of fistula, just above the nipple on the breast, was
discovered the day after a visit of the patient to a dentist by the
discharge smelling of a drug he had used. Cochineal injected into
the root appeared at the opening two hours later.
Cellulitis, — Of this complication there are several cases, of vary-
ing degrees of severity. Of the more serious cases. Heath quotes
two occurring in patients of intemperate habits. In the Dental
Record for March, a similar case is recorded. In it, an abcess in
connection with the right lower wisdoms was the focus of the
mischief, spreading down the neck, the inflammation reached as far
as the nipple. In all three cases death occurred from oedema
glottidis.
Necrosis. — Alveolar abscess may cause necrosis in two ways. It
may start as an ordinary apical abscess, and in attempting to point,
may fail to perforate the periosteum, strip it up and lead to necrosis
of large or small extent, or it may form round an erupting wisdom
and burrow beneath the perisoteum and lead to death of the bone in
THE DENTAL RECORD. 15
a similar manner. As an illustration of an extreme case of the first
variety, the Lancet for January furnishes an extremely interesting
one. The patient, a woman, stated that twelve months ago she had
several lumps at the angle of her jaw, which were incised and pus
let out. On examination, the second and third lower molars were
found carious. The patient being unable to open her mouth, it was
forced open under an anaesthetic and the tooth extracted. There was
no improvement ; she was still unable to open her jaw. A second
anaesthetic was administered, and the ascending ramus and joint
were exposed, the former was found dead and the latter suppurating.
The condyle was disarticulated and the necrosed bone removed.
The patient recovered and left the hospital a few days after.
Trismus. — This is of almost every day occurrence, and is due to
inflammatory effusion into the soft tissue. An impacted wisdom is
frequently the cause.
Meningitis. — There are now several well authenticated cases of
this on record. The most interesting one is that of Wehl. In his
case the pus burrowed along the jaws, ascending by the ramus to
the base of the skull, into which it gained access through the
foramina ovale, rotundum and spinosum.
Thrombosis of the Cavernous Sinus. — There is only one case on
record, and that was under the care of Mr. Pearce Gould. The
mischief started in an abscess in the lower jaw. The pus found its
way backward into the pterygoid region and caused thrombosis of the
venous pleans there, which later on spread to the cavernous sinus*
The patient died in a comatose state.
Empyema of the Antrum. — The cases of this are, comparatively
speaking, common, and generally due to abscesses in connection with
second upper bicuspids and first upper molars. It is due, of course,
to the proximity of the molar and bicuspid roots to the antrum, and
an abscess forming at their apices, following the course of least
resistence, enters the antrum.
Septiccemia and Pycemia. — There are a fair number of cases on
record, all of which ended in death in a few hours. It is very
common in animals. Cases of* pyaemia are more common. Mr.
Howse relates one arising from an alveolar abscess in a child aged
four.
Spreading Traumatic Gangren. — A case of this was reported in the
Cosmos some years ago. The patient was a labourer, and was
16 THE DENTAL RECORD.
admitted into hospital with temperature of 102, pulse 105, and
respiration 22. The patient died some few days later. Dr.
Marshal], in commenting upon it, said that "he believed it to be due
simply to an untreated alveolar abscess," and remarks "that if the
dentist who first saw it had properly treated the case the patient's
life would have been saved."
Gentlemen, I have shown you, I hope, alveolar abscess in its
mildest and worst forms, and although it is seldom that it reaches
these more severe stages, you will see the necessity for early treat-
ment ; we must persuade those who are wavering and compel those
who are obstinate. And I feel certain that if we pursue this course,
neither they nor ourselves will ever have any cause to regret.
E^pnrta of ^amtitst.
THE ODONTOLOGICAL SOCIETY OF GREAT BRITAIN.
The Ordinary Monthly Meeting took place on December
the 2nd, Mr. David Hepburn, L.D.S.Eng., President, in the Chair.
The minutes of the previous meeting were read and confirmed.
The President said that Mr. Todd, of Brighton, had presented
to the museum a portrait of M. de Chemant, the inventor of mineral
teeth. He would also pass round a book in his possession, printed in
1804, of which M. de Chemant was the author. It had the author's
autograph on the first page; it also gave illustrations of spiral springs,
a form of velum or obturator, a variety of methods of pivoting with
bridge work and other matters appertaining to the teeth.
Mr. Charters White said a short time ago a request was
made by the Curator for anything like old teeth for presentation to
the museum. He had had one set in his possession about fifty
years, and another about thirty, and he should be very happy to
present them. The first was a set worn by Turner, the aitist, and
gave a very good idea of the way in which they made teeth in those
days. Turner was a very stingy man, in dental matters especially —
the race was not extinct now— and having lost four teeth in the
centre he sent to the dentist who he employed for a piece of, what
was called in those days, " granulus," the soft part of an old sea cow
tooth. He fitted it in himself and filed it up roughly, so that it
THE DENTAL RECORD.
17
really showed some of Turner's own work. He thought it might
l?e interesting for the museum. The other set showed an example
of natural teeth inserted into bone. It belonged to a roaring old
Irishman named Dr. Clark, whose appearance with these teeth
reminded one remarkably of a gorilla. The lower part of the face
was very prominent, and these teeth did not add to his beauty at all.
It was a specimen of the way in which in those days natural teeth
were inserted in bone. Another specimen showed what was con-
sidered a very handsome set carved from the tooth of a hippopotamus.
The patient in that case would not have them carved up in the
proper way, with molars, incisors, and canines, but he wanted
double teeth all round, and it would be seen how difficult it was to
make them masticate. Afterwards he had another set made, and as
he (Mr. Charters White) did not care for the carving of hippopotamus
teeth, he made him a vulcanite plate, but that would not do unless
he inserted in the front three rows of mineral teeth, which gave the
gentleman great satisfaction.
Mr. H. L. Albert presented a model illustrating the case of a
young man, aged 25, who when eight years old fell out of bed and
completely displaced an upper central. He was taken to a dentist
the next morning, some eight hours afterwards, and the dentist
replaced the tooth after filling the root with gold. Being taken
home in a hansom the tooth was jolted out ; he was taken back to
the dentist, who replaced it and used ligatures to retain it in
position. The tooth did very well but never grew. For fourteen
years the young man retained it in his mouth, and about a month
ago brought the crown of the tooth, which was a mere cap of
enamel, all the dentine being absorbed. An interesting point about
the case was to know how the dentine was absorbed. In the centre,
occupying what was normally the root canal, there were some fair
sized granulations, about the size of a pin's head, and the patient said
that one or two loose pieces of soft gold had come out. He was
inclined to ask the question whether it was possible that chronic
periostitis and granulation had actually found its way into the pulp
canal, monopolising the functions of the dentine ? or whether the
root had become absorbed ? He did not think the root had become
absorbed ; in fact on looking at the crown of the tooth, there were
evident signs of fracture.
The President said the case was a very interesting one,
B
18 THE DENTAL RECORD.
especially as to the arrest of development which had taken place.
In a case which came under his own notice, a child met with an
accident by which two of the incisors, lateral and central, were
knocked out. They remained out of the head some thirty-six hours
and were replaced by the dentist and retained by the regulation
plate she was wearing at the time. He had the opportunity of
seeing that child some four or five years after the accident, and the
distinct arrest in the progress of the dead teeth was very peculiar.
The other teeth had grown and assumed a normal articulation with
the lower incisors, but the teeth which were replanted had been
quite arrested in their development. Whether absorption of roots
had taken place he could not say, because they were still firm.
Mr. Patterson said some specimens of teeth prepared by John
Hunter would be found in the College of Surgeons Museum in
which vertical sections had been made through the cone, and in the
root they would see growing up cockscomb tissue. Mr. Albert had
asked whether granulation might not have grown up into the root
of the tooth. Probably it had, it being very similar to the specimen
to be seen in the College of Surgeons Museum.
Mr. E. Lloyd Williams thought there could be no doubt of the
fact that granulation tissue did grow up into the pulp canal. He
had a specimen in his own possession showing this distinctly.
Mr. HuMBY thought there was another explanation, that some-
times where gold was inserted, occupying a root, absorption would
take the place of the root tissue, leaving the gold projecting from the
end of the root as a point, and producing irritation.
Mr. Albert said he could only imagine that the granulations
found their way into the apical foramen from the obvious reason
that there was a hole there. There were evident signs of fracture.
Moreover it was broken simply by the muscular action of the lip,
not fractured in biting.
The Foreign Secretary (Mr. J. Howard Mummery) read a
communication from Dr. W. D. Miller, of Berlin, on " The
Transparent Zone in Decay of the Teeth."
Dr. Miller stated that his notes did not pretend to give an
exhaustive treatment of the subject, on the contrary, the question
seemed to him further from solution than he thought years ago.
His only excuse for presenting them now was that the other side
might be heard in connection with the communication of Mr.
THE DENTAL RECORD. 19
F. J. fiennett to the Odontoloojical Society of Great Britain in May
last. Mr. Bennett seemed to infer that the transparent zone was due
to nothing more than a partial decalcification of the dentine, basing
his conclusion on the fact that enlarged and thickened tubes might
be demonstrated in the transparent parts. This was in diametrical
opposition to results obtained by Walkhoff, Wellauer and Baume by
the aid of the microscope. The views which Dr. Miller urged were
arrived at without the aid of the microscope, and were rather intended
as supplemental, to the deductions of the investigators he had named.
Secondly, where decalcification of the dentine takes place, as in
caries, the process advances in a fairly regular line, so that if the
softened dentine from a cavity of decay be removed, a smooth,
regular, concave surface resulted. True, the margin between the
decalcified and the hard dentine is sometimes found irregular and
jagged, but scarcely. Dr. Miller thought, to such an extent as the
inner border of the transparent zone. And in particular, narrow
bands or spurs of decalcified dentine extending quite to the pulp
chamber were never seen in the transparent zone. Thirdly, where
acid acts upon the dentine at any point, as in a fissure, the decalci-
fication would be observed extending laterally, as well as in the
direction of the dentinal tubules, and, in fact, almost, if not quite,
as rapidly in the former as in the latter direction. Would they
not therefore expect to find the transparent zone, if due only to
decalcification, on the lateral margins as well as towards the pulp
chamber ? As a matter of fact, in the great majority of the sections
which he had recently examined, where the transparent zone is
due to caries alone, he did not find it appreciably broader than the
broadest diameter of the decalcified territory, and he thought they
might say that, as a rule, the transparent zone is wanting on the
lateral margins. These last two considerations he regarded as of
minor importance, yet still deserving of notice. Founhly, he had
elsewhere given expression to the conviction that the transparent
zone does not form in dead teeth ; this conclusion was based upon
the examination of a large number of teeth which had been worn
on plates in the mouth. At that time he simply split the teeth
and noted the appearances to the naked eye. He had recently
ground sections from about a dozen different teeth worn on plates,
but found no transparent zone in the specimens which he had
examined. At least, he doubted if the appearances presented by
u 2
20 THE DENTAL RECORD.
the cuts can be called analagous to those seen in caries of living
teeth. He was inclined to believe that diffuse transparency may be
only the result of a slight difference in structure, causing a difference
in the permeability of the dentine to differences in thickness, &c.
Again, typical cases were found of transparent dentine in places
where the action of acids from without appears to be entirely
excluded. Leaving the transparency of the roots of senile teeth out
of account, they found transparency in cases where the enamel of
the cusps has been worn done, even though the dentine may not be
exposed thereby, and no traces of caries present. Further, chemical
analysis does not give results which are consistent with the theory
of decalcification. Some years ago he made an analysis himself,
and had another made by a Berlin chemist, Dr. Jeserich. Teeth
were chosen in which there was but a superficial defect in the
enamel, split through the defect and the pulp chamber, so as to
expose the transparent cone of dentine. The latter was burred out
with a very fine round burr, avoiding the parts next to the enamel
margin where there was any indication of decalcification. The
powder was treated with a magnet in order to remove any possible
particle of iron, dried at 102-105° C. and the ashes determined.
His analysis gave 71*9 per cent, ashes, while normal dentine from
the same teeth gave 72*1 per cent., a difference quite within the
limits of the errors of experiment. The analysis of Dr. Jeserich gave
for transparent dentine 69*5 per cent., for normal dentine from the
same teeth 68 per cent. These results do not indicate any decalcifi-
ation. The material was, in each case, obtained from about twenty-
teeth. Finally, the action of colouring matters upon transparent
dentine is not what might be expected if a partial decalcification
were present. It is well known that sound dentine does not readily
stain with most of the dies commonly in use, such as carmine^
eosine, &c. ; partially decalcified dentine, on the other hand, takes
on stains very readily. Dr. Miller had found an aqueous solution of
eosine a valuable means of diagnosing the presence of sHght
decalcifications. If a drop of strong mineral acid (nitric,,
hydrochloric) acts upon ivory for a single second, a subsequent
application of the eosine solution will immediately produce a bright
red spot where the acid came in contact with the ivory. A minute
drop of a i per cent, solution of acetic or lactic acid will bring about
a sufficient decalcification in twenty seconds to cause a deep staining
THE DENTAL RECORD. 21
with the eosine solution. So, too, they found carious dentine
becoming deeply stained by eosine. If, now, transparent dentine
represents a partial decalcification, would they not expect it also to
stain more readily than normal dentine ? This is, however, not the
case ; on the contrary, they found the transparent dentine even
more difficult to stain than the normal. In view of all these facts,
some of which are of minor, others of vital, importance, Dr. Miller
found it impossible, at present, to accept the decalcification theory
of the typical transparent zone found in caries and other pathological
conditions of the teeth.
With the communication Dr. Miller sent a number of cuts and
slides as illustrating and supporting the views he advanced.
Mr. F. J. Bennett gathered from the paper that Dr. Miller
objected to the proposition that the area of translucency was due to
partial decalcification of the dentine and nothing more. That was
not at all the position that he (Mr. Bennett) took up in his paper j
from first to last there was not an allusion to '' partial decalcification
and nothing more," and nothing in that direction at all. The fact
was the term was used, not by himself, but by a subsequent speaker.
His point was to disprove the vital theory, and to clear the ground of
this difficult subject by first showing what was not, in order that
they might subsequently show what was. Dr. Miller had said that
hard ground sections of dentine presented the appearance recognised,
because the tubes themselves were empty (save of air) and also the
intertubular tissues had a different refractory index. Anything
which would bring those two appearances nearer together might be
taken to produce translucency, and this might occur m one of two
ways, either by decalcification or by an increased calcification. Dr.
Miller said that a decreased calcification or a decalcification most
assuredly did not take place, and added that this was sufficiently
proved by chemical analysis. What was this chemical analysis ?
Dr. Miller stated that he took twenty teeth with translucent area
and submitted those to chemical analysis. The ashes from the
translucent area came to 71*9, whereas ordinary dentine submitted to
the same analysis yielded as ashes 72*1. Dr. Miller started to prove
that there was increased calcification and this was the result : 71*9
in the translucent zone — positively smaller than in the normal
dentine, which was given as 72*1. Assuming it was an increased
calcification, imagining for a moment that the tubule, instead of
22 THE DENTAL RECORD.
being filled with calcified matter, was the reverse, they immediately
had the optical appearance vanishing instantly. One specimen in
particular showed the typical pipe-stem appearance in the translucent
zone, and obviously there could have been no calcified fibril. Did
the appearance change ? not in the least ; it was exactly the same.
It was a jump from the calcified condition to a totally opposite
condition without any optical change, and that was most conclusive
that it could not originally have been an increased calcification in
the fibril. Dr. Miller had alluded also to the dark tubes alternating
in the translucent area— that he found dark tubes also in the
translucent area. That, he (Mr. Bennett) would quite admit, but in
specimens which he had shown, taking from the carious area to the
pulp, they found this translucent area, dark tubes, again translucent
area, and then the pulp. What utility was served by this?
By the dark tubes he meant that they were patent when dried,
but occupied by a soft fibril. It was not conceivable that
nature would calcify one little piece, leave a large margin
uncalcified, and again calcify. No barrier would then be
formed for the prevention of caries, and that was what was held
by those who advocated the increased calcification theory. He
would now pass on to the question of natural teeth mounted on
plates. Dr. Miller had examined several specimens, and sent two.
He had examined three specimens, each of which he claimed to
show the translucent zone pretty clearly. With the permission of
the President he would hand round two of these pulp cavities. In
one it was almost incontestable that the translucent zone appeared
in these artificially calcified teeth. It was admitted, of course, by
the vitalists that if it could be proved that there was a zone
connected with caries, even in one specimen, the downfall of that
theory was inevitable, for it was inconceivable that vital action could
take place in a dead tooth. Dr. Miller alluded to the attrition of
worn caps of enamel, and said that he got translucency in those cases
also. According to the specimens shown that evening, they also
equally got in some cases black tubes, which represented the patency
of the tube, and, therefore, that did not show that there was increased
calcification, even in attrition. He would refer to the very significant
communication made recently by Mr. Tomes, in which he actually
found in teeth much worn down by attrition, 'so far from there being
increased calcification, the chemical analysis made was -5 less than
THE DENTAL RECORD. 23
normal, that was to say, 71*4 instead of 71 '9, which was the normal.
That was rather a staggerer for those who beheved there was
increased calcification in attrition. Coming now to the stains,
Dr. Miller had used eosin, and, as had been explained, on applying
lactic acid and acetic to normal dentine, he found that a portion
became very much stained after the part had become decalcified.
He further mentioned that the translucent zone did not stain with
eosin. That might be so in the generality of cases, but he should
like to point out one rather contradictory thing which Dr. Miller in
his candour had stated. In specimen No. 2 he actually pointed out
the non-stain of eosin in which translucency had occurred, as he
considered, in response to attrition, and a little way off caries had
attacked that translucent zone, and although obviously it must have
decalcified the zone, according to his theory eosin did not stain,
That showed that eosin did not always stain the decalcified condition,
and Dr. Miller recognised that fact. It occurred to him on first
reading Dr. Miller's book, and the more so after hearing his paper
to ask why Dr. Miller was a vitalist, if one might call it so. He
thought they would all have been of his opinion if they had had
the fortune to reproduce caries artificially. As he said in his
book, all the phenomena of caries were reproduced artificially,
except the translucent zone. It was easy to talk of other people's
skill, but there was the point to have seized hold of. That was the
one exception. The discovery of argon was delayed a hundred years
because Cavendish failed to note a slight discrepancy in his calcula-
tion. He had perhaps spoken strongly, but he thought the position
he occupied in his paper was supported by his specimens. It only
remained to thank the members for so patiently hearing him, and
to express the hope that in anything he had said he had not gone
beyond the retort courteous.
Mr. Leonard Matheson read a paper entitled
" A Few Practical Points."
He was there in fulfilment of a promise, and regretted he had
nothing to offer in the shape of original research or new methods of
practice. All that^he had to present to their notice was one or two
considerations in respect of some practical details of every day work.
Just as, when one or two met for a chat they compared notes as to
their experience, and discussed their personal preferences for
different ways of attaining the same end, so he had ventured to
24 THE DENTAL RECORD.
enumerate a few points concerning instruments and materials
which might possibly be not quite ancient history to everyone, but
which, at all events, might, he hoped, raise the spirit of discussion.
To begin with, for the examination and definition of roots more
or less hidden, and of the cervical margins of labial cavities
extending below the edge of the gum, he preferred the form of probe
with a straight, tapering shank, which is bent upwards at a very
slight angle for about a quarter of an inch, and then downwards for
an inch, at an angle of forty -five degrees. This instrument he
found much more handy than that ordinarily sold, the latter being
too nearly rectangular, and did not sufficiently clear the anterior
teeth in the examination of posterior roots, especially when the
teeth stood high, and the roots are low in the gum. This probe was
not blunt, but pointed — a very unorthodox shape, but he confessed
he found the point much more effectual than the dull edge of the
usual form. Another kind of probe was one tapered to a fine point,
and quite straight, except at the extreme tip, which was bent at a
right angle to the shaft, for the length of a sixteenth of an inch or
less. Similar instruments were a pair of curved probes, of the form
commonly used, but having the rectangular tip of the one just
mentioned. These three shapes were invaluable for discovering
hidden approximal cavities, and for dropping into the marginal
flaws of fillings, which produce such different emotions, according
to whether the filling is of one's own, or of somebody else's insertion.
Passing from probes to rubber dam, he used Fernald's dam
holder. The discomfort of one's patients was diminished in three
ways. In the first place, the frame, to a large extent, did away with
the bridled gagged feeling that the retractor produced. In the
second place, the rubber not being drawn closely against the cheeks,
moisture did not pass by capillary attraction on to the skin of the face,
and one got rid of the slimy, messy, condition of things so common
were retractors are used. In the third place no band being required
round the back of the head, the necessity no longer existed of
having to bring into close contact with one person's head the elastic
tape that has been in close contact with other people's heads.
Taken separately, these advantages might look small ; but taken
together, and in practice, they were far from insignificant.
Another matter he felt strongly about, was the use — or rather,
the abuse — of clamps with the rubber dam. Occasionally the first
THE DENTAL RECORD. 25
upper molar required clamping, and very occasionally a bicuspid,
but by the well-known device of a bead, or a bit of amadou knotted
into the silk, the ligature would often effect the same purpose as a
clamp, and with very much less distress to the patient.
Into the consideration of the various means of excluding
moisture other than the use of the rubber dam, he did not propose
to enter, except to mention one method which he valued very hi -^hly,
and which was not he thousjht used nearly as much as, with
advantage, it might be. He alluded to the combined use of clamp '
saliva ejector, and paper-fibre lint. For a short operation on lower
molars, such as the application of a dressing, or the insertion of an
amalgam, or gold-tin filling, time was saved, and the convenience of
the operator and the comfort of the patient best consulted by this
way of working.
The mention of cases in which the rubber dam may be dispensed
with led him to speak of tin and gold as a filling material. Used in
the form of tape or loose rope, in the proportion of two sheets of
Abbey's non-cohesive gold, No. 4, to one sheet of White's tin. No. 4»
this combination was a very valuable one. In many instances it was
not merely a good alternative to gold, but it was much superior to the
precious metal used alone. In particular, it was most useful in dealing
with coronal and labial cavities in second and third molars, especially
in small and medium-sized cavities, and in teeth of a low standard of
strength. The rapidity with which it could be safely worked made
it extremely useful in cavities far back in the mouth And the fact
that absolute dryness is not essential to its successful working made
it pre-eminently suitable for cases where there was a difficulty in the
exclusion of moisture. And further, there seemed to be no doubt
that tin, and tin and gold together, do exercise a marked preservative
action on teeth of loose structure or imperfect calcification.
Tin and gold worked of course non-cohesively, and was quite
unsuitable for use with the mallet ; and this brought him to a part
of his paper which must provoke some antagonism, inasmuch as it
dealt with the comparative merits of hand pressure and mallet work.
Using hand pressure, as he did, to the entir3 exclusion of the mallet,
he could not consider himself an absolutely impartial judge, any
more than an operator who made the mallet a sine qud non could be
considered an impartial judge. But this much he would venture to
say, that the brilliant attractions of mallet work had tended to throw
26 THE DENTAL RECORD.
into the shade the less dazzling qualities of hand pressure fillings.
That a fine, dense, smooth surface could be more readily obtained ;
that more gold could be p^.cked into a given space, and the hardness,
compactness, and specific gravity of the filling greatly increased ; and
that a good deal of time and strength, on the part of the dentist,
might be saved by the use of the mallet, as compared with hand-
pressure, all these facts must be admitted. But what he wished to
point out was this — that a splendid surface did not by any means
imply undercuts soundly filled ; that perfect cohesion and high
specific gravity were quite compatible with imperfect adaptation to
the walls of a cavity ; and that, when time was balanced against
comfort, it was not always in favour of time that the scale dipped.
It would be urged, quite rightly, that a good operator would take
more care over the undercuts than over the surface of his fillings?
and that he would pack them perfectly, using, if necessary, in deep
angular corners and places diflScult of access, either a flooring of
oxy-phosphate, or gold inserted by hand pressure, or both, so
producing a plug the solidity of which could not be questioned.
This might be freely granted, and yet it might remain true that it
was easier to overlook and leave faulty the proper treatment of
undercuts with the mallet than with hand pressure. With regard
to close adaptation of the gold to the walls, and especially the
margins of the cavity treated, it would, he knew, be hotly con-
tended that it is just here that the value of the mallet so
conspicuously showed itself, but he could not help feeling very
strongly that there was a serious danger in the vibratory nature of
the mallet's blow of shaking the filling en masse^ and so of obtaining
a compacted homogeneous nugget of gold, at the expense of that
clinging to the walls of the cavity which was so desirable, and
which was so characteristic of good hand pressure work. As
to the important question of time, it was possible, of course, to
say that it affected the patient as much as it did the operator —
that the former was as glad to get the work done quickly as the
latter. Other things being equal, that might be so ; but he main-
tained that, to the vast majority of patients, the gain in time
afforded by the use of the mallet was as nothing compared to the
comfort of doing without it. And herein lay his chief indictment
against the mallet, namely, the distress that its use occasioned ; the
matter resolved itself not so much into the question how much
THE DENTAL RECORD. 27
pain we can induce our patients to bear, as how much it is necessar}'
for them ro bear. In weighing results, the all-important matter of
durability stood first. Given two teeth of average structure, presenting
similar cavities, and with operators of equal ability to fill them — the
one using a mallet and the other hand pressure — he thought that the
latter may be depended on to hold its own; he would go so far as
to say it would — in approximal cavities, and especially in teeth of
weak structure — more than hold its own. Comparative comfort
during the filling process, and the natural satisfaction of the patient
thereat, must certainly count among results — not only immediate,
but far reaching ; for he had frequently been forced to the conclusion
that fear of the '' hammer," as patients irreverently call it, frequently
added so much to the dread inspired by dental operations as to prolong,
disastrously in many cases, the intervals between the periodical visits
that ought to be paid. One more word he might perhaps be allowed
to say on this subject, and he would, if he might, address it to those
young operators who had only recently come under the fascination of
the mallet. To them he would say this, that whilst, with all its
drawbacks, very beautiful work might be, and was, done with that
instrument, and whilst he was not prepared to dissuade them
altogether from its use, he would, in addition to what he had already
said, add this, that the difficulties of doing first-rate work with it
were far greater than to the beginner they appeared to be. It was
so easy to make a filling perfect in appearance — so difficult to make
a filling perfect in reality. A dense central mass, a splendid surface
might be obtained by anyone ; but to build solidly against the walls
and into the out-of-the-way corners of the cavity, and to obtain
perfect margins without damaging enamel edges, required the
utmost care, and circumspection, and the greatest watchfulness in
testing at every step each layer of gold inserted. Whatever else
might be said in favour of the mallet, it could not be said that the
operator could feel his way so well with it as with the hand plugger ;
at least, not at first, nor for many a long day. And here he would
venture to make an urgent appeal to those just entering upon dental
practice, and to those whose business it was to teach their students,
not to make time a matter of the first importance. Three things
there were which went to make an ideal operator — thoroughness,
gentleness, quickness — and surely one should cultivate these qualities
in the order named. If gentleness of touch and manner were put
28 THE DENTAL RECORD.
first, then thoroughness must suffer ; if rapidity were put first, then
one might say good-bye both to thorough work and to considerate
work. It always made him shudder when in his hospital rounds he
heard a student boast of rapid work, or even ask how long such and
such an operation ought to take. Such a question asked of him
received the invariable answer, " Just so long as to ensure, in the
first place, absolutely sound work ; and in the second place due
consideration for your patient's comfort. Given sound work, given
due consideration for the patient, you may then think of the pace,
but not till then."
Turning to contour filling, the longer he practised the more
value did he set upon it as a means of preserving the teeth from
caries ; that is to say, when the filling could be so shaped as to
knuckle quite closely to the neighbouring tooth or filling, so closely
as to prevent the passage of food towards the interstitial gum. If
this close approximation to the adjoining tooth could not be
obtained, it was almost needless to say that the contouring of the
filling became not only useless, but generally worse than useless,
inasmuch as it rather favoured than prevented the lodgment of food
at the gum margin. And whilst such contour fillings were to be
deprecated, so too, in his opinion, were those extensive edifices
which, having no preservative influence, were built up solely to
restore the original outline of the tooth under treatment. They
were, to his mind, uncalled for, alike from a surgical, an artistic, and
a useful point of view. Likewise uncalled for and undesirable from
the standpoint of our patient's best welfare were huge gold contour
fillings in molars. Where filling was admissible, a carefully inserted
and carefully finished amalgam served the required purpose best in
the great majority of cases ; and where there was very extensive
disease, both mesial and distal, gold collar crowns, duly and properly
adapted, afforded the most satisfactory means of restoration. In the
insertion of large contour amalgams he had lately found great
assistance in the use of the new " Dentine Screws" just introduced :
their application was very simple and easy, and they formed a
valuable addition to the ordinary Howe screw post, which was so
convenient in the case of dead teeth. The contouring of fillings
as a safeguard against decay led one naturally to that other, and
diametrically opposite, means of attaining the same end — he meant
the isolation of approximal surfaces by the extraction of teeth. It
THE DENTAL RECORD. 29
was, he thought, abundantly proved by experience that in nine
cases out of ten young mouths were vastly improved and benefited
by the extraction of one tooth out of every eight, and that even
in those few cases in which the articulation was somewhat
disarranged by such extraction, the mal-occlusion was a lesser
evil than that resulting from the retention of the full thirty-two
teeth. One point with regard to overcrowding he would like to
emphasise, as it was apt not infrequently to be lost sight of. Cases
presented themselves of patients whose age might be anything
between thirteen and eighteen, or even more, and whose teeth were
closely set, with, perhaps, a very slight tendency in the canines or
laterals to overlap adjoining teeth, but without any noticeable
appearance of overcrowding, or consequent irregularity. This was
prior to the eruption of the third molars. Directly these teeth
began to show themselves a marked change took place in the arch,
the canines, or laterals, or both, being forced out of place, so as to
badly overlap their neighbours. Then it was one wished that
timely extraction had been performed at an earlier age, so as to
prevent the tremendous forward pressure exerted by the third
molars from affecting the front teeth.
Mr. Matheson concluded his paper by a detailed reference to
Mr. Whittaker's modification of Collar Crown, which he described
and recommended.
Mr. RoBBiNS said, with reference to the difference between hand
pressure and malleting, he had in his mouth something like twenty-
six fillings that were put in by one of the most thorough men he
knew, and to whom he owed very much, but on humanitarian
grounds he could not honestly ask nineteen-twentieths of his patients
to endure those beautiful little retaining bits, the malleting directly
upon the most tender part of the tooth, and the long sitting, even
for the ultimate beautiful result. A point not mentioned by Mr.
Matheson he would like to name, because he had spoken about it in
another place, and it was somewhat smiled at, the question of using
for the first third of the filling, when one did not wish to exaggerate
contour, that most valuable material, mat gold ; and where the
tooth was of a very fragile nature even underlying that with oxy-
phosphate, setting the mat gold in like wood blocks in a wood
pavement. They could then with firm but gentle hand pressure work
down the surface and bring that up to within one-third of the finish.
30 THE DENTAL RECORD.
Then if they wished the edges to be absolutely right and used gold foil,
the malleting would not be so very serious a matter, and they might
have a cohesive surface with a great deal more comfort to the patient.
He agreed perfectly with Mr. Matheson that there was as much value
to the patient got out of a good honest amalgam put into those
large cavities in the back of the mouth, and sometimes a little more,
than in those extraordinary acrobatic performances that took so long
— tiring both patient and operator.
Mr. W. Hern had seen the contrivance spoken of by Mr. Matheson
for holding the rubber dam, but had not used it much, because it
got a little in the way. He thought the difficulty might be overcome
by bending the wire somewhat in the shape of the lower jaw, the
end would then lie back out of the way and would not alter the
outline of the lower jaw. The one point to which Mr. Matheson
devoted a good deal of the paper was a defence of non-cohesive gold.
There was a time when he thought that no good work could be done,
at any rate in contouring, with anything but cohesive gold, and he
would go further, and say there was a time when he thought
cohesive work done with hand pressure was not at all equal to
cohesive work done with the mallet. He had now come to the
conclusion that very excellent work could be done with hand
pressure. In criticising the mallet the fact should be taken into
consideration that it was frequently used with a blow far out of
proportion to the requirements. The cohesion did not depend so
much on the force of the blow as on going accurately over the
whole surface, doing what the great master of the cohesive method
used to call *' bringing each piece of gold into the sphere of cohesion. '»
His sympathies were entirely with Mr. Matheson with regard to the
importance of contour. Contouring was the most important thing
in their work. He also agreed as to the value of collar crowns, which
had a value beyond all other crowns because they could be contoured
^n a way that could not be done with any other fixed crown such as
the Logan.
Mi. J. H. Badcock had used tin-and-gold in the way described
for a good many years, and with more success than he had found
from any other filling material. If he were obliged to make his
choice as to any one filling material, and to be deprived of all the
rest, he should certamly choose tin-and-gold. He had used it
chiefly in the way described, one sheet of No. 4 tin between two
THE DENTAL RECORD. 31
sheets of No. 4 gold, but lately he had been using No. 5 gold,
simply as wishing to improve the colour of the combination. He
found in all cases, except quite small ones, it worked very well, and
distinctly improved the colour of the resulting filling. He was
trying to get some No. 3 tin made to use with No. 4 gold, and so
obtain the same result with more ease to himself. The value of the
filling was extremely great in interstitial cavities in the bicuspids?
and even in molars when foil could be used. He had felt how
unsatisfactory amalgam is in such cases, and foil could be used
easily, fairly rapidly and very satisfactorily in this way.
Mr. Dennison Pedley said, with regard to the difference between
malleting and hand pressure in gold, a short time ago a young lady,
aged 21, consulted his partner with regard to caries in her teeth.
He found a large portion of her teeth were very carious. On
carefully examining the mouth he came across a very beautiful gold
filling. On asking her why with that good gold filling in her
mouth she had allowed her teeth to go so long she said " Well, my
mother took me when I was 16 to one of the best dentists, and I
had such a terrible time of it with the mallet that I vowed I would
never have another tooth stopped." He always confined himself to
filling teeth with hand pressure until he found out what sort of
nerves his patient might have. He thought the combination of the
two, filling first with hand pressure, and finishing off with the mallet,
was about the best method they could have, but practically they
could not lay down any definite law on the subject.
Mr. Beadnell Gill believed that an enormous amount of pain
was inflicted perfectly unnecessarily by malleting work ; in other
words, that those men who still advocated the use of the mallet
could continue it with a considerable amount of success and saving
of time to themselves and their patients by judicious management
as to the direction of their blows. He thought mat or crystal gold
was a material well worthy of investigation. He had filled with
crystal gold for over twenty years, and it was still his special
favourite. He believed that if a man was willing to adapt himself
to circumstances and according to his material he would find that in
all round filling there was nothing better than crystal gold. It
could be used either cohesive or non-cohesive, either by hand
pressure or by malleting.
32 THE DENTAL RECORD.
Mr. Baldwin said, with regard to the rubber dam holder, one
advantage which had not been mentioned was, that, at least on one
side, the patient could easily breathe, and they knew that many
patients could not breathe except through the mouth. He agreed
with Mr. Matheson on almost every point of his paper except that
he should not like to do away with the mallet altogether. Hand
pressure was perhaps the more useful of the two means, but the
mallet had its own special uses, especially in finishing off the filling.
When a filling was of any size, it would certainly produce a better
continuous surface, taking a higher finish and therefore being less
visible afterwards. It also did away with the great tendency of
hand pressure instruments to slip, which was a serious thing both
for the operator and the patient, especially when working with a
mirror.
The usual votes of thanks having been passed, the Society
adjourned until 13th January.
DENTAL STUDENTS' SOCIETY, DENTAL HOSPITAL OF LONDON.
An Ordinary General Meeting of the Students* Society of
the Dental Hospital of London was held on Monday, December 9th,
the President, Mr. F. J. Bennett, in the Chair.
The Minutes of the last Meeting were read and confirmed.
The following gentlemen were admitted as members : — Messrs.
N. Miller and R. H. Manning.
There was no further discussion on the paper on '* Fractures of
the Jaw," and Mr. W. F. Forsyth, Jun., briefly replied to the
questions already asked.
On Casual Communications being called for —
Mr. Hey showed models of an interesting case of open bite with
sHght anterior protrusion, occurring in a patient aged 12. There
was a distinct history of thumb-sucking.
Mi* D. p. Gabell remarked that the lower incisors were
somewhat raised above the level of the other teeth, he consequently
did not think that thumb-sucking had much to do with the
deformity.
Mr. Douglas thought the slight amount of superior protrusion
was due to too long retention of the upper temporary incisors.
THE DENTAL RECORD. 33
Mr. McDonald said that the formation of the jaws and the
arrangement of the teeth seemed to him perfectly normal every-
where, except in the upper incisor region, and he thought the
deformity was entirely due to arrested development of the pre-
maxillary bones.
Mr. Hey, in replying, said that the patient had had a habit of
continually passing his tongue over the biting surfaces of the upper
incisors only ; this was sufficient to account for the deformity, and
would not tend to push the lower incisors outwards, nor prevent
them being slightly raised.
The President then called upon Mr. Stanley Colyer for his
paper on ** Alveolar Abscess and Its Complications " (see page lo).
In the discussion which followed —
Mr. Densham said that rheumatic periostitis seldom resulted in
suppuration, and usually subsided under the application of counter
irritants and suitable general treatment. He thought it was in
most cases a mistake to extract temporary molars on account of
abscesses arising from them ; for in the majority of such cases
rhizodontrophy and filling would render the tooth comfortable and
quite serviceable for a long time. In the case of adults, it was often
a matter of considerable difficulty to decide which tooth was really
the cause of an existing abscess.
Mr. D. P. Gabell said that during the last fortnight he had
met with two cases of abscesses arising in connection with apparently
sound teeth. One of these resulted in considerable loss of tissue,
and the patient had since undergone a surgical operation. He
was rather surprised that Mr. Colyer had made no mention of
antiseptics.
Mr. W. S. NowELL thanked Mr. Stanley Colyer for his very
interesting paper. He said that untreated dead teeth were the seat
of frequent abscesses, owing to their canals becoming periodically
blocked with food. He mentioned two cases of alveolar abscesses
arising from lower molars penetrating down the cervical fascia, and
eventually causing death by bursting into the trachea. He thought
it possible that the more severe of the two cases recorded by
Mr. Gabell might have been due to actinomycosis, the actinomyces
might have obtained an entrance down the side of the tooth socket,
or through a wound of the gum ; it was a pity he had not kept
some of the pus and cultivated the bacteria. He thought a free
0
84 THE DENTAL RECORD.
vent, followed in a week by a thorough use of peroxide of hydrogen
was as good as any treatment for chronic abscess.
Mr. Douglas gave an account of two instances of abscesses
caused by impacted lower wisdom teeth.
Mr. Day wanted to know whether it would be better to extract
a temporary molar on account of intractable abscess and cause
subsequent overcrowding, or to leave the temporary tooth in and
run the risk of its injuring its permanent successor ?
Mr. Densham remarked that pyorrhoea alveolaris was frequently
a cause of an apparently healthy tooth becoming the seat of an
abscess. He had recently had a patient who complained of great
pain from an apparently healthy tooth ; finall}^ he had endeavoured
to open up the pulp cavity and canal, but though he had carefully
drilled to very near the apex of the root, he had been unable to find
any trace of a pulp chamber, nor was there any discoloured dentine
to indicate the presence of secondary dentine.
Mr. McDonald said that he had suffered great pain about a
week ago from a tooth ; he decided to have the pulp exposed under
gas. Three consecutive attempts were made to do this, but they
were unsuccessful. He then had the tooth extracted, and the pain
ceased. On splitting the tooth no trace of any pulp, nor any
indication of its situation could be found.
Mr. CoYSH recorded an interesting case of an abscess existing
round the apex of a tooth (a single rooted bicuspid), the pulp o^
which was living. The pulp was acutely sensitive, and after being
extracted entire with a Donaldson bristle, a considerable quantity
of pus came down the canal.
The President said that heavy biting was far the most frequent
cause of abscess arising from apparently health} teeth. He thought
it a mistake to regard an alveolar abscess as a trifling matter ; one
came to respect them more and more the longer one was in practice.
Dying pulps often remained acutely sensitive to the last.
The President then called upon Mr. Stanley Colyer to reply.
A vote of thanks was accorded to Mr. Colyer for his paper, and
to Mr. Hey for his casual communication.
The Annual General Meeting would take place on Monday,
January 20th, when Mr. McKay would read a paper on
" Amalgams."
The proceedings then terminated.
THE DENTAL RECORD. 85
THE DENTAL RECORD, LONDON: JAN. 1, 1596.
DEATH DURING THE ADMINISTRATION OF PENTAL.
It is our unfortunate duty to record the death of a
woman during the administration of pental at the Victoria
Dental Hospital, Manchester. The only account to hand is
a newspaper report of the coroner^s inquest, and this
:ontains but little information of real interest, though
some statements made by a medical witness excite our
surprise. For instance, this is certainly not the first death
during the use of pental, there are at least three others
recorded. Nor is it at all accurate to say that the deaths
during the administration of anaesthetics are equal to one
n a thousand. The question which concerns us, however,
is, whether it is advisable to give pental for dental opera-
tions. We recognize the fact that it is credited with giving
a longer period of anaesthesia than gas, but with a corre-
spondingly increased risk. We do not know of data on
which to base a comparison of the relative danger of these
two anaesthetics, but if we take the experience of the Dental
Hospital of London as typical of the use of nitrous oxide,
we have a drug which has been administered during the past
twenty-five years an enormous number of times, now
amounting to 8,000 or 9,000 a year, without a single fatal
accident. Contrast this with the limited experience with
pental in the whole of the United Kingdom, yet there is
already one death to record, to say nothing of the frequent
occurrence of dangerous symptoms. Surely the slightly
increased period of anaesthesia cannot compensate for this
increased risk, more especially when, after all is said and
done, two short periods of anaesthesia are usually, in dental
cases, almost as advantageous as one long period.
The report also suggests the remark, that, when pental
or any other drug is given, the idea should not be
allowed to creep abroad that "gas" has been ad-
c 2
36 THE DENTAL RECORD.
ministered. In this case the 'patient meant to have
^*gas/^ and so doubtless the error arose in the minds
of the reporters for the lay press, from whose printed
report one might fairly assume that, if pental and " gas "
are not the same thing, they are closely allied. We
are, indeed, of opinion that it is never wise even to give '' a
whiff of ether ^^ during the administration of gas Avithout
having previously told the patient, for we are convinced that
half the objections which patients feel to taking gas arises
from their own or their friends experience of '^a whiff of
ether/'
i^.etojs anit iJot^a.
There is a vacancy for an Assistant Dental Surgeon and for a
Demonstrator at the Dental Hospital of London. Applications
must be sent on or before Monday, January 6th, 1896.
We understand that a new dental society — " The Liverpool
District Odontological Society" — is about to be started by practitioners
resident in that district. The obligations of membership are the
same as those of the British Dental Association. Mr. J. A. Woods,
76, Mount Pleasant, Liverpool, is Hon. Secretary, /ro tern.
The second Ordinary Meeting of the Odonto-Chirurgical
Society (Session 1895-96) was held in the Rooms, 31, Chambers
Street, Edinburgh, on Thursday, December 12, at 7,30 p.m., Mr.
J. Stewart Durward, L.D.S., President, in the chair. Casual
Communications were brought forward by Mr. C. F. Sutcliffe
(South Shields) : — " Model of Irregular Teeth of a Male Patient,
19 years of age, with Explanation of Treatment by Immediate
Torsion " ; and Mr. J. T. Jameson (Newcastle) : — *' Models, showing
Hutchinson's Teeth, with Direct History of Syphilis."
THE DENTAL RECORD. 87
The following two notes are those sent by *' D. D. S.," and
mentioned in his letter published in our last issue. We shall be
glad to welcome others of like kind.
A Useful Plaster. — Take a piece of blotting paper, the size
required, saturate with mastic varnish or carbolised resin, pulverize
a tabloid of cocaine, spread on surface and apply, the varnish will
hold cocaine where required, and lips tongue and throat will not
be affected ; the result in all painful cases is most gratifying.
Before attempting to remove tartar from roots of teeth apply
Ac. Sulp. Arom. on cotton wool or asbestos fibre, leaving it in the
pockets for some minutes it will assist the operation greatly. The
drug is antiseptic, stimulating and astringent, and acts as a solvent.
(Dr. Kirk.)
The Inaugural Address of the season of the Glasgow Dental
Students' Society, was given on November 8th, by J. C. Woodburn,
M.D., the Hon. President of the Society. His address took the
form of general advice to the students, and was greatly appreciated
by the large number of officers and students present. An
ordinary Monthly Meeting was held in the Lecture Room of the
Hospital, on Friday evening, 6th December, when Mr. R. S. Grant,
Vice-President read a very interesting and practical paper on Gold
Plate Work.
Francis J. Van der Pant, L.D.S., has been appointed Dental
Surgeon to the Princess Louise Home for Friendless Girls, Kingston-
on-Thames.
At an ordinary Council of the Royal College of Surgeons, on
December 12th, Mr. Christopher Heath, President, in the chair,
the following resolution was received from the Board of Examiners
in Dental Surgery, and was referred to a committee of the Council
for consideration and report : The Board of Examiners in Dental
Surgery have fully considered the letter from the National Dental
Hospital as well as other questions arising out of it, and whilst they
do not recommend that an examination in mechanical dentistry be
38 THE DENTAL RECORD.
instituted " for dental students previous to their commencing their
surgical training," yet they are of opinion that the time has now
come when it is desirable that the examination for the licence should
be divided into two parts, and should include chemistry and physics
and metallurgy. The importance of these subjects to the dental
practitioner cannot be questioned, and it is generally felt that under
the present system candidates do not obtain a proper knowledge
of them, doubtless owing to the fact that there is no definite exami-
nation in chemistry and metallurgy. A letter was read from Mr.
Frank Marshall, Honorary Secretary of the Newcastle-on-Tyne
Dental Hospital, applying for the recognition of that institution by
the College for the purpose of teaching. The matter was referred to
the Board of Examiners in Dental Surgeiy for consideration and
report.
GENERAL MEDICAL COUNCIL,
November 29, 1895.
Sir Richard Quain, President, in the Chair.
The President announced the receipt of the following letter
from the British Dental Assistants* Association : —
" Sir, — A deputation will wait upon you to-morrow (Friday) in reference to
my petition and others at 1.45 p.m., at the Royal College of Physicians. Trusting
that you will receive us,
" I remain, Sir,
•* Yours most obediently,
"A. L. BURLIN."
Sir William Turner ; I see the deputation is now present.
This is entirely out of order, any deputation being present. If a
deputation is to be called in, well and good, but at this stage no
deputation can be here till the Council has consented to receive it.
I move that the deputation withdraw.
Dr. Glover : They are entitled to be here as members of the
public.
Sir Wm. Turner : If these gentlemen are to be here as members
of the public, I shall move " That the Council shall consider this
question in camera,^''
Sir Dyce Duckworth seconded the motion, which was agreed to.
Strangers then withdrew.
THE DENTAL RECORD. 89
On their re-admission,
The President : I have to inform you that the Council have
passed this resolution : " That the Council has already fully considered
the question on which the British Dental Assistants' Association
wishes to send a deputation to the Council ; and not being prepared
to depart from the decision of May 29, 1891, cannot receive a
deputation on the subject."
The deputation then withdrew.
Report of the Inspector in the Qualifying Examinations
IN Dentistry. Notice of Motion by Mr. Bryant.
Mr. Bryant : I beg to move '* that the Report by the Inspector,
Mr. C. Tomes, on the Qualifying Examinations in Denlistry of the
Faculty of Physicians and Surgeons of Glasgow, together with the
remarks by the body inspected, be received and entered in the
Minutes." I only ask that it be placed on the Minutes, I do not
want it to be considered yet.
Dr. Cameron : I have to ask the Council to pause before they
enter this on the Minutes, all the more as it is a matter which is not
going to be considered at this session. My reason I can explain in a
single sentence. Those who have read the report perceive that
there is considerable conflict between the Inspector and the Examiner,
not on matters of opinion but in regard to matters of fact, and I
think that by a little intercommunication between the Inspector and
the Council of the Faculty, these difficulties may probably be cleared
up. I will explain the matter in this way. At this Board, as at all
the Boards of the Corporation in Scotland, each student is examined
by two persons — one who acts as assessor and listens to the
examination, and notes down at the time on an official paper all the
subjects on which the examination takes place. That was done in
this case, and we have records of the subjects on which each student
was examined. The Inspector has found it to be his duty to make
what is a very serious charge, viz., that two of the six candidates who
passed should have been rejected, and he further gives some of the
subjects taken up at both of these examinations. But it happens
that the subjects as so detailed do not agree with the list of subjects
on which any one candidate was examined, so that, as a matter of
fact, there is no doubt whatever that he was in error, and that he
had got confused in regard to the particular men who were examined.
And the Council of the Faculty remark in consequence, '* As regards
40 THE DENTAL RECORD.
the results of the examination, the Inspector is of opinion that the
candidates who passed and failed at the First Examination deserved
the respective awards, but that two of the six candidates who passed
at the Second Examination should have been rejected.
" Unfortunately the data on which he formed his judgment
are not given at all in the case of one of these two candidates, and
only to a very small extent in the case of the other. The Council
submit that in recording such an opinion the Inspector was bound to
state in detail the facts on which it was founded ; and the obligation
was all the stronger that he had no one with whom to share the
responsibility. All that the Council on their part can say on the
matter, therefore, is that they have not the materials on which to
review the Inspector's judgment. If any over-marking there was
they have certainly no wish to extenuate it. It is simply a case of
the Inspector's opinion formed, as has been explained, under circum-
stances which practically preclude an adequate judgment against that
of the Examiner." There will also be found in those remarks by the
Body Inspector a statement which I have made that " he gives some
of the subjects taken up at both ; but it happens that the subjects as
so detailed do not agree with the list of subjects on which any one
candidate was examined. The Inspector is therefore probably in
error on this point. The list of subjects on which the candidate
is examined is taken down by the assessor on the candidate's marking
schedule. These schedules were in the Inspector's possession for
some weeks (as were the written papers) ; but this discrepancy
appears to have escaped him." Under these circumstances I think
it is undesirable to make these statements public property, and I
have no doubt that before it is necessary really to put this on the
minutes, some communication between the Inspector and the Council
of the Faculty will clear up this matter. I therefore have to ask Mr.
Bryant to let this remain off the minutes. I am very sorry I had
to be absent at the Dental Committee on account of an accidental
delay to the train in which I travelled from. Scotland, or I would
have mentioned the matter there. I think Mr. Bryant will find it
consistent with his duty to allow this to remain off the minutes till
we meet again. It will be in accordance, I know, with the wish of
^he body which I represent.
Mr. Bryant : There is not the least objection to the suggestion
of Dr. Cameron.
the dental record. 41
Communication from the British Dental Association.
The Registrar : The next business is to receive the following
communication from the British Dental Association.
" British Dental Association,
(Incorporated June 3, 1880^,
40, Leicester Square, London, W.C.,
November, 25, 1895.
Dear Sir, — I beg to submit the following matter of urgency to the attention
of the Medical Council at its present session.
"Joseph Stromier, of Glasgow, having obtained the D.D.S. diploma of
Michigan University, U.S.A., presented himself last October for examination at
the Faculty of Physicians and Surgeons, Glasgow, for the L.D.S. Diploma. He
ubmitted as his dental curriculum that of the Michigan College, and upon that
curriculum he was admitted to the L.D.S. examination of the Faculty. He failed
in the examination but it is his intention to present himself again in April next.
"The point I wish to draw the Councils attention to is this — the Faculty of
Physicians and Surgeons, Glasgow, accepted the dental curriculum of Michigan, a
curriculum no longer recognised as satisfactory by the Medical Council, in lieu
of their own, and admitted Stromier to Examination. In doing so I venture to
submit that the action of the Glasgow Faculty is ultra vires, and I beg the Councij
to take steps, as they may deem necessary, to prevent a recurrence of such action.
" I am, dear Sir, Yours truly,
" W. B. Patterson,
•' W. J. C. Miller. Esq., Registrar.'''' '^ Hon. Secretary.
Dr. Cameron : In regard to this I have really no information, I
had not heard of this case until I saw it here now.
Mr. Bryant : Was not that before the Dental Committee ?
Dr. Bruce : It is a pity that such accusations as this should not
be made direct,
Mr. Wheelhouse : I beg to move that this letter be received
and entered on the minutes.
Dr. Cameron : Surely we could have this settled by the Dental
Committee before it is put on the minutes ; one does not know the
truth of it in the least. I will move "That this communication
be referred to the Dental Education and Examination committee."
Dr. McVail : I will second that.
Dr. Cameron's motion was agreed to.
Monday, December 2.
Sir Richard Quain, President, in the Chair.
The Report of the Students' Registration Committee was
adopted and entered on the minutes. The following is the portion
of the Report relating to dental business.
42
THE DENTAL RECORD.
II. — Dental Business.
I. From the following students, who desired to antedate their
commencement of professional study, their Preliminary Examination
having been fully completed before they commenced : —
Name
Carpenter, Alex. C. ...
Colyer, Stanley W. R.
Crombie, Walter P. ...
Fyfe, David
Goldfoot, Moseley M. .
Moore, Hubert Wm. ...
Mullord, Charles
Ryle, Arthur B
Steveni, Geo. Henshall
Stoner, John W
Tebbitt, Ernest R
White, Eustace B. L.
Date of
Preliminary
Examination.
Date of
Commencement
of Professional
Study.
April, '94
Mar., '91
April, '89
April, '95
Sept., '93
June, '92
Dec, '90
Dec, '88
June, '95
Dec, '92
Dec, '91
June, '95
Oct. I.
May I,
Jan. 3,
May 17,
Oct. 21,
Aug. II,
Feb. II,
Sept. 10,
Jan. I,
Mar. 31,
Sept. 29,
Sept. 5,
93
'91
•90
'95
'93
'90
•84
'91
'95
'84
'91
'92
Date of
Registration.
Date to which
Student desired
to be Antedated.
June 13,
'94
April I, '94
Oct. 3,
'93
May I, '91
Aug. 15,
•95
Jan. 3, '90
Oct. 28,
'95
May 17, '95
Oct. 10,
'9.5
Nov. 10, '93
July 29,
'92
June I, '92
Jan. 30,
'93
May I, '92
Feb. I,
'92
Sept. 10, '91
Oct. I,
'95
June I, '95
Jan. 26,
'93
Dec. 8, '92
Dec 31,
'91
Dec. I, '91
July 26,
'95
June I, '95
Resolved : — That these applications be acceded to^
2. From the following student, who desired to antedate, his
Preliminary Examination having only been deficient in one subject
at the time of commencement of professional study : —
Name.
Dates of
Preliminary
Examinations.
Date of Com-
mencement of
Professional
Study.
Date of
Registration.
Subject in
which
deficient.
Date to which
Student
desired to be
Antedated.
Newton, Joseph
R.
( Sept.,'92 (
\ Dec, '92 j
June,20,'88
Jan. 2o.'93
French
Sept. I, '92.
Resolved \ — "That this application be not acceded toy
3. From the following student, who desired to antedate, his
Preliminary Examination having been deficient in more than one
subject at the time of commencement of professional study : —
Name.
Dates of
Preliminary
Examinations.
Mountain. Wm.
( Aug., '91
\ Aug.,'93
( Aug., "95
Date of Com-
mencement of
Professional
Study.
Nov. 2,'92
Date of
Registration.
Aug. 2 1, '95
Subjects in
which
deficient.
! Algebra
Euclid
French
Date to which
Student
desired to be
Antedated.
Nov. 2, '92.
Resolved : — "That this application be 7iot acceded to ^
THE DENTAL RECORD. 48
4. From John B. Watson, who passed in all the subjects of the
Preliminary in October, 1891, except Latin, and who passed in that
subject and became registered in April, 1894, requesting that he
might antedate to October i, 1891, on the ground that during the
years 1892-1893 he was suffering from hypersesthesia o<^ the retina,
respecting which he sends a medical certificate."
Resolved : — " That this application be acceded to^
Sir Dyce Duckworth : I beg to move the following resolution : —
" That on and after January, 1897, ^^^ registration of students under
Resolution XI., of June 2, 1891, shall be discontinued, so" far as
concerns the preliminary examinations of the Pharmaceutical Society."
I may say that the Committee have sat and heard all the cases
mentioned in the report, and it is satisfactory to note that the
students are coming more under the regulations of the Council. It
has been the custom previously to allow students who have passed
the preliminary examination of the Pharmaceutical Society to
register as medical students on taking the previously omitted
subjects, but the Council wish to discourage that in future, and to
encourage students to enter the profession who can show that they
have passed a good preliminary education before they start on
professional work.
Dr. MacAlister : I beg to second the motion.
The motion was agreed to.
Communication from the Midland Branch of the
British Dental Association.
The following Communication from the Midland Branch of the
British Dental Association was on the agenda paper of the Council,
and was, we understand, received and entered on the minutes : —
" British Dental Association (Midland Branch).
" Hon. Treasurer. — G. G. Campion, 254, Oxford Road, Manchester.
"Hon. Secretary. — I. Renshaw, Drake Street, Rochdale.
" May 30, 1895.
" Dear Sir,— I am desired by the Members of the Midland Branch of
the B.D.A., to convey to you the enclosed Resolution^ with the request that
you will place it before the General Medical Council at its next meeting.
" I am, dear Sir, Yours truly,
" I. Renshaw, Hon. Sec.
" W. J. C. Miller, B.A., Esq.,
•• Registrar of the General Medical Council.''
" Resolved : — That the best thanks of the members of the
Midland Branch of the British Dental Association, assembled at
44 THE DENTAL RECORD.
Bradford, be given to the General Medical Council, for their
resolution in regard to Dental Advertising, the Branch expressing
the hope that the Council would continue its policy until such
advertising was suppressed.
" I. Renshaw, Hon. Sec^
Association of Unregistered Dental Assistants.
A memorial from an Association of Unregistered Dental
Assistants was also presented to the Council.
COMER V. GWYNNE.
Before Mr. Justice Mathew, without a Jury.
This was an action, on December 6th, by a dentist to recover
^105 for professional charges and work done to the teeth of
defendant's wife. The defendant, without admitting liability, paid
into Court 50 guineas, which he said was sufficient to satisfy the
plaintiff's claim. Mr. Bray appeared for the plaintiff; Mr.
Macaskie and Mr. Glynn for the defendant. Mr, Bray, in opening
the plaintiff's case, said the action was for ;^io5 for work done in
fitting what was called the removal bridge work to defendant's
wife's teeth. The plaintiff was a dentist practising the American
system of dentistry. In July, 1894, the plaintiff did some work
for the defendant. In May, 1895, the plaintiff got a letter from
defendant's wife asking for an appointment. On May 4 she went
to plaintiff and he found she had a broken bridge-case, which she
wanted removed. The plaintiff said he could not state his fee
until he knew what had to be done, but it would not be more than
his printed terms, which he put up in his waiting room. It was
settled that defendant's wife should come up again. Her broken
bridge work was removed. She was then told that she might have
the removable bridge work in duplicate. It was put on in such a
way that it could be removed. She came again on the Friday to
have it fitted. On the same day the plaintiff sent in his account :
" To agreed price for professional services rendered for Mrs.
Gwynne, and supplying four-tooth removable bridge-case in
duplicate, ^^105." The defendant then wrote to the plaintiff that
the plaintiff agreed to do the work on the same lines as he worked
for defendant — namely, ^31 los. for seven teeth. The plaintiff
refused to alter his account, and brought his action. Mr. Frank
Comer, the plaintiff, examined, said he was a specialist in advanced
American dentistry. He practised at 9, Hereford-square, South
Kensington. In July, 1894, he had a communication with defen-
dant, and agreed to do the work for 30 guineas. The defendant
had a fixed bridge-case broken in upper jaw. He agreed to make
a small case for his lower jaw and repair the broken case. The
case was made of gold and platinum. The platinum screws were
screwed into the old stumps. By unscrewing the bridge it could
THE DENTAL RECORD. 45
easily be removed. He gave the defendant one of the books showing
his prices. The defendant's wife told him she had a broken fixed
bridge. He looked at her mouth and said he did not know what
it would cost, that defendant knew what his regular printed
fees were, and he should not charge more. The defendant's wife
said it would be all right, as witness would charge only what was
fair. On iVIay 8 Mrs. Gw3'nne came. He removed the broken
bridge, which was difficult to remove. He then picked up one of
his pamphlets, opened it at his list of fees, and said, " It now rests
with you to decide what j^ou wish to have done. If I put in a
four-tooth case with a fixed bridge it will be 60 guineas ; if with a
removable bridge-case in duplicate it will be 100 guineas." Mrs.
Gwynne said she wanted the best. He said, " Very well, it will
cost you 100 guineas." He was occupied on the case from
Wednesday to Friday almost continuously. Cross-examined — He
had a diploma from Central America. Removable bridge work
had never been done by any dentist but himself. He charged
^^31 los. for two or three hours on May 8. On May 10 she was
with him about three hours. He never made a removable bridge
case unless he made a duplicate set. Mr. Gwynne did not agree
that the price was to be 100 guineas. He suggested that Mrs.
Gwynne did not know the meaning of the word duplicate. Mrs.
Gwynne refused to accept the duplicate bridge. That closed the
plaintiff's case.
Mr. Macaskie, for the defendant, said his case was that there was
no bargain to pay 100 guineas ; that the defendant was not party
to any such bargain ; and that the charges were excessive and
unreasonable. Mr. Gwynne, the defendant, called, said the
plaintiff told him he could not exactly say the price. The
plaintiff said he would do the work for his wife on the same lines
as his own. He never agreed to pay 100 guineas or authorized
his wife to agree to those terms. Cross-examined. — He saw the
testimonials with the price list. Mrs. Gwynne was called, and
corroborated the defendant as to what plaintiff said about terms,
and further said that the plaintiff did not mention the cost to her
and said nothing on the first occasion about a duplicate set.
Cross-examined. — She could not get the teeth out. The plaintiff
did hand to her a book of fees while she was in the chair. Miss
Allen, called, said she was with Mrs. Gwynne at the plaintiff's.
Nothing was said about terms. Mr. Charles S. Tomes, F.R.S.,
examined, said he was a consulting dentist. Had been examiner
at the College of Surgeons on dental surgery for 13 years. He
had examined Mrs. Gwynne's teeth. The work was very ordinary,
and was aone by hundreds of dentists here and in America. It
was an average piece of work. For one set a fair charge would
be from 1 5 to 20 guineas, but it was difficult to answer the question,
as most dentists charged by time. Two guineas an hour was the
recognized charge for dentists in first class practice. That was
while the patient was with the dentist. A good deal of the
laboratory work could be done by a skilled artisan. For the
duplicate set he would say ten guineas was ample. The duplicate
46 THE DENTAL RECORD.
set was not required. Cross-examined. — He thought the charges
in plaintiff's book most extortionate. He thought some of the
statements in the plaintiff's pamphlet showed great ignorance of
anatomy and physiology. He did not look upon the plaintiff as a
professional equal. He had often made removable bridge plates.
The principle was not new. There was no such thing as dentistry
special to a country. There was no jealousy between English and
American dentists, when they practised on professional lines.
Mr. W. B. Paterson, honorary secretary to the British Dental
Association, examined. — Said he was a practising dentist. He
agreed with Mr. Tomes as to the charges being excessive. Cross-
examined. — He had made several removable bridges. He did not
know of the Comer system.
Mr. Justice Mathew, in giving judgment, said that the true
explanation of the action was that the plaintiff believed that
because he put his price list into Mrs. Gwynne's hand, she, there-
fore, must be taken to know what was in it. What were the pro-
babilities about that ? The defendant had been attended to by
the plaintiff, and for the work he did he was willing to take 30
guineas. The defendant said he went to see what the charge for
his wife would be, and was told on the same lines as his own. If
the evidence in the case supported the defendant's version, and
not the plaintiff's, what occurred subsequently ? The plaintiff put
the book of charges in Mrs. Gwynne's hand while in the chair.
He was satisfied that the plaintiff did not call the attention of the
lady to the charges. He advised the plaintiff if he meant to make
such a charge as this to write first to the person he intended to
make liable. He had evidence of men of experience called before
him, who stated that there was nothing unusual or extraordinary
in the work done by the plaintiff. He would allow him 30 guineas,
and direct that the remaining 20 guineas paid into Court be paid
out to the defendant, with costs of the action. — The Times.
THE DENTAL HOSPITAL OF LONDON.
The Annual Dinner of the past and present students took
place on the 30th November, at the Cafe Royal. A large and
representative gathering met under the chairmanship of Mr. F.
Canton. The health of ** The Queen and Family " having been
duly honoured, the chairman proposed " The Past and Present
Students.'' As an old. student himself, to propose this toast seemed
like proposing his own health, and when it was first intimated to
him that he was expected to undertake that pleasurable duty, he
put the case before their worthy Dean, but the Dean was immovable,
and replied that this being the students' dinner " The Past and
Present Students " was the toast of the evening, and must come from
the chair. His position then must be accounted for by the fact that he
THE DENTAL RECORD. 47
did not feel sufficiently separated from the hospital to defy the
Dean with impunity. On reflection he was sure that the Dean was
right, for though there were other important toasts down on the
list, the one that was entrusted to him must claim priority when
they remembered that if there were no students there could be no
Dental Hospital of London. Further, the students of to-day were
the practitioners of the future, and therefore, in their hands lay the
honour and dignity of the profession. Fortunately for them the
path had been made smooth by those who had preceded them.
The large majority of hospital appointments held by the past
students of the school was abundant testimony to the ability of the
men turned out by the London School of Dental Surgery and the
thoroughgoing study and work in the right direction which they
had undergone.
iMr. John Ackery, in replying for the past students, alluded to
the fact that it was twenty years since he entered the hospital, and
reviewed the progress and development of the work since ; only two
of che staff that existed then now remained with them, viz. :
Mr. David Hepburn and Mr. Bailey. As the chairman had said,
most of the important dental positions at the hospitals in London
and in the provinces were held by past students of the Dental
Hospital of London. In speaking of the new building which they
looked forward to possessing at an early date, he referred with
satisfaction to the amount subscribed by past students. It was now
for the public to come forward and supply what was wanting.
Mr. W. H. PiDGEON appropriately responded for the present
students.
Dr. Sydney Coupland proposed "The Hospital and School,"
connecting Dr. Joseph Walker's name with the Hospital, and Mr.
Leonard Matheson with the School.
Dr. Walker (the Treasurer of the Hospital), in reply, referred
to the fact that this was the 37th anniversary of the wedding of the
Hospital and School, and he had the pleasure of being present at
that wedding thirty-seven years ago. The married couple had
worked amicably together since, and they could only wish the same
harmony might prevail for another thirty-seven years. He had the
pleasure to announce that the negotiations for the purchase of the
new site were going on most favourably, and that they were within
measurable distance of seeing the foundation-stone of the new
48 THE DENTAL RECORD.
Hospital laid. He took the opportunity of thanking the Staff and
Students for the noble response they had made to the request of
their Dean. He was not going to ask the Students for any more
contributions, but the further necessary sums should come from the
public, and to them appeal must continually be made if they were to
see their way out of their difficulties. Dr. Walker also paid tribute
to the great business capacity of their Secretary.
Mr. Leonard Matheson dwelt in eloquent terms upon the noble
traditions which had grown up in the past thirty-six years, of which
everyone connected with the Hospital and School might well be
proud. In alluding to the names connected with the past he
mentioned Mr. Gregson's long connection with the Institution, and
made sympathetic reference to his serious illness. He also spoke of
the debt of obligation the School was under to their Dean, without
whose services during the period he had been Dean the School
would have been a very different one. Mr. Morton Smale worked
in such a quiet, unostentatious way that few perhaps realised how
much they owed him.
Mr. W. H. DoLAMORE proposed " The Visitors," for whom
Mr. Ernest Lane responded.
Mr. J. Smith Turner proposed the health of " The Chairman,"
and referred in eulogistic terms to the services he |had rendered the
profession. He had held nearly every official position that it was
possible for him to hold.
Mr. Canton, who was most cordially received, briefly, but
feelingly, returned his sincere thanks.
The Dental Surgeon's Daily Diary and Appointment Book.
Published by John Bale & Son.
An excellent book for the purpose indicated by the title, price
6s., interleaved with ruled or blotting paper, 7s. 6d.
The Dentist's Diary for 1896 with Supplement. Published by
the Dental Manufacturing Company.
A diary in small compass, well arranged, neatly bound, and
containing much information useful to dentists, price 3s. 6d., or
interleaved with blotting paper, 5s.
The dental RECORD.
Vol. XVI. FEBRUARY 1st, 1896. |No. 2.
©riginal (!t0mmunications.
NOTES ON THE TREATMENT AND FILLING OF TEETH.
By W. Cass Grayston, L.D.S.
{^Continued fro7n page 5.)
Combination of Filling Materials.
Many dentists consider that a combination of filling materials is
of great value.
It is considered very advantageous to line all cavities with osteo
before filling with amalgam. This is easily accomplished by mixing
the osteo rather soft and placing it in the cavity with a small spatula,
scraping the cement off the blade against one of the edges. A pellet of
amalgam is then placed on to the cement, and with suitable instru-
ment, using the amalgam as a buffer, the osteo is readily adapted to the
floor and walls, the excess that is pressed out being at once removed,
firm pressure against the edges preventing any cement being here
exposed. More amalgam is then added until the filling is completed.
The shrinkage of the amalgam seems to be somewhat controlled,
and it does not appear to so readily become defective at the edges.
The unsightly appearance given to a tooth by amalgam if the walls
are thin is avoided, and the tooth is considered to be better preserved
altogether.
In many cases front teeth may be filled with this combination
without their appearance being spoilt. It is important in these
cases that the cavity does not encroach on the labial wall.
If preferred, small pellets of a tough, slow setting cement may
be first carefully worked against the floor and walls, and then, when
the lining is thus made, the amalgam is introduced. The former
method is perhaps better when the retainage is doubtful, and it is
desired to rely somewhat on the sticky properties of the osteo to
cement and hold the amalgam in place.
Some operators have mixed the filings of amalgam alloy with
osteo, and others, after mixing the alloy with quicksilver in the
usual way, have then mixed it with osteo, the resulting mass being
introduced and packed like osteo. Neither of these methods in my
hands has given any better results than osteo alone, and the colour
of the resulting filling is disagreeable if exposed to view.
VOL. XVI. D
50 THE DENTAL RECORD.
The mixing of amalgam prepared in the usual way, with osteo
may be very valuable if the surface is protected with amalgam.
There may be a better union between the amalgamised osteo and
the amalgam itself than between osteo and amalgam alone.
Experiments in this direction are worth trying.*
To line a cavity with osteo and fill with gold is very difficult, and
except in occasional cases is not worth the extra time and trouble.
After placing the osteo in the cavity several pieces of gold are
pressed into it, and it is allowed to set, keeping it dry all the time.
The pieces of gold embedded in the cement are then consolidated
and form so many retaining points, on to which the gold is built.
It is unwise to rely solely on these retaining points for holding the
filling in place, and some other retainage must also be obtained or
the gold will be dislodged if subjected to much strain. Either the
gold will break at the retaining points or if the union here is
strong the cement will break at this part. To test the strength of
phosphate cement I took a piece of No. 240 foil, which is as thick as
thin plate, bent the ends at an acute angle \ 7 and placed it in
a tooth out of the mouth that was filled nearly up to the enamel
with osteo, first placing osteo carefully on the under side of the
plate and in the angles. After leaving it to set until the next day, I
scratched the surface of the plate and built up a gold filling with
hand pressure. On trying to dislodge it with an excavator the
whole of the gold came away '* en masse " bringing with it part of
the osteo. A combination of guttapercha and osteo is useful in
cases where it is difficult to keep the cervical wall perfectly dry
throughout the operation. Place a layer of guttapercha at this part
and then complete with the cement.
1
* The combination of osteo and amalgam was first suggested by Mr. F. A.
Bellamy, and described by him in the "British Journal of Dental Science,"'
February, 1887. In reply to a letter asking for his views on the adhesion of an
amalgam surface to a filling of a mixture of osteo and amalgam, he informs me
that although he usually presses the amalgam into the mixture, he finds the
union is very good in cases where the amalgam is simply laid on as a veneer,
and that unless the filling has been strained in biting before it is set, the veneer
will very rarely break away. He also finds the adhesion of amalgam to the
mixture decidedly stronger than the adhesion of amalgam to osteo alone. Mr.
Bellamy does not, however, advocate simply veneering with amalgam, preferring,
whenever it can be satisfactorily accomplished, to secure in addition mechanical
union by pressing the am.algam well into the mixture.
THE DENTAL RECORD.
51
Gold and Amalgam.
A combination of gold and amalgam is very useful in many
cases of approximal decay of molars and bicuspids. It is often
difficult to pack the gold accurately against the cervical edge and the
lateral walls of the cavity where they approach the cervical edge,
and it is at these parts that recurrence of decay is usually to be feared.
If amalgam is used from half to two-thirds of the way towards the
crown the dangers of defects in the filling are greatly lessened. By
making the masticating part of gold, the chipping of the edges, so
often found with amalgam, is avoided. When gold and amalgam
are thus used in combination, the amalgam usually turns black, but
does not appear to shrink.
In manipulating this combination the amalgam may be allowed
to set, and at a subsequent sitting the gold may be inserted, or the
gold may be packed at once directly on to the amalgam. In the
latter case a matrix is usually used, very tightly clamped or tied in
place, so as to prevent the pressure of packing the gold forcing the
amalgam out of the cavity. Sponge or crystal gold unites fairly
readily with amalgam. At first it appears to be swallowed up by it,
but after a time this ceases, and the gold works in the usual way.
As soon as this occurs the filling can be completed, if desired, with
foil. It is claimed that an intimate union takes place between the
gold and the amalgam, but it is unwise to rely in any way On this
union for retainage. Undercuts should always be made in the
coronal part of the tooth. Personally, I have found it more con-
venient and easier not to begin working the gold on to the amalgam,
but to extend the cavity well across the crown and commence the
filling in a small pit or undercut made in the dentine at the part
iurthest removed from the amalgam and then to work the gold
solidly from this starting point back across the crown until the
amalgam is reached (Fig. 2), being careful to attach each piece of
Fig. 2.
A. Amalgam.
G. Gold.
S. S. Starting points for the Gold.
d 2
52 THE DENTAL RECORD.
gold (foil or crystal gold as preferred) to that already in place before
working it on to the amalgam. By proceeding in this manner the
matrix may be dispensed with, and if care is taken in packing the
gold to apply the force as far as possible at right angles to the long
axis of the tooth, the amalgam will not be forced out of the cavity
or broken by the pressure.
In packing gold on to amalgam that is in a more or less plastic
condition, the absorption of some of the quicksilver by the precious
metal probably prevents any shrinkage of the amalgam taking place :
for this reason, and also because by the time all the gold is packed
the amalgam is just in the right condition to be easily and smoothly
finished, it is usually better to complete the operation at one sitting.
To make a combined fiUing by either of these methods some-
times takes up as much time as making the filling entirely of gold,
but those who have given it a long trial consider these teeth are
better preserved by it than by gold alone, and this is probably the
case, particularly in diflficult cavities.*
Mr. Humby in making fillings of this description takes the
extra precaution of first lining the cavity with osteo.
It will be readily understood that all the materials used for filling
teeth are valuable and indispensable if a dentist is to do the fullest
justice to his patients. To quickly grasp the peculiarities of each case,
and select the most appropriate material demands considerable
experience ; but as far as general rules can be laid down it may be
said that when the mouth looks clean and healthy, and the decay is
not rapidly reducing the teeth to weak shells, and the teeth themselves
do not show distinct pits or chalky patches in dangerpus positions,
diseased conditions have not been recently treated and neither the
tooth nor the patient is unduly sensitive, gold is indicated, unless
pecuniary considerations stand in the way, with the exception,
perhaps, of very small cavities in the approximal surfaces of molars
and bicuspids, and of cavities in general which present extraordinary
difficulties in the way of manipulation, or of front teeth so much
broken down that gold would be unsightly.t Amalgam, preferably
* Dr. Kingsley, of New York, was, I believe, the originator of the method of
packing gold directly on to amalgam ; and to Dr. Clapp belongs the credit of
showing how it can be done with a matrix and Steurer's plastic gold.
f An osteo filling, if exposed to view, soon, however, becomes unsightly'
owing to wear, or destruction of its surface.
THE DENTAL RECORD. 53
with an osteo lining, is indicated in all cavities in the molars or
'bicuspids, and sometimes, if not in any way exposed to view, in the
front teeth (always in that case with an osteo lining) where gold
is for any reason contra-indicated, unless there is any fear of having
to refill in a short time, when osteo or guttapercha is preferable.
Osteo, besides being useful as a lining for all, or nearly all,
amalgam fillings, is indicated for filling medium and large-sized
cavities in the front teeth where gold is contra-indicated, for filling
saucer-shaped shallow cavities that are too sensitive to be properly
shaped, and as a test filling in doubtful cases in general.
Guttapercha is of principal value in the filling of small cavities
not exposed to mastication on approximal and labial, buccal and
lingual surfaces, where it is not desired to use gold, and for filling
cavities, particularly if not large, for delicate patients and children
where rapid and easily renewed operations are desirable.
It must not be forgotten that by commencing with osteo and
guttapercha fillings, and replacing them when necessary, the teeth
will in many cases be preserved until an improvement in the
conditions admits of the use of gold, whereas if gold had been used
at the commencement in unfavourable or doubtful cases, the teeth
would have probably been lost. Should the conditions not improve,
the osteo and guttapercha must be renewed as often as necessary,
and if the patient will only attend to this matter and have the teeth
examined at regular intervals, they will be preserved for a number
of years and the wearing of artificial teeth postponed until late in
life.
It is very discouraging for a dentist to find that his advice
respecting regular and continuous examination of the teeth is often
disregarded, and in consequence his services have been of com-
paratively little benefit, but he can only do his duty, and if the
carelessness of patients causes much good work, and the money that
has been paid for it to be practically wasted, he can only regret it and
continue to do his best according to the conditions he is called upon
to treat, and keep on giving good advice. In many cases he will
find it bears fruit.
To sum up the merits and demerits of the different materials, it
may be said that gold is indestructible in the mouth, that if skilfully
manipulated a tight filling can be made that will not wear or chip
at the edges. This edge strength is possessed by gold alone. That,
54 THE DENTAL RECORD.
mechanically, it is therefore decidedly the best material. It is
difficult to work, and consequently a good patient is necessary. A
healthy mouth and fairly good teeth are also demanded. It must be
inserted by one who is skilled in its use, who recognises the tendency
of tooth structure to decay at the margins of fillings, and who realises
that this can be prevented in the majority of cases by what is known
as contour and free edges. The colour of gold is objectional in
many badly decayed teeth at the front of the mouth, but in the
majority of cases front teeth can be so filled that it is not noticeable.
Gold is a good conductor of heat and cold, and in some cases this
causes death of the pulp. This can usually be avoided (wherever
there is( room for it) by flooring the cavity with a non-conductor or
a low conductor before inserting the gold.
Amalgam is second to gold in durability as a material, and a
better filling than gold for many difficult patients and for many
extremely difficult cavities. Its appearance is disagreeable, and
consequently it must not, as a rule, be used in cavities exposed to
view. The same rules as to contour and free edges apply to amalgam
as well as to gold, although for difficult patients it is not always
possible to obtain them.
Tin foil is of value principally as a low conductor under gold
and as a convenient starter for gold fillings. It should not be used
in front teeth as it gives a dark appearance to the labial wall.
Osteo and guttapercha are not in themselves as durable materials
as gold or amalgam, but, as already explained, there are many cases
in which they can be more satisfactorily used.
Combinations of fiUing materials are often far more valuable than
the use of any of them separately. Thus, an osteo lining adds to
the value of an amalgam filling. Amalgam at the cervical part
often adds to the value of gold fillings on the approximal sides of
molars and bicuspids, and guttapercha at the cervical.part of osteo
fillings in certain approxirnal cavities also is valuable.
The Manipulation of Filling Materials.
Gold. — A description of the manipulation of gold for filling
teeth may be divided into a consideration of the preparation of
cavities, preparation of the gold, packing the gold, and trimming
and smoothing the surfaces of the fillings.
THE DENTAL RECORD.
55
To prepare a cavity for the reception of gold it is necessary, in
nearly all cases, to cut avray part of the tooth, to enable the instru-
ments to be freely used, in the removal of decay, the cutting of
the retainage, and the insertion and packing of the gold.
A certain amount of " opening the cavity," as it is called, is
necessary, no matter what material is selected, but the cutting must
be much more freely done if gold is to be used, for every piece must
be placed at once just where it is wanted, and condensed by the direct
action of the plugger. There is no possibility of pressing the gold
round a corner and squeezing it into position. This cutting away of
part of the tooth does no harm. The part removed is replaced with
gold, and it can be done in such a manner that the tooth is in no
way weakened or in any way made less useful. To open a crown
cavity, the overhanging edges of enamel are cut away until they are
level with the interior walls. It must be remembered that, owing
to the body of a tooth being composed of dentine, it usually
decays to a greater extent than the enamel, and on the removal of
the decay, the interior is consequently larger or more hollowed out
than the orifice. (Fig. 3<a;). The rule in crown cavities is to make
Fig. 3a. Fig. 3&.
the orifice as large as the interior, so as to do away with any over-
hanging ledge under which it would be almost impossible to
accurately pack the gold. (Fig. 3^). This applies also to cavities
on the labial, buccal and lingual surfaces of the teeth, and to a
certain extent to all cavities.
To open a mesial or distal cavity in the six upper front
teeth it is usually advantageous to cut away either part or the
whole of the lingual wall. Occasionally part of the labial wall may
be removed instead, but this should, as a rule, be avoided, for, although
it makes the whole operation considerably easier, and it can be
completed in less time, the gold shows somewhat, and this should
56 THE DENTAL RECORD.
always be prevented if possible. Some operators, instead of cutting
away either the lingual or labial wall, separate the teeth widely by
pressure, and beyond trimming the edges to obtain smooth, firm
margins, do not remove any of the walls for the purpose of obtain-
ing access. Having originally practised this wide separation method
with preservation of both the lateral walls, I must say I infinitely
prefer a slight separation, and the access obtained by cutting away
one of the lateral walls ; the packing of the gold can then be done
with greater certainty, the nuisance of obtaining a wide separation
is avoided, the patient is not worried with keeping the cotton
wool or tape, or whatever may be used to obtain the desired space,
between the teeth for a considerable time ; the teeth rarely become
sore, and the cutting secures free edges at parts of the filling, at
any rate. It is advisable, however, to obtain a slight separation by
pressure, so as to admit of the gold being accurately carried over
the labial edge if working from the back, or the lingual edge if from
the front, and to admit of the trimming and polishing tapes and
discs being easily used. This space can be obtained immediately, if
desired, by pressing a wedge of wood between the teeth or by cutting
with a thin separating file. In the latter case, the slight division
thus made will noi spoil the appearance of the teeth, and is decidedly
preferable to showing a line of gold ; but, personally, except for
preventing the exposure of gold, I rarely file or cut away more of
the labial wall than is absolutely necessary to obtain a smooth border
at this part.
To obtain access to all medium and large sized cavities on the
approximal surfaces of molars and bicuspids, the overhanging enamel
at the coronal part is entirely cut away, and if necessary, as it
sometimes is in a distal cavity, part of the buccal wall is also
removed. In all medium and large-sized cavities in these teeth,
both the lateral walls should be cut away sufficiently to secure free
edges, but more than the cutting necessary for this purpose is
admissible in certain distal cavities where the access is difficult.
(^To be continued^
THE DENTAL RECORD. 57
AMALGAM.*
By R. McKay.
Mr. Pkesident and Gentlemen, — In the ireatment of dental
caries there are certain cases in which the use of gold is impracticable,
so that a substitute must be used which will be of equal service in
mastication and in resiscing the action of the fluids of the mouthy
The only substitute at present known is '* Amalgam," and I think
amalgam is indicated in preference to gold in broken down teeth
where the walls are frail — in teeth of weak structure — in large cavities
occurring in the teeth of those who are unable to bear the strain of a
prolonged operation — in cavities at the back of the mouth, or in
positions difficult to get at — and in teeth of children.
The advantages of amalgam are that it is quick and easy of
insertion, it is also claimed that some varieties have a preservative
action upon the tooth substance, but whether this would be possible
with a watertight filling — and of course every filling should be water-
tight— is open to doubt, for palladium, the only absolutely water tight
amalgam with which we have long experience, does not do so, not-
withstanding that its sulphide is black and is freely formed upon its
surface.
Amalgam also has its defects. An objection raised to its use
when first introduced was " that the mercury is so feebly held that
it can escape and exert its poisonous effects upon the person in whose
mouth the filling is, and upon those who handle it." With regard
to the latter, even now some practitioners tell us that they cannot
mix amalgam in their hands without their health being markedly
affected, but no one still believes that the mercury in a filling could
produce the dire effects which have been ascribed to it in times past,
viz., mercurial salivation, headache, insomnia, diarrhoea, amaurosis,
aphthae, loss of memory, gangrene of the mouth, and many others,
it is very much like the story of red rubber dentures producing
salivation and other untoward results.
The valid defects are classified by Tomes as five, viz : —
I, Shrinkage in setting ; 2, Change of form in setting ; 3, Want
A paper read before the Students' Society of the Dental Hospital of London.
58 THE DENTAL RECORD.
of toughness or hardness ; 4, Discolouration of the surface of the
amalgam itself, and 5, Staining of the substance of the tooth
by it.
Shrinkage takes place in the setting of all amalgams, with the
single exception of palladium, which slightly expands. It has been
found that the greatest changes in bulk occur in the first
few hours after the amalgam has been mixed, and subsequently
is slight in amount, though it is often not completed for twelve
hours.
Change of form. — Until last year this was supposed to be due to
the tendency to assume a spheroidal shape during setting, by reason
of which Dr. Dodge said, " every point of the surface most distant
from the centre of the mass would move towards the centre, and
every point less distant would move from the centre," in other words,
all long diameters would shorten, all short ones lengthen, therefore,
in preparing cavities for amalgam, the depth should be greater than
the width, the walls of the cavity being left round rather than
straight. But this theory was upset by Dr. Black when he announced
his discovery of a property unique to amalgams, viz., that of flow
This is the property of yielding constantly to a heavy stress and
yielding repeatedly to the same amount of stress even when applied
at intervals, it is the antithesis of rigidity and elasticity and
accounts for the cup-shaped depression on the surface of old large
amalgams.
Want of toughness or hardness. — This chiefly affects the edge
strength, for no edges can be safely left thin, as the edges of a gold
filling may be, hence the edges of the enamel should be left straight
and not bevelled, as the thin layer of enamel thus left is less liable
to fracture than the thin ledge of amalgam which would be present
if the edges were bevelled. The hardness or toughness seems to
depend on the toughness of the metals composing the alloy, but this
point has not yet been definitely settled.
Discolouration of the surface of the filling and of the substance of
the tooth. — This is due to the presence of silver or copper. In the
case of silver, the sulphuretted hydrogen of the mouth forms with it
the sulphide of silver, while the same should also be true of copper,
but Tomes says '' that the sulphide of copper under the influence of
exposure to air and moisture readily becomes oxidised and forms the
sulphate. Hence it is almost certain we shall have sulphat.2 of copper
THE DENTAL RECORD. 59
formed upon the exposed surface of the fiUing. Now this sulphate
is freely soluble, and hence is likely to permeate the dentine, when it
will again be converted into the sulphide, whilst the sulphides of
other metals, not being so readily converted into soluble salts, will
not so thoroughly permeate the teeth." Whatever the reason, it is
undoubtedly true that a tooth so discoloured is at the same time
preserved.
To overcome these defects and obtain a perfect filling very
numerous experiments have been carried out, and these may be
detailed under three headings, viz : —
I, The composition of the amalgam ; 2, The preparation of the
cavity ; and 3, The methods of mixing and insertion of the amalgam.
I. The composition of the amalgam. — To M. Taveau, of Paris, is
due the introduction of amalgam, for in 1826 he advocated the use
of what he called his " silver paste " for permanent fillings. Some
few years after this the two brothers Crawcour presented their
'' Royal Mineral Succedaneum " to the American dental profession,
it was made from silver coin filings which were composed of an
approximate to nine-tenths silver and one-tenth copper, the amalgam
was made by mixing about equal parts of mercury and filings, the
result being a mixture of fifty parts mercury, forty-five parts silver,
and five parts copper in loo. Although this material saved teeth,
its surface blackened and the teeth were deeply stained by it, it was
the origin of the '' Amalgam War " in America, and was used by
comparatively few dentists. In 1845, Dr. Clowes, who used it, made
the discovery that tin overcame this tendency to blacken, in the
following manner : Two large approximal cavities presented them-
selves for filling, one in front of a molar, the other at the back of a
contiguous bicuspid, in such cases his usual practice was to fill the
cavity fronting with tin, and the opposite one with amalgam at
different times for fear of getting things mixed, but in this case he
performed both operations at the same time, got the materials mixed,
and supposed the fillings spoiled, instead, at the next visit, to his
amazement and joy the surface of the amalgam presented a silvery
whiteness. Of all the known metals, nearly everyone has been
pressed into the service of amalgam, but only silver, tin, copper, gold
platinum and zinc are of any utility, and their comparative usefulness
is indicated by the order given. Silver forms the bulk of all
amalgams, the setting is hastened by copper and probably by gold
60 THE DENTAL RECORD.
while tin materially retards it, besides increasing the amount of
contraction and decreasing the edge strength, zinc in the proportion
of I to ^ parts in loo, or even less, seems to control shrinkage
perfectly, gives a fine working quality and adds whiteness and
maintainance of colour to the filling. Besides zinc, copper and
antimony diminish the contraction, but the latter is so very dirty to
use that it has been almost entirely abandoned.
Amalgams consisting of mercury and one other metal, as copper
amalgam and palladium amalgam, have been termed Binary,
ternary, quaternary, etc., when they contain three, four, or more
meials. An example of a ternary amalgam is found in the old
coin-silver amalgam, while both contour and submarine come under
the quarternaries. Contour amalgam contains silver, tin, and gold.
Submarine — silver, tin, and copper, and standard amalgam —
acknowledged by the best authorities to be an excellent material —
contains silver, tin, gold and copper. ^
Of front tooth alloys there are two, one contains silver, tin, gold
and zinc ; the other, copper, silver, and tin.
The composition of Flint Edge I have been unable to find.
2. In the preparation of the cavity besides the points already
noticed with regard to the shaping of the cavity, every care should
be taken to sterilize and thoroughly desiccate it, for even if a
watertight filling has been introduced and there is moisture left in
the cavity, oxidation and precipitation of the salts will take place
and the tooth be stained. To aid in readily accomplishing this
Dr. A. C. Hewitt uses as a dentinal desiccant.
i Alcohol (pure), fl 5. y.
Chloroform, flj. iij.
Beta Naphthol, gr. "f .
nX Apply to flood the cavity thoroughly and evaporate e warm water.
Dr. Hewitt also proposes to coat the surfaces which are to be
covered in by the amalgam with some resinous solution such as
Sandarach Varnish ] -- ^ „.
laa n. 5j.
^ Damar „ j
Alcohol (absolute) fl. 5J.
Beta Naphthol gr. 7.
after evaporation of the liquids the resins are left lining the cavity
into which thin amalgam should be burnished.
THE DENTAL RECORD. 61
3. The Mixing and Insertion of the Amalgam, — Since chemical
combination takes place between the metals (for evidences of
chemical combination are found in the very property of setting, in
the elevation of temperature and in the changes of volume of the
mass attendant upon the act of setting) the best results will be
obtained by a method in which all the constituents are chemically
united in atomic ratios. The method of adding filings to the
mercury until a proper working quality is produced to suit the taste
of the operator, is a bad one, for there is no guide whatever to
indicate when the chemical affinity of the mercury employed has
been exactly satisfied ; another objection to this method is that the
filings are liable to be added in excess when the resulting mass will
be lacking in homogeneity and liable to local electrical disturbance.
The best result is obtained by using the parts in such proportions
by weight as have been found by experiment and trial, and
for this purpose either Kirby's or Fletcher's balance should be
employed.
After mixing with the pestle and mortar or by shaking up in
Kirby's tubes the mass should be rubbed in the palm of the hand,
which must be absolutely free from grease, until crepitation is
obtained ; this is a sound like that produced by bending a bar of pure
tin and is said to be indicative of an excellent alloy ; and the make
should be held in the palm of the non-operating hand by closing the
fourth and little finger upon it, as the warmth helps to keep it in a
degree of plasticity.
In inserting his fillings, Flagg introduces small quantities of
amalgam into the cavity at a time, and taps each into accurate
apposition with the walls by light blows from a serrated plugger ;
without the blows hj sa3's the unions are imperfect, the lines of
demarcation between the pieces clearly apparent, and leakage
inevitable.
Kirby mixes two portions of amalgam, a soft and hard portion ;
the soft consists of equal parts by weight of filings and tnercury, the
hard ot twice as much filings by weight as mercury. He then fills
the first half or two-thirds of the cavity with the soft amalgam, using
a burnisher for this purpose, and the remainder with the dry
amalgam in much the same way. By this method, as was proved by
analysis, equal distribution of mercury throughtout the filling is
obtained, the mercury passing from the moist to the dry part.
62 THE DENTAL RECORD.
Bonwill uses fairly plastic amalgam and expresses the excess of
mercury by firm pressure with pads of bibulous paper ; the exuded
mercury left on the surface is then raised away and more amalgam
added and treated in a similar manner. This same result may be
produced by using either a round soft rubber point, gutta-percha,
chamois skin leather, or rubber dam.
Kirke, who mixes his amalgam by adding mercury in excess to
comminuted alloy and then removing the excess by squeezing with
heavy pliers through chamois skin till a workable mass is obtained,
finishes by absorbing all excess from the surface by pellets of freshly
annealed sponge gold ; this he says gives a better result than either
gold foil (recommended by Rhein and Ottolengui) or tinfoil which
is sometimes used. After absorption of the mercury the filling
should be burnished over and finally polished to a mirror-like surface
as usual.
Mr. Tomes, as the result of a series of experiments devoted to
the means of getting the best results with the amalgams in ordinary
use, told the Odontological Society in January of last year
that :—
1. With the exception of palladium it was found impracticable
to get absolute water tightness by any method of packing in vogue.
2. Perfect results can be obtained by making the mass of an
osteoplastic, using the amalgam only as a protective agent, to keep
the fluids of the mouth from havins^ access to the plastic filling.
3. Advantage, short of perfect results, can be got by diminishing
the amount of fresh amalgam with its shrinkage still to do, either
by imbedding rings, lumps of hard amalgam, or other foreign bodies
in the soft mass.
4. The larger the mass the worse the shrinkage ; no large filling
should, therefore, ever be composed of fresh amalgam alone.
5. Absolutely perfect results can very generally be got by using
old standard amalgam heated and packed in small pieces, burnishing
it well against the walls ; but this is troublesome and in some classes
of cavity perhaps impracticable.
6. In a large number of cases equally perfect results can be got
by a mixture of new amalgam with old that has been heated to its
softening point and a beautiful finish can at once be got upon the
plugs.
THK DENTAL RECORD. 68
Mr. Tomes in using amalgams after this fashion says that
matrixes are invaluable, and that the easiest method of manipulation
is to rapidly burnish a small quantity against the walls, then to take
a large piece which will fill up the bulk of the cavity and to finish
by the addition of small pieces. If during the accomplishment of
this, the amalgam has set, heat the final portions just as though the
whole filling were being made with old amalgam and use hot
instruments. If old amalgam is to be used for the whole operation,
the best plan is to heat the whole lump in a spirit or bunsen flame
and lay it on a hot plate over the flame so as to keep it soft. As
good results are only obtainable with a rapidity of setting which is
rather inconvenient, the cavity must be dried and protected from
moisture before mixing up or heating the amalgam mass.
One of the most useful possibilities in connection with plastic
filling is expressed by the phrase " cold soldering,^'' for it is a property
of amalgam, that additions of this material can be secured firmly and
homogeneously to either gold or amalgam fillings, whether they be
old or of recent introduction. In this way old fillings may be joined
on to and made subservient for retaining purposes in cases of new
decay encroaching upon such fillings. Large reparations may be
made in cases where masses of tooth structure have been broken
away from heavily filled teeth. Pins and tubes for pivoting may be
fixed in position by amalgam.
The face of the metal to be soldered upon should be made bright
by scraping with an excavator, smoothing with a file or cutting with
a burr, and very soft amalgam rubbed over it until thoroughly
amalgamated, after which all superfluous amalgam should be
removed, the appropriate amalgam mixed, and the filling made in
the usual way.
In cases where it is wished lo use golJ, and the cavity is fa^-
beneath the gum, it is a good plan to fill the part beneath the gum
with submarine and continue with gold. In doing this one of two
methods may be employed ; either the amalgam may be allowed to
set, trimmed up and polished before the gold is started, or the gold
may be started on the moist amalgam, when the first few pieces of
gold will seemingly disappear, a matrix is also necessary to carry out
the latter method.
In accessible cavities, where dryness can be obtained and main-
tained, in which lining with oxychloride and final filling with either
64 THE DENTAL RECORD.
a single or combination amalgan is thought to be the proper practice,
Dr. Flagg advises a '' guard'' of gutta-percha at the cervical edge ;
this he says, should be made as thin as possible consistent with
certainty that it thoroughly protects the cervical edge. It may be
given bulk in moderate degree within the cavity and worked to a
feather edge at the cervical margin, it is also better that it protrudes
so that the lining and final filling having been accomplished and
the amalgam having sufficiently set, the guard may be neatly
trimmed off with a heated instrument, this ensures nice adaptation,
desirable finish, and excellent protection.
In concluding, I may say that the last year has been an important
one in the history of amalgams, for very interesting communications
have been published by Tomes, Black and Kirke, and for the detail
of these I would refer you to the originals, since the points therein
treated are too long for a short essay like this.
H^pnrta of Annettes.
THE ODONTOLOGICAL SOCIETY OF GREAT BRITAIN.
The Ordinary Monthly Meeting of the above Society was held
on the 13th ultimo, the President, Mr. David Hepburn in the Chair.
Mr. W. A. Maggs (Librarian) announced the usual exchanges.
Mr. Storer Bennett (Curator) stated that several specimens of
bone plates had been sent to the Museum, some of them with the
teeth themselves carved in the b^ne, and others with natural teeth
let into the bone base. They were very interesting specimens, kindly
sent to the Museum by various members of the Society in response
to the appeal made a few months ago. Mr. Aubrey Fairbrother had
sent a specimen of vulcanite plate of rather primitive workmanship,
and had also sent four upper incisor teeth affected by erosion.
Three of those teeth were very deeply eroded, but the right upper
central had only a very slight groove ; looked at by itself that right
upper central might besupposed to be affected by pressure of the teeth,
but the other teeth were so differently affected that the contrast of the
erosion between that one and the other three was very remarkable.
Erosion was said never to ^crur in dead teeth, but in looking at the
THE DENTAL RECORD. 65
tooth referred to it was difficult to decide whether it was alive or
dead when it was first attacked by erosion. Two specimens had also
been presented by Mr. Morton Smale, both pathological specimens of
animals, namely, the skulls of two deer affected by alve )lar abscesses.
Mr. Gartley presented a model showing two supernumerary
teeth in a boy aged 12 to 14.
Mr. Mummery showed specimens of ivory of great interest. One
was part of an elephant's tusk, showing a very large pulp stone in
the centre. It might possibly be, he said, that some foreign body
formed the nucleus of the pulp stone, but he had not had the
opportunity of opening it properly. He also presented, on behalf of
Dr. Miller, of Berlin, a particularly large and very interesting
specimen taken from an Indian elephant which had been moved
from one part of the country to the other and undergone a change
of food. For about a year the animal had fed on some vegetable
substance which stained the ivory in exactly the same way that
matter stained bone, and a ring of green would be seen all round.
The elephant then appeared to have been moved back again to another
part of the country where the food was different, and ivory of a
natural colour formed over the stained growth.
Mr. Mummery then read a brief Paper, by Dr. T. H. Denz,
Utrecht, on '* Causes of Deformity in the First Temporary Incisor."
Mr. J. F. Colyer brought forward an exampleof very rapid decay
in a comparatively young child. The patient was in attendance.
She was about eight years old when she first came under his observa-
tion, and at that time the upper central incisors were very badly
attacked about half way down. The four lower incisors were
decaying very badly, and her temporary molars were also in a similar
condition, being practically level with the gum; the first permanent
molars too were carious. The decay was of so very soft a character
that it seemed almost hopeless to do anything for the pa lent, but the
following treatment was adopted with apparent success. Once a
week, for the first month, the teeth were given a thorough coating
of nitrate of silver, whilst at the same time he suggested to the
mother that twice a day the teeth should be dried, and spirits of wine
applied to the surface, keeping the mouth open for two or three
minutes if possible, in order that the spirit might evaporate, and by
that means harden the dentine. He saw the child every two months,
and applied a fresh coating of nitrate of silver. The result had been
E
66 THE DENTAL RECORD.
very satisfactory. The objection that nitrate of silver' turned the
teeth black, though equally true with regard to the temporary teeth,
had not the same force as with respect to the permanent ones.
Mr. Van Der Pant asked Mr. Colyer whether he went into the
history of the case at all with the parents. Was the child anaemic,
or could the premature decay be accounted for in any way ? There
was no doubt something in the nitrate of silver treatment, and he
should like to ask Mr. Colyer as to how he had applied it. He
(Mr. Van der Pantj had heard that it was applied on a piece of
platinum wire. They could not very well get nitrate of silver into
the interstitial cavities of teeth without some special method.
Mr. Beadnell Gill's experience of nitrate of silver extended
over twenty years. He was of opinion that it did not make
much difference whether spirits of wine was used or not. Spirits of
wine seemed somewhat outside the mark of practical use, but the
nitrate of silver, both in temporary and in permanent teeth, when
judiciously applied, would, no doubt, if persevered in, give very good
results in cases where nothing elso was of any avail. He would like to
ask if Mr, Colyer had used it in permanent teeth to any extent, and
over what period he had had the opportunity of applying it.
Mr. F, J. Bennett suggested that as the child was young when
the teeth were shed, Mr. Colyer should save them and make sections,
because when nitrate of silver had been applied for a known period,
and the previous condition of the teeth was also known, it would be
very valuable to see the exact effect upon the dentine under such
conditions.
Mr. F. J. Colyer said he had no wish to claim the use of nitrate
of silver as anything new, but he thought that now and then even a
well worn topic bore reviving. He could not account for the
extensive decay in the teeth of the patient any more than the fact
that she was of an extremely strumous type. The way in which he
applied nitrate of silver was that which he had learnt as a student
from Mr. Storer Bennett, by melting it on a piece of wire. That
was certainly the best way, because it could be taken to any part that
was desired, and there was no possibility of its slipping and passing
down the throat. He had constantly used nitrate of silver ever since
he had been in practice, and always found the most satisfactory results.
With regard to Mr. F. J. Bennett's request, he should be only too
pleased to give him one or two of the teeth when they were extracted.
THE DENTAL RECORD. 67
Dr. DuDLE7 Buxton then read a Paper on
" The Nature of Anaesthesia.''
To understand precisely what anaesthesia is had proved a
difficult problem to many. To explain it was no mere academic
exercise, for given such an explanation, it must influence alike the
methods adopted in handling the various anaesthetics and the means
we employed to prevent inherent dangers or to avert accidental
perils. For example, in days when nitrous oxide was deemed to be
an asphyxiant it was the practice to give it rigidly excluding all air.
Now it was recognised to have a true anaesthetic action, and so
it was given, as other general anaesthetics were exhibited, with air or
oxygen, to avoid the occurrence of asphyxial symptoms, as
unnecessary as they were undesirable. Nor would it be justifiable
to employ substances as powerful as were anaesthetics unless their
physiological behaviour could accurately be appreciated. It was to
inquire what was known about anaesthesia that this note was
written.
Paths of Aitcesthcsta. — All would be familiar with the disorders
of sensation, which occur in various forms of nervous disease, and
give rise to hyperaesthesia on the one hand, and anaesthesia upon the
other, {a) Variations in the internal relations of the end-organs of
the skin or mucous membrane ; (b) of the sensory nerve, or nerve
of conveyance ; {c) of the ganglionic nerve centres which translate
the sensory stimulus into a feeUng ; and {d) the consciousness which
perceives the feeling as pain or pleasure, may under morbid conditions
of the organism give rise to true anaesthesia. Hypnotism furnished
an example of a state in which pain was felt, but perceived as
pleasure. Although there was every reason to believe that both the
end organs in the skin, the sensory tracts, and the ganglionic nerve
tissue, were intact, and capable of producing and conveying sense
stimuli, nevertheless the perception arrived at was not that of pain.
The perceptive mechanism was blocked.
Peripheral Sense Organ Ancesthesia. — Local anaesthesia — the
blocking of the sense stimulus at the skin or mucous membrane — was,
of course, of little value for any save the most trivial operations.
The agents employed and the elaborate plans suggested to produce it
had not proved themselves safe or sufficient.
Bichat taught the duality of life, a life of mere functional
existence and one of relativity. In anaesthesia produced by agents
E 2
68 THE DENTAL RECORD.
such as nitrous oxide, ether, chloroform, the life of relativity falls
into abeyance, while the functional life or existence persists. But
just as it is found impossible to limit the activity of a local anaesthetic
to a regional area, so it is impossible to draw a hard and fast line
between the influence of a general anaesthetic upon the cerebral
centres and its overthrow to the vital centres.
Aim of Ancesthesia, — The problem was to discover how best to
produce anaesthesia without allowing the ordinary processes of life to
be trenched upon. Some advance along the road leading to this
discovery had been made, but much remained to be learned, and
very much more to be unlearnt.
Definition of Ancesthesia. — It seemed to be now generally
admitted that although many things might produce loss of sensation
through abeyance of the faculty whereby pain was felt, yet none
should be regarded as anaesthetics unless they exerted some definite
influence upon the tissues of the body rendering them indifferent to
pain, and that quite irrespective of their preventing due access to
the tissues of some vital constituent.
True and false Ancesthesia. — Rendus Brown-Sequard has
pointed out that when CO2, chloroform and other vapours are
allowed to impinge upon the mucous membrane of the larynx,
trachea, or even upon certain skin areas, while they are prevented
from entering the lungs, they produce unconsciousness of pain
although the animal is awake and alert. Carbonic anhydride had
been also used as a general anaesthetic. Ozanam employed a mixture
of75C02to25 of air ; he rendered a young man unconscious while an
abscess was opened. It had also been suggested that ether was
rendered more effectual by combining its use with that of CO2,
and even nitrous oxide had been used in combination with the
inspired air of patients, thus producing a mixed anaesthesia due to
these two agents. Waller had further shown that COo produced a
brief abolition or diminution, followed by prolonged augmentation
of electrical excitability in the isolated nerve of frogs. This
however, was influenced by the amount of CO2 used. The use of
carbonic anhydride as a local anaesthetic took them back to the days
of Pliny. But experiments had been undertaken which prove that
carbonic anhydride possesses the power of producing unconsciousness
only so long as the oxygen tension in the blood remains below a
THE DENTAL RECORD. 69
certain level. Grehaut employed mixtures of common air and
carbonic anhydride, and found that when the animals experimented
upon were completely narcotised, the gas of the blood contained
95*4 per cent, of CO;^ as against the normal 34*3 per cent. Grchaut's
results had bee'i obtained by Lallemand and Perrin as early as in
i860. This state of unconsciousness, however, was not one of
anaesthesia, and was only obtained at the expense of grave peril to
the individual. The bodies commonly employed as anaesthetics —
nitrous oxide, ether, chloroform — must then, differ in their action
from COo. That this was so, their present knowledge permitted
them to say, but compelled them to admit that so far as many of
their methods were concerned, anaesthesia was, as Dastre had said,
the first itep in a general poisoning of the organism. It was the
realisation of the truth of this dictum which compelled them at
once to recognise the necessity of understanding the precise range of
safety limiting artificial toxaemia, and to appreciate the responsibdity
falling upon those who undertake the control of producing and
limiting it.
Theories of Ancesthesia. — The theory of Flourens and Louqet,
two very careful observers, that anaesthetics possess a selective action
on the nervous tissues was now known to be false, inasmuch as the
nervous tissues do not actually take up more of the anaesthetic, but
retain more of it.
Mode of Action of Ancesthetics. — Knowledge as to the way an
anaesthetic enters the organisation, what path it takes, and by what
means it is thrown off, was essential in order to ascertain how far
anaesthesia trenches upon the vital processes of the organism. The
lungs, the heart, and the brain have been called the tripod cf life.
Death must occur when the lungs or the heart cease to perform
their function, but of the cerebro-spinal axis only the lower
ganglionic centres are, even in mammals, essential to the existence
of the animal. Hughlings Jackson in his lectures on the Evolution
and Dissolution of the Nervous System, after pointing out that the
evolution of the nervous centres is the ** putting together of the
nervous system," and involves a correlation of the most automatic
with the most voluntary, goes on to show how dissolution is the
reverse of this evolution — is, in point of fact, unpicking the lock of
life. He adds : " In uniform dissolution the whole nervous system
is under the same conditions or evil influence — the evolution of the
70 THE DENTAL RECORD.
whole nervous system is comparatively evenly reversed. In these
cases the whole nervous system is ' reduced,' but the different
centres are not equally affected. An injurious agency, say
alcohol, taken into the system flows to all parts of it, but
the highest centres being the least organised, give out first and
most ; the middle centres being more organised, resist longer,
and the lowest centres being most organised, resist longest. Did
not the lowest centres for respiration and circulation resist more
than the highest do death by alcohol would be a very common
thing." If the word alcohol be replaced by alcoholic anaesthetic in
Dr. Jackson's remarks, the pith of the subject, in Dr. Buxton's view,
is arrived at.
It is the sum and aim of the scientific use of anaesthetics to act
upon the higher and more unstable centres of the nervous system
without affecting the lower or automatic centres. But the problem
could not be narrowed down to this easily appreciated theorem.
The inter-relations of the higher with the lower centres, in highly
differentiated animals, were many and intimate. Dangers appear in
every zone of narcosis, lest impulses become initiated which involve
the stable centres through the unstable ones.
Under normal conditions the purely vital functions of life are
controlled by the lower centres, and indeed, in the more humble
animals, are incapable of being influenced by higher centres. In
man the cerebro-spinal axis influences the processes of life in
obedience to impulses from without which require some modification
of the routine of life. The diver, lor example, can control the
automatism of his breathing ; while under the influence of pain,
of shock, or of suggestive fear of pain, the heart's action may be
inhibited. Such interference, however, is seldom excited without
voluntary connivance. The simple reflexes of life are controlled
when the higher centres are working in health. As soon,
however, as any disturbance of these centres occurs, though
it may be an "injurious agent," as Dr. Jackson calls it, there is a
danger — and a very real danger — lest simple stimuli from without
cause the most widespread reflex actions. Even those protective of the
vital processes become, when unrestrained by limiting nervous
control, inco-ordinated and make for the destruction of those very
processes of life which it is their function to preserve. And, further
the due performance of the vital processes requires that nerve
THE DENTAL RECORD. 7X
impulses and viscera and muscles shall be in such a condition of
vitality that they can perform their physiological duties and be able
to meet unusual calls made upon them. It also necessitates that
throughout the whole time of the action of the injurious agent the
tissues of the body shall receive their due quota of nourishment,
implying that the blood stream shall be maintained pure and in
sufficient circulation. Nor was this the whole problem. Elimination
of the injurious agent is at least as essential as the due control of
those safeguarding vital processes against which it militates. In the
same way heart failure might occur in spite of a normally acting
system of safeguards in the nervous system. If in response to
demands made upon the heart by impulses from the nerve centres,
that organ through disease were unable to execute the work required
of it, fatal syncope would arise. All anaesthetics in common use
enter the blood stream through the lungs. The inhaled vapour in
passing over the pulmonary mucous membrane produces changes in
its epithelium which, according to McKendrick Newman and Coats,
is inflammatory in character, " The capillaries are contracted, their
walls become less distinct, and the blood corpuscles in them become
partially dissolved." In every case blood removed from the body
and shaken with an anaesthetic shows destruction of the corpuscles,
and reduction with pouring out of the haemoglobin. It would
appear also that a similar if less marked phenomenon occurs in the
body. Da Costa has demonstrated that " Etherisation produces a
marked diminution in the haemoglobin of the blood." He finds
also that with destruction of the red discs, a change in the character
of the leucocytes becomes apparent. Dr. Buxton was at present
investigating this point, and had up to the present time found that
a decided diminution in the corpuscles takes place under nitrous
oxide, ether and chloroform. It was, however, not improbable that
factors other than the anaesthetics may be found at work in bringing
about the result.
The combination or association between the gaseous anaesthetics
or vapours and the constituents of the blood must be a loose one,
since in their presence oxygen is displaced. Were they to form
combinations as stable as that which carbonic oxide establishes, not
only would the anaesthetic displace but would render it impossible
for the reformation of oxy-haemoglobin. Hence death must result.
Whether or not, in certain conditions, the corpuscles have less power
72 THE DENTAL RECORD.
of again taking oxygen after prolonged anaesthesation it was impossible
to say. It seemed that probably such was the case. Deoxydation of
the tissues at one time was thought to be the explanation of anaes-
thesia ; it was now recognised this was not so, for among other
reasons profound anaesthesia with hyper-oxygenation could be
produced, and many deoxidating bodies had no anaesthetic
properties.
When it was remembered that the tissues are dependent upon
the red corpuscles for their nutrition this question of their destruction
by anaesthetics assumes a position of great importance. It was not
impossible that the behaviour of anaesthetics towards the corpuscles,
which it had been shown they affect so profoundly, might be such as
to modify in a material degree their capacity for conveying oxygen to
the tissues. The behaviour of anaesthetics towards corpuscles also
had an important bearing on the question whether the central nervous
system absolutely controlled the vagaries of anaesthetics. Certainly
in the case of chloroform the belief was delusive. Waller and others
had demonstrated the changes in isolated nervous tissue, but
as yet no full research had been conducted upon the nervous
elements as they occur in the body. An attempt was made
in this direction by Dr. Buxton in working out the physiological
action of nitrous oxide with results which he thought proved the
anaesthetic properties of that gas. It must then appear probable that
the changes brought about in the blood elements react upon the
more stable tissues by lessening their supply of oxygen while the
tissues themselves were brought under the influence of the anaesthetic
which the blood stream conveyed to them. The next changes which
were brought about by the anaesthetic were those connectei with
respiration, circulation, and nerve regulation. In obedience to
stimuli conveyed from the lungs, diminution of the .amount of
oxygen or its excess lead to corresponding respiratory efforts. In
association with these were the somewhat complicated series of
changes in the blood-pressure, the cardiac rhythm, the dilatation and
constriction of the capillary areas which go to form the blood circula-
tion. Not only might these be thrown out of gear by impediment
to the pulmonary circulation arising from asphyxia, the commonest
danger of anaesthetics, but might be profoundly affected from without
through skin or visceral stimuH, leading to disaster. Under chloro-
form especially, the shock conveyed by the removal of a tooth would,
THE DENTAL RECORD. 78
if the anaesthesia were not deep in a certain number of cases, produce
reflex inhibition of the heart. That this reflex inhibition did occur, had
been proved by many observers, but the results of Amrus and Gartner
were conclusive. Even where the animal is deeply anaesthetised, they
found weak faradic currents applied to the vagus produced a very pro-
longed heart- stoppage. When the heart-pause had persisted for a
certain time, respiration also failed, and slight spasms succeeded.
Lauder Brunton insisted upon a form of death under anaesthetics
which was certainly a common one, and which, when recognised, must
relieve anaesthetics of responsibility in very many fatalites. Adopting
Caspar's views, he attributes these deaths to neuroparesis. Not only
do circulation and respiration fail simultaneously, but all the nervous
centres are instantly annihilated. The death is one of shock.
Anaesthetics were not simply dangerous per se. They too
frequently had to be given to those whose tissues were already in a
diseased condition. What, then, were the practical lessons our
present knowledge taught ? In general they must conclude that the
action of the anaesthetic should be restricted within those clearly
defined limits which involved only the higher ganglionic centres ;
that under no circumstances should incomplete anaesthesia be deemed
sufficient for even the most trivial operation.
Of methods, their present knowlege allowed them to say much,
but it was impossible for him to do more than indicate in the briefeit
way what rules should guide them. All methods involving asphyxial
symptoms were open to grave censure. In the case of all anaesthetics
it was possible to produce unconsciousness, and yet to avoid
cyanosis. Nitrous oxide, once thought to be an asphyxiant, was now
known to be a true anaesthetic, and to be capable to being given with
oxygen or air, and to produce peaceful anaesthesia without any
asphyxial phenomena. Of ether the same is true. Of chloroform it
must be said that any association between it and asphyxia must
lead in the healthy subject to grav3 peril, in the diseased to fatal
results. A word further. Close study of the behaviour of anaes-
thetics made him certain that all methods which employ a large
quantity of anaesthetic substances are faulty. The pneumonia, the
renal catarrh, the cardiac asthenia following anaesthesia are due, in
most cases, not so much to the anaesthetic as to the unwary way in
which it is employed. When anaesthesia is better understood, and
those who employ anaesthetics recognise more the responsibility they
74 THE DENTAL RECORD.
incur ; when the Examining Boards demand of their candidates at
least a nodding acquaintance with anaesthetics and their uses, then
will theie be fewer fatalities and more common-sense practice of this
branch of the healing art.
Mr. Stoker Bennett said that in the time he was justified in
occupying he could not do more than refer to two very interesting
points brought out by Dr. Buxton in his paper. First, the solution
of blood corpuscles that took place when chloroform had been
administered, and the very happy explanation of those otherwise
inexplicable deaths that occurred soon after the patient recovered
from anaesthesia. It had often seemed a mystery why a patient,
who had apparently recovered to a certain extent from the
anaesthesia induced by chloroform, without any adverse results,
should later succumb. Hitherto, the cause of these deaths had
remained unexplained, but Dr. Buxton's theory seemed correct, and
was a happy solution of the mystery. The second point was
the one alluded to as a sort of fatty degeneration that took place
when chloroform had been administered on several occasions. That
had a very practical bearing, for patients often came to the dentist
stating that they had had chloroform on more than one occasion,
and urging it as a reason why they should have it again. They
seeme(i to think that, having had it once, twice, or thrice without
any unfortunate circumstance arising, was a reason why they might
continue to have it. If, however, as explained by Dr. Buxton, each
repeated administration left the patient less capable of withstanding
the dangerous effects of chloroform, the dentist would in future feel
more strongly supported than ever in resisting the wish of their
patients to have chloroform administered.
Dr. Hewitt, responding to the invitation of the President, said
he had listened with the greatest interest and profit to the very
brilliant resume of the whole subject of anaesthesia which Dr. Buxton
had given them. He fully concurred in the views expressed by
Dr. Buxton. It was certainly their duty to interfere as little as
possible with the processes of life in the administration of anaes-
thetics, and that was the point which was so admirably brought out
in Dr. Buxton's paper. He did not know that he could add
anything to it.
The usual votes of thanks concluded the Meeting.
THE DENTAL RECORD. 75
DENTAL STUDENTS' SOCIETY, DENTAL HOSPITAL OF LONDON.
The Annual General Meeting of the Students' Society of the
Dental Hospital of London, was held on Monday, January 20th.
The President, Mr. F. J. Bennett, in the Chair.
The minutes of the last meeting were read and confirmed.
The President then declared the ballot open for the election of
Officers for the present 3^ear. Messrs. Dun lop and Carter being
appointed scrutators.
Mr. McKay (the Treasurer), after reading the balance-sheet for
the past year, said : In presenting to you this evening the Annual
statement of the Students' Society's Accounts, I should like to state
that although tha year's expenses have been satisfactorily met, the
Subscriptions from the students are not nearly so great as they
should be, in fact, but for our most generous staff, we should have
had to draw on the balance of former years. The two new features
of the year have been the insurance of the instruments of the
members at the Hospital, and a grant of ^5 for the purchase of
books for the Library.
Mr. H. W. Trewby (Secretary), said : In presenting you
with their 33rd Annual Report, your Council regrets that the Society
has not shown the usual progress. Your President has this year
very generously offered a prize for the best Casual Communication,
and the energy of the Members is shown by our Transactions. The
Society's prize has been awarded to Mr. N. G. Bennett, for his paper
on *' The Micro-organisms of the Human Mouth." Your Library
and Museum have received many additions, to the former your
President has contributed several books. The Microscopical
Demonstrations and Exhibits under the very able supervision of
Mr. W. J. May have been well attended, and it is with very great
regret that we hear of his intended resignation.
The President then called on Mr. McKay for his paper on
*' Amalgams." (See page 57.) In the discussion which followed : —
Mr. D. P. Gabell said amalgams made far more perfect fillings
practically than one would suppose possible after considering them
from a theoretical point of view. He thought any deep or sensitive
cavity should be lined with a thin coating of varnish before filling
with amalgam, this added greatly to their safety and comfort,
effectually preventing thermal changes. In using amalgam he
76 THE DENTAL RECORD,
thought it best to use it moist at first, and then add drier and drier
amalgam in com.pleting the filling ; and as the filling was setting the
use of the burnisher prevented shrinkage to a great extent. He was
in the habit of lining the cervical edge with gutta-percha in using
copper amalgam.
Mr. W. J. May thought certain amalgams gave better results if
they were mixed some little time before using.
Dr. Miller thought the use of varnish under an amalgam was a
decided advantage, he preferred sandrach varnish himself.
Mr. W. S. NowELL said he did not believe in the use of gutta-
percha in conjunction with amalgams, and if the cavity extended to,
or below the cervical edge did not employ copper amalgam, but used
some other kind which had not such a tendency to fail at this point.
He liked to use amalgams as dry as they could be worked with
comfort, and nearly always used a thin matrix. If it was gett'.ng
near a meal time he used tin cylinders to absorb mercury and
hasten setting. All amalgam fillings should be thoroughly polished
at a subsequent sitting, and special care should be taken to see that
the cervical edge was smooth, the bite quite free, and no amalgam
left under the gum margin. He had not tried varnish in this
connection, but employed osteo and amalgam combined as a lining
to a deep or sensitive cavity.
Mr. Douglas referred to the various properties of various amal-
gams, and the suitability of certain amalgams for contouring purposes.
Mr. McKay then briefly replied.
Mr. D. P. Gabell proposed a vote cf thanks to the President,
which was seconded by Mr. Douglas, and carried with acclamation.
The President then said a few words of farewell.
The names of the newly elected officers are : — President — Mr. J.
Colyer ; Vice-Presidents— Mx. D. P. Gabell, Mr. H. W. Trewby ;
Treasurer — Mr. Heath ; Secretaries — Mr. W. S. No well, Mr. Stanley
Colyer; Curator and Librarian — Mr. J. C. Douglas ; Second Yearns
Councillors — Messrs. Malone, Turner, Padgett, Myers and James ;
First Year's Councillors — Dr. Austen, Dr. Miller, Mr. Thew and Mr.
Woodhouse.
A vote of thanks was accorded to Mr. McKay for his paper.
The next Meeting was announced for Monday, February loth,
when Mr. A. R. Heath would read a paper on " Honeycombed and
Syphilitic Teeth." The Proceedings then terminated.
THE DENTAL RECORD. 77
THE DENTAL RECORD, LONDON: FEB. 1,1596.
GOLD AS A FILLING.
Like all the other ideas and inventions, that in recent
times have enriched our Science and Art, that of filling
teeth with cohesive gold has been abused. Gold having
been used from time immemorial for this purpose, it is
obvious that a new method of using a proved friend w^as a
great boon. To a certain extent it w^as, and is, possible to
contour fillings made with non-cohesive geld, but the poten-
tialities in this diieciion of gold worked cohesively are very
great. Theie is practically no limit to the extent to which
gold can be built up save the sufficiency of the base.
Otherwise it becomes purely a questi'^n of skill. But skill,
however laudable in itself, is often apt to overstep the
bounds of expediency. Gold is so beautiful a metal, and
fillings made with it have so cleanly and finished an appear-
ance, that it is perfectly easy to understand how attractive
is the view that this metal is jpar excellence the best filling
material. Thus it is easy to compreh<=^nd why a certain
school should regard gold filling in each and every ca"^e as
the ideal filling, and lo^k upon skill in its use as the test of
proficiency in the practice of dentistry. Such views have
perhaps not found such acceptance at hom^ as they
have in the States, nevertheless, it was by no means
an uncommon thine^ to hear, lack o^ time — duo to diffi-
culty in obtaining adequate remuneration — or reluctance
of the patient to the appearance gold fillings urged
as reasons for non-acceptan:e of this dogma. True it
is that many have objected to gold as a proper filling
for certain kinds of teeth, but we fancy we have de-
tected a greater freedom of citicism on this point at
recent society meetings than was the case some years ago.
We are glad to notice this tendency, not because we do not
fully recognise the use of gold, nor because we wish to see
diminution of skill in its use, nor lack of finish in the results ;
78 THE DENTAL RECORD.
but because we believe the use of gold has been and is abused,
and because if we once accept the belief that, even among the
somewhat narrow limits of fillinp!' materials known to us,
gold is always the best, we degrade ourselves into mechanical
gold fillers and narrow the possibility of finding other and,
perhaps, even better materials. What are the objections to
gold, and in what direction is it abused? It is abused when
used for large fillings in out of the way places, difficult of
access, and in which perfection is but rarely obtained. It is
abused when by the necessatily wearing tediousness, or
even pain, in its manipulation a weakly patient is worn out,
or so sickened of the very process as to neglect the care of
the teeth for the future. It is abused when its use in un-
needed places is made the excuse of taking money from a
poor patient. But over and above these and other perhaps
obvious abuses is the vexed question of expediency of its
use in certain kinds of teeth. This is a subject worthy of
more discussion than space permits now, but for this very
reason we welcome the evidence of others on this point, for
doubtless the clinical observations of careful men are even
more worthy of we^^ht than mnre r-jr le-^s theoritical deduc-
tions from experiments, no mattsr how carefully made.
Mtb3s antr ^atts.
Mr. J. Hopewell Smith has been appointed Lecturer on Dental
Surgery at the National Dental Hospital.
Mr. J. M. McMillan, L.R.C.S., L.R.C.P.Edin., L.D.S. Glasgow,
has been appointed Lecturer on Dental Surgery and Pathology to
the Dental Hospital, Glasgow, in room of Mr. Rees Price, L.D.S.
Eng., who has resigned ; and Mr. John G. S. Angus, L. D.S.Glasgow,
has been appointed House Surgeon to the hospital in room of Mr-
J. M. McMillan, above mentioned, who has resigned.
A Practical Tuition Class for the next Examination (May,
1896) in Mechanical Dentistry for the L.D.S. Eng. will be held at
THE DENTAL RECORD. 79
the Institute of Dental Technology and School of Mechanical
Dentistry. Mr. C. Browne Thomas and Mr. E. C. Dimock, L.D.S.
Eng., under the superintendence of Mr. W. Lombardi ; and will
include both Demonstrations and Practical Work, on Tuesdays and
Fridays, from 6 to 9 p.m., beginning February 4th and ending March
31st. Fee, 7 guineas, payable in advance.
The following have been appointed on the Dental Staff of the
Edinburgh Dental Hospital for a period of five years. Dental
Surgeons'. — Mr. Malcolm MacGregor, L.D.S. , Mr. George W.
Watson, L.D.S., Mr. J. S. Durward, L.D.S., Mr. James Mackintosh,
Mr. J. S. Amoore, L.D.S., Mr. J. Graham Munro, L.D.S. Assistant
Dental Surgeons : — Mr. Frederick Page, L.D.S., Mr. John Turner,
L.D.S. (leave of absence granted), Mr. David Monroe, L.D.S., Mr.
Thomas Gregory, L.D.S., Mr. H. B. Ezard, L.D.S, Mr. Sewell
Simmons, L.D.S., Mr. R. N. Hannah, L.D.S., Mr. Frederick J.
TurnbuU, L.D.S., Mr. J. Malcolm, L.D.S., Mr. Robert Lindsay,
L.D.S., Mr. D. Bailie Wilson, L.D.S., Mr. Thomas A. Mackintosh,
L.D.S., Mr. John A. Young, L.D.S. (ad interim).
The Students of the National Dental Hospital held a " Smoker "
on the nth ultimo at Ashley's Hotel, Covent Garden, Mr. Bland
Sutton in the chair. The gathering was most convivial, and the
programme excellent. Messrs. F. M. Farmer, Browne-Thomas,
Etheridge, and Guy Harper specially distinguished themselves
amongst the vocalists, and Mr. Yeatman-Woolf as a reciter. The
occasion was taken advantage of by the students to show their
appreciation and regard for Mr. F. M. Farmer by presenting him with
a handsome timepiece. It need hardly be said to those who know
Mr. Bland Sutton that he was very felicitious in making the presen-
tation. Mr. Farmer, in acknowledging, expressed surprise at the
kind feelings existing among the students for him, for he was afraid
as House Surgeon he had at times been somewhat harsh. Although
lie was severing his connection with the hospital, he should always
remember their kindly expressions towards him, and if in the past
his poor efforts with the National Dental men had been of service,
they would know where to find him, and he should always be
pleased to help them in any way in his power. A cordial vote of
thanks to Mr. Bland Sutton for presiding closed the proceedings.
80 THE DENTAL RECORD.
The 36th Annual Meeting in connection with the Birmingham
Dental Hospital was held on January 23rd, at the Council House,
under the Presidency of the Mayor (Councillor James Smith;. The
Surgical Committee reported that the work of the Hospital during
the last twelve munths had largely increased. The poHcy of reducing
the number of operations under ether, by employing nitrous oxide
wherever possible, had been carried out to a most satisfactory degree.
The work for the preservation of the teeth was nearly double that of
the previous year. Three students had obtained diplomas in dental
surgery, and eleven new students had entered the hospital during the
year. The operations performed from October ist, 1894, to
September 3o:h, 1895, numbered 21,127, compared with 18,336 in
the previous twelve months ; while attendance of patients numbered
9,801, compared with 9,733. The financial statement showed a
balance in hand of /116 qs. 2id., after clearing off the adverse
balance of £/[S 19s. at the end of September, 1894. The appeal for
funds which was issued in December, 1894, did not result in as large
an increase to the subscription list as was anticipated, the sum of
;^43 IIS. 6d. only being received. The Chairman referred with
pleasure to the increased usefulness of the institution. The hospital
was one at which the poorest could get the best skill, they could get
their teeth saved as far as possible The report from the surgical
staif, he thought, was very satisfactory, and they must be all very
much indebted to the staff for the ability with which they performed
their duties. The report was adopted. Mr. J. A. Jones moved the
thanks of the meeting to the honorary hospital staff and officers, and
Mr. J. M. Smith seconded the motion, which was unanimously
agreed to. Mr. Huxley then proposed the election of the Mayor
(Councillor James Smith) as President, Lord Calthorpe as Vice-
President, Mr. J. Wilton as Hon. Treasurer, and Mr. W. C
Addinsell as Hon. Secretary for the ensuing year. The resolution
v.as seconded by Mr. Donagan, and agreed to. On the motion of
Mr. W. Thomas, seconded by Mr. Barrow, Messrs. F. R. Howard,
W. T. Madin, J. Mountford, and J. E. Parrott were appointed Hon.
Assistant Dental Surgeons ; and Mr. Phihp Bates was elected Hon.
Auditor. The proceedings closed with a vote of thanks to the
Mayor for presiding.
THE DENTAL RECORD. 81
We regret to record that Mr. George Gregson passed away on
January 17th, after a long illness. Mr. Gregson will be lamented
by all who had the pleasure of his friendship. He was a man of
a cheerful, gentle manner, who was known to many generations of
students as a teacher, who taught kindly and well. He studied at
the Middlesex Hospital, taking theL.D.S. in T862 and theM.R.C.S.
a year later. In due course he was elected an Assistant Dental
Surgeon and afterwards Dental Surgeon to the Dental Hospital
of London. For many years he was the senior Surgeon to this
hospital and Chairman of the Medical Committee, indeed, it is but
recently that he retired, amid the universal regret of his colleagues.
He was a very old member of the Odontolo^ical Society of Great
Britain, having been elected in 1857, and he retained his membership
to the last ; in 1884 he was a elected a Vice-President of the Society.
He was also for some time Dental Surgeon to the Metropolitan
Free Hospital. He was a Fellow of the Royal Geographical
Society and a member of several medical and dental societies,
though he took no very active part in these nor in dental
politics. It must have been obvious to those who met Mr.
Gregson during the last year, that his health was not as good as
formerly, though he apparently did not admit it to himself ; few,
however, expected his early death, which is to us, and we are sure
to others, a great grief. Mr. Gregson was unmarried. He was
elected a director of the Dental Manufacturing Company in 1879.
He took a keen interest in the progress and welfare of the Company,
and retainel his seat on the Board until his death. He ifras a very
regular attendant at the Board meetings, and was much respected by
his colleap'ues.
I^gaL
THE DUNDEE DENTAL PROSECUTION.
In Dundee Sheriff Court, on January 17th, A. Davie, South
Lindsay Street, was charged with offences against the Dental
Acts, the complainer being the Honorary Secretary of the British
Dental Association. The complaint, which was laid under thii
Summary Jurisdiction (Scotland) Acts, 1864 and 1881, and the
Criminal Procedure (Scotland) Act, 1887, set forth that A. Davie,
F
82 THE DENTAL RECORD.
3, South Lindsay Street, Dundee, not being a person registered
under the Dentists Act, 1878, and not being a legally qualified
medical practitioner registered under the Medical Act, 1886, did at
the times and places mentioned in the complaint represent himself
as a person registered under the said Dentists Act, or that he was a
person specially qualified to practice dentistry, and was a legally
qualified medical practitioner registered under the said Medical Act,
or as possessing one or more of these characters and qualifications,
by having, during the last five months of 1895, had attached to the
gables of his house or the windows, ''A. Davie, successor to
Dr. Stewart," and during a portion of the time the additional
words " Surgeon Dentist," the said Dr. Stewart having been a duly
registered dentist. He was also accused of having displayed on the
east gable a side-board bearing the words, '' Mr. A. Davie, successor
to Dr. Stewart. Teeth, teeth, teeth," &c. The fourth head charged
him with advertising in somewhat similar terms on the private
lamps in front of his house ; the fifth with using the name or title
of "dentist" by having it cut on a stone on the pavement ; the
sixth with having inserted in the ** Dundee Directory " of last year
the title, sddition, or description of " Dental Institute" along with
his name the seventh with causing to be inserted in the same
publication an advertisement wherein there were inter alia " popular
dentistry, ** dentist," "surgeon dentist," "successor to Dr. Stewart ;''
and the eighth charged him with inserting an advertisement in the
Evening Telegraph with references to his work and charges, hours
of attendance, and signed " Mr. A. Davie, successor and ten years
branch manager to Dr. Stewart, South Lindsay Street, Dundee.
Established 1842." All these charges, it was alleged, Davie
committed contrary to the Dentists Act, 1878, Section 3, as amended
by the Medical Act, 1886, Section 26, whereby he was liable in a
penalty not exceeding X^o-
Mr. Andrew Buchanan appeared on behalf of the complainer,
Mr. H. S. Glenny represented the accused, and Mr. A. M. Ferguson
watched the case on behalf of the Unregistered Dental Practitioners'
Association.
Mr. Glenny took exception to the complaint on the ground that
the prosecutor was not present himself. Section 9 of the 1881
Summary Jurisdiction (Scotland) Act — one of the statutes on which
the complaint proceeded — provided that every complaint at the
THE DENTAL RECORD. 83
instance of a private prosecutor or complainer under the Summary
Jurisdiction Acts must be signed either by the prosecutor or
complainer or by a duly qualified law agent on his behalf, and such
law agent might in the absence of the private prosecutor appear in
Court and conduct the prosecution on his behalf. The complaint
was signed, not by a law agent, but by the prosecutor himself. In
these circumstances the authority which this Act conferred upon a
duly qualified agent to appear on the prosecutor's behalf did not
exist. It was only when the complaint was signed by an agent on
behalf of the principal that an agent could appear. If a principal
chose to sign the complaint himself he must conduct the prosecution
personally.
The Sheriff asked what was the statutory authority for this
English gentleman appearing at all as a prosecutor in a Scotch
Court ?
Mr. Glenny replied that he supposed the authority was conferred
by Section 26 of the Medical Act, 1886, which made a complaint
possible at the instance of a private prosecutor, where such a
complaint had only previously been possible at the instance of the
Council.
The Sheriff — The Medical Council ?
Mr. Glenny said he wished the prosecutor had been present
himself, because they would have had some interesting information
from him as to the actual position of the body of men calling
themselves the British Dental Association. A private prosecution
was possible, but whether at the instance of an English gentleman
was questionable.
The Sheriff — What kind of prosecution is it ?
Mr. Glenny — It is a prosecution for a statutory offence.
Mr. Buchanan — Imprisonment being competent make? it
criminal.
Mr. Glenny — Imprisonment is only possible if the fine is
not paid.
The Sheriff — Will that make it a criminal offence ?
Mr. Buchanan — A quasi-criminal offence.
The Sheriff — If it is a criminal case it must be sent to the
Fiscal.
Mr. Buchanan said it was brought under the Dentists Act
of 1878.
F 2
84 THE DENTAL RECORD.
The Sheriff — This gentleman who prosecutes is a private person
only ? He does not prosecute in an official capacity ?
Mr. Buchanan — I have inserted the designation of the prosecutor
in order to remove any possibility of a suggestion on the other side
that it was a trumped up case.
Mr. Glenny said the statute did not prohibit a man from
practising as a dentist, but it prevented him from using the term
dentist or dental practitioner, or words which would imply that he
was registered under that Act; or that he was a person — and this
was the crux of the whole case — not " qualified to practise," but
'* specially qualified to practise dentistry." Unless the Prosecutor
could show that his client had been representing himself to be a
person specially qualified in the sense of the Act there could be no
case against him.
The Sheriff said he could not sustain the objection. As he read
the Act, a private prosecutor might do the work himself if he
liked, or he might employ a qualified legal practitioner to do it for
him, or he might do part of the work and get a qualified legal
practitioner to do the rest. It was a very common practice for a
private prosecutor to sign papers and get a legal practitioner to do
the work. His Lordship had had several poaching cases before him
that day, and all the complaints, if he remembered aright, were
signed by policemen. A qualified legal practitioner, however,
appeared to lead evidence.
Mr. Glenny asked the Sheriff to note his objection in view of the
case going elsewhere.
The Sheriff — I see plenty of confusion for the case to go anywhere.
Mr. Glenny said there were two " A. Davies " at the address
stated in South Lindsay Street. He did not know which one his
friend was to take.
The Sheriff — Take them both.
Mr. Buchanan — I'll take the man the complaint was served on.
Mr. Glenny proceeded to object to the relevancy of the sixth and
seventh counts.
The Sheriff — It is a very long document. This prosecutor must
have been descended from some Scottish evangelical preacher. His
complaint has eight heads.
Mr. Glenny continued that the sixth count was entirely irrelevant,
for the reason that the locus and time were not stated. The same
THE DENTAL RECORD.
85
objection applied with equal force to the seventh count, it having
to be averred also that the offence was committed within six months
of the date mentioned. With regard to counts three and eight, it
was said that his client was contravening the Act by having attacned
certain words to the gable of his place of business. But he would
point out to his Lordship that these words applied to Mr. Davie's
work, not to Mr. Davie himself. In count number eight the words
" a marvel of cheapness — unequalled in the profession " were taken
exception to.
The Sheriff — What profession is referred to ?
Mr. Glenny — Profession means anything. I have known a man
who was a joiner subsequently register to draw teeth, and call
himself a professional man. Mr. Glenny then went on to speak of
the business conducted by the late Dr. Stewart. That busmess had
been carried on by the deceased gentleman for many years, and
amongst his servants was Mr. Davie, who managed several of his
branch establishments.
Mr. Buchanan objected to Mr. Glenny leaving the question of
relevancy.
Mr. Glenny said he was endeavouring to show that Mr. Davie
was no quack.
Mr. Buchanan — That, my Lord, is a question for proof.
Proceeding, Mr. Glenny stated that after Dr. Stewart's death his
widow continued to conduct the business with the aid of assistants.
After a time she sold the business to Mr. Davie, and he entered into
the premises as successor to Dr. Stewart in May, 1895. Dr. Stewart's
old sis:ns were then existing. Having been registered under the
rvct. Dr. Stewart displayed such signs as ''surgeon dentist,"
"dentist," &c., and particularly he had engraved on his windows the
words " surgeon dentist." That was the condition of matters when
Mr. Davie took over the business. That was not the position of
matters now, however, for Mr. Davie had had every objectionable
sign removed, and his Lordship was asked to punish him for an
offence which he had never committed. Disguise this complaint
how the prosecution might, heap charges upon charges as they
liked, the glaring fact remained that this was an attempt by the
registered dentists to elicit a legal opinion on the question of whether
an unregistered dentist was entitled to advertise. That was at the
bottom of the whole complaint, and nothing else. Under their
86 THE DENTAL RECORD.
regulations the registered dentists were prevented from advertising
They got their diplomas upon the condition that they did not
advertise, and they gave a guarantee that they would not do so.
But they were feeling the pinch of those gentlemen who were
equally capable, but who did not care to become registered under
the Act. That was the position of affairs. They were brought face
to face — disguise it as they might — with an attempt on the part of
the Dental Association, with comparatively few members, to force
upon people who were not subject to their jurisdiction an offence and
penalty for advertising their business. Mr. Glenny then read
the advertisements complaii ed of, and pointed out that in none of
these advertisements did a word about dentistry appear, and he
submitted that in so far as they did not imply that Davie was a
person " specially " quahfied to practise dentistry he committed no
offence. Proceeding, he said although there was a penalty against a
man practising medicine there was no penalty against a man
drawing teeth.
The Sheriff — Except an action for damages for pulling out the
wrong one.
Mr. Glenny said he objected to the complaint on the ground not
only that it must specify that he was not a person registered under
the Act, but it must specifically state that he did not fall under one
of the exceptions of the Act.
Mr. Buchanan said Mr. Glenny had missed the most important
part of the complaint. He was charged with a specific breach of a
statute, and the complaint mentioned eight different ways, in any
one of which the prosecutor could prove that he had committed an
offence. If the prosecutor proved one of these ways he was entitled
to a conviction. Count number three of the complaint dealt with
the signboard, in which it was stated that he was the successor to
Dr. Stewart, who was a registered dentist. Mr. Davie was not in a
position to carry on the practice that Dr. Stewart did, and in using
the words ''successor to Dr. Stewart" he was using words that fell
within the terms of the Act of Parliament. If a man advertised
himself as successor to Dr. Stewart, he thereby implied that he was
a man in the same position and qualified to do the same business as
the gentleman to whom he said he was successor. Mr. Buchanan
then quoted a number of authorities in support of the relevancy of
the counts of the complaint.
THE DENTAL RECORD. 87
The Sheriff said he read the Act to mean that it was to be penal
for any man to call himself a dentist or dental practitioner, or to use
any such words as would have the effect of passing himself off as
registered under this Act of Parliament and that he was specially
qualified to practise dentistry. That was to say, that he was
sufficiently qualified to practise dentistry as to entitle him to be
registered. Tt was to stop a representation of that kind, unless
where the person was registered. It was to provide that a man
working among teeth, and professing to do what was necessary in
the way of pulling and stuffing them, should be properly qualified,
and that he should not pass himself off as a registered practitioner
unless he was actually registered. The question here was whether
in this complaint there was enough to set forth that Davie had
violated the provision of the Act by passing himself off as a dentist,
dental practioner, or a man so qualified as to be capable of being
duly registered under the Act. He thought the complaint
sufficiently set forth that Davie violated that provision of the
Act of 1878. The objections to the relevancy of the libel had been
stimulated and probably induced by the prosecutor giving^ rather too
much information — more information than he was bound to give in
the way of details — and in giving, in fact, a sort of synopsis of a
precognition. All that required to be stated was that within a
certain time — within six months — Davie used the term '' dentist "
and made other representations to the effect that he was a registered
practitioner under the Act. Mr. Glenny had referred to the
exception in the case of medical practitioners, but his Lordship
thought the doctrine had been laid down and acted upon in England
that where an exception was to be pleaded in defence it was for the
accused to prove the exception, and that it was not necessary to
negative the exception in the complaint or by the evidence adduced
in support of the complaint. The result of legislation like this was
to set aside certain professions for certain people. A man might be
qualified to be a Professor of Chemistry, and yet be prosecuted if he
were to sell goods upon the representation that he was a chemist. The
word dentist was rendered sacred to this registered body, and no one
was entitled to use it unless a member of that body. If a prize-
fighter called himself a dentist he would be liable to prosecution
under this Act of Parliament, although he had no instruments for
extracting teeth except his fists. This legislation had for its purpose
88 THE DENTAL RECORD.
the preservation of innocent and gullible members of the public
from believing representations that were made, and from trusting
themselves to the skill of persons who pretended to be doctors,
chemists, and dentists, and who had no proper skill or qualification,
and who might do a great amount of mischief to them ; and it was
left to a private person sometimes, and in other cases to public
authorities, to prosecute. In regard to the title to prosecute here,
there could be no doubt whatever, except that the prosecutor
seemed to be an Englishman. Any dentist in Dundee, so far as his
Lordship could judge, could have prosecuted just as well. As to the
objection that the date of the adv^ertisements was not given, all that
it was necessary to show was that the course of misrepresentation
went on within six months. *' Successor to Dr. Stewart " was an
ambiguous term. It might mean successor to some part of his
business, or to his house, but it did not prove much and certainly
did not prove that Davie represented that he succeeded to Dr. Stewart
because Dr. Stewart was a registered dentist, and that he also was
the same. Some people might reason that way. There was a
St. Andrews story his Lordship had heard that implied that kind of
reasoning. A gentleman who used the title of Major was once
golfing in St. Andrews, and some one asked his ** caddie " to what
regiment the Major belonged. The " caddie " said — " Weel, I dinna
think he's a Major at a'. He married a Major's widow, and keeps up
the title." That was the kind of successor it might have been. His
Lordship concluded by remarking that he would have been glad to
avoid proof in this case, but he did not see it was possible to do so.
After some conversation with the agents as to the nature of the
plea to be tendered, the Sheriff said he did not think it was a
serious case at all. It did not require a gentleman from London
to protect the teeth of the people of Dundee, as the Small Debt
Court could do it as well.
Mr. Davie finally denied the charge, and the case was continued
till Monday ^or proof.
On the resumption of the case on January 20th —
Mr. Glenny stated that, following on what took place on Friday
last, the agent for the prosecution and he had had several consulta-
tions regarding the matter. The result of these consultations was
that they had adjusted a limited plea. The specific charges 3, 4, 5,
THE DENTAL RECORD. 89
6, 7, and 8 were all withdrawn. Under i and 2 accused proposed
giving a limited plea that during a portion of the time mentioned in
the libel he contravened the Dentists Act, section 3, by having the
words *' Dr. Stewart, surgeon-dentist," upon the windows of the
premises of which he was a tenant.
Mr. Buchanan, who intimated his acceptance of the plea, said,
under the section of Act, the penalty was a fine not exceeding ^^20
and expenses.
The Sheriff — Where do you find expenses ?
Mr. Buchanan — Under the Summary Jurisdiction Act.
Mr. Glenny said he was afraid he could not plead that a private
prosecutor was not entitled to expenses, although a Public Prosecutor
was not entitled to them unless the Act under which he prosecuted
specially allowed them.
The Sheriff — What is to become of the fine if I impose it ?
Mr. Buchanan replied that the Queen's Remembrancer had sent
out a circular to the effect that the fine was to go to the Exchequer.
The Sheriff said he did not know the Queen's Remembrancer
had power to supplement Acts of Parliament.
Mr. Buchanan — It would probably fall on a Treasury minute.
Mr. Glenny stated that his client had pleaded guilty to a very
technical breach of the Act, and that being so, it was only a case for
a nominal penalty. It was the first prosecution of the kind in
Dundee, and it was not the aggravated offence of a person actually
putting up the words complained against, but it was the simple
infringement of allowing words which previously existed to remain
for a longer time than perhaps should have been done. Mr. Davie
became successor to Dr. Stewart on 28th May last, and at that
time there were a large number of signs up, and, so far as prac-
ticable, Mr. Davie removed all those signs between the time of his
entry and July. The words he had pleaded guilty to using were
painted upon the windows, and they remained there till September.
The reason why these signs were left so long was partly on account
of the painters' strike, which lasted for six months, and only ter-
minated some time in July. Following upon the settlement, there
was a fortnight's holiday. He submitted that the sign was removed
with all reasonable despatch. It was not there now, nor was there
any sign which was objectionable to the Act. The word " dentist"
on the carriage door step, which was cut out by Dr. Stewart, was
90 THE DENTAL RECORD.
cemented up in July, and when it was picked out by boys it was
again cemented up. Mr. Davie had done his best to prevent a con-
travention of the Act, and he had no intention whatever of contra-
vening the Act in the future. Seeing that it was not a sign actively
put up by him, but one that was passively allowed to remain, it was a
case for a very modified penalty. Mr. Davie had incurred considerable
expense in the case already, and the plea which had been accepted
had been offered all along.
Mr. Buchanan said he wished to controvert the statement made
by Mr. Glenny that this was a merely technical breach of the Act.
Accused had pleaded guilty to using the words "surgeon-dentist"
on the windows of his premises during a portion of the time between
July and December.
The Sheriff — Is it not rather an encroachment of the freedom of
English speech to set apart the word ** dentist " for the use of 300 or
400 men ?
Mr. Buchanan — There are some 3,000 or 4,000.
The Sheriff — The English language would become very scarce of
words by and by if every 3,000 or 4,000 people were to claim one
single word.
Mr. Buchanan — There is no getting behind the Act of Parlia-
ment. The same principle applies to veterinary surgeons and
chemists.
The Sheriff — There is no Act of Parliament against using the
word *' Doctor," except in a certain sense.
Mr. Buchanan — There is an actual Act of Parliament here. I do
not think we can go beyond that. Using the words " surgeon-
dentist " does not form a merely technical breach of an Act which
prohibits an unqualified person using the word " dentist " at all.
The Sheriff — He may have been in furnished apartments.
Mr. Buchanan — He has pleaded guilty to being a tenant of the
premises.
The Sheriff — Lodgers cannot meddle with landladies' windows.
Mr. Buchanan — Even if he had been a lodger and used the words
he would have been hable under the Act.
The Sheriff — If he used them ; but if he merely looked at
them.
Mr. Buchanan — If by the use of the words he induced people to
enter his premises and operated on their teeth he would be liable.
THE DENTAL RECORD. 91
The Sheriff — He is no*: charged with drawing teeth.
Mr. Buchanan — He is charged with representing himself as a
dentist, and has pleaded guilty to that.
The Sheriff — It would be a far stronger case if it were proved that
he said to some one that he was a registered dentist.
Mr. Buchanan — I am not bound to enter into that.
The Sheriff— That is the reason I did not sustain the plea of
irrelevancy.
Mr. Buchanan referred to previous prosecutions in Cupar and
Edinburgh, and stated the penalties imposed ranged from £2 los. to
^7, with expenses.
Mr. Glenny — There were several cases in England and Ireland
where the expenses had been modified to £1 is.
Mr. Buchanan — I never heard of them.
The Sheriff — Acts of Parliament ought have reason and justice at
the back of them. Can you tell me what justification there is in
reason for the imposition of a penalty on a man calling himself a
dentist ?
Mr. Buchanan — It is to protect the public.
The Sheriff — That is to say, to secure to the public that the man
who does the work of a dentist shall be properly qualified ?
Mr. Buchanan — Yes.
The Sheriff — The public generally can protect themselves against
people improperly skilled.
Mr. Buchanan — Probably after experience.
Mr. Glenny — My information is that there is only one registered
dental practitioner in Dundee who is qualified by University training
for the practice of dentistry.
Mr. Buchanan — I am afraid I must contradict my friend.
The Sheriff — I do not see how it requires a University training
to be a dentist any more than it requires such a training to be a
cabinetmaker or a jeweller.
The Sheriff said it was his duty to administer the law — both
statute and common — according to its fair meaning and intent. It
was no part of his duty to scrutinise the principles of justice that
underlay a statute, except in so far as to see that he did not carry its
effects if he could help it beyond the confines of justice. Every penal
Act required to be strictly construed, more especially an Act
imposing penalties, which had the double purpose of protecting
92 THE DENTAL RECORD.
a monopoly and protecting the public. The latter was a social
necessity : the former was not, unless in so far as it contributed to
the latter. No monopoly could be justified by the principles of any
code of social philosophy except ttie princi{)le that the special mono-
poly was upon a wide view of the interests of society for the greater
advantage of the whole community. That alone in the field of right
and wrong could justify interference with individual freedom — that
was with the unfettered freedom of trade and of personal skill and
labour. The professions of law and of medicine were strongly
fenced in as monopolies because a special education and standard of
attainment was expedient in the public interest to protect bodily
health and organic structure and function from the experiments of
rashness and of ignorance, and the property and freedom of indi-
viduals from the exhortations of persons with zeal without knowledge,
and the irresponsible advices and devices of swindlers and beggars.
The Church was not so well fenced in except as to manses and
stipends and creeds established by statute, or settled by contract,
because the religious advice of fanaticism and of ignorance sometimes
did good even in the way of amusement — and beyond sending an
occasional nervous weak-minded person to a lunatic asylum never
did any harm. That dentistry — that branch of the medical and
surgical art which related to the care of the teeth — should be constituted
a monopoly in the interest of specially skilled qualified persons, but also
in the interests of the public, he was very far from doubting. He
thought no one should be induced to trust a single tooth, however
ruinous, to an artist who pretended to have had a special dental
education of the kind that was guaranteed by his being enrolled in a
statutory register, when in point of fact he was not. On the other
hand, he did not see why a joiner or a blacksmith, or a barber, or any
one that could use the pinchers should not draw a tooth if the person
upon whom he was to operate was not deceived as to the nature and
extent of his dental skill ; or why a jeweller who worked in gold and
precious stones should not make and do the necessary setting for
false teeth, or of real teeth which had lost their natural foundations.
When he looked anxiously for the only principle that could justify
this prosecution, he ascertained that it was not to support a mono-
poly, though that might be a consequence of it, but to put a stop
to the practice of deception (if the deception be without purpose)
or of positive fraud (if the deception be set about with intent to
THE DENTAL RECORD. 93
deceive). He had already decided that the use of the term
dentist and dental practitioner was forbidden to all except regis
tered dentists under the Act of 1878, and the Medical Acts
providing for registration. He might think that the statutory
consecration of a word like " dentist " to the exclusive use of the
institute of registered dentists or any other trade unior,, however
educated and genteel its membership, was an interference with the
free use of the English language which had no proper justification ;
but he had not been able to discover how he could help himself
when he found that under a similar Act of Parliament Mr. Justice
Hawkins, one of the most acute and accurate logicians in England
and one of the most liberal minded and rationalistic occupants of
the English Bench decided that it was penal for a tradesman so
unscientific as a sioer of horses, which was to a greater and less
extent the calling of every country blacksmith in Scotland, to
describe on a signboard his establishment as a '* veterinary forge,"
though the Sheriff fancied if he were like most English horse-
shoers he would have described himself as a "veteran forger," or
by any other flaunting epithet, with the serene indifference of
ignorance. His Lordship had held the libel relevant, because he
must, and might have had to determine whether it was proved,
and, if proved, whether the deception was innocent and unconscious
deception. The plea of guilty now tendered and accepted, rendered
it unnecessary that proof should be led. The plea involved admission
on the part of the accused, after taking possession of the premises
occupied by the late Dr. Stewart, that he allowed the words
surgeon-dentist, painted on the widows for Dr. Stewart, and
correctly designating him, to remain from June to September,
when they were removed, as he understood, voluntarily, and not
under threat of this prosecution.
Mr. Buchanan — With all due deference, my Lord, yes.
Mr. Glenny — With all due deference, my Lord, no.
Mr. Buchanan — He was warned by the Association.
Mr. Glenny — The order to do this work was given long prior —
immediately on Mr. Davie's entry.
The Sheriff said he took the deception caused by the allowing of
these words to remain to be presumably — and was obliged to presume
all that was possible in favour of innocence — to involve the minimum
of guile or fault in so far as the statute was concerned. It would
94 THE DENTAL RECORD.
have been a very different thing if he had passed himself off to an
individual as a registered practitioner. The criminality of failure to
remove two painted words did not appear to his Lordship to be great
when weighed in the scales of morality, and, if possible, still less when
weighed in the scales of Mammon. He had no reason to believe
that this unregistered dentist ever did any harm to the public
or any member of it, considered merely as a member of the public.
If he did, the law of reparation could be invoked against him. He
believed accused had rendered cheap dental services to the poor. He
doubted if he had deprived any dental registered monopolist of any
lucrative part of his business. At all events, he did not feel bound
to support any monopoly by the imposition of a vindictive punish-
ment. The fine he imposed was the nominal one of is., and the
expenses he allowed by way of enforcing and advertising the statute
were £2 2s., the alternative being six days' imprisonment. — The
Dundee Advertiser.
At the West Ham Court, on January 2nd, Ernest H. Richards, of
Zingari Terrace, Gipsy Lane, Forest Gate, was summoned before
Mr. Bagallay for taking and using the title of dentist without being
registered as such under the Dentists Act. Mr. Frederick George
appeared for the complainant, Mr. G. R. Mailand, a registered
dentist of Romford Road, Forest Gate. Mr. Pettifer defended. On
December 31st, Mr, Matland, accompanied by a lad in his employ-
ment, went to the defendant's place at Gipsy Lane, and asked to see
the dentist. He was told the dentist was engaged, but he afterwards
saw the defendant. He told him his *' teeth were shaky," and he
wanted the assistance of a dentist, and the defendant, after examining
his mouth, said he would do what was required for los. 6d. Mr.
Matland said he would consider the matter, and after he had had the
boy's teeth looked at and received the defendant's advice, Mr.
Matland asked to have a cast of his mouth taken, and paid 2s. 6d^
deposit. The defendant gave a receipt for the money, and also
handed Mr. Matland a circular which read, " Mr. Richards, late with
Mr, Goodman, surgeon-dentist." Mr. Pettifer admitted that the
defendant was not registered as a dentist. He was a manufacturing
dentist, and when persons called on him to have operations performed
he took them to another dentist. Mr. Bagallay said the Act was
THR DENTAL RECORD. AS^
desipjned to pretect the public as well as dental practitioners. The
defendant had clearly by his documents represented himself to be a
surgeon-dentist, but he was admittedly not registered. He would be
fined £^ and £\ los. costs.
THREE NEW DRUGS.
Gaiacoleine. — Prepared by C. Andre, of Paris. Agents :
The Dental Manufacturing Company.
The anaesthetic action of Guaiacol has been but recently
observed. Gaiacoleine is a mixture of chemically pure Guaiacol
with olive oil, which has been treated with chloride of zinc to
precipitate the resins and colouring matters, washed with alcohol
to remove the acids, and then heated for some time. It is claimed
for Gaiacoleine : that it is an absolutely inoffensive medicament,
producing neither general nor local complications ; that no local
irritation will occur if the lotion of the Guaiacol is properly pre-
pared. The anaesthesia with Guaiacol is said to be deeper and to
last much longer than that with Cocaine.
Chinosol. — Prepared by Fritzsche & Co., of Hamburg. Agents :
The Dental Manufacturing Company.
A product belonging to the Chinoline series, is a crystalline
powder of a yellow colour possessing a slightly aromatic odour
and an astringent taste. It is readily soluble in cold water and
insoluble in ether or concentrated alcohol. It is a perfectly stable
salt, keeping well in every climate and it is not hygroscopic. It is
stated to be non-caustic, extremely diffusible, not to coagulate
albumen, to be absolutely non-toxic, and to act as an efficient
deodorizer.
Dr. Rapp, of the Munich University, in order to test the toxity
of Chinosol, injected a rabbit subcutaneously with 20 centi-
grammes of Chinosol in 10 grammes of water, and during the
three following days the animal was given by the mouth 85.
grammes of the drug, that is to say abcut 130 grains. No ill
effects of any kind were noticed at the end of the third day.
96 THE DENTAL RECORD.
Professor Dr. Emmerich, of Munich, reports that Chinosol
possesses the power of arresting the growth and of kiUing bacteria
in a much greater degree than does carboHc acid. Even in as
weak a solution as i : 40,000 Chinosol checks the development of
the pus organism, and this fact explains the excellent results
obtained from its use in the treatment of ulcers and septic wounds.
It presents the further advantage that the alkaline reaction of the
secretion sets free oxychinole in a state of very fine division by
which the effects of the latter are markedly enhanced. He
satisfied himself that even in concentrated solutions Chinosol has
no caustic action and does not coagulate albumen at ordinary
temperatures, thus conferring upon it great powers of penetration
in respect of the tissues.
For the convenience of Physicians and Surgeons Chinosol is
made up in tablets of one gramme=i5 grains. Proportionate
solutions can be made as follows —
I tablet in 5 fluid ounces of water=i : 150.
I „ „ 10 „ „ „ =1 : 300.
I ,, „ I pint „ =1 : 600.
I J, „ I quart ,, =1 : 1200.
I „ „ 1 gallon „ :=i : 2400.
' I „ „ I „ ,, = I : 4800-
It is not advisable to use Chinosol for the disinfecting of
instruments, because steel and iron in contact with Chinosol turn
black in a like manner as when brought into contact with vinegar
or fruit. It does not, however, attack the metal, and the stains
produced by it can easily be removed by the aid of a little
whitening.
Ferropyrin. Agents : Thk Dental Manufacturing Company.
Ferropyrin is a styptic. It is claimed that it acts quickly,
does not stain the teeth and leaves no disagreeable taste in the
mouth, that it also acts as a local analgesic. It forms with blood
a black granulated surface which keeps for several days. After
extraction of a lower tooth Ferropyrin is applied by placing the
powder direct into the alveolus with a little spoon, or after an
upper, a little moist wadding is dipped into the Ferropyrin, and
the adhering powder is then wiped into the alveolus.
The dental RECORD.
Vol. XVI. MARCH 2nd, 1896. No. 3.
©rigtnal ®0mmuttit:ati0ns.
NOTES ON THE TREATMENT AND FILLING OF TEETH.
By W. Cass Grayston, L.D.S.
( Co n tin ued fro m page 56.)
Having opened the cavity, the next step is the removal of the
decay. This is easily accomplished (unless very sensitive) by the
use of sharp spoon and hatchet excavators of various curves and
sizes. Now, with the exception of the labial walls of front teeth,
break down all frail overhanging enamel at all parts, and be
particularly thorough in this respect at cervical walls.* This can
be easily done by placing a spoon excavator at the edge just outside
the cavity, and breaking it down by inward pressure. The plug
trimming files (Smith's discs and Rhein's trimmers) are also very
useful for supplementing the spoons and for trimming edges generally.
Use chisels, or sharp em^ine burrs, or both, for cutting away the over-
hanging enamel in crown cavities, and also for frcjingand smoothing
the lateral walls of approximal cavities. Sjrape, cut, burr or file
cervical walls, as is most convenient. Be careful to bevel cervical
walls and all coronal walls, whether for crown cavities or the coronal
part of approximal cavities. As a general rule, bevel all edges of
cavities if gold is to be used, except the labial walls of front teeth
when this edge is exposed, or the walls of labial cavities in general.
It is easier to carry the gold over a bevelled edge and to correct any
• Cavities that are to be filled with gold are alluded to, not frail shells that
can only be filled with soft plastics.
VOL. XVI. G
98 THE DENTAL RECORD.
imperfections by subsequent surface condensation. If, however, the
edge is left square and the access to all parts of it isleasy a finer, cleaner
edge will appear when the filling is finished. On coronal surfaces
the force of mastication will tend to further condense and rivet the
pold down if the edges are bevelled. Having removed decay and
trimmed the edges, proceed to make the retainage (the final finishing
of the edges should be done just before the insertion of the gold).
Retainage. — In a crown cavity of medium depth, it is only
necessary to cut the floor fairly flat, and if the walls are at right angle
to the floor, giving the cavity somewhat the shape of a box with the
lid off", the filling will be retained without any undercutting. If the
cavity is fairly deep and the orifice not very large, the walls may even
diverge somewhat outwards, and the filling, if carefully packed, will
still remain firmly in place. In shallow cavities with a large orifice
a slight undercut groove may be made all round the bottom of the
cavity with an inverted cone burr or suitable excavator if the cavity
is round, and if it is oblong, a distinct pit or undercut may be made
instead at each end. If there is any fear of weakening a crown cavity
wall by undercutting, or even by cutting it at right angles to the
floor, it may be left sloping outwards, and a counterbalancing
undercut made at some strong part of the cavity. When cracks
or fissures running from a crown cavity are to be cut out and filled,
they should be deepened suflBciently to retain the gold, or an
undercut pit may be made at the enJ of each fissure.
In making an undercut for purposes of retainage, it must be
understood that the making of distinct pits or holes in the dentine
is of very little value (except as starting points) unless the orifice of
the pit is fairly broad. There is very little strength in a narrow
neck of gold which unites the main body of the filling to that
which is in the undercut, and if a filling is dislodged, it is a common
occurrence to find the gold remaining in the pits, the filling itself
having broken away at this connection. A general inward slope of
one or more walls of the cavity forming a dovetail is the strongest
kind of retainage, and next to this a groove or grooves, if possible,
slightly dovetailed.
All retainage must be made in accessible places. It is no use
making an accessible part of a cavity either inaccessible or difficult
of access by undercutting, and it must not be forgotten that to
\
THE DENTAL RECORD. 99
I
make an undercut takes up time and often causes pain, and that to
fill the undercut also takes up time, it therefore may be laid down
that it is distinctly advisable to make retainage in places that are
readily reached and can be readily and accurately filled, and that no
more undercutting should be done than is absolutely necessary.
The methods of securing retainage in crown cavities will apply to
all cavities surrounded by four walls and freely exposed, viz., on the
labial, buccal and lingual surfaces, and sometimes on approximal
surfaces, where the adjacent tooth has been extracted.
To secure retainage in mesial and distal cavitie- in the six upper
front teeth a groove is generally made at the cervical wall, and an
undercut pit near the cutting edge. These two opposing under-
cuts, if the cavity admits of their being satisfactorily made, are
sufficient to hold the filling in place. The labial wall, in working
from the lingual surface, will usually be at right angles to the
floor on the removal of the decay, and if this wall is weak
the removal of the decay and discoloured dentine is all that
can with safety be effected here. If, however, this wall is strong,
and well supported with dentine, it is well to make a slight groove
in the angle formed by the juncture of this wall with the floor of
the cavity. This groove is not necessary for retainage providing the
cervical and cutting edge undercuts are satisfactorily made, but it
greatly assists the packing of the gold, particularly if soft gold is
used as a base. In many cases the decay has so encroached on the
cutting edge that no undercutting can be here attempted with safety.
If the wall at this part can be prepared at a right angle to the floor,
it will still be of considerable value, but if, as often happens, it is
advisable to avoid its breaking down after filling by sloping it
outwards, extra retainage must be made at other parts.
The cervical undercut should then be made deeper than usual, and,
if possible, a distinct pit should be made at each end of it. These
pits, which in themselves would be of little value, form, in connection
with the groove, a strong retainage. An undercut at the labial wall
will be of great value now if it can be made with safety, but if not,
and if the cervical undercut, together with what may be left of the
lateral walls is not sufficient, the cavity must be boldly extended
across the lingual surface, and a distinct undercut made at this part.
Care must be taken in doing this, and the extension had better be
02
100 THE DENTAL RECORD
broad and shallow, rather than small and deep, so as to avoid cutting
too near the pulp. (Fig. 4). Small cavities on the approximal
Fig. 4.
sides of the upper front teeth may be prepared in many cases
somewhat after the manner of shallow crown cavities. A slight
undercut may be made all round at the juncture of the floor and
walls, or an undercut made at two opposing parts. Many of these
small and also medium sized cavities can be freely exposed, and
consequently, readily filled by making the old-fashioned V-space —
(Fig. 5) — bevelling the approximal surfaces from the labial to the
Fig, 5. Fig. 5.
Lingual Surface. Labial Surface.
lingual side. This can be accomplished with chisels if the teeth
are only slightly separated, or with a diamond disc if the space
obtained by pressure is sufficiently large to admit of its use, and a
Butler carborundum point is also very useful, the teeth being finally
made smooth with emery paper discs. This manner of bevelling
the approximal sides of upper front teeth can always be done with
advantage, providing they are fairly regular. Practically, the same
result is obtained with large gold fillings, on these surfaces by
trimming away the gold in finishing the fillings. This method of
shaping the teeth must be strictly confined to the incisors and
the mesial surfaces of cuspids. Any cutting away of the bicuspids
and molars that is not reproduced by the filling is distinctly bad.
It causes food to become wedged between them, and induces instead
of preventing decay.
THE DENTAL RECORD. 101
In the molars and bicuspids the retainage in approximal cav^ities
converted by opening into compound approximo-coronal cavities, is
usually obtained by grooving the lateral walls. It is considered, as
a rule, bad practice to undercut the cervical wall. There is very
little dentine between the edge of the cavity and the pulp at this
part, and there is a risk of either cutting too near the pulp or too
near the enamel edge. In the latter case, this margin would probably
be damaged by the packing of the gold, and extension of decay
would soon take place. Personally, as a general rule, I prefer not to
groove the lateral walls; in many cases it weakens them, and it is
usually difficult and tedious to carefully and accurately work the
gold into these grooves. It is preferable, in my opinion, to cut the
cavity well across the crown ; to make this coronal cavity slightly
dovetailed, and to make a distinct undercut at the end furthest
removed from the approximal cavity. All the retainage is thus
made where the tooth is strongest, where it can be most easily made,
and where it can be accurately and solidly filled.* The lateral walls
may be left at right angles to the floor, or very slightly sloping
either inwards or outwards. In cases where the cavity is shallow at
the cervical part, and it is difficult to start the filling there it may
be commenced in the coronal undercut, and worked from there along
the floor to the cervical edge, and then back again towards the
crown in the usual way.
In approximal cavities in the molars and. bicuspids, in which it is
not considered advisable to open through the crown, many operators
obtain access by cutting through either the buccal or palatal wall.
In my own practice, if the decay is not sufficiently extensive to
justify the coronal opening, I prefer to fill with a plastic material,
usually guttapercha.
In preparing the edges of cavities, it is necessary to cut out all
little cracks, chalky patches, or defects which may be found there.
This is particularly the case with the cervical edges, where these
defects seem to abound. In order to obtain a clean margin at this
part, it is often necessary (particularly in molars and bicuspids) to
extend the cutting to the cementum. This, in many cases, adds to
the duration of the filling, for if the teeth are properly contoured
the gum will cover and protecc this part.
* See Fig. 2.
102 THE DENTAL RECORD.
The margins should be made as smooth as possible with chisels,
spoon excavators, fine cut engine burrs, fine files, emery tape, and
discs, &c., using of the above whatever is most suitable for the case
in hand.
Preparation of the Gold. — Gold for filling teeth, after being
carefully and peculiarly refined, is beaten into foil of varying thick-
nesses, or it is precipitated into a sponge-like form, known generally
as crystal gold.
Foil is prepared either as cohesive or non-cohesive gold.
Absolutely pure gold possesses the property of welding when cold,
providing the surfaces to be united are perfectly clean and dry.
The least deposit on the gold, either of moisture or any extraneous
substance, interferes with this welding, and, consequently, it is always
necessary to anneal it before use, in oiderto cleanse off anything that
may happen to have collected on its surface. This welding property
is made use of by the majority of dentists in making gold fillings.
Pieces of foil are rolled, or folded into small masses or strips of a
convenient form and size, and after the first few pieces are fixed in
the cavity by being pressed or hammered into some pit or undercut,
or by being tightly wedged between the walls, the other pieces are
one by one pressed or hammered on to this toundation in such a
manner that each piece sticks to the gold already in place, becoming
solidly united with it, and the filling proceeds in this manner until
it is completed, the gold being intimately united into one solid mass.
Gold foil is prepared for introduction into a tooth in the following
ways : — By simply tearing small pieces from the sheet with tweezers
or foil carriers ; by rolling the sheet, or part of it, into a rope, and
then cutting it into small pieces or pellets, as they are termed ; by
folding the sheet flat upon itself several times, and then cutting it
into strips of convenient length and width ; by further cutting
these strips into small squares ; by cutting the sheet into strips and
rolling them round a spindle into a cyhnder-like form ; by tearing
small pieces from the sheet and rolling them into little balls, and by
cutting strips or squares from a sheet of very thick foil.
Different operators use one or more of the above mentioned
methods of preparing the gold, as may seem best for them. The
most intimate union of the molecules of the gold producing the
most perfect weld is doubtless obtained by the use of small flat
THE DENTAL RECORD. 103
squares, providing each one is packed as flat as possible without any
curling up or doubling of the edges. This is, however, a very
tedious and slow method of working, and although most satisfactory
and beautiful fillings are produced by it, the majority of operators
will find they obtain practically as good results by more rapid
methods.
In using tape, some operators after attaching one end to the gold
already in place, proceed to pack it by folding the strip backwards
and forwards on itself, layer by layer, as flat as possible, taking care
to weld each layer separately to the already condensed gold. This,
while an excellent method, is also a slow one, unless the tape is very
thick, and in this case it is difficult to obtain good adaptation to the
walls of the cavity. The doubling or folding of the tape must
generally take place against the walls, and this double thickness of
an already thick strip is very difficult, if not impossible, to accurately
adapt ; other operators use their tape and pack it down rapidly
several layers at a time. The end of the strip is placed in the
cavity and packed on to the gold already in place without any
particular care being taken as to whether it is flat or not. The
point of the plugger is then placed on a part of the projecting strip
in such a manner that one, two, three, or more layers are simul-
taneously packed down and condensed, the gold being worked on
the whole fairly flat. This is a rapid method, and if the strips do
not contain more than about four thicknesses of No. 4 foil, the gold
will work beautifully, easily and softly, and excellent adaptation and
solidity will be obtained. Greater thickness than this makes the
gold work harshly and stiffly. This method is particularly well
adapted to the fast stamping mallets.
Irregular masses of gold, such as pellets cut from a rope or little
balls, do not, as a rule, produce such evenly condensed fillings as the
flatter forms. The welding does not appear to be perfect all through
the filling, probably owing to the innumerable irregularities of these
pieces, there are parts that never become thoroughly condensed.
The cohesion that is produced is, however, very good. The slight
imperfections in the condensation are shown by the surface of the
filling becoming somewhat uneven where it is subjected to the force
of mastication. This can be avoided by making the surface of flat
gold, preferably cut from a sheet of heavy foil ; gold in the cylinder
104 THE DENTAL RECORD.
form is usually purchased ready prepared. These ready made
cylinders are for cohesive work, generally made from exceedingly
thin gold, and do not appear, as far as my experience goes, to be so
reliable in their working properties as foil. I have thoroughly
tested in practice the foil of five different manufacturers, and from
one of these firms I have used four varieties. Every one of the
above worked easily and well on the cohesive principle. I also
purchased three single books of foil from three other makers, and
two of them were perfectly satisfactory. I have, therefore, although
I have used many varieties, only come across one book of foil in
more than ten years that did not work to my satisfaction. Cylinders
I have found on several occasions refuse to cohere, although, on the
other hand, I have often found them to work easily and well. It is
very annoying to find a whole bottle of cylinders unworkable, no
matter how carefully they may be annealed. Whether this is due
to the thinness of the foil from which they are made, making it
difficult to hit the happy medium between under and over anneal-
ing, or whether the gold had originally been annealed to the fullest
extent, and would not bear any more to restore the cohesive proper-
ties that all gold loses in time, I do not know. Perhaps my
experience has been unfortunate, and consequently limited. I can,
however, do anything with foil that I could do with good ready
made cylinders, and I therefore prefer to stick to what has, in my
hands, proved the more reliable article.
Foil can be prepared in what is practically a cylinder form, and
without the nuisance of the loose edge that exists in home made
cylinders rolled round a spindle, by folding the sheet into a loose
tape, and then gently rolling it until it is cylindrical. The cutting
of short pieces from this long roll will flatten them somewhat and
give them a block-like form, but this does not in any way interfere
with their working properties.
Small pieces of foil torn from the sheet will usually be found
useful for filling very fine grooves and pits and very small cavities,
etc., while very heavy foil, such as No. 60, is principally used for
large fillings.
Non-cohesive gold is so prepared that there is no possibility of
one piece sticking to another. This is probably attained by subject-
ing the leaves of foil to some vapour which deposits something on
THE DENTAL RECORD. 106
the surface. If this non-cohesive gold is annealed it will often be
noticed that a vapour is given off, and then it becomes, as a rule,
thoroughly cohesive. There are a few makes of non-cohesive gold
which become so slightly cohesive on being annealed, that this does
not prevent their being worked non -cohesively. These foils, the
character of which is only slightly changed by annealing are often
spoken of as " true non-cohesive gold." They can be worked
cohesively, but it demands special care and manipulation. What it
is that gives them this particular property is a trade secret. In some
cases it is probably due to a very slight admixture of alloy, these true
non-cohesive foils, however, seem also to have been subjected to the
action of some vapour, for, as above mentioned, they are not so
absolutely non-cohesive when annealed, and heating them causes a
vapour to be given off just as with other makes of non-cohesive
gold.
Non-cohesive gold is used by wedging masses of it tightly
between the walls of cavities. It is important for each piece to
project somewhat from the orifice, so that by surface condensation
it may be pressed somewhat further into the cavity, and still
sufficient gold be left to admit of proper finishing. In packing this
gold lateral pressure is used, but surface external condensation is
usually necessary in addition, in order that the surface of the finished
filling may be as solid and dense as possible. This gold may be
prepared in much the same form as the cohesive, except that if rope
or pellets or cylinders are used, it is advisable for them to be more
tightly rolled, and each piece must be sufficiently large to extend
from the floor of the cavity to some little distance beyond its
orifice.
The most generally useful method of using this gold is in the
form of cylinders. If procured ready made, they should be tightly
rolled — hard cylinders they are often termed. Very satisfactory
cylinders can be made by folding one or more sheets of foil into
as narrow a tape as possible, and then rolling or twisting
the tape into a cyHndrical form, and cutting off lengths of the
desired size. Each piece will be somewhat flattened at the ends by
the cutting, and should be restored to a cylinder by rolling between
the thumb and finger. It is necessary for the cavity to be surrounded
by walls, and although the majority of cavities can be so prepared,
106 THE DENTAL RECORD.
it is usually very difficult to satisfactorily work non-cohesive gold,
except in crown cavities. Broad, shallow cavities are particularly
awkward to fill non-cohesively.
It is claimed that fillings are much more rapidly made with non-
cohesive gold ; that the adaptation to the walls is better, and that by
reason of this superior adaptation teeth are better saved than with
cohesive gold. I was originally taught to use non-cohesive gold and
to believe it was infinitely superior to cohesive as a preserver of tooth
structure ; with the exception, however, of making a few experimental
fillings in the mouth every now and then I have given up its use
(except in connection with cohesive gold) for several years. Had I
remained faithful I might have overcome some of the difficulties
which caused me to fly to cohesive gold, and consequently I have
considerable diffidence in expressing the following opinions, viz. :
that in crown cavities very rapid and good fillings can be made
that except in very simple cavities its use on the incisors and cuspids
is very difficult, owing to the shallowness of these cavities ; that its
use in approximal cavities in bicuspids and molars is also very
difficult if contour fillings are to be made that will stand ; that in
the majority of approximal cavities there is very little, if any, saving
of time, when the preparation of the cavity, packing the gold and
finishing the filling are all taken into consideration ; and that in any
case exposed to mastication the filling will not remain so smooth
nor will the edges stand as well as with cohesive gold. The carrying
of gold over bevelled edges, often so valuable, can only be satis-
factorily accomplished with cohesive gold.
Respecting the superiority of the adaptation I am satisfied this
only exists in very favourable cases, and I am also convinced that as
good an adaptation as is necessary to preserve a tooth can be made
with cohesive gold, and that any superiority in this respect that may
be procured by non-cohesive gold is of no practical value. Used in
connection with cohesive gold it has in many cases undoubted
value. In the olden days, when V-spaces were made between
molars and bicuspids, and approximal cavities were filed flat and
filled flat, non-cohesive gold could probably be used with very
much more ease and satisfaction than is possible nowadays when
the value of contour is realised.
THE DENTAL RECORD. 107
Cases are often alluded to where non-cohesive fillings have
preserved teeth for a great number of years, and the features of a
good deal of the more modern cohesive work are compared with
them. It is to my mind simply a case of survival of the fittest.
Our own failures are always before us, while those of the past
generations have been dead and buried and forgotten long ago — only
their successes remain. I am sure that had these same teeth been
well filled with cohesive gold they would have lasted quite as long.
Some of the finest cohesive fillings I have ever seen have been
saving the teeth for 30 years, and appear likely to save them as long
as the patient lives. It is a case of excellent work and in first-class
quality teeth in the mouth of a healthy individual.
Crystal Gold.
The crystal gold that is best known is the one that has stood
the test of time longer than any other similar preparation
" Watts' Crystal Gold." This is the only kind that I have had
any lengthy experience with, and I must therefore confine my
remarks to it. It is a cohesive gold, and must be used strictly as
such. Anyone who can work cohesive foil successfully can use it
satisfactorily, at first it may appear to present some diflBculties of
manipulation, but these soon disappear, and after a little experience
an operator will wonder why its use ever seemed troublesome.
{To be continued?)
HONEYCOMBED AND SYPHILITIC TEETH.*
By Mr. Heath.
Mr. President and Gentlemen,
We heard last month a paper on a subject of much practical
usefulness, which was followed by an interesting and animated
discussion. Our subject to-night cannot be called exactly practical,
and is hardly of such general interest, so that I must ask your
pardon for having brought before you only dry bones, devoid of
originality, hoping that all mistakes and blunders may be
thoroughly laid bare, that a lively criticism may do something to
* A paper read before the Students' Society of the Dental Hospital of London,
108 THE DENTAL RECORD.
peptonize, and render soluble, the undigested mass of facts and
theories now about to unfold.
Teeth present numerous malformations, some congenital, others
produced after birth. Of these malformations three are sometimes
confused, which it is important to distinguish — those known as
honeycombed, rickety, and syphilitic teeth, and it is on these three
that I propose to touch this evening.
Under the head of honeycombed teeth we have a variety of
irregular forms of tooth-structure. The commonest kind of so-called
honeycombing is that in which the surface of the affected tooth
presents numerous pit>, with irregular yellowish enamel forming a
large part of the crown. In the incisors the cutting-edge is sharp
and irregular, with the pits sometimes penetrating to the dentine ;
while molars in a like case usually present instead of smooth
rounded cusps, sharp spinous portions of enamel sticking out
abruptly from an irregular honeycombed crown surface. Examined
under the microscope the tissues are seen to be deficient in quality,
as well as in quantity, the dentinal tubes near the affected surface
being irregular, and the enamel porous, with the brown striae of
Retzius well- marked. This malformation usually affects like
teeth to nearly the same extent ; more often than not half the
crown of the centrals, about one-third of that of the laterals, the tip
of the canines, and the major part of the first molars being the seat
of the disease, the bicuspids in these cases escaping. This applies to
both the upper and lower jaws. It may happen, however, that only
the tips of the centrals are affected, in which case the laterals and
canines escape, and the first molars suffer but little. Teeth are
often seen with grooves and ridges alternating, sometimes one or
two only, occasionally the whole crown presenting a furrowed
surface. Also there occur all gradations between the typically
honeycombed and the grooved teeth, any number of rocky, ridged,
spinous, and pitted forms being found. This deformity is usually
confined to the permanent dentition, though honeycombing of the
temporary teeth now and then occurs. The cause appears to be one
acting during the time the crowns are calcifying, that is to say
during the first two or three years of life, and evidently also it is a
cause that after a time ceases to act, as the later formed portions of
enamel are often perfect.
THE DENTAL RECORD. 109
Some diversity of opinion exists as to the cause of honey-
combing.
The three best known views are the following : —
(i.) That it is due to the influence of mercury.
(2.) That it is caused by convulsions.
(3.) That it is the result of the various exanthematous fevers.
The first theory we owe to Mr. Jonathan Hutchinson. He
found that lamellar cataract, a disease never present at birth, often
attacked children who had suffered from convulsions. He further
noticed that a large number of such children had honeycombed
teeth, and at first considered the convulsions, cataract, and
honeycombing were three results of the same obscure cause. But
patients were often seen with lamellar cataract whose teeth were
unaffected, and others with honeycombed teeth who had merely
suffered from convulsions without lamellar cataract supervening.
This seemed to complicate matters until it was noticed that in most
of the cases mercury in some form had been administered to combat
the convulsions. Here appeared to be a clue to the mystery, and
after some careful observation Mr. Hutchinson declared his belief
that honeycombing was due to disturbance in the nutrition
of the teeth caused by mercury administered in . infancy, this
malnutrition being brought about either by a definite stomatitis, or
simply by the effect of the prolonged presence and influence of
mercury in the system. The test teeth for this condition he
considered to be the first molars. The usual form in which the
drug is exhibited is that of teething powders, the majority of which
contain calomel and morphia. One of the chief reasons for the
harmful effect of these powders is that, being primarily sedative, the
morphia soon induces sleep,. which lasts for some hours, during
which period the mercury has time to be absorbed into the system,
as it is only when the effect of the morphia has passed off, and the
child wakes, that the calomel exercises its aperient action. In
support of this theory it is noticed that many persons with
honeycombing are unusually susceptible to the effects of mercury,
which helps to explain why their teeth have been affected in infancy,
when the teeth of others who have been similarly drugged may
have escaped. Again it is extremely difficult in diagnosing a case of
honeycombing, apparently idiopathic, to be sure that the child has
110 THE DENTAL RECORD.
not had powders secretly administered by a nurse at some time or
other to keep it quiet. Many, however, believe that this condition is
not caused by mercury, but rather by the convulsions to prevent
which the mercury was given ; and it is to be remembered that
hundreds of those who take plenty of mercury in infancy escape
with perfect teeth. While finally there is no doubt that measles,
scarlet fever, and the other exanthemata often lead to a malformation
of the teeth, especially to the grooved condition already referred to,
this being similar to the groove occasionally left on a nail after a
temporary illness, it is possible sometimes by careful inquiry to
find out that an attack of one of the eruptive fevers took place at
the time the part of the tooth affected must have been calcifying.
In certain cases, where the health has been alternately decidedly
good and bad, the many-grooved condition may result. Other
causes of honeycombing are given, such as heredity, inflammation of
the preceding temporary teeth, the wrong dieting of infants,
disturbance in the circulation by such things as whooping-cough,
and, finally, rickets.
Mr. Storer Bennett draws a distinction between honeycombed
and mercurial teeth, holding that the former present an irregular
worm-eaten appearance, while mercurial teeth have the tubercles of
the incisors exaggerated, and the cusps of the molars pointed and
standing distinctly out.
The results of honeycombing are a more than normal liability
to caries, with a somewhat increased probability of the setting in of
arrest of decay.
The treatment consists in smoothing down sharp projections, and
filling hollows where pos?ible, though in the case of the first molars
a large number will be best treated by extraction, as the teeth cannot
be relied upon to resist decay for long, and are of diminished use in
mastication owing to their usually imperfect articulation with
each other.
The second class of malformed teeth we mentioned are rickety
teeth. In rickety children both permanent and temporary teeth
erupt late, and are prone to decay quickly and be lost. They are
bluish and smooth, and though the enamel is not apparently
defective, it is probably of poor quality. In shape, typical rickety
teeth are tapering, and often slightly notched.
THE DENTAL RECORD. Ill
Lastly, we have to take up the peculiar malformation produced
on certain teeth by congenital syphilis.
The attention of the profession was first drawn to this subject by
Mr. Jonathan Hutchinson. In studying cases of interstitial keratitis,
a disease of the cornea, of syphilitic origin usually, Mr. Hutchinson
frequently noticed peculiarly-shaped teeth which are now known as
syphilitic, peg-shaped, or Hutchinson's teeth.
If these are found of quite typical shape they are an absolute
mark of congenital syphilis, so that it is a matter of extreme
importance that they should not be mistaken for other teeth of
unusual form.
To begin with the upper central incisors, which are the test
teeth : these are often but ill-developed, and are, therefore, seen
at a glance to be small and stunted. The form is characteristic,
being variously described as barrel or peg-shaped, the important
point being that the cutting edge is narrower than the neck of the
tooth. This causes gaps between the teeth, and has the effect of
making them appear farther apart than they really are.
The colour is dirty grey in bad ca^es, but i« not found if the
enamel completely covers the crown, being caused by dentine
showing through in places where enamel is absent. The teeth are
soft and soon wear down. The central incisors are most often affected,
the canines sometimes, and the laterals seldom being changed, while
the first molars now and then are, presenting a characteristic dome
shape, the cusps being represented by rings of enamel quite unlike
the sharp spines on a honeycombed or mercurial tooth. The
centrals often have their mesial borders inverted and are not always
symmetrically affected — one may present the typical shape and its
fellow be quite normal. Finally, there is, in the case of the incisors,
a mark which often causes simple honeycombed teeth to be mistaken
for syphilitic — 1 refer to a notch in the centre of the cutting edge
which is not there when the tooth is erupted being replaced by
several small serrated tubercles. Tartar is seldom found around
these teeth, and the additional complication of honeycombing is
unusual. Furthermore, the lower incisors are rarely notched or
much affected.
I have here a typical syphilitic upper central and a model of the
lower teeth of the same patient, the incisors of which seem somewhat
112 THE DENTAL RECORD.
peg-shaped, though, unfortunately, the model is rather a poor
one.
The temporary dentition rarely suffers from congenital syphilis,
though a case is recorded by Mr. Oakley Coles of a child presenting
well-marked syphilitic temporary incisors.
In diagnosing these teeth, especially in noticing the notched
condition, care must be taken to distinguish between syphilitic
notches and notches due to honeycombing and subsequent wearing
away of the cutting edge, or notches due to breakages or the use of
a pipe. The last two causes, however, usually produce so
symmetrical an appearance that they present little danger. The
honeycombed condition, however, may give rise to confusion if the
notch is the only character relied upon in forming an opinion. I
have a model here of a case in point, of a boy free from any
syphilitic taint, with well-marked notches on the upper centrals,
due to honeycombing of their tips and wearing down.
Confirmatory symptoms of syphilis should always be obtained
in doubtful cases. These are scars radiating from the angle of the
mouth, a dusky skin, prominent frontal eminences, and interstitial
keratitis. Also ulcers of a distinctly syphilitic origin may help in
the decision.
Syphilis usually hastens eruption of the teeth, the temporary
incisors being occasionally erupted at birth destitute of roots, but
only in a very small percentage of cases does it produce the
characteristic malformation we are considering. It is a curious fact
that when ulceration of the palate occurs as a result of congenital
syphilis the teeth nearly always escape.
It will be well to consider for a moment how the form of the
syphilitic incisor is produced. If a newly-erupted normal central
be taken it will present three tubercles at its cutting edge, often
emphasized by two grooves running longitudinally towards the
neck. The crown thus appears to be made up of three denticles.
If, during the development of the tooth the central denticle is
stunted and imperfectly developed, especially its first-formed portion,
we shall get a falling together of the two outer denticles, producing
the typical peg-shaped tooth, while the rudimentary tip of the
central denticle will quickly wear away, leaving a notch, and this
appears to be a true explanation of the deformity. The reason the
THE DENTAL RECORD. 113
whole tooth is below the normal in size is that syphilis acts upon
the tooth continuously from its earliest germ, whereas mercury has
a definite action for a defined space of time upon teeth perfect up to
birth.
Syphilis acts by disturbing the vascular supply of the pulp, and
shows its chief effect upon the dentine, while mercury expends its
force on the enamel, and, in cases where syphilis is complicated with
mercury, may prevent the formation of the typically syphilitic
shape.
I have here models of mercurial teeth in the mouths of two
children, sisters, afflicted with congenital syphilis. One, a child of
nine, has ulcers of syphilitic origin on the 1 -gs, and a broad sunken
bridge to the nose, while the other, aged fifteen, gives a history of
trouble with her eyes. Finally, a still younger child in the same
family has snuffles. In both these cases the teeth show very little
of the typical Hutchinsonian shape, the mecurial (or possibly
exanthematous) effects, being by far the most prominent, a lateral
only in one case and two centrals in the other presenting any
suspicious appearances.
Before sitting down I wish to express my thanks to Mr. Wallis,
Mr. Turner and Mr. Freeman, who have kindly lent me both
models and specimens. And, finally, Mr. President and gentlemen,
I thank you for the attention with which you have been good
enough to favour me this evening.
THE ODONTOLOGICAL SOCIETY OF GREAT BRITAIN.
The Ordinary Monthly Meeting was held on the 3rd ultimo,
the President, Mr. David Hepburn, in the chair. The minutes of
the previous meeting were read and confirmed.
Messrs. G. H. Bowden, L.D.S.Eng., Reigate, and T. Rubery
Chambers, L.D.S.Eng., were proposed for membership.
Messrs. W. S. Nowell, M.A. (Cambridge), L.D.S.Eng., F. Lawson
Dodd, L.R.C.P., M.R.C.S., L.D.S.Eng., Ernest Catt, L.D.S.,
D.D.S., W. F. Cornelius, L.D.S.Eng., and E. L. Dudley, L.D.S.
Eng., were elected members of the Society.
The Librarian (Mr. W. A. Maggs), announced the usual
exchanges.
H
Il4 THE DENTAL RECORD.
The Curator (Mr. Storer Bennett), acknowledged the receipt
from Mr. Morton Smale of the skull of a crab-eating raccoon. It
was an interesting specimen, said the Curator, inasmuch as it showed
a supernumerary premolar in the upper jaw on the right side —
supernumerary teeth in the lower animals not being very common.
He had also to announce that the Council had consented to the
purchase of two skulls, one of an old dog showing a great deal of
absorption of the alveolus with deposits, and the other that of a
young baboon, a much more interesting specimen, of the period at
which the first and second dentition were changing. It was a very
ricketty skull indeed, the teeth in consequence had erupted rather
late and very irregularly.
The President said he regretted to have to record the death of
Mr. George Gregson, who had been a member of the Society since
1857, and many years ago filled the offices of Honorary Secretary
and Treasurer. He had also been a member of the Council, and
was in 1884 elected a Vice-President. He was well known, and his
death would be a great sorrow to them all.
Mr. Arthur Underwood brought forward a case of an artificial
nose, the patient was present. Mr. Underwood explained that this was
his first attempt, and he thought he saAv his way to improve upon it
in one or two particulars. At present the nose was attached to a
pair of spectacles. His plan had been to take a model of the face
in plaster, and have the nose modelled in wax and vulcanized, then
hollowed out considerably. Before vulcanizing, small points of gold
were inserted on either side of the bridge. These were tapped, a
screw was introduced and fastened on to the pair of spectacles, and
so the whole apparatus was held in place. At present the nose was
painted with oil paint, and when it was dry he destroyed the glaze
by means of a powder, but he hoped later on to arrive at some
kind of enamelling which would bear all the washing and wear
without destroying the colour. Models of the nose were exhibited.
Mr. Robert H. Woodhouse showed a model of a case of fracture
of the bicuspid region as a result of a blow on the chin. The
patient was a boy, aged 14, who, in playing football, was violently
struck on the chin by the head of another boy. The bicuspid on
the right side of the mouth was fractured and the inner cusps
knocked off, while the left bicuspid was completely fractured through
ihe pulp chamber. The boy suffered a great deal of inconvenience
THE DENTAL RECORD. 115
for a few days, and then the teeth were removed. The curious point
was, that notwithstanding the severity of the blow, a week after the
accident there was no trace of it on the face.
Mr. C. F. RiLOT also narrated a case of football accident, the
patient being a gentleman, aged 30, a member of the International
Team. He had received a kick in the mouth while plaving, and on
examination the two upper central incisors were found to be loose,
elongated, and leaning somewhat inwards. The teeth were extracted,
the coronal portion coming away quite distinct from the apical
portion. In each case distinct evidence of absorption could be
traced in the fragments, the apical portion of the pulp being
expanded into a large fleshy mass. The patient volunteered the
remark that he had an exactly similar accident two years before
The teeth had been painful for a time, but that passed off, and
beyond a slight elongation they had been quite right until the
second accident. It was evident from the specimens that the
fiacture must have occurred on the occasion of the first accident,
and the interest of the case lay in the fact that the teeth should
have been perfectly comfortable for two years under these conditions.
Mr. Charles S. Tomes in delivering his paper — "Notes upon
Enamel and Dentine," referred very little to his MS., preferring to
give it'^ substance, somewhat in colloquial form, leaving the full paper
to be studied from the " Transactions of the Odontological Society,"
in which it will appear. The following report adopts the form in
which the paper was delivered, as far as possible : —
Some notes that are omitted in this paper have been more or
less published elsewhere — not very fully. With respect to part of
the subject, viz., that dealing in detail with the chemistry of enamel,
as it has been contributed to the Journal of Physiology^ it will first
appear in that j'^urnal.
"What set me to work on the question of the chemical nature of
enamel and dentine was reading the series of papers published in
the Dental Cosmos by Dr. Black, to the experiments for which an
enormous amount of trouble has been devoted by him. The results
are most interesting, but they are open to criticism in some respects.
I do not want to go here fully into the points in which I think his
experiments might be improved.
"Whilst embarking on the chemical portion of his subject, Dr.
Black had neglected some precautions, well known to chemists,
H 2
116 THE DENTAL RECORD.
which somewhat invalidated his results But he not only has pub-
lished results giving decimal places, which far transcend the possibility
of any experimental accuracy, but has also bailt deductions upon
these. Still I have the greatest admiration for the work he has done.
Dr. Black has unfortunately overlooked the work of Dr. Galippe,
who published a series of papers on this question, but dealing with
it in a way not perfectly conclusive for our present purpose, as he
used entire teeth instead of separated enamel and dentine.
" The principal points are these — we have all of us been familiar
with the fact that there are bad teeth and good teeth. Some decay
so that we are able to save them with some certainty, others are
difficult to save. It has been thought that these bad teeth were,
like ricketty bones, deficient in lime saUs. Dr. Black's method was
to cut thin sHces taken from the necks of the teeth, which, therefore,
contained but a small proportion of any other tissue than dentine,
and to incinerate, or burn away, the organic matter. Dr. Black
states that the poorest teeth he could get were not more deficient in
lime salts than the good teeth. Now, these results seemed so
remarkable, that I thought they wanted checking. Taking teeth
irom the same mouth and using jaws tolerably complete and toler-
ably free from caries, I drilled out all the dentine I could get without
running the least risk of having any enamel or cementum in my
turnings. These shavings of dentine were dried in a constant
temperature oven for eight hours, afterwards they were weighed
in a platina crucible, then burnt in a muffle, and then weighed
again. The ash was then moistened with ammonium carbonate — in
order to restore any carbonic acid which might have been driven off
by ignition from the carbonates present — dried, and weighed again.
The residue of course represented the lime salts. Taking a great
number of experiments, I daresay over a hundred, the average* of
lime salts was 72-3 or thereabouts In these experiments the turn-
ings remained from first to last in the crucible, so that there was no
chance of loss, and the amount of dentine obtained from each tooth
was about twice as much as the quantity experimented on by
Dr. Black, this, of course, again tending to diminish error. Then
taking teeth from the same mouth with the view of checking some
of Dr. Black's results, I found in one denture that the percentages of
lime salts in teeth of poor quality ranged somewhat lower than those
of good quality, still the difference is not great, being only about one
THE DENTAL RECORD. 117
per cent. Again, Dr. Black says that teeth on the opposite sides of
the mouth differ, that is to say, the central incisor on one side of the
mouth differs as to percentage of lime salts with the central incisor
on the other side. I tried this, and though I did find differences,
they were so very small that anyone knowing anything of quantita-
tive analysis would not build any theory upon them. It is well
established amongst chemists that small differences to decimal points
in analysis can only be relied upon when they constantly appear
in a large number of experiments.
" I should say that in Dr. Black's experiments he introduced a
tremendous source of experimental error by removing his block of
dentine from the vessel where it had been calcined. It should never
have been touched from the time it was first weighed to when last
weighed, but you may rely upon Dr. Black's figures so far as the
integrals are concerned. Well, then, there is another point which
I have found quite constant, viz., a higher percentage of lime
salts in the dentine of molars and bicuspids than in that of the
incisors and canines. That, you will see again, is not conducive to
our believing that the amount of calcification determines whether
there is to be caries or no caries — all these figures relate to dentine
simply ; they do not include the enamel nor the cementum. Find-
ing this to be a constant thing I went back to Dr. Black's figures, and
I found that, having separated out his molars and canines, the same
difference was apparent. Then I was rather curious, having dis-
covered this, to see if it extended to other examples. I have not had
time to carry out much in this direction, but I thought I would take
the elephant, the ivory of whosetuskwe knowcontains only 57 per cent,
of salts — a low percentage ; but the dentine of the molar I discovered
to come almost up to the usual mammalian proportion of 70 per cent.
Well, I think that is as much detail as I need give on that point ;
it is set forth in greater detail in the paper, but that is roughly the
main feature of it. Then the rest of my investigation into dentine
had relation to something which does not appear in any of the
ordinary published analyses, that is, water. If we get from a piece
of dentine 72 per cent, of salts, chemists have been in the habit of
setting down 28 per cent, as organic matter, but if you set about it
the other way you find you come very far short of that 28 per cent.
Taking a human tooth, decalcifying it, washing it till free from acid,
and drying it, I find the organic residue left is, instead of 28, only
lis THE DENTAL RECORD.
19 per cent., and the rest is mostly water, as you can very easily
demonstrate. Of course all these experiments were performed on
dried dentine, namely, that which has been kept in a temperature of
1 12 for several hours. Well then, we have in dentine 9 per cent, of
water, 72 lime salts, and the remainder organic matter. As one
knows pretty exactly what the amount of calcium phosphate is, so
one knows what the amount of water ii: chemical combination
with it ought to be, but it never is what it ought to be. In dentine
we find this amount, 9 per cent, of water is rather more than two
equivalents of water, so that the salt would be Ca3P20g(2HaO). You
may take it as quite certain that the calcium phospnate contains at
liast I per cent, of water which it will not give up short of red heat.
Hiving got so far, and it is a somewhat important matter — this
presence of water in chemical combination — it seems quite possible
that the difference between the bad and the good teeth may have to
do with the combined water of crystallization — it may be so, on the
other hand, it may having nothing to do with it. Then of course
the difference between the bad and good teeth may lie in the enamel,
it may have nothing to do with the dentine, but the one thing to
which I wish chiefly to call your attention is that there is a large
amount of water in dentine ; water which cannot be dried out ; water
which is in chemical combination with the calcium phosphate."
Mr. Tomes, continuing, said he next turned his attention to the
question of enamel, and carried out a series of experiments to
ascertain what the nature of the organic matter in enamel is. He
was exceedingly surprised to find that enamel is practically an in-
organic tissue. The small percentage which has usually been set
down as organic matter being in fact mainly water. The amount of
organic matter was too small for quantitative estimation. Having
arrived at this conclusion, Mr. Tomes was met with the problem — If
enamel contains no organic matter, how does it come by its structure ?
and in this direction it occured to him to make comparison of
enamel with the prismatic structure of pinna shells, which, after
decalcification, though leaving a considerable mass of organic matter
as to size, have only i per cent, of the weight of the fresh dried shell.
The pinna shell consists, as to weight, of crystalline prisms of calcic
carbonate, containing no organic matter in themselves, but deposited
in a honeycomb of conneciive tissue. Mr. Tomes is of opinion that
it is quite conceivable that the lime salts in enamel may be deposited
THE DENTAL RECORD. 119
similarly in the interior of the enamel cells, their exceedingly delicate
walls playing the same part as the connective tissue honeycomb in
the pinna shell, and the comparative absence of organic matter in
the finished product, he thinks, may be due to the exceeding tenuity
of these walls, as well as to the absence of organic matter from the
prisms themselves, which are purely crystalline. The incineration
of enamel alters its structure but little ; after being brought to a
bright red heat the prisms, though they show a slight granularity,
retain their form and size. Mr. Tomes, as will be noticed, in the
course of his investigations, thus found himself at issue with
Heitzm.an and Bodecker.
Mr. Tomes proposed to carry on his investigations and ascertain
it there is greater difference between the enamel of good and bad
teeth than between the dentine of good and bad teeth, and thinks it
possible that the difference may lie principally to the former, though
this is only conjecture.
The paper was illustrated by very beautiful lantern slides, some
of them lent by Mr. Leon Williams, and others t he work of Mr. Howard
Mummery, to both of whom Mr. Tomes expressed his indebtedness.
Mr. Leon Williams, invited by the President, said he really did
not expect to be called upon to say anything, and was hardly in the
frame of mind to express a critical opinion. He believed Mr.
Tomes's analyses of dentine and enamel were the most careful and
critical that had ever been made. It was a great satisfaction to him
to be able to say so, because it always gave a little tingle of delight
to be able to say " I told you so," he believed he had been on record
a number of times during the past fifteen years as confirming the
position which Mr. Tomes was now able to take up. Some of the
members would undoubtedly remember the controversy he (Mr.
Williams) had in New York with Heitzmann and Bodecker on that
point. For a long time he stood almost alone in criticising what he
regarded as the very unwarrantable claims made by some with
regard to organic matter in enamel. The result of the analyses
before them opened up a very wide field for investigation, and it
would certainly be necessary to modify very much the views that had
been held with respect to the causes of decay in teeth, and these
analyses were in line with the conclusions and observations of Or.
Miller, who said that they should lo jk for these causes very much
more to the environment of the teeth than to ihjir inherent
120 THE DENTAL RECORD.
structure. It would be regarded doubtless as a very heterodox state-
ment, but, in his judgment, the worst formed teeth, as to inherent
structure, in a perfectly healthy mouth would never decay, while in
an unhealthy mouth the most perfectly formed teeth would never
be able to resist decay ; and yet it seemed to him that that was the
position they had to come to. If they might take that as the con-
clusion that had been reached, it had a very direct and practical
bearing on the treatment of decay of the teeth.
Mr. GoADY had been very much interested in the paper, the more
so as he had himself been working on the structure of dentine. The
point of chief interest that he had arrived at in his investigations
was that in caries the microorganisms were always in lines in front
of the caries, and that elastin was capable of being broken up by
micro-organisms into mylo-acetic acid ; so that they had from the
micro-organisms, given elastin, an acid produced apart from the
natural production of acid in the mouth. He had isolated a few
micro-organisms from teeth and got a reaction, showing probably
that there was mylo-acetic acid present.
Mr. J. Howard Mummery said the paper was one of great interest.
As regards the structure of enamel, it possibly indicated that the
enamel was formed by secretion and not formed in the cells. The
secretion view which was held by many as to dentine, and Mr.
Tomes' discovery, did not seem to quite upset the secretion view.
Of^course, the point about the molars being more fully calcified than
the other teeth was a matter of great interest, and was very surprising
considering all the conditions of the mouth.
Mr. C. S. Tomes in reply, said he was exceedingly interested to
hear of the action of the bacteria upon elastin breaking it up into a
mylo-acid, because, knowing how exceedingly resistant a substance
elastin was to weak acid, it had always been difficult to understand
exactly how it did get dissolved, and Dr. Miller accounted for it by
a peptonizing action on the part of some of the bacteria.
He had omitted in his previous remarks to mention the bearing
of his paper upon the formation of enamel which had been touched
upon by Mr. Mummery, viz., as to whether it was a conversion or a
secretion. Supposing his (Mr. Tomes') guess to be correct that the
calcium phosphate was deposited inside the enamel cells, it siill
might be regarded either as a secretion or a conversion.
The usual vote of thanks terminated the meeting.
THE DENTAL RECORD. 121
DENTAL STUDENTS' SOCIETY, DENTAL HOSPITAL OF LONDON.
Ordinary General Meeting, held Monday, February loth, the
President, Mr. J. F. Colyer in the chair.
The minutes of the previous meeting were read and confirmed.
On casual communications being called for : —
Mr. Douglas said : I have here an interesting specimen of some
rarity, viz., a saHvary calculus, about the size of a bean, which was
removed from the mouth of a man aged 40, by Mr. Dolamore, in the
extracting room a few days ago. From the size of the swelling
before, and the flow of blood after the operation, it was somewhat
difficult to determine whether the calculus was embedded in
Wharton's duct leading from the sub-maxillary, or in Bartolin's duct,
which is the continuation of the union of one or more of the small
ducts of Ravinus, which lead from the sub-lingual gland and join
Wharton's duct just before it opens on to the floor of the mouth, by
the side of the fraenum linguae.
However, the patient returned two days later, and on again
examining the wound, also after a further examination of the
specimen, I am inclined to believe that the calculus lay in the
junction of the two ducts (Wharton's and Bartolin's) just before
they opened into the mouth, and had caused that opening to be
enlarged, and have two divisions as it entered the mouth.
This I conclude from the peculiar shape of the interior of the
wound, which showed a clear impression of the position of the
calculus, also from the appearance of the calculus itself, which you
will notice has a large bell like opening at each end, with a canal
extending along its whole length from one to the other.
The swelling in the patient's mouth was hard and of an india-
rubber like feel, with distinct circumscribed area, very red and
inflamed, and situa':e about half-an-inch from the anterior edge of
the fraenum and close up to the border of the tongue.
All the history we can get is that the patient had noticed the
swelling some three months ago, but that except occasional twinges,
had not until lately had any pain with it.
The condition of patient's health is good ; his occupation, I
believe, a stableman ; age 40. His teeth are short, dark yellow in
colour, and his lower teeth have deposits of tartar of the hard
variety, deep under the gums, but little appearing above the gum
122 THE DENTAL RECORD.
level. This tartar is much discoloured by the use of tobacco.
Several of the teeth were loose.
Salivary calculus, or tartar, as found round the teeth, is said to
consist of the triple phosphates of ammonia, lime and magnesia,
along with epithelial scales, debris of food, and frequently the
leptothrix buccalis. This, however, is deposited from saliva flowing
fri)m the parotid, and small glands of the mouth, as well as the
sub-maxillary and sub-lingual.
In the specimen before us we have to exclude the saliva of the
parotid and small glands, as in all probability they have nothing to
do with its formation. Whilst the parotid is known as a serous
gland, the sub-maxillary principally, and the sub-lingual to a lesser
extent, are known as mixed glands, i.e.^ partly mucous and partly
serous.
The secretions of these glands differ according to their construc-
tion ; serous glands, as the parotid, secreting a thin watery fluid,
which is very poor in solids (only about 0*3 to 0*5 per cent.) and no
mucin, whereas the mixed or mucous glands, as the sub-maxillary
and sub-lingual, secrete a thick ropy viscid fluid named mucous,
which in the case of the sub-maxillary contains from 2*i to 2*5 per
cent, ot solids, and in the sub-lingual as much as 275 per cent.
The special u^es of these glands are well illustrated in different
animals. In herbivorous animals, such as the cow and horse, the
parotid being the predominant partner, as these animals require a
large quantity of a thin watery saliva to assist in the mastication
and deglutition of their rather dry food, whereas amongst the
carnivora, such as the dog and cat, the sub-maxillary and sub-lingual
glands take a more important place, and when one studies the ant-
eater, one finds scarcely any parotid lat all, but large sub-maxillary
and sub-lingual glands.
Of the different solid constituents of mixed saliva, we find by far
the larger part is made up of the salts of lime and magnesia, and of
these the greater in quantity are the lime salts, viz., calcium carbo-
nate and phosphate, and these I have shown are chiefly found in the
sub-maxillary and sub-lingual saliva.
If the saliva contain large quantities of such salts, and if the
secretions be augmented, as in iodine or mercurial salivation, the
tar ar is deposited with greater rapidity.
In crder to start a deposit a nucleus is required, In the teeth
THE DENTAL RECORD. 123
and gums such a nucleus is rea'^ily found, especially in mouchs
where the tooth-brush or other cleanser is an infrequent visitor. In
such a po>ition as a duct, liowever, the case is slighily difTerent, as
from the shape and size of the orifice food cannot get into them. I
am therefore incHned to believe that if we c uld find the actual
nucleus of a calculus from a duct v.e might find a minute quantity
of dead epithelium or some such substance which hid been caught
by the wall of the duct when the flow of saliva was small, and had
remained there, gradually collecting round itself more and more of
the calcareous deposit. Sections of these salivary calculi are so
difficult to make, and one runs such a great risk of utterly destroy-
ing one's whole specimen when even cutting it in half, that we can
only speculate as to the probable and possible nucleus round which
it has formed.
Castle says that occasionally tartar is deposited in the foramen,
which serves for the transmission of the dental nerves, causing
severe neuralgia. How it may come to be deposited there it is
difficult to say, unless it may be after the periosteum has been
stripped from the tooth adjacent to the foramen. •
All authorities seem to agree that with the exception of caries
nothing is so pernicious to a healthy condition of the mouth as the
presence of tartar.
Salivary calculus in the duct, if neglected, may give rise to a
considerable amount of suppuration, and possibly fistula.
Stricture of the duct may follow its being opened to remove a
calculus. According to Walsham, should this occur, the duct must
be divided transversely.
Mr. WooDHOUSE said a patient, a young man aged 28, came to
the hospital to have a tooth extracted. On looking at him he
noticed symmetrical swellings under each masseter mu5cle, about the
size of a small walnut, situate about one inch above and anterior to
the angle ; the swelling on the right side being the larger. The
patient said they had been there all his life, and were not growing^
In his (Mr. Woodhouse's) opinion, these swellings were compact
osteomata, or the ivory exostoses of other pathologists. He
mentioned that the usual situations for them was on the temporal
and mandibular bones, and that they were almost always single and
not multiple.
The President said, that although not mentioned in books upon
124 THE DENTAL RECORD.
surgery, the most common situation for these compact osteomata is
on theinnerside of the mandible, between the canine and first bicuspid.
Messrs. Nowel and Miller each said that they had one in that
situation.
The President then called upon Mr. Heath for his paper upon
^* Honeycombed and Syphilitic Teeth " (see p. 107).
In the discussion which followed —
Dr. Austen, after thanking Mr. Heath for his paper, drew atten-
tion to the lack of accurate knowledge on the subject. He showed
how unsatisfactory was the information that the majority of parents
gave, for although they might be certain that the child had taken
teething powders, yet they generally were uncertain whether they
contained mercury or not. He also stated that from personal
experience, children were able to take more mercury comparatively
than adults, and that if, by chance, excess of the drug was admini-
stered, they generally got rid of it either by vomiting or by the
bowel. He urged a more thorough invesiigation of cases at the
Lock Hospital, where a more accurate history in the treatment of
congenital syphilis might be obtained.
Mr. F. J. Bennett thanked Mr. Heath for the comprehensive
and accurate nature of his paper, and said that a few years ago it
had been his fortune to obtain about half-a- dozen jaws of children
who had died of exan'hematous fevers under the age of three. He
had gone into a most careful investigation of them, but what with
the difficulty of preparing such specimens and the scarcity of the
material, he was somewhat disappointed with his results, and
although, at the present moment, he was not in a position to state
his theories, yet one fact he would tell us, namely, that in all the
cases examined by him the stellate reticulum was considerably
atrophied. He, therefore, thought that he was justified in drawing
the conclusion that the stellate reticulum played a groaier part in
the formation of enamel than has been previously taught.
The President, after expressing his deep interest in Mr. Bennett's
investigations, proposed a vote of thanks to M^*. Heath and those
gentlemen who had brought forward casual com niunica ions.
He then read an introductory address.
The proceedings then terminated.
The next General Meeting will be held on Monday, March 9th,
when Dr. Miller will lead a paper on " Should Women be Dentists.''
THE DENTAL RECORD. 125
THE DENTAL RECORD, LONDON : MAR. 2, 1596.
UNSATISFACTORY BALANCE-SHEETS.
This is the season of the annual general meetings of the
Governors of Hospitals, and, from a financial point of view,
the reports, given at these meetings, are melancholy reading
enough. Disappointed hopes and even actual deficits seem
the order of the day. Birmingham is disappointed at the
result of a special appeal, and Liverpool, Manchester and
Brighton are each in debt to their treasurer for current
expenses. Nor can we honestly say that the metropolitan
hospitals are more fortunate, for, though it is probable that
the forthcoming report of the London Dental Hospital will
show no deficit in its working expenses, yet it is an open
secret that the appeal for funds for rebuilding has not met
with as generous and ready a response from the general
public as was very reasonably expected. There is, however,
some consolation in the fact that general hospitals are, for
the most part, quite as badly supported as are dental
hospitals. But, in the case of the former, the enormous
expenditure needed by their ever increasing size is a
plausible excuse for an insufficiency in funds which is
lacking in that of the latter, whose moderate outlay .•-tands
in striking contrast to the amount • f suffering to which they
dispense relief. Dental hospitals doubtl?ss suffer from their
youth. The public, as yet, have but recently opened their
eyes to the need of such, and their fingers are probably far
too engaged in rubbing away the scales of sleep to find leisure
to write cheques or to pty out guineas. But it is most
satisfactory to find that the municipal head of the provincial
towns we have mentioned, rach appreciates fully the claim
these hospitals have on the public purse, and, at any rate
at Liverpool, his disinterested action in coming to the
126 THE DENTAL RECORD.
meetings to plead this cause has already been of direct
value. We may honestly say that the d'^ntal profession has
done i^s level best to support these charities, which, except
as schools, are of no direct value to them. This is a point we
would emphasize, though it is one often missed by speakers.
The appointment of a general surgeon or physician to a
general hospital^ at which students attend, is an almost
necessary step to the attainm^^nt of i rivate practice, on it
to a large extent hi''> future living depends. But this is not
so with the appointment of a dental surgeon to a dental
hospital, which may bring him professional status, but is of
little pecuniary ben fit. How much greater, therefore, is the
public indebted to him for his services and for the very large
proportion of the expenses of these hospitals which he
actually provides. It m^y be said that his direct object is
not so much the benefit ot the charity as to help the school,
and this may be true, but it should be remembered that
though it would not be possible to separate the dental
hospital from the dental school, it would be quite feasible to
separate the school from t^^e charity. Indeed, the needs of
the charity are often an impedim'^nt to ^"he teaching
in the school. The e are thinkers who would gladly
see this separation, believing it to be desirable on
teaching grounds. But, A\hilst we admit a divergence of
opinion, though we cannot now argue the matter, yet we
would repea that the very possibility of this step increases
t'le obligation of the public to these charities. We could
understand their denying the need of dental hospitals,
though we might pity their ignorance, but this they do not
do ; no, the poor rr wd the rooms of the hospitals, and the
rich, on behalf of their needy dependants, importune
subscribers for orders they should properly obt lin by them-
selves becoming donors. Mr. Quinby rightly urged at
Liverpool th'-^t the students^ fees are not paid to support the
charity, but to provide teachers and teaching material ; for
"^.houg^^, on the one hand, we might admit that it would be
but fair for the school to pay rent for such rooms as are used
THE DKNTAL RKCORD. 127
purely for school purposes, yet on the other we claim that
this is more than covered by the gra^-uitous service renc'ced
by the staff and students to the charity, to say nothing of
the fact that the teachers and students, past and present,
have in every case subscribed to the charity more than
enough to cover both the building and the maintenance of
these.
i^.^tos anir jSnt^s.
Lewis- Osborn, L.D.S., Eng., has been appointed Demonstrator
of Operative Dental Surgery at the Liverpool Dental Hospital.
Mr. F. Graham Young, L.D.S., has been appointed Dental
Surgeon to the Bristol (old part) Lock Hospital.
Mr. J. Dencer Whittles L.D.S , Ene., has been appointed
Lecturer en Materia Medica and Practical Pharmacy to Mason
College, Birmingham.
The following gentlemen having passed the necessary examina-
tions at the Royal College of Surgeons in Ireland have been
admitted Licentiates in Denial Surgery of the College. Mr. William
King Carew (Dublin), and Mr. John Alfred Pook (Norwich). The
next examination is fixed to take place on Monday, May nth, 1896.
The Annual Meeting of British Dental Association will be held
in London on the 12th, 13th, 14th and 15th of August next. It has
been granted the use of the Examination Hall, Victoria Embank-
ment, for the General Meeting. The Whitehall suite of rooms of
the Hotel Metropole have been secured as General Head quarters.
We are glad to notice that the Liverpool Dental Hospital has
received the following donations, Lord Derby (the Lord Mayor),
;^50 ; Mr. Alfred Booth, £2^, ; and Mr. E. J. M. Phillips, ^25, a
welcome answer to the appeal published in another page.
128 THE DENTAL RECORD.
At a meeting of the Southern Counties Branch of the British
Dental Association, held at Beckenham, on January 26th, the Hon.
Sec. read a letter he had received from the Hon. Sec. of the British
Dental Association relating to the alteration of Bye-laws 15 and 18.
After some discussion Mr. J. F. Colyer proposed, and Mr. H. Beadnell-
Gill seconded, the following resolution, viz., ^'That this Branch is
satisfied with the Bye-laws as they now standi Carried 7tem. con.
At the Meeting of the MetropoHtan Branch, held on January 30th,
at Leicester Square, a discussion took place upon a communication
received from the Representative Board inviting the opinion of the
Branch as to Bye-laws 15 and 18 of the Association, and the following
proposed by Mr. H. B. Gill, seconded by Mr. J. N. Baxter, was
carried : — " That in the opinion of this Branch some alteration
is necessary in Bye-law 15, empowering each Branch to send up
two representatives to the Board, not necessarily being the President
and Secretary of the Branch for the time being." Are there two
Mr. H. B. Gills, or is this a case of Dr. Jekyl and Mr. Hyde ?
In the Report of the Brighton Dental Hospital, presented at the
annual meeting on January 31st, the Committee of Managment said
that at the end of 1887, when the Dental Hospital had been in
existence a year and a half, over 2,000 patients had been
received ; whilst in 1895 the number of cases treated amounted
to 3j053j the largest number yet admitted in any one year.
A very large proportion of patients were children under 14
years of age, a class of patients who would derive the greatest
future benefit. Last year they numbered 987. It was a matter
of regret, however, that an appeal for increased subscriptions was
necessary. The deficit now amounted to £2^ 5s. 5d., and the
committee had to deplore that the Hospital Saturday Fund yielded
last year cnly ;f20 to the Jnstitution, or just half of what it did
in 1894. The receipts had been /198 9s. 8d., including cash
advances by the Treasurer and Secretary of ^34 12s. 5d. ; subscrip-
tions, ^69 15s. 3d. ; Hospital Saturday Fund, /20 ; and Hospital
Sunday Fund, /20 17s. 2d. The expenditure had been /i 90 2s. 8d.,
leaving a balance at the bank of /8 7s., which, deducted from the
sum due to the Treasurer and Secretary, left a deficit of /26 5s. 5d
The chair was occupied by the President of the Institution, Alderman
Sir Joseph Ewart, M.D., J.P., who moved the adoption of the
THE DENTAL RECORD. 129
report, and remarked with satisfaction upon the great increase
in the usefulness of the Institution. In several of the institutions
in the town there could, he thought, be no question that relief
was, to a certain extent, abused. It was, however, satisfactory to
know that no such abuse could take place at that Institution, where
careful supervision as to the recipients was exercised. He regretted
the presence of a deficit in the hospital accounts, considering it was
the only Dental Hospital south of London, he thought the circum-
stance was not very creditable to those who should support them.
The twelfth annual meeting of ihe governors and patrons of
the Victoria Dental Hospital, Manchester, was held at the
Hospital, Devonshire Street, All Saints', on February 14th. Mr.
W. A. Copinger was in the chair. The number of patients, although
fluctuating slightly from year to year, continues to maintain its
average; and the fact that 126,308 persons have been treated, and
158,581 operations performed, is a proof that the work of the
Institution is held at its proper value. The committee appeal
again most earnestly to the public for support. The hospital is
largely in debt to the treasurer on its current account. The Chair-
man moved the adoption of the report, and expressed his regret that
the hospital, which was doing most satisfactory work, did not
receive more support from the public. Mr. W. Headridge seconded
the motion, and the report was adopted unanimously.
It will intertst old students of the Charing Cross Hospital to
learn that the authorities do not propose to re-let Toole's Theatre,
which is the property of the Hospital. Though desirable — on the
ground of safety- from fire — the Hospital can ill afford the loss of
rent — ^1,000 per annum — especially as during each of the last two
years there has been a deficit, about ^^4,000. At the annual meeting,
held on February 19th, the chairman stated they had practically
realised all their available securities. With regard to the suggestion
that the only remedy for its hopeless financial position was to remove
the hospital to Camberwell, he said the associations of the Institution
were so bound up with the neighbourhood that Charing Cross could
not do without its hospital.
I
130 THE DENTAL RECORD.
In the Gji/s Hospital Gazette Mr. Newland-Pedley gives a case
of a buried temporary molar. A lady, aged 29, consulted him
about an acute alveolar abscess on the right side of her lower jaw,
which, between the cheek and the first molar, discharged foul pus
on pressure. The lower teeth were translucent, free from caries,
and devoid of the discolouration which is likely to ensue upon death
of the tooth-pulp. The second bicuspid was missing, and the crown
of the first molar had tilted forward until it met the first
bicuspid. It seems as if the crown of the missing bicuspid had been
lost years ago, and that its root remained buried between the con-
tiguous teeth. A similar abscess had formed in the same position
six years previously, and had recurred two years ago. Palliative
measures were tried, but on December 26th Mr. Pedley removed
the first molar. The tooth had a living pulp, and the roots were
free from visible pathological changes. Next day the crown of the
second temporary molar was removed by the patient from the site of
the operation. The crown of the tooth was well formed, but the
roots had been entirely absorbed, leaving the eroded surface which is
commonly found in the milk teeth during dentition. The abscess
gradually subsided. Mr. Pedley thinks there is just a chance that
the second bicuspid may even yet erupt and take its proper position
in the arch, though he could not. detect it on probing the socket.
M. S. Broussilowsy, writing in V Odontolgie, says :— " I passed
last season in Crimea, the population being composed of Tartars,
Karaimes and Tziganes, whose manners and customs are in a primi-
tive state. According to their religion, the Tartars must consult the
doctors ; but, will admit as an exception exterior treatment such as
massage, friction, &c. Naturally the dentist is unknown to them ;
nevertheless I was astonished to see such fine teeth. Whilst
collecting professional information, I observed a habit, especially
among women, of chewing a white substance. This was an
interesting fact. The substance was ' gum mastich ' ; an addition
of white wax gave it a slimy consistence. This fact is also observed
in Siberia, but here, according to Faimenoff, the substance chewed
is a kind of mastic and tar. All Siberian women, from the age of
two years, indulge in the habit of using this mastic. The result of
THE DENTAL RECORD. 181
masticating this substance will cause development of the teeth, and
cleanse them as if by using a dentrifice. A proof of the effects of
this chewing, is that dental caries is of rare occurrence in childhood
and in youth, except in institutions, where the children of the
wealthy people live, who are forbidden to use this mastic, it being
considered a vulgar habit."
The Dental Manufacturlng Company point out to us that the
reference to them, in our last issue, as agents for the sale of
Ferropyrine and Chinosol was open to a misinterpretation. They
supply it retail^ Mr. B. Kiihn being the sole wholesale agent.
LIVERPOOL DENTAL HOSPITAL.
The Annual Meeting of this Institution was held on January
31st, at the Town Hall, the Lord Mayor presiding.
The Honorary Secretary read the 35th Annual Report, which
stated that during the past year the number of patients treated at
the Hospital had been 21,182, an increase as compared with the
previous year. The patients' voluntary contributions had amounted
to ^85 2s. The Committee regretted that of the balance of
£\'] IS. I id. remaining unprovided for in respect of the cost of
the alterations and extensions, there remained £l^^ still to be
provided. There was also a balance of ^45 7s. iid. due to the
Honorary Treasurer on the working account, and the Institution
was in urgent reed of an increased subscription list. The
Committee recorded with thanks donations to the general fund
amounting to £'^ los. 6d., and to the alterations and extensions fund
amounting to £(^\ 4s., and they had further to thank the Liverpool
Dramatic Company for the performance given in aid of the Hospital
in April last, which resulted in the addition to its funds of ^33 los.
The thanks of the Committee were due to the medical, surgical and
dental staff for their valuable services during the past year, and to
Mr. H. C. Quinby for his grant for school prizes.
The LoRu Mayor, in proposing the adoption of the report,
remarked that he had constant evidence of the popularity of the
Dental Hospital. People wrote to him for orders upon many
I 2
132 THE DENTAL RECORD.
charitable institutions, and he did not think he was far from the
mark in saying that those who appHed for orders for the Dental
Hospital were in number something like all the others put together.
The individual ailments might not be serious, but collectively they
represented a good deal. He looked with some anxiety to the
adverse balance that seemed to attach to the Institution, but since
last year the sum had been reduced, and, no doubt, there would
be further reductions. In conclusion, his lordship said that he
should be glad to contribute a sum of ;^50 to whatever fund the
Committee might think well to apply it. (Applause.) He hoped
that the Hospital would long continue its good work.
Mr. QuiNBY, in seconding the proposition, said that when the
many charitable people in Liverpool have learned more of what we
do in philanthropic and educational work, we shall not have to
appeal in vain to have our small debt paid off and our subscription
list increased. Everyone who has suffered from bad teeth will be
ready enough to admit that they are the cause of much misery and
unhappiness ; but only those who have made numan teeth and
their functions a special study have realised how essential their
preservation is to the health and vigour of body and mind. They
play an extremely important part in the enjoyment of our food, as
well as in the preparation of it for easy digestion and assimilation,
so as to make it naturally and satisfactorily a part of ourselves. A
dirty mouth gives nourishment and sustenance to every form of
disease eerms, because dirt and decay are what they thrive best
upon ; and what can be so dirty as a mouthful of decayed and dying
teeth, with putrescent pulps and suppurating gums ? How can any
healthy function of body or mind be co-existent with such a state of
things at the starting-point of nutrition ? To nurse up and preserve
a healthy set of teeth we must begin with the mothers, and teach
them how to look after their children's first as well as their second,
teeth ; that the temporary teeth are intended to do service as
masticators until the child is ten or eleven years old, and that there
is no time in human life when good digestion is more important
than to the growing child, who needs not only a constant supply of
food, but every care to keep the teeth in condition to masticate it
properly to meet the necessities of development. The great majority
of mothers never teach cleanliness in the mouth, never practise it
themselves, and the result is that the children's teeth very soon
THE DENTAL RECORD. 133
reach that condition of decay and death which poisons the food
before it reaches the stomach. This is far too often the case among
the better classes in life, who have the means of learning better ; and
what can be expected of the very poor ? All the work in the
hospital is done in accordance with the advice of members of the
staff or of the house surgeon. But the school greatly needs two or
three demonstrators, with a small salary, to assist in the teaching,
and the students' fees would amply suffice for their stipends if they
were justly appropriated. The working of the hospital is wonder-
fully economical, and well it may be, for the honorary staff give
their services, and the fees paid by the students for their teaching,
instead of being, as the students naturally expect, entirely devoted to
educational purposes, are equally divided between school expenses
and the general expenses of the hospital, amounting in the last year
to nearly one-quarter of the whole income of the latter. This is
very unfair to the students, and should not be permitted by the
people of this great city, whose struggling but respectable poor are
treated at our hospital with a skill and care which are scarcely more
than equalled in private practice. We earnestly commend the work
of the hospital to the employers of young people, male and female,
who are apprentices, learning to be the future artisans and trades-
men and women. Every one of these should be a liberal subscriber
or a life governor to an institution like ours. Our school stands
very high for the work it is doing, while its debt and expenses are
very small compared to what is asked for and obtained in other large
cities. We could clear ourselves from debt with ;^i,200, and an
increase of ;^200 to our subscription list would make us quite happy.
While one dental hospital in London is asking for ^^40,000 for new
buildings on a new site, and is earnestly begging for an increase to
its subscription list, which is nearly eight times as much as ours
already, another dental hospital in London has received a free gift
from one generous donor of buildings specially erected for its
purposes at a cost of ;f 10,000; and a new dental hospital has
recently been erected, in connection with one of the oldest general
hospitals of London, at a very considerable expense, of which they
do no't give details. Manchester is asking for ^10,000 for a new
dental hospital, and Edinburgh is expending about ;^6,ooo for a
similar purpose. Our alterations and extension, which have given
us one of the best equipped and most comfortable dental hospitals I
134 THE DENTAL RECORD.
have ever seen, were completed at a cost of ^'1,250 ; and our whole
income from all sources for the year 1894, which is the last report
available at the time of writing, amounted to £'^(^/^ 6s. 5d.
The resolution was carried with applause.
The Rev. R. Cuffe proposed a vote of thanks to the president,
chairman, committee, honorary treasurer, honorary auditor, and
honorary secretary, for their services during the past year.
Mr. Brakele seconded the motion, which was duly carried.
Mr. W. L. Jackson proposed that the Earl of Derby be elected
president of the Institution for the coming year, that the committee
be re-appointed, and that the hospital staff be re-appointed, with
certain alterations.
Mr. G. Wynne seconded the resolution.
The tesolution having been carried, Sir James Poole asked the
meeting to thank the Lord Mayor for presiding.
Lieutenant-Colonel Nicholson seconded the proposition, and
remarked that many of the recruits that it was his duty to examine
at Seaforth Barracks suffered greatly from the decay of the teeth
and the Dental Hospital was a very useful institution to which to
send them.
The proposition was carried with applause, and the Lord Mayor
was further thanked for his generous donation, on the proposition
of Mr. C. Birchall.
OPENING OF THE NEW DENTAL HOSPITAL OF IRELAND.
The New Dental Hospital of Ireland was formally opened on
February 17th at a public meeting held in the Conservation Room
of the new building, Lincoln place. There was a large and
fashionable attendance. The Right Hon. the Lord Mayor,
accompanied by the Lady Mayoress, presided. On his right sat her
Grace the Duchess of Abercorn, who has taken the deepest interest
in the hospital. Of this her Grace has given many tokens, and
that day she attended for the purpose of laying the corner-stone of
the second block of the new building. The block now completed
has cost nearly ^4,000, and the second block is estimated to cost
a similar sum.
The Right Hon. the Lord Mayor having taken the chair,
Dr. R. Theodore Stack gave a short sketch of the movement
THE DENTAL RECORD. 135
for a dental hospital in Dublin. The first dental hospital established
in the United Kingdom was opened about the year 1858, in London,
when it at once became apparent how useful to the poorer people
this valuable institution was capable of becoming. In London now
there are two large dental hospitals, and all the large hospitals in
London have large and useful dental departments. Outside London
no special dental hoipital was started for about twenty years
subsequent to the opening of the London Dental Hospital. Yet it
was always in the minds of the dentists in each of the larger cities,
that the moment they found the public ready to support them
by building such a hospital they would feel it their duty to give
their voluntary services to such an institution on behalf of the
poor. It may be truly said, then, that the delay in starting a
properly organised hospital has not been due to any unwillingness
on the part of the dentists to give their charitable services to
such an institution, but that it has been due to the slowness of
the public mind in seeing the necessity for such an institution.
The first great function of a dental hospital is to try and prevent
decay of the teeth by taking it in the very earliest stage.
The poorer classes, badly housed, and living on insufficient food,
suffer terribly from the effects of badly decayed teeth. It is a
matter of serious reflection among dentists in all the large cities —
" Could we not in the first instance do away with this trouble
altogether by careful attention to the teeth of children, or, at all
events, if we could not do away with it altogether, could we not
by an organised effort do something, and something very con-
siderable, to eliminate at least this one item of hardship from the
lives of the children of the poor ? " When people have come to
years of discretion it must lie with themselves how they have their
teeth treated, or whether they will run the risk — the very serious
risk — of some of those untoward results of neglect of teeth.
But the young children have not this power of choice. If mothers
could be brought to understand that an institution has been
built by the charitable public for the arrest of decay in their
children's teeth, they would welcome it as bringing within their
reach very material advantage for their children. The conservation
room is the only one of the apartments in this block of buildings
that is at all of the proper, comfortable size for operating in, and it
is impossible to develop the charitable work satisfactorily until the
136 THE DENTAL RECORD.
block of buildings, of which the foundation stone is to be laid to-day,
is completed. Between ;^5,ooo and ;^6,ooo more is wanted to take
full advantage of the site. The public, seeing this organised effort
of dentists to give their aid in the cause of charity, will not leave
them without suitable buildings. If these buildings are once erected,
the question of charitable dentistry for the poor will be practically ^
solved, because once sufficient buildings have been erected, with
numerous, properly-lighted operating rooms, the maintainence of
such a hospital as this is a very small matter. In this city, where
differences of religion often interfere with harmonious work, the
members of this staff, Catholic and Protestant, work most
harmoniously together. This union and cohesion is not a matter of
a day or a year, but gradual growth and development during the
past sixteen or seventeen years. This matured organisation is
now offered to the public to take advantage of as one of the
greatest factors of the capital resources of this institution. Dr.
Stack concluded by saying : — " You, dear madam, our gracious
duchess, have done your part nobly. You spared neither time nor
energy in promoting our cause to the Venetian Fete, and here we
have this building brought so far from the fund then realised — close
on ;^3,ooo. That this money has been judiciously laid out, that the
hospital has been solidly built, and built of good materials, you have
the best evidence we can give, for it not only has been subject to the
approval of our own architect, but also every portion of it has been
superintended by our landlord's architect, so that the building has
been put up in a solid and substantial manner. Apart from the
great interest which your Grace gave to our Venetian Fere, you
were able to hand over to the hospital, as a solid result of your
exertions, a sum of /300. May we hope that some others of our
wealthy people may follow this noble example. Truly, madam, after
all this we can surely say that it is you who have laid the foundation
stone of our hospital buildings. Without your great assistance we
feel the that we should hardly have made any progress yet, and we
feel now, with this building so far advanced, in a very different
position from that which we occupied when we had no rallying
spot worthy of our charitable cause. We are honoured, and it
gives us the greatest pleasure to think that it is your hand
which will lay the corner stone of our further building, thereby
advancing in a most necessary way our charitable aims, and as long
THE DENTAL RECORD. 1S7
as that stone shall endure engraven with your name, may all
Irishmen remember with keen and vivid affection the enlightened
interest and sympathy you have taken in our charitable work."
The annual report, which gave an account of the progress of the
hospital from its foundation to the present time, and pointed out the
necessity for its extension and development, was submitted.
The President of the College of Physicians moved that the
report be adopted. He said he could heartily congratulate Dr. Stack
on the admirable address he had delivered on the advance of the
institution. It was pleasant to be able to congratulate the friends,
managers, and administrators of the institution on the advances
which had been made in the construction of the new building, and,
above all, in the advance that had taken place in dental surgery.
Dental surgery had been placed in a more substantial and more
useful position in the city of Dublin than it had hitherto occupied,
and he (Dr. Grimshaw) felt especially pleased at this. They might
permit him to say that in his early youth he had intended to make
dental surgery his profession. He should like to notice that in the
development — in nearly the final completion of that institution —
they had completed the circle of medical charities in Dublin. It
was the only link, he thought, that was wanting. He was glad to
know that lady visitors to the poor could have there an opportunity
of learning sufficient to enable them to see the serious consequences
likely to arise to children in after, and even in early, life from bad
teeth and to enable them to teach these people how to avoid the
evils, which, no doubt, were very numerous indeed, from the early
disease of the teeth. He believed himself that Dr. Stack had not in
the least exaggerated — he thought he had rather under-estimated —
the evils that arose from diseased teeth. He himself was pretty well
satisfied that life might be very materially prolonged if everyone was
brought through the period of youth with a sound set of teeth. An
old friend of his used to say that dental surgeons, by artificial teeth
alone, had tended to prolong life more than any other branch of the
profession. He would not go so far as that. As Registrar-General
he had learned that the average of life had been raised by the
increased expectancy of life in the earlier half of life and not in the
latter. Now, he thought that dental surgeons might claim a little
of this. How much he did not venture to estimate, but he thought
they might claim a share of it. That institution afforded many
188 THE DENTAL RECORD.
educational advantages to the medical profession It was advantageous
to have the work connected with dental surgery concentrated in one
centre, where pupils might attend and learn the treatment of
diseases of the teeth and matters connected therewith. This was a
subject that had been very much neglected — the teaching of dental
surgery — in the early days of medicine and surgery, although it was
mentioned very long ago, but to have a systematic method of
teaching was a matter of great importance, and that could only be
provided at such an institution as they were now assembled in. His
father was the first regularly constituted lecturer in this city on this
subject, and he could not help congratulating them on the progress
they had made in recent times.
Dr. James Little, in seconding the resolution, said he was not
naturally enthusiastic, but he must say that anyone who had come
in contact with Dr. Stack, and had seen the self-denying enthusiasm
with which he had approached the subject of this hospital, and the
perseverance with which he had contended against all difficulties,
could hardly fail to have caught up some of the enthusiasm with
which he had worked up the establishment of this dental hospital. A
great number of nervous ailments from which young people suffered
were connected with the teeth. He was quite sure that headaches
and an incapacity for study were very often dependent upon troubles
which the dental surgeon could remove. It was stated in a novel
by Sir George Cornewall Lewis that the first necessity of every being
was that he should be a good animal. Certainly the sufferings
resulting from neuralgia and other ailments of that sort placed them
in a bad position for fighting the battle of life. Want of teeth
injured the digestive organs. Whatever might be said of the want
of nobility in the man who lives to eat, it was absolutely necessary
that they should all eat to live. It had been said that the happiness
of life depended not so much upon the great things as upon the
small, and although he could not speak with any personal knowledge
of the misery of a toothache yet he was sure that it took much
from the pleasures of life. Those who knew what suffering was,
knew that ill-health spoils the temper, disappoints engagements, and
goes a long way to destroy the happiness of life. The staff of that
hospital would in his opinion, deserve well of the public if they
assisted in lessening what were sometimes spoken of as small
miseries.
THE DENTAL RECORD. 189
The resolution was adopted.
Sir Thornley Stoker (President of the College of Surgeons)
moved '* That the Dental Hospital is worthy of support." As the
present representative of surgery in Ireland, he could say that this
hospital was not only doing a great and humane service among the
poor, but it was forwarding the cause of dental education in a way
that was particularly necessary in this country. Until this hospital
was founded there was no systematic instruction in dentistry possible
except what students obtained at the hands of private practitioners.
It was of the utmost importance that the public should interest
themselves in a work of this kind, which should not be left to
private enterprise. He could say that it had been of great service
to a class of persons above the extreme poor — he referred to the
poorer shopkeeping class, clerks with small incomes, and seamstresses,
&c. Further, he was aware that in many cases it had supplied
appliances at small cost, and in some cases at no cost at all, where
the recipients were unable to pay for them. The fact that it had so
many friends was in itself satisfactory evidence that the public
thought it worthy of support, and that they would always be forth-
coming when support of a practical character was wanted.
Count Noble Plunkett seconded the resolution in the absence
of Alderman Dillon. He performed that duty very heartily, and as
the first layman that had spoken he might be allowed to express the
strong feeling of the public, both as to the need of the hospital and
the admirable manner in which the work had been carried on under
trying circumstances for many years. He joined in the hope that
the public would contribute such means as the new building and the
maintainance of the whole institution, as an institution, called for.
The resolution was unanimously adopted.
Mr. W. Booth Pearsall moved " That the best thanks of the
meeting be given to her Grace the Duchess of Abercorn for her
attendance that day."
Dr. FiTZGiBBON seconded the vote of thanks. He said it was
about eight years since he had the honour of being on the same
platform with her Grace at a meeting on behalf of the Dublin
Dental Hospital. At that period the institution was in its infancy.
It had no place of its own in which to hold that meeting, and he, as
President of the College of Surgeons that year, had the privilege of
being able to place a room in the College of Surgrons at the disposal
140 THE DENTAL RECORD.
of the Committee of the Dental Hospital in which to hold the
meeting. Her Grace very kindly presided, and that meeting was,
he believed, the first impulse which was given to the public of
joining in raising money, which had developed into the establishment
of this new and promising hospital. He knew from his connection
with the Post Office that the employees there received great
benefit from that institution. The Post Office sorters, postmen,
telegraphists, and telegraph messengers were included in that
statement. No one that was not connected with such a department
could realise the trials that men had to go through in delivering the
citizens' letters in the early morning and late at night, and if they
added to the hardship of the work the fact that they often had to go
out suffering from toothache, they would hardly be surprised that
their letters would sometimes be late.
The resolution was put and carried amid applause, and the Lord
Mayor conveyed its terms to her Grace.
The second chair having been taken by Mr. Pollock,
On the motion of Dr. Baker, seconded by Mr. Corbett, jun.,
a cordial vote of thanks was passed to the Lord Mayor for
presiding.
The Lord Mayor, in acknowledging the compliment, tendered
to her Grace the Duchess of Abercorn on behalf of the citizens of
Dublin, their sincere thanks for the continuous and substantial
patronage which she had bestowed on the hospital. The necessity
for a hospital of the kind was unfortunately too long unrecognised,
and now that they had got it they should see that its effectiveness
would not be limited or restricted by apathy or neglect.
The meeting then terminated.
Subsequently the Duchess of Abercorn laid the corner-stone of
the additional new wing in the presence of a large assembly. The
silver trowel which she used on the occasion was presented by the
contractor, Mr. Good, and it bore the following inscription — "With
this trowel the corner-stone of the Dental Hospital was laid by
Mary, Duchess of Abercorn, February 17th, 1896."
The following is the inscription on the corner-stone : — " This
stone was here placed by Mary, Duchess of Abercorn, on the 17th
day of February, 1896 ; on which occasion also this Dental Hospital
was declared open by the Right Hon. R. F. M'Coy, Lord Mayor of
DubUn."
THE DENTAL RECORD. 141
^bsirarts anh ^tUctxona.
THE ACTION OF ANAESTHETICS ON ISOLATED NERYE.
By Dr. A. D. Waller, F.R.S.
The paper read by Dr. Waller, at the Meeting of the St. Mary's
Hospital Medical Society, on November 6th, was, as he explained,
a resume of some results obtained in one branch of the wide subject
upon which he is working, viz., the influence of reagents upon
isolated nerve ; nerve being here considered chiefly as excitable
living matter, as a strand of protoplasm easily modifiable by the
action of reagents, whether in the form of gas or liquid, and capable
of expressing the most delicate of those modifications by a
corresponding change of electrical state. These electrical changes
are demonstrated by means of Thomson's reflecting galvanometer,
the deflections of which are photographed on a slowly moving
sensitive plate. A word must be said as to the choice of nerve as
the test tissue. There is first, immunity from fatigue effects ; as the
researches of Wedensky, Bowditch, and Waller have shown, nerve
is practically inexhaustible. Then as to responsiveness; Chemical
and thermic evidence of metabolism in nerve is entirely wanting,
the one objective sign and measure of activity, obtainable on
stimulating a nerve by an induction shock, is that electrical change,
called by Du Bois Reymond the negative variation of the current
of rest. How direct and simple an expression of nerve change the
negative variation is Dr. Waller had already learnt in previous
researches. He has shown (Bram, 1895) that in nerve, contrary to
what obtains in muscle, stimulus and response, cause and effect are
proportional, the curve expressing their relation to one another
being a straight line. In the use of reagents, the extreme sensibility
of nerve to even very small quantities of, for instance, such a gas as
carbon dioxide, and the regularity of the effects produced, would be
barely credible without the evidence of the galvanographic records.
The greater number of plates shown were records of the effect
upon nerve of carbon dioxide, ether, and chloroform respectively,
and in some cases of combinations of these anaesthetics. The chief
facts may be thus summarised : —
142 THE DENTAL RECORD.
Carbon dioxide in small amount produces primary augmentation
(expired air produces primary augmentation.)
Carbon dioxide in large amount produces primary abolition
secondary augmentation.
A moderate amount of COj gives rise to primary augmentation
in conflict with diminution, followed by secondary augmentation.
Ether produces similar results ; much ether gives primary and
temporary abolition ; the subsequent recovery is less prompt and
complete, and secondary augmentation less regular and pronounced
than in the case of CO,.
Chloroform produces similar results as regards its primary effects ;
little chloroform gives augmentation, much chloroform gives
abolition, and under the conditions of experiment adopted (vapour
in full stream for one minute), there is little or no recovery, the
abolition being final and absolute.
After a moderate amount of chloroform recovery occurs, but
always less perfectly than after ether under similar conditions.
Using the term " anaesthetic " to characterise temporary abolition
followed by perfect recovery, " toxic " to characterise perfect
abolition of excitability, we have : carbon dioxide most anaesthetic
and least toxic, ether more anaesthetic than toxic, chloroform more
toxic than anaesthetic. An isolated nerve is most certainly and
safely anaesthetised by CO2, less certainly and safely by ether, least
certainly and safely by chloroform. It is most easily killed by
chloroform, less easily by ether, less easily by COj.
The striking facts brought out by these experiments is the
superiority of ether over chloroform where recovery of the nerve
excitability is desired. Records of the mixture of chloroform and
CO2 show that CO2 diminishes the toxic action of chloroform, giving
an effect very similar to that of ether. Results of experiments with
other ethereal substances were also shown.
Not the least interesting of the records was that of an experiment
demonstrative of the production of carbon dioxide in the nerve itself
in consequence of its action. Long observation of the effect of carbon
dioxide in augmenting nerve excitability had given the clue to a
curious puzzle with regard to the nerves. In the earlier experiments,
when a frug was killed, one sciatic was removed for use while the
other was left intact until required. It was noticed that the second
nerve was usually more excitable that the first, and when, as
THE DENTAL RECORD. 143
sometimes happened, a nerve was left in the body all night, the
negative variation was offen an extremely large though a declining
one. The explanation suggested itself that this phenomenon must
be due to the action of carbon dioxide produced by the tissues
surrounding the nerve, and this led on to the question whether
there was evolution of carbon dioxide in the nerve tissue itself, and
if so, whether by prolonged action its presence would not be
manifested by an augmented negative variation.
Before trying the experiment a drawing was made upon the
blackboard showing what the galvano-graphic tracing should be,
supposing that the surmise proved correct. Five or six normal
deflections were to be registered, and the tetanising current was
then to be kept on for five minutes; at the end of this long
stimulation the deflections ought to show a rise above the normal
followed by a gradual decline. The two plates which Dr. Waller
showed in the lantern, the one of his own forecast and the other of
the galvano-graphic record of the experiment itself, were most
striking in their close resemblance. — St. Mary^s Gazette.
From the February issue of the Dominion Dental Journal we
learn that Mr. Charles James Fox died on the 4th of January, from
an overdose of chloroform, in Gravenhurst, Ont., in his 66th year.
" Owing to some trouble in England," says this journal, " he gave
up a lucrative practice in the West-end of London and came to
Canada with his son and took up a free grant of land in the town-
ship of Wood, trying his hand at farming ; but his skill as a dentist
becoming known, his services were sougnt after by a large number
of people in the town, which ultimately necessitated his removal to
Gravenhurst. Only a short time ago he bought a property which
he named after the old family residence in London, ' Hollana House.'
It was largely by his efforts that the profession became a corporate
body in England. He received a testimonial signed by all the
leading dentists in Great Britain, accompanied with a purse of one
hundred guineas. As editor of the British Journal of Dental
Science^ his name was associated with the contest against quack
advertising, as well as many various reforms. Last winter his wife
144 THE DENTAL RECORD.
Hied from an overdose of chloroform which she took to relieve
severe neuralgic pain." Mr. Fox was one of those most actively
engaged in battle for reform of the dental profession some thirty or
forty years ago. He came of a family of medical practitioners, and
althougjh he did not himself take a medical qualification till some
years after he had been in practice, yet he was one of the first to take
the L.D.S. diploma in the year of its inauguration, i860. Mr. Fox
was a man of independent mind ; one taking a strong view of
questions, and striving earnestly for that end. Such ideas almost
necessarily brought him into controversy with some of his professional
brethren, but all readily concede that their difference were those of
means not of the ends they had in view. Mr. Fox was a member
and official of the now defunct College of Dentists, but he joined
the Odontological Society on its formation, and was secretary for
some years. He was for many years editor, and for some time
proprietor, of the British Journal of Dental Science. When
Assistant Dental Surgeons were added to the staff of the Dental
Hospital of London, Mr. Fox was appointed, becoming full Dental
Surgeon in due course. He was also Dental Surgeon to the Great
Northern Hospital from its foundation in 1856. We cannot but
regret the death of Mr. Fox, removing, as it does, another of those
links which connect us with the past, and one who was foremost in
the battle of reform.
We regret to announce that John Turner, L.D.S. , one of
Edinburgh's most promising practitioners, died at his residence on
Thursday, February 13th, aged 35, after a lingering illness. Mr.
Turner was one of the founders of the Edinburgh Dental Students'
Society, being early elected on the Council. He was Secretary
in 1889-90, then Vice-President, and finally President during
1890-91. He was also an Assistant Surgeon to the Dental Hospital,
where his thorough practical knowledge, and his conscientious work,
found recognition by all who had the pleasure of his acquaintance.
Mr. Turner was earnest in his convictions, and faithful to his
friends, and the profession mourns one who faithfully worked in its
best interests. The Students' Society, by the hand of its President,
placed a wreath on his last resting place as a tribute to his great
worth, and as a mark of their esteem.
The dental RECORD.
Vol. XVI. APRIL 1st, 1896. No. 4.
Original C0mmnnicati0na.
NOTES ON THE TREATMENT AND FILLING OF TEETH.
By W. Cass Grayston, L.D.S.
( Continued from page 107.)
It is sold to the dentist in cakes of ^ oz. each, and of 3 degrees of
density. No. i being the lightest in regard to its bulk, No. 3 the
densest, and No. 2 intermediate. No. i is the form generally
preferred, and which I have found the most satisfactory. It works
softer and more easily than the other two numbers. It is best
prepared for use by holding the cake lightly with one hand (pro-
tecting it if desired from actual contact with the fingers by holding
it with the thin paper in which it is wrapped) while with the other
small pieces are torn or dragged from the cake with foil carriers. By
this means, if the foil carriers are handled lightly, there is practically
no compression of the particles of gold, and it is in the best condition
to work satisfactorily. Some operators pin the cake to a piece
of wood by running needles through it, and tease out pieces
with two other needles set in handles ; others cut up the cake
with a razor into suitable blocks or pellets. A rotary knife in the
engine has also been employed. Small or large pieces may be
used, but each piece must be small enough to place in the desired
position without any squeezing through the orifice of the cavity, or
any compression that will in any way condense it before it receives
the direct impact of the plugger point. Direct force is very
important in working this gold. If it is necessary to use an
instrument, the point of which is not in a line, or nearly in a line
with its shaft, it is advisable to use hand pressure. A sliding blow,
which may often be employed with advantage in working foil, is
VOL. XVI. K
146 THE DENTAL RECORD.
inadmissible with crystal gold. It is a fascinating preparation to
use ; it can in many cases be gradually worked into solidity by
commencing with light pressure, almost patting it to place, and
then gradually increasing the force until it is solid. Each piece
must, however, be carefully and accurately solidified, with even more
care than is necessary with foil. After using crystal gold exclusively
for three years, and having also made numbers of experiments with
it out of the mouth, I have come to the conclusion that in order to
obtain the best results it is necessary to use a plugger with a small
condensing surface. What is known as a retaining point plugger is
about the size. This gold will pack down apparently satisfactorily
if larger points are used, or if foot pluggers of moderate size are
employed, but the filling will be wanting somewhat in solidity and
adaptation, and the greatest possible solidity is necessary with this
gold if it is desired to make what are known as fine fillings. When
all the gold is packed as solidly as possible with fine points, the pro-
jecting gold of approximal cavities may with advantage be flattened
and condensed down with foot pluggers, but their use in the
interior of cavities is with this gold best avoided. No prepara-
tion of gold demands greater care, and conscientious and long
continued application of condensing force, and this takes up
a great deal of time. With foil, foot pluggers of moderate size may
be used with advantage, and, if the gold is not too thick, excellent
cohesion and solidity will result, while if a fine point is used
(particularly with hand pressure) a greater weight of foil may be
condensed at once than is possible with crystal gold, if equal results
are to be obtained. Some operators claim that more rapid work
can be done with crystal gold than with foil, and the directions in
some of the books favour this idea. My experience is that all
attempts to do rapid work by using either very large pieces or broad
points result in imperfect work, and also that the directions often
given to use a broad point at first and follow it with a fine one are
misleading. Start with a fine flat point, either very finely serrated
or smooth if a mallet is used, and finely serrated (to prevent slipping)
if employing hand pressure, and never change it for a larger one
until all the gold is packed. Use a mallet wherever a straight or
nearly straight point can be used, and hand pressure in all other
cases. The results obtained with this gold are excellent, providing it
is worked in the above manner with great care.
THE DENTAL RECORD. 147
Annealing Gold. — All gold that is to be used cohesively, whether
foil or crystal gold, should be annealed before use. It can be heated
just to a dull red without injury, and, in fact, if the greatest
cohesion is desired, it is necessary to heat it to this point. The gold
will, however, in many cases work more softly and easily if not so
highly annealed (particularly if in the pellet form), and as something
less than extreme cohesion is often desirable in order to secure ease
of working and ready adaptability to the walls of cavities, many
operators find it useful to anneal each piece of gold by passing it
over or through the flame just before placing it in the cavity, and
by this means to vary the cohesiveness as desired. Others, again,
will anneal all the gold necessary for an operation before commencing
it. Personally, if I am using thin tape, I prefer to anneal a con-
siderable quantity at a time, and it can be made just red without in
any way injuring its working qualities, while, when I am using
pellets, particularly if dense, I prefer to anneal, and often to vary
the heating as the work progresses.
Annealing can be done either with the naked flame of a spirit
lamp or by placing the gold on a thin sheet of mica or platinum, and
holding it over the flame. Either method gives good results. The
balling up of cohesive gold so often alluded to is simply caused by its
refusing to cohere. This may be due either to insufficient or excessive
annealing (usually the latter) ; to the use of pluggers or pliers, the
points of which are not clean ; to the use of a dirty spirit lamp ; to
failure to thoroughly prevent moisture from getting to the filling ;
or to want of skill on the part of the operator. Given a good make
of gold and an operator of some experience who is careful in little
things, it is rarely that a piece of gold will ball up. On the other
hand, given a careless dentist, whose foil carriers are smeared with
dried mastic varnish or chloropercha, the serrations of whose instru-
ments are rusty or dirty, and who anneals his gold in the naked
flame of a spirit lamp, the wick of which is thoroughly charred, or
contaminated with the fumes of the matches in lighting it, &c., it is
not to be wondered at if he finds the working of cohesive gold
particularly difficult.
If tape is heated directly in the flame there is a risk of the part
held by the foil carriers being imperfectly annealed. It is therefore
always advisable to reanneal this part, holding the tape in another
place. If thin tape is to be annealed in the flame, it is well to
K 2
148 THE DENTAL RECORD.
prepare broad pieces about half an inch wide and from about one to
two inches long, as may be convenient, and then after heating to cut
these pieces into strips as narrow as desired. It is very difficult to
pass a thin narrow strip through a flame with any certainty of its
being evenly heated. When a sheet of mica or platinum is used, oi
course there is no difficulty. It is thought by some that cutting the
tape into narrower strips after annealing will harden the edges and
interfere with the proper working of the gold. I have never noticed
that it makes any difference, and I usually anneal thin strips in this
manner. The only trouble is, that the gold has a tendency to stick
to the cutting edges of the scissors, but this is a very little matter.
Some dentists, to avoid it, place the gold between sheets of thin
paper, and cut through both paper and gold.
Comhinatiun of Non-cohesive and Cohesive Gold. — It is necessary
in using cohesive gold to fix the first pieces in one or more pits or
undercuts that have been made for this purpose in the dentine. It
is not always easy to do this just in the most convenient place, and
sometimes the dentine is sensitive, and as little cutting as possible is
desired. A few pellets of non-cohesive gold can generally in these
cases be wedged to place between the cavity walls, and a foundation
easily made that with cohesive gold would have been difficult. In
molars and bicuspids if there is any difficulty in making the non-
cohesive gold stay in place, tin foil may be substituted with — as
previously explained — very happy results. Cohesive gold will not
cohere with non-cohesive — the film that has been deposited on the
foil to make it non-cohesive prevents this. It is therefore necessary
to make the union by forcing the one well into the other, using
pluggers with very sharp and fairly long serrations, or by pressing
pits or undercuts in the non-cohesive to hold the first pieces of the
cohesive gold. Unless, however, the cohesive is thoroughly locked
into the non-cohesive by means of undercuts, the union is not to be
depended on solely for the retainage of the cohesive portion. This is
not of much importance where the non -cohesive is only used to
facilitate the starting of a filling, but many operators will fill from
half to two-thirds of a cavity with non-cohesive and complete with
cohesive, and here the importance of a good mechanical union is
manifest. To drive cohesive gold into non-cohesive or to make pits
and under-cuts in it is troublesome, and takes up time. I prefer
therefore to use true non-cohesive foil annealed, or to make a
THK DENTAL RKCOKD. 149
foundation of unannealed or very slightly annealed cohesive gold.
With a little practice it is not difficult to wedge either of these
golds to place, and the annealed cohesive (particularly if thin
pieces are used) will at once stick to the foundation thus made,
and the work proceeds "straight away'' without any trouble.
I would not, however, build out much and trust solely to
this union if any great strain is likely to come on the filling.
Using it as I do, principally to start fillings, I find it very convenient.
If tin foil is used as a foundation it is desirable, and saves trouble, to
use a gold that will at once readily cohere with it. Leslie's crystal-
line gold will do this. When the tin is covered with this gold, the
filling can be completed with any form of cohesive gold that the
operator prefers.*
Maniptilating Cohesive Gold. Cohesive gold is packed to place
and made solid by hand pressure or by mallet force, or by a
combination of both.
When the cavity is accessible and a fairly straight plugger can be
used, the necessary solidity can be better and more readily attained
by a mallet. If thin tape is used the work can be fairly rapidly
accomplished without any risk of jarring or injuring the tooth in
any way, or causing the patient either pain or inconvenience.
Occasionallv a patient is met with who cannot endure the lightest
tap of any mallet, but it is rarely a complaint will be made. I
have frequently asked patients if the mallet was causing them any
inconvenience, and the usual reply is " not the slightest." When-
ever the cavity will admit of it, a smallioot plugger will be found the
most convenient mallet-instrument to use with foil (particularly if thin
tape is used). If rather dense pellets or blocks are used, it is well to
tack them to place with hand pluggers with sharp, deep serrations,
and then to complete the condensation of each one with a mallet.
Loosely rolled pellets can be packed entirely with mallet force if
desired and the access will admit of it. Cavities that cannot be
readily reached with a straight plugger should be filled with hand
pressure, and in many cases the more difficult parts may be filled
with the hand plugger and the filling then completed with the
mallet. A denser filling will be made with a mallet than by hand
pressure alone, unless a very long time is taken. It is, however, often
unnecessary to obtain the greatest possible solidity all through the
* Solila gold also coheres with tin.
150 THE DENTAL RECORD.
filling, and a hand-made filling with the last few layers condensed
with a mallet can in many cases be made quite as rapidly, and in some
more rapidly, and the appearance and wearing of the gold will be
quite as satisfactory as if entirely made by mallet force. In using a
mallet, either very finely serrated or smooth pluggers should be used
(the latter being preferable with a fast striking mallet), with hand
pressure, the instruments may be finely or deeply serrated or smooth.
Deep serrations seem quite to have gone out of fashion, but rapid and
good work can ofien be done with them, particularly if somewhat
tightly rolled or dense pellets are used, and although the resulting
condensation will be somewhat uneven, the cohesion produced is very
strong, and the adaptation to the cavity walls is good. The surface
of the filling, however, no matter how carefully it is smoothed and
burnished, will, under the force of mastication, soon assume a pitted
appearance. It is therefore advisable to use finely serrated or
smooth points, as the surface is approached — preferably with a mallet.
Very fine fillings can be made with smooth points used with hand-
pressure, providing the condensing surface is not too large, and in
addition to direct force a rubbing or burnishing of the gold to place
can be satisfactorily accomplished. In the hands of the inexperienced,
however, there is a risk of the instrument slipping and wounding
the mouth. The happy medium between deep serrations and smooth
points is arrived at by the use of finely serrated pluggers, and
these are the most generally used and popular instruments,
Non-cohesive gold should be placed in position with foil carriers, and
pressed to place with either the side or the point of the plugger.
It is generally important to press the whole of the cyhnder or pellet
well up against the wall at once. Foot pluggers are also useful in
this connection. When two or more cylinders are firmly locked in
place, they may, if desired, be further condensed laterally with fine
points. The last pieces should be driven down between the layers
of gold already in place, like a rivet, so as to key them in
position.
To explain methods of packing gold into teeth a few typical
cases will be rcentioned. It does not come within the scope of this
work to minutely describe the filling of numbers of cavities in all
sorts of positions, each of which may present instructive peculiari-
ties. It is intended merely to allude to the fiUing of certain cavities
the general principles of which will apply with slight modifications
THE DENTAL RECORD.
151
to the vast majority of cases, for it is presumed that an operator
who has once grasped these principles will be able to modify them
as circumstances may demand.
To fill a very small crown cavity or a very small cavity in any
exposed position, take a small pellet of cohesive gold and simply
press or hammer it in. A cavity of this size may be considered as a
retaining pit, and filled accordingly. Pack in other very small
pellets one by one, attaching them to the previously condensed gold
until the cavity is full. If non-cohesive gold is used, take a very
tightly rolled cylinder that can just be placed in the hole so that one
end will rest on the floor and the other project slightly, place a
fine instrument in the centre of the protruding gold, and press
down with considerable force. If this makes a hole of any depth
in the first cylinder, place in it in like manner an even smaller
cylinder rolled to an almost wire-like consistence, head this down
like a rivet, condense the overlap and finish. Sometimes the first
cylinder can be headed down and the filling made with only one
piece of gold. To fill a cavity a little larger than this with cohesive
gold, press in a larger pellet unannealed, and hold it down with an
instrument held in the left hand while it is condensed down. If
this does not make it stay in place, press in to one side, or, better
still, remove it, and press a fresh pellet on to the floor and to one
side, and in the space thus made wedge other pellets until they can
be condensed down without any rolling. By the use of the two
instruments, one to hold the gold and the other to condense it, there
is usually no diflficulty in making the foundation, and the filling is
then completed with pellets or tapes as desired. To fill with non-
cohesive gold, insert a cylinder as before, press it to one side, press
another one against the opposite wall, and head down a third
between these two. If the cavity is deep, press the third cylinder
well down on to the floor, so that it extends only half way up to
Fig. 6.
Fig. 7.
152 THE DENTAL RECORD.
the crown, and then on to this cylinder head down another one,
which completes the filling. (Figs. 6 & 7). Medium and large sized
cavities are filled on somewhat similar lines. If the cavity is box-
like in shape there is no difficulty in wedging the foundation for
cohesive gold, while if it is awkwardly shaped, a pit or undercut
must be made sufficiently deep to hold the first pieces of gold, and
the filling gradually worked from this foundation across the floor
and then built up to the orifice. It is usually inadvisable to use
non-cohesive gold in these cases.
To fill a large box-like cavity with non-cohesive gold, place the
first cylinder against the posterior wall, and if the hole is fairly
round, place them in succession against the walls, condensing with
lateral pressure, and head down one or more keying cylinders in
the centre as previously described.
If the cavity is oblong, commence at the posterior, and work from
this to the anterior wall ; when this is nearly approached place one
or more cylinders against it and rivet the last pieces into the
intervening space.
To fill a star-like cavity consisting of a central cavity with fissure
like extensions, wedge unannealed pellets towards the ends of each
arm until the centre is reached then wedge more pellets in the
centre, condense down and build up with cohesive pellets or strips.
If the extension arms and the centre cavity are too shallow to admit
of wedging a foundation, drill a retaining pit at the end of each
extension and work the gold from these pits carefully over the whole of
the floor and then up to the surface. With non-cohesive gold, pro-
viding the cavity and extensions are cut deep enough to admit of its
use, press the cylinders to the end of each extension until the centre
is reached, and then treat the centre as an ordinary cavity, or fill the
posterior arm first, then the two at right angles to it, then place
cylinders in the posterior part of the centre cavity and condense by
Figs. 8 9 10 11.
Fig. 8. — The extensions are filled first, leaving the centre to be filled as a
simple cavity.
Figs. 9, 10 & ii shew the posterior and two lateral extensions filled first,
then the centre ; then the anterior extension, the ■*• being the final keying piece.
THE DENTAL RECORD. 153
pressure in this direction ; then, when the centre is filled, condensing
still with posterior pressure, proceed to place the cylinders in the
anterior extension, pressing them towards the gold already in the
the centre. Continue; in this manner until the end of the extension
is nearly reached, place a cylinder at the end of this arm, and the
keying cylinders between the gold at the end of the arm and the
rest of the filling. (Figs. 8 lo ii).
Filling Upper Incisors and Cuspids. — In working from the
lingual surface, place a pellet of unannealed, or, if preferred, non-co-
hesive foil against the cervical wall, pressing it into the undercut, but
not thoroughly condensing it, place one or more pellets against the
labial wall, pressing them somewhat ccrvicalwards until the cutting
edge is nearly reached, then place a pellet against this wall and into
the undercut at this part. Now thoroughly condense the gold,
working it with very fine pluggers into the grooves and undercuts.
Condense it generally by surface pressure with a broad plugger,
pressing it down on to the floor, applying the pressure principally
towards the labial wall. Be very careful to see that the labial wall
is well covered, and turn the gold over it with a broad-faced condenser
and a flat burnisher. Now proceed to pack annealed gold on lo this
foundation, work it well up to and over the labial wall, turn it
over the edge with a flat burnisher. Be also very careful to work
the gold over the cervical edge. Tt is almost impossible to afterwards
add any gold at these parts should defects be found there on trimming
the filling. Proceed in this manner, and keep on turning the gold
over in the direction of these edges until it is built sufficiently from
between the teeth to admit of the remainder of the filling being packed
by direct pressure in all directions — when in fact the part that is between
the teeth is completed, the lingual surface is readily built up with
right angle or corkscrew pluggers, and the surface in general flattened
with a broad faced condenser. Where the space between the teeth
is narrow and the turning down and condensing of the gold in the
direction of the labial and cervical walls has not sufficiently built up
the gold between the teeth, small squares of No. 60 foil or of No. 4
foil folded up to No. 64, or 128 may be conveniently placed between
the teeth on to the filling in the desired position, and by pressure of
flat condensers and by rubbing with thin flat burnishers made to
satisfactorily cohere. If it is difficult or impossible to start the filling by
wedging, a starting point must be drilled in the dentine at one end
154 THE DENTAL RECORD.
of the cervical groove, usually in working from the back, at the
cervico labial angle. The gold is annealed, worked into this pit,
carried across the cervical wall, and then worked down the labial
wall, packing it well into the angle formed by this wall and the
floor, working the gold at first with upward pressure so as not to
drag it away from the cervical wall. It must be packed up to and
over the labial and cervical borders, in fact, the manner of working
is precisely the same as has just been described, except that instead
of wedging a few pellets of annealed gold to place as a foundation
for the more cohesive portion, the whole filling is absolutely cohesive
and is gradually worked from a starting point, using at the commence-
ment smaller pieces of gold. It is necessary to carefully work the gold
over all edges, but the labial and cervical are particularly mentioned
because they present the greatest diflSculties. If it is desired to
introduce the filling from the front, the method of procedure is very
similar, except that no grooving of the labial wall is, as a rule,
admissible ; on the contrary, it is distinctly advisable to slope this
wall outwards. This makes the accurate packing of the gold at this
part easy and certain ; the lingual wall is not cut away beyond trim-
ming the border, and if the dentine will admit of it, it may be
slightly grooved or undercut — it becomes, in fact, what the labial is
in working from the back. The cervical and cutting edge
undercutting is the same as in the other case, with the exception that
if a starting point is made, it must be drilled at the cervico-palatal
angle. The procedure is the same as in the former case, with the
exception that the lingual wall is to be treated as was the labial in
filling from the back, the careful turning over of the gold being done
at the lingual instead of the labial wall. In introducing the filling
from the labial surface, a mallet can generally be used for the bulk
of the filling, while in working from the back its use is often diflficult
and sometimes impossible. If the cavity is on the distal surface,
the cutting and filling from the front can generally be done without
spoiling the appearance of the teeth to any great extent. In many
of these cases the gold is hardly noticeable if carefully finished,
while on mesial surfaces the result from an aesthetic point of view
usually leaves much to be desired. It is better, therefore, to get
into the habit of filling all these cavities from the back whenever it
is possible to do so, although it takes up more time.
(7b be continued^
THE DENTAL RECORD. 155
"SHOULD WOMEN BE DENTISTS?"
By F. Miller, M.B.
Mr. President and Gentlemen, — During the past few years,
since the New Woman blossomed forth in our midst, I have often
wondered when it \youId fall to my lot to hear a discussion en the
subject of our debate to-night. I never thought I should be the
one to open the discussion , but on Mr. Stanley Colyer asking me to
undertake it, I promised to do what I could, and I beg that you will
excuse the light manner in which I am afraid I have gone into the
subject. We do not find in the history of the attempts of women to
gain admission to the examination for the L.D.S. any thrilling tale
of difficulties only met to be overcome, such as we find in the record
of the endeavours of ladies to become medical practitioners, and
we have no Sophia Jex-Blake nor Elizabeth Garrett Anderson
champions of the Dental Women. At the present time women are
admitted as candidates for the L.D.S. Edinburgh, for which they
have to pass two examinations the first in general medical subjects,
and the second in purely dental work. Their hospital course is, as
with us, two years, and I might mention that this includes a course
in anaesthetics, i.e.^ administration of CH ClsandN^O. Lady students
are not, as we are all aware, admitted at the London Dental Hospital,
but they are at the National, Great Portland Street, vv^here they take
out the same course of study as the men. In gathering information
on the subject of our debate I wrote to the Dean of the National
Dental Hospital, and in reply received the following note : —
'' Dear Sir, — In reply to your enquiry about lady dental
students, they are also admitted at the Edinburgh Dental
School. We have also from time to time allowed lady medical
missionaries to come and take a course of extraction, &c."
As far as I can ascertain there is only at present one lady with
an Edinburgh Dental qualification, the young lady, in question
being Miss Murray, who obtained her L.D.S. in May last year.
There are a number of women on the Dental Register as being in
practice before 1878, but many of these do not practice at all, and
most of those who have a practice entrust it to an assistant or have
it carried on by their children in their name. We may, I think,
conveniently and profitably look at the subject of our discussion
to-night, firstly, from the general aspect and then go into the details
of the question.
156 THE DENTAL RECORD.
Firstly — We of the latter part of the nineteenth century are
becoming used to the creation which has sprung up mushroom-like
in our midst, and goes by the — what I consider appropriate — name
of the '' New Woman." Whereas our grandparents were only
accustomed to see women carrying on business in a small way as
retailers of linen or drapery, or as village school and post-mistresses,
we of the '' latter day " are used to lady doctors, female teachers of
every branch of science and art, clerks, typewriters, female assistants
in every branch of business, but such I do not in my mind class
under the head of the ** New Woman." This, as I said before,
appropriate name I reserve for those females (generally women of
leisure) whom one meets occasionally, and who have several diagnostic
or pathognomonic features. One easily recognises the tall, large-boned,
muscular woman, with prominent cheek and massive jaw-bones, who
wears pince-nez^ tailor made dresses (often badly fitting) and hair
closely cropped ; we hear she lectures on " Women's Rights " (and
are not in the least surprised), and if she has so far descended from
her own pedestal as to marry, her husband is more often than not a
little puny individual, whose only attempt at originality is to wear
different trousers occasionally, and we feel involuntarily that there
has been some mistake and that those necessary articles of attire
ought to have been allotted to his better half
On the 13th of last month I had the pleasure to hear a paper
read at St. Bartholomew's Hospital, before the Abernethian Society,
on *' The Sexual Branch of the Connati Instincts." Dr. Clay-Shaw,
the author, entered very fully into the questions of Hetero and
Homo-sexualism, and discussed the extreme examples which have
recently come before the public. It is not in place to enter into
this subject here, so I shall in my following remarks only touch
lightly on the question. As, far as my experience goes, one does not
meet with the ordinary feeling of jolly-good-fellowship so often
among women as one does among men ; but, on the other hand, I
think it is more common to meet with examples of " Hero-Worship '*
in women than in men. By this I do not mean that men do not
make constant and devoted friends, but in an unwritten compact
such as exists in the latter case the two parties are on an equal
footing, while in what I call " Hero-Worship " in the opposite sex
the bond of equality is lost, and one becomes the willing slave almost
of the other. This I consider to be a minor form of Homo-sexualism
THE DENTAL RECORD. 157
or perverted sexual instinct, just as I look upon the case of the
"Women's Rights " lady above referred to. I think it is almost as
common, if not more so, to meet with this perverted sexual instinct
in a small degree in young men than it is to meet it in women.
One classes as such effeminate men the youths one meets strutting
about as if their sole object in life was to act as a walking advertise-
ment for their tailor, their individuality being displayed only in
their choice of the exotic which they daily wear in their button-hole.
We are all familiar with the monsters of muscle and the monsters
of intellect who move in our midst, and, though it is a little harder
to understand such, we no doubt have monsters of sexual instinct
living with us. Many are inclired to think that these attempts of
women to enter the various professions are but part of the move-
ment which has de*^eloptd of recent years, and which is thought
by those who have made a special study of psychology to be due
to a perverted sexual instinct ; on the other hand I should be
inclined to argue that women have to live as well as men, and if
they are to earn their own daily bread, why should they not, if
they are able to satisfy the boards of examiners, enter the learned
professions. Dr. Clay-Shaw, in his paper which I mentioned above,
quoted what he called the greatest tribute he ever heard given to
Hetcro-sexualism. A female patient was leaving a lunatic asylum
cured : he asked her what she thought of lady doctors. With a
look of great contempt she answered " Who attended Eve ? "
This same patient said, " Ladies will never succeed as doctors
amongst ladies because they can't sympathize with us like men
can." I think this is one great disadvantage that women labour
under as dentists. Almost all the ladies I have known to have
had their opinion asked on the question of whether they preferred
to have a lady or man dentist decided without hesitation in favour
of the latter.
A friend of mine, who lives in New York, went to her dentist
one day, and, as he was not able to attend to her, his assistant
(who was a female Philadelphian D.D.S.) was about to take his place,
but the patient absolutely refused to be treated by her. I think
personally that women have more than a fair share in deciding the
question of whether a movement like the one we are about to discuss
shall succeed or not, and as lady dentists are almost tabooed by ladies
(who form the bulk of dental patients I think), I don't imagine the
158 THE DENTAL RECORD.
future of lady dentists is, at any rate at present, as bright as I may
say I should like it to be. Up to 1894, with the chivalrous enthu-
siasm which I think is innate in us all, much as some of us may have
allowed it to degenerate, I would have given my humble vote,
indiscriminately, in favour of anything women chose to undertake.
I am afraid I was more romantic then than I am now ; a course such
as all here more or less have to go through takes a little of the
upper crust of gilt off, and shows the subaureate stratum. In the
summer of 1894 I went over to Dublin to the Rotunda Hospital to
take out my midwifery and obstetric work, it was there my lot to
make my first acquaintance with the lady medical. At first (before
I saw them) I was biassed in their favour, and thought they deserved
more encouragement than they got from the members of a liberal
profession, but in a very short time my ideas underwent an extreme
change. There were some nine or ten lady students taking out their
midwifery course at the Rotunda, and with the exception that they
lived out of the hospital, while we were " Intern Students," they
were treated just as we were, taking their cases in turn in the labour
wards and outside, and coming round the wards every morning with
the Master or Assistant Master.
As far as the extern patients were concerned I have known these
lady students sent back time after time from labour cases, the
Irish women refusing to be attended by them at any price. In
the winter of 1894, I heard a paper read before The Owens College
Medical Students' Debating Society, on the subject of " Lady Doctors,"
and after some very heated discussion (in which I well remember the
amusing expression " they're not real ladies," was used) a vote on
the subject was taken. As the result of the division, a resolution
very similar to the following was carried by a large majority. *' That
in the opinion of this meeting, ladies, provided they can satisfy the
Board of Examiners, have every right to become medical practi-
tioners.'' I may say that I voted in favour of the motion. In the
discussion following the paper by Dr. Clay-Shaw that I alluded to
above, I remember one gentleman saying that *' the time will come
when women will, in every profession, try to rob us of our daily
bread." I did not think it was very polite of the gentleman, and
would have liked to advise him in that event to make love to one of
the most accomplished robbers. I have heard several men express
their idea that a reaction will come which will be too powerful for
THE DENTAL RECORD. 159
the new woman to resist, and then lady dentists, new woman and
rational costume will alike become things of the past. I think in
these cases, however, the " wish was father of the thought."
Secondly — It is in this, the second part of our paper, that we
must look for the practical pros and cons of the question, on which
it will even'ually be decided whether women are able, physically and
mentally, to become dentists, and whether, having taken this first
fence successfully, the}' can make their profession profitable to
themselves.
On asking Mr. Patterson where I should be likely to get some
information on the subject of lady dentists, he advised me to write to
Miss Murray. I accordingly did so, and received in answer to my
letter the following reply : —
" Dear Sir, — I will endeavour to do my best to give ycu
some details concerning the question of the advisability, fitness,
or otherwise of women as dental practitioners as far as I know
them. I have only known one woman besides myself who has
been in practice, hence it is somewhat difficult for me to make a
statement concerning women generally. As there are some men
who could never be dentists, so it is the case with women.
Women have practised dentistry with success — this is a great
argument in their favour. Of course, generally speaking,
women have not the physical strength and sustaining powers
requisite for a practitioner who attends to all branches without
assistance, but as an operator in the conservative department
there can be no doubt that a woman is eminently fitted for the
work. A woman should always turn her attention specially to
the treatment of children's teeth, for her tact and tenderness
will always succeed with them, and they will go to her more
readily, and be less in fear of her than the ordinary man. As an
extractor, a woman, if she has the necessary skill, will succeed
quite as well as a man with the same qualification. Even every
man cannot extract. I once heard an eminent dentist remark
that 'an extractor is born, not made, though much comes by
practice.' It is in the mechanical department that a woman is
least successful, as the work is often rough and needs strength
as well as skill, and more mechanical brain power than the
ordinary woman is blessed with. A cool head and clear brain
are indispensable adjuncts; this, as a rule, women fail in at the
160 THE DENTAL RECORD.
critical moment, in other words, they are liable to lose their
heads under excitement. Their natural tenderness and
sympathy are against them in carrying out their work with
that thoroughness which is so necessary to a successful filling.
For instance, when in gold filling it is necessary to drill
retaining points in sensitive dentine, which defies all efforts to
obtund it, it requires a great struggle against the natural
antipathy to giving pain in order to drill on while the patient's
tears flow freely. From a business point of view too, she is, as a
rule, not competent. For one rarely meets qualities requisite
for a skilled dentist and good business capacities combined in one
woman. Here again a woman's sympathy stands in her way,
for she gives way before the pitiful tales that are poured into her
ears — as likely as not from an impostor who works upon her
easily moved feelings. The sentimental nonsense that is so
often uttered whenever the subject of medical and dental women
arises, about woman losing her finer sensitive feelings and
becoming masculine, is very absurd. No one can realise the
amount of suffering and sorrow in the world unless brought into
actual contact with it, and the best way to show how sensitive
one's feelings are and express one's true sympathy lies in
alleviating these pains and sorrows to the best of one's ability,
and the true way to do this is to learn to study properly the most
scientific, the best and the kindest methods. You cannot remove
pain or relieve it by v\eeping over the sufferer, and often only
make it worse by losing time in useless wringing of hands. It
has given me much pleasure to write this, and this pleasure will
be increased if I havj been of any use.
" Yours faithfully,
"Lilian Murray."
I think Miss Murray, in her letter, for which I am greatly indebted
to her, has touched upon and ably discussed most of the practical
points in connection with this question ; if anything, she has, in my
opinion, rather underrated the points in favour of women and over-
stated those which might be adduced as reasons why women should
not become dentists.
For instance, strength does not come into play very much in
the routine work of a dental practice, except now and again in
extracting some troublesome stump and occasionally in the work-
THE DENTAL RECORD. * 161
room — that is unless the feats of strength and wielding of hammers
which one occasionally sees downstairs may be said to form part of
a dentist's education. As for brain power I think that even the
most bigoted opponent of women entering the professions will
allow (remembering their successes at Cambridge and elsewhere)
that in this respect the average women comes up to, if she does not
surpass, the average man, and in gentleness and symp''thy, when
these qualities are needed in a dentist, she certainly has no rival in
a man. Everyone will agree that patience is almost as indis-
pensable to a dentist as patients are, and according to the old saying,
" Patience is a virtue seldom found in women, and never in a man,'*
so women here would seem to have the advantagj over the opposite
sex. Still, I think the patience which is so necessary for the dentist
has to be combined with a power to keep one's head in a difficulty,
and this, I think, would be where the majority of women would fail
as not possessing the combined qualities of patience and level
headedness. Another quality, which if not absolutely necessary is
still very desirable, at any rate in an operating room, is neatness, and
here women, I think we will admit, would show themselves superior
to men. As Miss Murray said in her letter, young children would
naturally be more amenable to treatment at the hands of a woman
than of a man, and it would be with them that a woman would
succeed better than the latter. On the other hand, as I have said
before, women patients would almost unanimously prefer a man as their
dentist. As regards men patients I can't say. Many, I daresay, would
perhaps, for the novelty of the situation, like to have a tooth filled
by a lady dentist, but I don't think an athletic, powerful man, if he
had been tortured by toothache would think about going to a lady
dentist to have his tooth extracted.
Jleporta of ^otxttus.
THE ODONTOLOGICAL SOCIETY OF GREAT BRITAIN.
The Ordinary Monthly Meeting took place on the second ultimo,
Mr. David Hepburn, the President, in the Chair.
The minutes of the previous meeting having been read and
confirmed, Mr. Harold D. Matthews, L.D.S., was elected a member
of the Society, and the following gentlemen signed either ihe
L
162 THE DENTAL RECORD.
obligation forms or the obligation book and were admitted to
membership :— Mr. Walter S. Nowell, M.A.Cantab., L.D.S Eng. ;
Mr. Ernest Catt ; Mr. Cornelius W. Fryer and Mr. E. L. Dudley.
The Librarian (Mr. W. A. Maggs) reported the usual
exchanges.
The Curator (Mr. Storer Bennett) announced that Mr. Beadnell
Gill had sent to the museum a model showing three upper temporary
laterals which were very interesting from the fact that irregularities
amongst the temporary teeth are more rare than among the
permanent ones. He had also received six specimens of bone work.
These specimens unfortunately arrived during his illness, and he was
not aware who the donor was. Dr. Wallace has kindly presented a
portion of the mandible of a female tapir, and he had in addition to
acknowledge a specimen comprising a portion of the mandible
containing a lower molar from a cave bear. This specimen was
found under fifty feet of limestone rock in the Riviera, at the same
spot were three human skeleltons were some time previously
discovered. These specimens undoubtedly dated back to a time to
be reckoned in thousands of years.
Mr. Storer Bennett then brought forward a casual communi-
cation with the object of illustrating the damage sometimes attending
the injudicious use of elastic bands in attempting to regulate the
natural teeth. The case was one of superior protrusion in a young
lady aged thirteen years. Her health being bad, her parents took
her to the seaside, where she was left for three or four months.
Mr. Bennett thought it would be useless to send her away with an
appliance needing constant attention and adjustment, and decided to
put two collars on the first molars on each side and on the canines,
and to attach elastic bands. The parents were given some elastic
bands of various sizes to be attached to small hooks, the smaller
bands to be substituted as the teeth yielded to treatment.
Unfortunately, the bands which should have been attached on the
inner side of the palate were entirely neglected, with the result that
traction was only made on the outer side. On* examination it was
found that the canines had been rotated outwards very seriously,
while the first molars were tilted very much forward. Mr. Bennett
also exhibited models from the mouth of a lady, aged thirty-three,
showing the absence of permanent teeth in the upper jaw. There
were only two central incisors, the stump of a very bad canine
THE DENTAL RECORD. 163
and some temporary teeth. In the lower jaw there was the root of
a temporary molar, a lower canine and some temporary teeth. The
case was the more interesting from the fact that the patient's sister
was said to present a very similar appearance. The two foregoing
cases, as also the following, were illustrated on lantern slides. The
skull of a white nosed monkey, nearly adult. The canines were
nearly erupted, but there were no temporary central or lateral
incisors. There were also two teeth, which he took to be temporary
laterals. The alveolar ridge was remarkably thin, and there was no
trace of either permanent centrals or laterals.
A further model was exhibited on the screen representing the
skull of a monkey in which there was only one central incisor.
That incisor had been deflected very considerably to the left. This
also was probably a case of suppression. Mr. Bennett brought
forward these instances as interesting in connection with the paper
on Evolution about to be read.
Mr. J. F. CoLYER asked why Mr. Bennett extracted the molars in
the second case referred to.
-.— 'Mt. S^forer Bennett said that there was absolutely no possibility
of getting the front teeth back sufficiently without doing this.
Mr. Sydney Spokes asked with respect to the case of the lady
whether there were any other signs of suppression. Was the hair
luxurious, and were the nails perfect ?
Mr. Reinhardt mentioned the case of a lady aged twenty-eight
who had but five teeth, only two of which were permanent. She
had a luxurious crop of hair and the nails were quite normal.
Mr. Storer Bennett said in the case he had brought forward
there was nothing abnormal excepting the teeth.
Mr. Charters White reminded the Society that some years
ago a case was brought forward of similar suppresion of the teeth
associated with a profusion of hair all over the face.
The President well remembered the instance, and remarked
that Mr. Oakley Coles also brought before their notice a Russian
family known as "the hairy people" whose faces were entirely
covered with hair. One of the family, a child aged seven, had some
three or four central incisors, while the father had never erupted
more than some four or five rudimentart sort of teeth in the front of
the mouth. There were other instances on record where this
peculiarity had been associated with an abnormal development of hair.
L 2
164 THE DENTAL RECORD.
Mr. Blain exhibited and briefly described appliances as used by
Dr. Martin in his system (prothese immediate).
Mr. J. F. CoLYER remarked that on four or five occasions he had
endeavoured to make similar appliances. As specimens of ingenuity
and workmanship these instruments were very beautiful, but he was
not quite so sure of their practical utility. Would they not
interfere with the healing of the jaw ? and would not the action of
the muscles on each side pull the two halves towards the median
line and thus have a very prejudicial effect ? He recollected a case
where Mr. Boyd removed half a lower jaw for myeloid sarcoma. A
plate was put in the lower jaw with a spring to counteract the
tendency of the right side of the jaw to be displaced. Theoreti-
cally the appliance was perfect, and at first it worked very
beautifully, but within three days absorption rapidly set in on the
free margin of the portions remaining where the plates came. In
the case of malignant growths also he thought that the appliance
would set up a large amount of irritation.
Mr. C. D. Davis showed an artificial nose made by a Mr. Bond.
The patient some years previously was operated upon in Glasgow by
Dr. Heron Watson, of Edinburgh, who removed the whole of the
external and internal parts of the nose and also a large perforation
of the palate. Until quite recently the patient had worn the nose
attached to a pair of spectacles. In the present apparatus there was
a gold tube passing from the centre of the plate to the opening.
The nose had a strong gold pin with a short belt on it which ran
into the slot in the tube. It was put on slightly sideways and then
being twisted straight the fit against the plate held it tightly.
Dr. M. Tims then read a paper on
" The Origin of Mammalian Teeth."
Among the elasmobranch fishes the surface of the skin of the
body is covered with dermal denticles, structures having the characters
of ordinary teeth. They were formerly of considerable size and
served for protection. In other fishes they have become modified
into the ordinary fish scales. Similarly teeth develop from the
fining membrane of the mouth, which is derived from the same
embryonic layer as the epidermis.
In the teleostean fishes all the bones of the mouth, as well as
THE DENTAL RECORD. 165
those of the hyoidean and branchial arches, may b^ar teeth. Among
the higher vertebrates, position becomes more Hmited and ultimately
they are confined to the pre-maxilla, the maxilla and the mandible.
In these situations they are found upon the inner side as well as upon
the free edges of the bones, and as the latter become worn down,
fresh ones take their place, thus giving rise to the so-called
polyphyodont condition.
Among the reptilia, the teeth of the lower jaw are in some cases
fused to a kind of ledge on its inner side, a condition known as
pleurodont ; in others they are situated at the free edge of the jawi
when they are said to be acrodont. In the crocodilia, the thecodont
condition obtains, that is, the teeth are imbedded in alveoli, thus
adding to their firmness.
As a rule the dentition of the reptilia is homodont, but in
hatteria and some extinct forms of the American trias a heterodont
condition is found, that is, the teeth are differentiated into incisiform
caniniform and molariform. This differentiation attains its maxi-
mum only among the mammalia, in which also another very
important structure is added to the teeth, the cingulum. Owen
introduced the terms monophyodont, that is animals with a single
set of teeth, diphyodont or those with two sets. Among the former
were placed the marsupials, the edentates and the cetacea. A
difficulty at once arose in connection with the marsupials. It is
generally believed that the ancestors of the mammalia were reptiles,
and these are known to have been polyphyodont. The marsupials
are regarded by many as being among the lowest in the mammalian
series and in the direct line of ancestry. The anomaly at once
becomes apparent, the polyphyodont reptilia giving rise to the mono-
phyodont marsupials, and these in turn succeeded by the diphyodont
mammalia. In 1869 Sir William Flower showed that in the nine-
banded armadillo and in one or two other edentates, of the eight
teeth habitually present on each side of the jaw, all except the most
posterior are preceded by milk teeth, which are shed at the time of
almost full development. Thus the edentates can no longer be
classed as monophyodont.
Evidence has been brought forward in support of views that two
other dentitions are represented amongst the mammalia, a pre-milk
and a post-permanent dentition. The evidence in favour of the
existence of the latter is, I think, now beyond doubt. Lecke and
166 THE DENTAL RECORD.
Kiikenthal have observed such traces in the seal, Rose in man,
M. F. Woodward in erinaceus, and I have noted its existence in the
dog. The evidence in favour of the pre-milk dentition seems
insufficient. It rests upon the discovery by Lecke of tooth
rudiments on the labial side of the functional teeth in certain
marsupials. The existence of these rudiments is not disputed ; they
have been verified by M. F. Woodward in myrmecobius, phascold-
gale and dasyurus, but Lecke's interpretation of these rudiments
depends entirely upon the question as to whether the single
functional set of teeth in marsupials is in reality the milk set. It is
well known that in these animals only one tooth is replaced,
the deciduous tooth being molariform in character. Kiikenthal
discovered tooth rudiments on the lingual side of the functional
teeth in certain marsupials, which he regarded as representing the
successional teeth, and the functional set as corresponding with those
known as the milk teeth ; consequently Lecke has regarded the
rudiments on the labial side of these as representing a pre-aiilk
dentition. There is no instance of four dentitions being present in
any one part of the jaw of any animal, and there is undoubted
evidence of the existence of the representative of a post-permanent
dentition. Consequently, the three dentitions of the marsupials may
be regarded as homologous with the three dentitions of the hedge-
hog, dog and man. If this be so, then Lecke's pre-milk dentition no
longer exists, but what he interprets as such are the vestigial remains
of the milk dentition, and the functional set as homologous with the
permanent dentit'.on. Thus the marsupials are no longer to be
regarded as truly monophyodont, though the term is sometimes still
used, but as indicating that one set of teeth alone is functimaU In
the odontoceti, Kiikenthal has proved the existence of tooth
rudiments on the lingual side of the single functional set of teeth, and
regards these whales as having a persistent milk dentition. It would
be better to regard these as representing the permanent set with the
post-permanent representatives, the milk teeth having disappeared.
Lecke has expressed this opinion with regard to the dentition of the
whales, noting that in other cases of monophyodontism it is the first
dentition which disappears. Thus : —
1. That there is not sufficient evidence to warrant the belief in
the existence of a pre-milk dentition.
2. That the dentitions are tending to disappear from without
THE DENTAL RECORD. 167
inwards. This is in agreement with a conclusion of Wiedersheim,
who adduces facts which indicate that a "gradual reduction of the
milk dentition is taking place."
3. That there is ample evidence in favour of the existence of
three dentitions, the deciduous, successional and post-permanent ;
thus bringing the mammalia more into line with their polyphyodont
reptilian ancestors, and doing away with the former difficulty as to
whether the milk or the permanent is the super-added dentition,
since both are of equal antiquity handed down from our reptilian
progenitors.
Turning next to the molars and first pre-molar, which, as a rule,
are represented in one dentition only, the question arises to which
dentition do they belong ? Beginning with pmi, which is replaced
in a few animals only, such as the Indian tapir, hyrax, in some cases
the rhinoceros and pig and the extinct palaeotherium. In the dog it
is not replaced, and is occasionally absent altogether. In a section
through this region in the dog, three down-growths of the dental
lamina are to be seen, and it is from the central one of these that
this tooth develops. Now, it has been said that the deciduous,
permanent and post-permanent dentitions are represented in this
animal, consequently I think that the single pm of the dog is to
be regarded as belonging to the permanent series. The molar teeth
are to be regarded as belonging to the same series. The sectorial
tooth replaces a molariform tooth. For the same reasons as given
above in connection with pmj, this may be regarded as belonging to
the so-called permanent series ; its successor developing on the
lingual side and quite independently of the tooth which it replaces.
According to this view (see Dental Record^ August, 1895), the
protocone and protoconid represent the primitive reptilian cone.
Such being so, we should expect them to develop first in the
embryonic history of any tooth, if protogeny does recapitulate
phylogeny.
In the paper above referred to, Professor Osborne admits that it
does, for he says, '* we should expect in the embryonic jaw that the
calcification of the tooth germ would be very significant, because we
know that the embryonic structures in their development follow the
order of addition or evolution." Now, this development has already
been worked out by Rose in the marsupials and primates, and by
Taecker in the ungulates, with these results : In the lower jaw the
168 THE DENTAL RECORD.
proLoconid dees develop first. With regard to the paraconid and
metaconid, which should be of equal importance, and secondary only
to the protoconid, the paraconid develops second in the marsupials
only, while in the primates and ungulates it is absent altogether,
and the metaconid in the marsupials does not develop until after the
hypoconid and entoconid. Taking these three orders together, even
the lower jaw does not lend much support to this view. But in this
paper Professor Osborne says, " in the lower molar teeth " (he is
dealing with the primates only) '' the order of calcification is
precisely the order of evolution."
It is, however, in the upper jaw that still stronger evidence
against this theory is to be found, for in not one of the three orders
does the all-important protocone develop first. It is the paracone in
every instance, while in the ungulates the melacone also develops
before the protocone. Professor Osborne goes on to say, m speaking
of the lower jaw, '' so we find the order of embryonic development
exactly repeats the order of historical development, and in every
way presents the strongest kind of confirmation of the theory of
cusp formation." The upper jaw, which presents the most damaging
evidence, he dismisses with the single sentence — " but this, you see,
is not exactly the case in the upper molars."
There is one other theory that must be referred to — the multi-
tuberculate theory. According to this view, the early mammalia
were thought to have had teeth possessing many cusps, and that by
a gradual suppression of some of these, the teeth of existing
mammals have been derived. Two pieces of evidence are in favour
of this theory : (i) Quite early fossil forms, such as tritylodon, have
been found with multi-cuspidate teeth ; and (2) that the montremes,
among the most primitive of existing mammals, have teeth of the
same description.
With regard to the fossil forms, it should be borne in mind that
their dental formulae tend to show, by the absence of the canines
and the reduction in the number of incisor teeth, that they were
probably highly-specialised forms. That some of the mammalia
may have been derived from the multituberculata is possible, but
that they have all been is highly improbable.
With regard to the origin of the multituberculata from the
reptilia, a possible explanation is to be found in Kukenthal's con-
cresence theory. By this a fusion of several teeth of the same
THE DENTAL RECORD. 169
dentition and of different dentitions is supposed to have taken place,
causing a reduction in the number of teeth ; the nine cusps in the
teeth of tritylodon being due to the fusion of three teeth and of
three dentitions.
Mr. F. J. Bennett said, as far as he understood the paper, what
the author would like chiefly was for them to say how far their own
experience would bear out the views he had enunciated. In a short
paper he ^Mr. Bennett) read before the British Dental Association
some time previously, he endeavoured to prove that there were traces
of teeth under what they calbd the first, second, and third permanent
molars. He then ventured to express the opinion that those
observers who said that those three molars belonged to the tempo-
rary series had substantial grounds for believing so, owing to the
strong similarity between the first and second temporary, and the
first, second and third permanent molars. There was good evidence
of epithelial structures surrounding the first permanent molar,
pointing to their being enamel germs. Mr. Eve had dealt with
this, evidence in a paper, and a foreign observer had also discovered
epithelial structures in the substance of the periosteum. He
(Mr. Bennett) fancied that these enamel modules afforded almost as
good evidence as could be obtained, as showing that there are really
germs of a later series underneath these three teeth. At the same
time, he was quite aware that there were a few what might be called
staggering objections.
Mr. Arthur Smith Woodward had listened with great interest
to the paper, but regretted he could only speak of the latter part
irom personal knowledge. For several years he had the privilege of
studying vertebrate fossils in the British Museum, and the facts of
palaeontology suggested some interesting points in connection with
the problem which Dr. Tims had brought forward. In solving these
very broad questions it seemed necessary to turn first to those cusps
of organisms in which they found their simplest expression ;
accordingly, he had been much interested in examining the teeth of
extinct fishes, whose skeletons naturally occurred in great abundance
in almost all water-formed rocks from the date of their earliest
appearance up to the present day. The study of the earliest sharks
revealed most distinctly that the complicated teeth of these fishes
are often due to the fusioa of originally separate cusps, each little cusp
having been formed round its own pulp, and primitively free from
170 THE DKNTAL RECORD.
all surrounding cusps. One family of upper palaeozoic sharks
exhibits the fusion into plates, not only of adjoining teeth of one
series, but also of successional teeth of several series. It was thus
clear that tooth complication does naturally take place among the
lower vertebrates by the fusion of cusps belonging to more than
one series. On the other hand, there was equally clear proof among
fobsil sharks that tooth complication sometimes happens by another
method, viz., multiplication of cusps by some organic process which
is not yet understood. With reference to the gradual acquisition
of a regular arrangement of the dental armature, one of the families
of the mesozoic ganoid fishes have a pavement of grinding teeth,
and this pavement, though very irregular in the earlier members of
the family, is reduced to a few comparatively regular longitudinal
series of teeth in the latest members. These being the facts in
regard to fishes, there would be no improbability in any of the
theories of tooth complication pointed out by embryologists who '
have studied the mammalian dentition. Palaeontology, however, had
not yet thrown any certain light on the subject. It did not even
afford any information concerning the supplementary successional
teeth, of which rudiments are stated to occur in several existing
mammals. Even the tritubercular theory to which Dr. Tims had
referred with some well merited criticism had a much more insecure
palaeontological basis than most of its supporters and exponents
claimed for it.
Mr. W. A. Maggs was of opinion that the multituberculate
theory had some prima facie evidence to support it, that is to say,
in the earliest mammalian fossil teeth, represented by the mesozoic
or secondary period, the types correspond with the diprotodont or
polyprotodont marsupials, either with tuberculate molars or with
triconodont molars. It was quite possible that these animals, if they
were not protothesian, had not progressed in the zoological scale at
all, and that they were the marsupials, or would be the marsupials, if
they existed, of the present time. Then, as Mr. Woodward had
mentioned, there was a gap in the geological records, and an absence
of any new teeth forms until the tertiary period in which the
trituberculate molar was found to predominate, and they had a form
of molar like that seen in some of the carnivora and insectivora of
the present day. The homology of the upper cusps was rather
doubtful in all orders of mammals. It was difficult to say how the
THE DENTAL RECORD. 171
multicuspid teeth were formed, whether by fusion of separate
conical teeth, owing to a more limited succession, or by what other
means. Dr. Tims got rid of the pre-milk dentition, which was
satisfactory in one way, in that it simplified the ground a little, but
he (Mr. Maggs) was not at all sure about the correct interpretation
of the tooth change of marsupials. When a dentition like that of
the opossum or the macropodidae, or any of those animals with a
large number of teeth was said to belong to the milk set, it was
giving a formula for the milk dentition to which there was nothing
at all comparable in euthesian mammals. He did not know whether
that was a sound argument against it, but it was going from one
extreme to the other — the other extreme being to say that those
marsupials which had no milk dentition had simply one molar on
each side above and below. Dr. Tims did not mention the develop-
ment of the deciduous teeth from the epithelial band before the
permanent teeth, but there was a reason for supposing that if one
set of teeth was developed only it should belong to the deciduous
dentition. It had been shown that all mammals had a diphyodont
dentition, but it was not always the same dentition which persisted.
Dr. Tims showed on the screen some teeth germ in the premaxillary
region of a dog, but Mr. Maggs would like to know whether he had
seen this epithelial lamina — which he believed to indicate a third
dentition — going all round the jaws, because it was quite possible that
it might be an abnormality — an abortive tooth germ in this situation,
or the origin of a supernumerary tooth. The so-called first pre-
molar of the pig was interesting. This tooth was erupted early, had
no predecessor, was lost early, and it had always been a debatable
point whether it belonged to the deciduous or permanent set. Owen
and Flower placed it in the former category.
The discussion having been further contributed to by Mr. W. B.
Paterson and Mr. H. Baldwin, Dr. Tims replied, and the usual votes
of thanks concluded the meeting.
DENTAL STUDENTS' SOCIETY, DENTAL HOSPITAL OF LONDON.
An Ordinary General Meeting was held on Monday, March 9th,
the President, J. F. Colyer, Esq., in the chair.
The Librarian, Mr. J. C. Douglas, said that nnce last meeting
172 THE DENTAL KECOKD.
he had received a gift of books from Mr. F. J. Bennett, the late
president. He proposed a vote of thanks to the donor, which was
seconded by Mr. Strand, and carried unanimously.
On Casual Communications being called for : — Mr. J. C. Douglas
showed a pair of pliers, made by the Dental Manufacturing Company
after his own pattern, which, he said, were specially designed for
turning up gridiron springs and bands. He stated that he was able
to turn up a gridiron spring with them within half a minute. The
essential portions of the pliers were the beaks, which were long, oval
on section, and tapering towards the extremity. The inner side of
each beak was grooved in three places, to receive and hold the wire
in position when bending it.
Dr. Miller said, I have here three sections of a piece of bone
removed from the lower jaw of a woman, aged 40, by Mr. H. Lloyd
Williams. The patient had her second and third right lower
molars removed some eight years ago, and since had worn a plate.
Six weeks ago the patient's gum and face, corresponding to the
position of these teeth, began to swell and be painful. Her dentist
painted the gum with iodine, and her doctor treated her constitu-
tionally. The swelling subsided slightly, but the patient was still in pain
and consequently came to the hospital. On examination, there was an
indefinite and fairly hard swelling in the position above mentioned
and on pressure pus exuded from four or five sinuses ; on exploring
with a probe a solid body, either a stump or piece of bone, was dis-
covered loosely imbedded. An incision was made and the wound
packed with wool and carbolic (1 in 20). Two days afterwards the
loose body was removed, and on the sections being cut and examined,
it was seen to be a bit of very dense bone. Microscopically one sees
the bone is very vascular, the lacunae being numerous, and the lamellae
arranged irregularly with only a feeble attempt at formation ot
Haversian systems. The irregular arrangement of the lamellae and the
structure of the specimen give one the idea that there has been
chronic inflammation ; the inflammatory material being subse-
quently calcified, since a fibrous appearance is still visible in some
parts of the specimen.
Mr. Stanley Colyek said he had come across a case which
seemed to him to throw some light on some of the unexplained
cases of alveolar abscesses, in connection with live pulps, which had
been reported lately. A patient came to him to have a cement filling
THE DENTAL RECORD. 173
restored, and on examining the tooth he found that it was consider-
ably darkened in colour, and that there was a little chronic abscess at
the apex which the patient said discharged itself occasionally, but gave
her no pain whatsoever. Assuming that the tooth was dead he drilled
into the pulp, and to his surprise got quite an extensive haemorrhage,
but caused the patient little or no pain. He applied a fibre and the
patient returned in a week's time, when, instead of finding a pulp in
the usual leathery condition, he found a thin cheesy looking liquid —
resembling thick pus — occupying the pulp canal. When he came to
fill the roots with gutta percha points he found that one disap-
peared through what was evidently an enlarged apex into the
abscess sac. After that he filled the root loosely and completed the
tooth with osteo. The patient has since been quite comfortable. In
his opinion it was a case in which the pulp had died and was only
sufficiently septic to set up a slight irritation and that granulation
tissue had absorbed the apex of the tooth and grown into the pulp
canal, absorbing and replacing the dead pulp.
Mr. Douglas showed a specimen of exostosis on the roots of a
lower twelve year old molar, and said that it was not often you
came across exostosed lower molars ; that they were much less
frequently attacked than bicuspids, wisdoms, or upper molars. He
also pointed out that the apical foramina were almost if not entirely
closed in the specimen.
The President said that he was unaware that lower molars were
said to be less frequently attacked than certain other teeth, he had
come across several cases.
The President then called upon Dr. Miller for his paper on
" Should Women be Dentists ? " (see page 155).
In the discussion which followed
Mr. DoDD, who spoke in favour of the women, said that in his
opinion women were quite as fitted to be dentists as men. That it
was scarcely fair for us to say that they were incapable, if we never
gave them a chance of proving whether they were incapable or not.
He did not understand what Dr. Miller meant by perverted sexual
instinct. If a woman extracted a tooth, was that to be called
perverted sexual instinct ? In days gone by, and in certain other
countries still, women did and still do the work of men; is that to be
called perverted sexual instinct ? No, he thought not. He con-
sidered that Dr. Miller had given a caricature of the new woman.
174 THE DENTAL RECORD.
No one, he said, could cut and dry what men should do, or what
women should do ; any one who did simply stood in the way of progress,
Mr. Strand said that the majority of the objections raised were
those which seemed inharmonious with customs. If it were only in
the struggle for existence women ought to be allowed to enter
dentistry, and thus be enabled to earn a fair income. The majority
of men, he pointed out, were incapable of supporting a wife, so that
women must live somehow.
Mr. Myers said that his chief objections were the possibility of
maternity, which would either lead to her neglecting her household
duties or her professions — he could not do both. He did not think
that men would go to women dentists except out of curiosity.
Mr. Ross-Poole considered that Mr. Dodd had upheld the
women too much, and that it was a typical new woman craze.
Mr. Heath said that although he was among those who con-
sidered that woman was always at her best in her home, yet he did
not see why she should not have full chance ot proving her capacity.
Mr. Densham said that although he agreed with the general
consensus of opinion, yet there was no denying the fact that uterine
troubles were much more frequent among women who stood for
long times together than among those who did not. This was
proved distinctly by factory statistics. He considered if women did
marry they should leave the profession, but he thought also that
women who desired to become dentists as a rule did not wish to
marry. It were better for them to be dentists than they should add
to the army of old maids having nothing to do ; a class of woman,
as a rule, narrow-minded and unsympathetic ; a type difficult to
look up to.
Mr. CoYSH saw no reason why women should not enter dentistry.
He did not doubt their capacity, but thought, as with men, some
would be good and some would be bad. He laid stress upon their
lack of originality, pointing out, by way of illustration, that although
they had taken extremely high honours, both in arts and science,
they never seemed to get the '' forrader."
Mr. May showed how little midwifery progressed until it was
taken up by men, and thought that it would probably be the case in
dentistry. With regard to standing for long hours together, he
thought that that could be easily remedied, for they could choose
their own time.
THE DENTAL RECORD. 175
Mr. J. C. Douglas said it had been urged that women were more
sympathetic, and that their touch was more deHcate, but he had
found that they were only tender towards men. In the same way he
argued they were only neat when they expected men.
Mr. Breese said the discussion had been extremely onesided.
He felt that they ought to have had ladies present to defend them-
selves. He saw no reason why women should not be dentists.
The President said that maternity was absolutely out of the
question in women-dentists ; it was quite impossible for them to
attend to both at once. Mr. Densham had distinctly shown the
effect that standing had upon the health of women, and looking at
the matter from a national point, was it right that such women should
marry. He himself knew five women doctors, two of whom had
gone to France for their health, while the other three were far from
healthy. He considered that the clerical and legal professions were
far more suitable than the dental.
Dr. Miller then briefly replied to the various speakers.
The President then proposed a vote of thanks to Dr. Miller, and
to those gentlemen who had brought forward Casual Communica-
tions, and announced that the next General Meeting would be held
on Monday, May nth, when Dr. Austen would read a paper on
'• Some Effects of the Acute Exanthematous Fevers en the Mouth."
The proceedings then terminated.
Dr. Hearder, Assistant Medical Officer to the West Riding
Asylum, Wakefield, sends the following short note to the Lancet : —
"Several cases of subluxation of the jaw occurring during epileptic
fits have been recorded in the Lancet and elsewhere, but, so far as I
am aware, never as occurring during a seizure in the course of general
paralysis. A man, aged thirty-eight years, was admitted into the
West Riding Asylum, Wakefield, in May, 1893, suffering from
general paralysis. In May, 1895, being then in the second stage, he
had a series of slight epileptiform seizures, during one of which he
sustained double dislocation of the jaw forwards. It was reduced
with considerable difficulty, an anaesthetic being necessary to over-
come the spasm of the muscles, which were above normal. His jaw
also is massive. Since then he has several times dislocated the jaw
and the reduction has been comparatively easy."
176 THE DENTAL RECORD.
THE DENTAL RECORD, LONDON: APRIL!, 1896.
TWO DEATHS FROM CHLOROFORM ADMINISTRATION.
The fact that in the current issue it is our duty to note
two deaths during anaesthesia, inducedfor dental operations,
and that in both instances the drug used was chloroform,
should give rise to very earnest reflection. Whether the
deaths were due to the drug being badly administered or
not, whether the choice was tnat of the dentist or the doctor,
is beside the mark. Whatever be the cause, the fact remains
that fatal accidents are more common when chloroform is
admini>tered than when some other agent is used. That
sometimes, though certainly not often, a longer period of
anaesthesia is needed for some dental operations than can be
induced by the use of nitrous oxide wp may readily admit ;
but even then we are not bound down to the use of chloro-
form, we have to hand that much safer drug, ether.
Surely the greater safety of the latter drug was m^st clearly
brought out by the paper Dr. Hewitt read on the subject at
the Edinburgh meeting of the British Dental Association,
a paper which should still be fresh in the minds of al]_, for
all should have read it. Let it be clearly understood the
blame for such accidents rests with the administrator : it is
the medical man who legitimately j-hould be called to
account for accidents like these. But if he does not appear
conscious of the increased danger of the use of chloroform
then the dentist should, and not for the first time, play the
part of teacher. This is why we refer to the matter. We
honestly believe that in the greater number of cases th'^
real reason why medical men now use chloroform i'' that
they neither possess the apparatus required for giving ether,
nor understand its method of administration. But although
we venture to suggest to our confreres that they should
point out to their medical friends the opinion of those
competent to judge on the dangers coincident to the
THE DENTAL RECORD. 177
use o' chloroform, we cannot understand the remark of the
Lancet that '' It is a matter of regret that dental practitioners
should not be better informed upon these matters than to
permit the employment of chloroform upon their premises as
an anaesthetic.''^ We, certainly, did net think it was
precisely etiquette for a dentist to dictate to the anaethetist
whether he should administer chloroform or ether; nor do
we '-•ee what the s'ate of information of the dentist has to
do with the matter if he calls in a medical man We
wish him lo have the fullest information, but he is surely not
expected to instruct the medical man on the subject, l^r, if
that be so, what becomes of the contention, which we
believe the Lancet to have aforetimes made, that no dentist
shovild give an anaesthetic unless he aKo possesses a medical
qualification ? Nor do we think any judge will be so unjust
as to follow Mr. SewelF-^ suggestion, in the Lancet of March
28^h, and pass a verdict of "manslaughter against the
operator" if by operator Mr. Sewell means the dentist and
not the administrator, who, in both, the above quoted
cases, was a medical man. Neither the Lancet nor
Mr. Sewell seem to be very well acquainted with the
rang'^ of movement of a modern dental chair. Thus, the
Lancet says : — "The p"^ ture of the patient is not mentioned ;
probably the boy Vv^as in a dentist's chair — a position of
body unsuited for the administration of chloroform, ^^ whilst
Mr. Sewell remarks : '*.... administration of chl lo-
form tor tooth ex'raction in a dentist^s char — the mo.^ t
d-ingerou'^ of po'^itions.'" Possiblv both the Lancet and
Mr. SewelPs idea of a dental chair coincides with that
depicted by Mr. du Maurier in his noted Punch Picture.
Wc; may assure them that the modern dentist has a chair in
which the patient can be placed in almost any position from
the prone to the vertical. And, indeed, to infer because
the administration was at a d-^ntist\s, therefore the patient
was in a chair, is, in \}- e absence o* other confirmation, a by
no mean*^ certain deduction.
M
178 THE DENTAL RECORD.
DENTAL HOSPITAL OF LONDON.
The thirty-eighth annual meeting of the governors of this
Hospital was held on Thursday, March 12th, at the Institution,
Leicester Square. Mr. F. A. Bevan, a trustee, presided.
The report, which was taken as read, stated that the benefits the
Charity was able to bestow upon the suffering poor were due to the
liberality of the general public and the medical and dental
professions who subscribed towards its maintenance, and the
committee expressed both surprise and regret that the Hospital did
not receive much greater public sympathy and support. As a
reason it had been suggested that the charitable public failed from
lack of knowledge to comprehend the benefits conferred by the
Institution upon the necessitous poor. On an average, 200
operations — some of them extending over long periods of time —
were performed within the building every working day, all of them
were either preventive, palliative, or conservative in character. If
that single fact be considered some idea might be grasped of the
amount of work done in the Hospital, and of its utility to all classes
of the community. The total amount received for the general
fund during the year was ^^2,226, as against ^^2,248 in 1894. The
annual subscriptions amounted to ;^i,i2i, as against ^^1,102 in 1894.
The total amount received or promised for the building fund at the end
of the year was ^^i 2,41 2. In expressing the warmest thanks for the
support already given to the Hospital, the committee venture
to urgently appeal on behalf of the building fund. The necessity
for a new building had been more than once described, and it was
still a growing necessity, and the chosen site was such as could not
be found elsewhere in London. It was so central that the patients,
many of whom came and went many times while being treated,
could do so at the smallest possible sacrifice of time and monev- It
was entirely and permanently open to a northern light, and that gave
opportunities for a large number of windows and a proportionate
number of chairs, each of which were as essential to a dental as
beds were to a general hospital. An increased number of chairs
meant more work being done at one time, and that in turn meant a
lessening in the time spent in weary waiting by the patients. The
freehold of No. 37, Leicester Square has been purchased for ^4,000,
and ;^400 has been paid as deposit for the purchase of No. 38,
THE DENTAL RECORD. 179
Leicester Square, both of which would form pari of the site of the
new Hospital. The property now held by the trustees for the
Hospital consisted of the undermentioned freeholds, viz. : — Long's
Court, Nos. I to 5 ; Green Street, Nos. 22 and 23; Leicester Square,
Nos. 35, 35a, 36, 37 and 38 ; St. Martin's Street, No. 37 ; together
with the site of the existing Hospital buildings, with the exception
of one moiety of the Tower House, for the purchase of which
negotiations were in progress. To enable the committee to make
the above purchases, money had had to be borrowed from the
bankers, and to them was owing ^18,000, as against ;^i9,65o owing
at the end of 1894. There was also owing to the City Bank ^3,600,
which had been temporarily advanced on the guarantee of the
treasurer. In conclusion, the committee acknowledged the obligation
they were under to the medical staff, whose untiring labours alone
enabled them to carry on the great philanthrophic and educational
work of the Hospital ; and to the Secretary, Mr. J. F. Pink.
The Chairman, in proposing the adoption of the report and
accounts, said : Ladies and gentlemen, it gives me very great
pleasure to be here this afternoon and to move the resolution I have
just read. Though this is the first time I have had the honour of
presiding at the annual meeting, I have for a long time taken a great
interest in the Hospital, and as perhaps some of you are aware my
father was for a long time treasurer of the Hospital and took a very
great inte-est in it, and, I believe, on several occasions he took the
chair at the annual meeting. He was also a tolerably large
subscriber, and, therefore, it is from him that I inherit a love of the
Institution. I have also been acquainted with several gentlemen
who have taken a very active part in it, notably Mr. T. A. Rogers,
one of my earliest friends. To come to the Hospital itself and its
working, I am sure all you who know the Institution must feel
more and more that the premises we now occupy are totally
inadequate for the work being carried on here. Whether we look at
the entrance, or the staircase, or the rooms in which the w rk is
carried on, it is perfectly evident we have completely outgrown
ourselves, and it is essential for the good of the patients and for the
work of the Hospital itself that we should as quickly as possible get
into better and more commodious premises. I rejoice to know that
considerable progress has been made with a view to this chan^^e.
We have now bought nearly the whole block on the same side of
M 2
1^0 THE DKNTAL RECORD.
the Square, arrangements have been made for taking up a large
mortgage upon it, and at no distant date I hope we shall really
begin to build a new Hospital. I think it only right to say that we
feel all very much indebted to my friend the treasurer, Dr. Joseph
Walker, for the part he has taken in the matter, for his unfaiUng
zeal and pertinacity, and I trust that at no distant date he may see
the work crowned with success for which he has so assiduously
laboured for some time past. We do get support, but we do not get
sufficient support. I have just had a very pleasing letter put into
my hands from the Goldsmiths' Company, making a donation of
;^ioo to the funds. Now if we could get all the City Companies
to give in that sort of way it would be a very great help to us.
And when we consider the number of persons who derive benefit
from this Hospital, I really am surprised that the donations and
subscriptions are not much larger than they are. Speaking for
myself I know scarcely a day passes tnat I have not an application
from somebody for a letter for the Dental Hospital, and very often I
have two or three or more in a day. If I have these applications no
doubt it is the same with other subscribers, and that at least shows
how thoroughly the Hospital is appreciated and how many must
know about it ; and if all who have benefited by it would only make
it known to their friends, I believe we should soon have the funds
sufficient f jr building this new Hospital and carrying on the work
under much better circumstances. One would think, as everybody
must, I suppose, have more or less suffered with their teeth, that
everybody would have sympathy with a work of this kind. It must
appeal, I should have thought, to a larger number even than General
Hospitals, but I suppose it is thought that the whole thing costs
very little, and that there is not much need of help. If only we
could get per'^ons to understand the situation in which we are
placed, and if those who are interested in the Hospital would come
to it and see what a crowded condition we are in, I do believe they
would at once say " well, we will take care that the work shall be
carried on more efficiently." Of course, the principal object of our
meeting is for the sake of the public at large, and all I can say is
that the more I know the work the more I shall take an interest in
it. I shall hope to give my friend. Dr. Walker, something more
later on towards the carrying out of his grand scheme.
Mr. Hepburn, in seconding the motion, said that while thankful
THK DKNTAI. KKrOKD. IHl
for the support accorded the Hospital, they could not but feel that
the sympathy of the public might be with them a little more than
it was. It was rather difficult to understand why subscriptions did
not fall in more readily to the Institution, but he trusted that when
the public knew of the efforts being made to rebuild the Hospital
they would come forward with liberal support.
The report was then unanimously adopted.
Certain retiring members of the committee having been re-elected,
on the motion of Mr. Hutchinson,
Mr. W. H. Ash proposed, Mr. Storer Bennett seconded, and it
was agreed, to add the names of Dr. F. W. Hewett and Capt. H. B.
Murray to the committee.
Mr. A. Marsh had great pleasure in proposing the re-eleclion of
their treasurer, Dr. Joseph Walker, and remarked that they could
not sufficiently thank him for his past services.
Mr. Ash, seconded the proposition, which was carried.
The auditors having been re-elected,
Mr. Hepburn proposed a vote of thanks to the treasurer, the
chairman, deputy-chairman, the committee of management, the
finance and election committees, and the medical staff. This was
seconded by Mr. E. Lloyd-Williams and carried.
A vote of thanks to the Chairman terminated the proceedings.
^tias ani JJot^s.
Thp: first annual general meeting of the governors of the
Newcastle Dental Hospital was held on February 28th, in the
Board Room of the Institution, 37, Nelson Street. The Mayor
(Mr. Riley Lord) presided. The Hon. Secretary (Mr. Frank
Marshall) read the report of the Provisional Committee, which
stated : — " The continuous and steady increase in the number of
patients availing themselves ot the benefits of the hospital,
notwithstanding that its existence is as yet by no means widely
known, has already amply demonstrated the necessity for its
establishment. Between March 25th and December 31st, 1895,
1,107 patients were treated. The work of the hospital has indeed
become so large and important that it is felt an earnest endeavour
182 . THE DENTAL RECORD.
should be made to bring its claims before the attention of the
public, so that it may be thoroughly equipped and a sufficient
annual income secured. It is hoped that in the course of the
present year the hospital may be added to the list of Institutions
participating in the benefits of the Hospital Sunday Fund. From
the audited statement of accounts presented herewith, it will be
observed that at the end of 1895 the hospital had a balance to credit
of ;^22 6s. id. Against this, however, there were outstanding
accounts amounting to £2^ 17s. 2d., exclusive of current liabihties,
such as rent, rates, taxes, &c., so that there was really a deficiency
on the nine months' working. It is worthy of note that the
voluntary contributions of patients up to the end of 1895 amounted
to ^7 8s. 5d." On the motion of the Mayor, seconded by Mr. G.
R. Brewis, the report and financial statement were adopted. The
meeting concluded with votes of thanks to the members of the
honorary dental staff for their services during the past year, and
to the Mayor for his services in the chair.
The annual meeting of the Glasgow Dental Hospital was held
in the Religious Institution Rooms on February 28th, Sir John
Neilson Cuthbertson in the chair. The secretary's eleventh report
showed that the cases treated during last year numbered 7,068, and
of these no fewer than 3,115 were preservative operations. The
increase in the number of patients and students has overgrown the
accommodation, so that it has been found absolutely necessary, to
enable the work of the hospital to go on, that larger premises should
be secured. The directors felt that they would not' be justified in
proceeding with the building of a hospital meantime until they
had a more substantial nucleus of a building fund. They had not
been able to conclude negotiations for suitable premises in time for
this report. While the treasurer's accounts showed an apparent
falling off in the income, as compared with last year, the result of
the year, financially, was satisfactory, there being a balance in bank
at the close of the account of ;^i67 5s. The public subscriptions
and donations amounted to ^^98, being practically the same as last
year. The Chairman, in moving the adoption of the report, said
he had heard it attributed to the late Lord Brougham, when his
teeth proved rather rebellious at a public meeting, that he said one's
THE DENTAL RECORD. 188
teeth were the cause of discomfort from the cradle to the grave.
He (Sir John) believed that that was strictly so. In keeping with
the remark, he could not help saying that there was always a sort of
feature of the ludicrous in anyone's being afflicted with toothache.
It was very difficult to get up much sympathy for a person suffering
from toothache. At the same time it was a very real and distressing
state of things. He was quite sure that that hospital was doing a
great public good in ministering to the wants of those persons who
were unable to obtain at their own charges the assistance of a
competent dentist. Mr. Harvey seconded, and the report was
adopted.
Dr. Miller narrates that he fed two puppies, of the same litter,
the one on food stuff poor in calcareous matter, and the other on an
ordinary diet. After six weeks the bones of the latter were quite
normally developed, but the tubular bones of the latter were
extraordinarily thin and soft, the epiphyses being like little sponges,
which could be crushed between the fingers. But he did not notice
that the teeth of this animal had developed more slowly or less
perfectly than those of the dog fed in a normal way.
During the past month the price of cocaine hydrochlorate fell
to I2S. lod. per ounce, which is the lowest figure ever known for the
anodyne drug. Soon after the article was introduced in 1884 it was
sold at over ^32 per ounce. This figure was so profitable that the
production rapidly increased, with a consequent great reduction in
the market value. Even at the beginning of ,1892, however, the
price stood at 23s. 6d. per ounce. It is understood that this
decrease in price is due to competition by a new manufacturer.
On the 4th ult. Dr. Walton held an inquest touching the death
of Rose de la Mare (13), the eldest of two daughters of the Rev.
S. T. de la Mare, superintendent minister of the Wesleyan Circuit,
Northallerton. As far as can be gathered, Dr. Tweedy had been
attending deceased for the last six or seven weeks for a complication
of diseases. She had been suffering excessively from neuralgia,
which had rendered her nights sleepless. One side of her mouth
was ulcerated with the bad teeth, and it was deemed necessary to
184
THE DENTAL RECORD.
extract a number of them to give relief. Accordingly the doctor
called in Mr. Sugien, dentist, and taking into consideration her
condition, it was thought necessary to administer chloroform.
Deceased was cheerful, and her pulse was beating strongly. One
-drachm of chloroform was given. After one tooth had been
extracted deceased gave a little start and shout, indicating evidently
that the chloroform had not taken sufficient effect. The dentist
was then proceed'ng to extract the second tooth, when the patient
changed colour, becoming a death-like hue. The pulse giving
cau-e for apprehension Dr. Walton was called in, and the Vattery
and other restorative measures used, but without avail. Dr. Walton
>aid he should not give evidence in his own court, but he could
corroborate the evidence of Dr. Tweedy as to doing all they cuuld
to revive deceased. In answer to Mr. W. Reed, a juryman,
Dr. Tweedy said that he did not consider in this case it would have
been better to have administered ether, and he was of opinion that
deceased was more than equal to the small dose of chloroform. The
jury returned a verdict that deceased died owing to the failure of
of the heart's action under the administration of chloroform.
On February 21st an inquest was held on Ernest Henry Tinsley
(15), son of Mr. W. H. Tinsley, solicitor, Dudley, who died whilst
under the influence of chloroform. The mother of deceased said
that the lad desired to join the navy, in order to do which it was
requisite that he should submit himself to dental treatment. She
took him to see Mr. Morris, Castle Street, who advised him to have
eleven teeth extracted. Dr. Bellingham said he carefully examined
deceased's heart and chest, and came to the conclusion that he was
justified in administering chloroform. Insensibility having been
produced, one tooth was extracted, when deceased showed signs of
recovery, and witness again administered the chloroform. When
the operation was completed, Tinsley appeared to be in a condition
usual with chloroform patients, but soon after his pulse ceased, and
he expired. Dr. Messiter, who had made a post-mortem, said he
should have been prepared if the case had been under his treatment
to have administered chloroform. He considered that the ansesthetic
was properly administered. The jury, in returning a verdict of
" Death from misadventure," expressed the opinion that no blame
could be attached either to the doctor or the dentist.
THE DKNTAL RECORD. 185
The Medical and Dental Registers for 1896, which are of such
great importance to the medical profession, are just published. The
tables given at the beginning of the Dental Register we turn to
with interest. These, however, show but little variation compared
with those of last year ; such as there is, however, is in the bame
direction as in previous years ; an increase of those registered in
virtue of the possession of a diploma and a diminution in those in
practice before 1878. The figures must, however, be taken as only
approximately accurate, for, in the first place, many of those having
the right to be registered have apparently not done so, and on the
other hand the Register contains the names of many who cannot be
found at the address given, and of not a few who are dead. During
the year one name less has been registered than in 1895. For the
first time for three years the Dental Committee held during 1895
two meetings, the average being 1.3. In 1894 the Committee did
not meet. We notice that the President's period of office terminates
in May of this year, but he is eligible for re-election. With
reference to the balance-sheet of the Dental Registration Fund, we
certainly cannot blame the Council for overestimating the value of
the ;^8,ooo 2| Consols, when they put them down at about ^96^
per cent.
The Home Office Committee on the causes of the explosion of
gas cylinders and on the precautions to be observed during the
manufacture of gases ha? issued their report. The members of the
committee were Professor Unwin, F.R.S., Professor Boys, F.R.S.,
Professor H. B. Dixon, F.R.S., Dr. Dupre, F.R.S., and the Rev. F.
J. Smith, F.R.S. They state " that the manufacture of compressed
liquefied gases is carried on on a large scale and by many different
manufacturers in different places, and so far as can be judged the
manufacture is likely to increase still more, and the compressed
gases are tending to become indispensable auxiliaries in various
important industries." That the risks of explosion of cylinders of
compressed gases are due (r) to negligence in the manufacture,
annealing and testing of the cylinders ; and (2) to neglect of pre-
cautions in filling the cylinders. *' Looking to the magnitude of the
trade, the risk to the pubHc and to users of the gases, and the partial
and imperfect regulation attempted by the action of the railway
186 THE DENTAL RECORD.
companies," the Committee think "that some control of the trade
by official inspection is required." They suggest that this inspec-
tion should be under the direction of the Factory Department of
the Home Office, or a Department of the Board ot Trade, and that
it should be directed to all matters referred to in the report as im-
portant in securing safety. The description and manner of testing
to which cylinders should bj submitted are detailed with care and at
some length, many of the conclusions being based on experimental
evidence conducted at Woolwich Arsenal and elsewhere.
^bstrarts anh ^dtdians.
PROSTHETIC DENTISTRY.
By L. P. Haskell, Chicago, 111.
When I commenced work in a dental laboratory, fifty years ago,
wax was the material used for impressions, my preceptor having
first commenced the use of plaster. At that time tin was used for
dies, and of course the counter die had first to be made by drying
the plaster model, and holding it in the lead, and then casting the
tin into that. A few years later, after having used zinc, type-metal,
and even brass castings, I ventured to try Babbitt-metal, then just
introduced for machinery bearings. I have found it the only alloy
suitable for dental dies, the necessary qualities for w^hich are non-
shrinkage, sufficiently hard not to batter ; sufficiently tough not to
break, and making a smooth die. Nothing has so simplified the
fitting of plates as the use of this metal. The proper formula is :
one part copper, two parts antimony, eight parts tin. As pure lead
cannot be pounded upon this without danger of adhering, the
melting temperature is reduced by the addition of tin : five parts
lead, one part tin.
In the preparation of the model for the die one thing is largely
overlooked, viz., that the centre of the palate is hard, and the only
portion of the upper jaw that never changes, while the alveolar
ridge gives way from absorption caused by undue pressure, and more
especially from the retention of undue heat of rubber plates. Unless
provision is made for it, the plate sooner or later rests and rocks over
the hard centre. This is remedied by a " relief," a film of wax with
the edges champened thin. No air-chambers are needed in full
THE DENTAL RECORD. 187
upper plates ; in many cases they are positively detrimental to a
successful use of the plate.
Since the introduction of a pure aluminium there is no reason
why a patient should wear irubber for permanent work. It makes a
rigid plate, and I never have been able to discover that it is aflfected by
the secretions ; have worn a plate in my own mouth for more than
a year to test it. In attaching the rubber the use of the " loop-
punch " removes the difficulty of securing close adhesion of rubber
to the plate. In thickness it should range from guage 24 to 22. In
swaging aluminium, if there are deep undercuts, cut away the portion
of counter-die which fills the undercut, as otherwise the plate may
tear; then, when swaging is finished, burnish or hammer the plate
into the undercut. For annealing, hold the plate over a Bunsen
burner till a match chars over it.
In case of heavy under cut make a core of plaster and asbestos, as
it has a fibre to hold together. Dry thoroughly, mould and replace
core in the mould and cast.
Too much attention cannot be given to the correct articulation
of dentures. More failures result from faulty articulation than from
any other cause. None of the six anterior teeth should meet ; the
pressure should be upon the bicuspids and first molars : exact
pressure on both sides. If there be a second or third molar that has
assumed an angle of 45 degrees, or thereabouts, the upper molar
should not meet its face, for thereby the plate is crowded forward.
Dr. Bonwili, some thirty years ago, made an exhaustive study of
the subject of the principles involved in nature's arrangement of
the teeth, and discovered certain great underlying principles. He
ascertained that the six anterior teeth form the arc of a circle, the
radius of which is determined by the combined width of the central,
lateral and cuspid teeth. A circle of brass, or other metal, of which
this is the radius, if applied to the cutting edges of the incisors
leaves the cusp of the cuspids a trifle outside, and the first bicuspids
right on the margin, same as incisors, leaving about one-third of the
second bicuspid outside the circle, and including the anterior lingual
corner of the first molar. A line drawn through the centre of this
circle will always pass through the centre of the second bicuspid,
and a Ime across the posterior periphery of the circle passes across
the posterior margin of the second molar, thus showing the relation
of the different classes of teeth to each other as regards width.
188 THK DENTAL KKCORD.
This is easily demonstrated by applying it to the natural teeth when
they are not displaced. This rule is of great aid in the arrangement
of artificial teeth.
Dr. Bon will also discovered that the lower jaw forms an
equilateral triangle, varying not more than a quarter of an inch
from four inch?s from top to top of condyle, and four inches from
condyle to median line of alveola. There is no doubt that his
method of arranging teeth by the use of his articulator is the correct
one, if artificial teeth were made like nature's in all respects.
Unfortunately the combinations of teeth — the posterior to the
anterior — are usually much out of the way. Often large anterior
have small posterior, and vice versa. Then again, as a rule,
bicuspids and molars have generally too small masticating surface.
While the lingual cusp of the upper should always be shorter than
the buccal, they are usually made as long. A very serious fault
with bicuspids and molars (in rubber teeth) is placing the pins so
near the crown as to leave but little cusp above it, so that in
articulating it is often ground off, or nearly so ; not only this but it
brings the artificial gum too near the crown. This is often the case
in the longest of teeth, when it is totally unnecessary. Justi's teeth
are freer from these faults than any that are made. In arranging
an upper set to lower natural teeth, it must be remembered that
whatever the position of the lower anterior teeth the uppers must be
arranged symmetrically, as they give expression to the mouth more
than the lower ones. In arranging a lower set, begin with the
bicuspids, so as to insure correct articulation ; then, if necessary,
crowd or lap the anterior teeth. Avoid too close closure of the
jaws, as it not only gives a bad expression to the mouth, but renders
it more diflScult for the patient to use them. However, in old
people the jaw is thrown forward by shortening of the ramus, and
the lower teeth had better not be made as long as they should
otherwise be.
Select plate teeth with straight or perpendicular pins, as the teeth
are stronger and less liable to break in soldering and in wear than
the cross-pins. There is no difficulty in soldering if all the conditions
are right. Close up any spaces under the backings, which should
be of thicker gold than the plate, gauge twenty-four. Do not rivet
the pins, but split, and then the solder will flow down the sides of
the pins. Apply the borax and solder, cut in small pieces. Heat up
THE DENTAL RECORD. 189
over large burner, hot as possible, and with the blow-pipe apply the
heat at first to ihe centre of the plate, as the backings are so
exposed they heat first, and the tendency of the solder is to flow
when it is hottest. A large-flame gas-soldering burner in a
horizontal position, such as manufactured by H. D. Justi, at my
suggestion, will be found belter than anything heretofore used.
The mouth blow-pipes sold at the dental depots are simply jewellers',
who use low carat solders, and have no investment to contend with.
The dentist needs a much larger one, the mouth-piece of which is
pressed against the lips so the muscles are not fatigued, and he can
blow a larger blast. The dental supply companies now furnish such
a one, made at my suggestion. — Pacific Stomotological Gazette,
TREATMENT OF PYORRHOEA ALYE0LARI3.
As regards the constitutional treatment of this disease, Dr. Pierce
and Dr. E. C. Kirk, two firm believers in the efficacy of constitu-
tional treatment, and equally firm in the belief that uric acid troubles
in the mouth cannot be cured or even benefited permanently without
such treatment, Dr. Pierce has had and is having absolute cures from
his form of treatment, which is as follows. Almost invariably
patients suflfering from pyorrhoea alveolaris will, upon inquiry, be
found to be large feeders, and above all large meat-eaters, taking
little or no exercise, frequently addicted more or less to the use of
alcoholic liquors. In the first place all butcher's meat — such as
beef, mutton, veal, &c. — is forbidden, in its place is substituted a
diet of fish, the white meat of fowls, oysters, soft-boiled eggs, and
milk ; alcohul in every form is forbidden, and the patient is given
the following treatment : fifteen minutes or half-an-hour before
breakfast a glass of hot water with a five-grain tablet of tartarlithine
dissolved therein, before luncheon another five-grain tablet in a glass
of hot water, and after dinner the same dose is repeated, then at
bedtime a glass of hot water without the tartarlithine is taken ; so
that the patient receives fifteen grains of tartarlithine and at least
two quarts of hot water during the day. The tartarlithine dissolves
the urates, and the hot water washes them out and aids their
excretion in the urine. This treatment is kept up for several weeks,
when the* dose is gradually decreased, until but five grains of the
tartarlithine are taken per day, but tlie h(jt water is kept up as
before. Locally, any deposit there may be is carefully removed and
190 THE DENTAL RECORD.
the pockets treated with peroxide of hydrogen to remove any trace
of pus there may be present, then washed out with a solution of
hydronaphtol — one drachm to two ounces of water.
The patient is then given a prescription of hydronaphtol, ten
grains; alcohol, one ounce; glycerin, one ounce; and water two
ounces, and told to take a few drops and rinse the mouth several
times a day. Under this treatment Dr. Peirce has had in every
case marked and rapid improvement, and in several cases absolute
recovery. Dr. Kirk's treatment is very similar to the above, except
that he gives larger doses of the tartarlithine, in some cases as high
as forty grains being given in the twenty-four hours ; he also
recommends in some cases the use of salicylate of ammonia, one
drachm divided into six powders, taken three times a day ; also
tartarlithine and cascara in combination, and reports equally
gratifying results as those treated by Dr. Pierce. It must be
remembered that, as this is a constitutional disease, at least I firmly
believe it to be, if the patient goes back to the former mode of
living, with the use of butcher's meat, alcoholic drinks, lack of
exercise, etc., the blood will agai*^. become charged with an excess
of uric acid, the deposit will, in all probability, be again formed
upon the teeth, with the subsequent formation of pus, etc., and all
the symptoms of haematogenic calcic pericementitis be again present.
In this connection of uric acid in relation to dental disease, I
believe, and I think those who have had more experience in its
study and treatment than I, will bear me out in the statement, that
in many cases of pyorrhoea erosion is also present, to a greater or
less degree, and from the same constitutional causes. In those
cases where there is extreme wasting away of tooth-structure and
perhaps no symptoms of pyorrhcea present, if the general health of
the patient is inquire 1 into, and his mode of living, it will be found
that the symptoms are almost identical with those resulting from
pyorrhoea, and that sooner or later the individual will be found to
be a sufferer from rheumatism or gout, which are closely allied in
the uric acid diathesis. — George Darby, in InternattonaL
COCAINE.
When Peru was taken by the Spaniards, the inhabitants were
observed to be particularly fond of a certain shrub ; in fact, quite
dependent upon it. They regarded it as the heavenly tree which
THE DENTAL RECORD. 191
satisfied the hungry, strengthened the weak, made man forget his
misfortunes, and they consequently almost worshipped it. The rude
invaders forbade its use, claiming that it was a weak people who de-
manded artificial support. The discontinuance of its use by law
caused an alarming amount of sickness and other infirmities, with so
many deaths, that the cultivation of the shrub was again ordered.
The alkaloid is obtained from erythroxylin coca, which grows to
a height of six to eight feet, having numerous branches. It is raised
in deep, warm valleys of Peru, Bolivia, Colombia, Brazil and the
Argentine Republic, at an altitude of 5,000 to 6,000 feet. Three
times a year the leaves are collected with the greatest of care, so as
not to injure them. After being carefully dried in the sun, the
leaves are packed in certoes of 30 pounds each, and are exported to
London, the wholesale drug market of the world. It has been
estimated that 40,000,000 pounds are shipped annually. In 1853
the coca leaf was investigated, but nothing save the coca tannin
determined. In 1855 Guedeke found a crystalHne principle, and
called it erythroxylin, which Losson, in 1865, affirmed, but changed
the name to cocaine. — E. J. Hausle, D.D.S., in Dental Practitioner,
ANCHORING LARGE CONTOUR FILLINGS IN INCISORS.
Let us suppose we have a large mesial cavity on a left npper central
incisor. There is little penetration of the decay toward the pulp,
but the entire mesio-occlusal angle of the tooth is gone. This form
of cavity apparently presents greater difficulties to the average
operator than where the decay has penetrated deeper. In the present
method of preparation the cervical half of the cavity is shaped in
the ususl way, being liberally extended cervico-labially and cervico-
Imgually. To obtain anchorage at the occlusal portion of the
filling instead of drilling into the axial wall in the ordinary manner
a groove is cut along the occlusal surface leading from the cavity
distally to near the disto-occlusal angle. This groove must be
made sufficiently wide and deep to admit of a large enough mass of
gold being packed into it to insure strength, and in order to
accomplish this in teeth with thin occlusal surfaces it is often neces-
sary to cut dway the lingual plate of enamel somewhat freely,
This may be done with safety provided the enamel margins are
properly bevelled and gold built over them in the insertion of the
filling. The distal end of the groove may be deepened somewhat
192 THE DENTAL RECORD.
to assist in retention. The philosophy of this form of anchorage
consists in two things :— First, it will prevent absolutely the tipping
of the filling previously alluded to, and second, it increases materially
the seating capacity of the filUng. With the form of anchorage just
outlined it becomes impossible for a filling to get out of a cavity short
of a breakage, and if the mass of gold is made thick enough it will not
break. Some operators may feel a hesitancy about drilling into sound
tissue in this way for anchorage, but it must be remembered that in
the preparation of any cavity sound tissue is often sacrificed for this
purpose. In this instance I am convinced that it is sacrificed to
good account, and I feel sure that when the operation has once been
done in this manner the operator will to a large degree find his
hesitancy gone. There is a feeling of security when the gold has
been built well over and anchored into the occlusal surface that does
not obtain in any other kind of cavity formation for this class of
fillings. Another objection might seem to rise in the apparently
unprotected labial plate of enamel. The labial plate is always left
standing for appearance, even when the lingual must be cut away
for strength, and if not properly protected might prove an element
of weakness. But by carefully beveUing the enamel margin and
building gold over the bevel, it is so perfectly protected that in all
my experience with this method I cannot recall a single instance
where this wall has failed. The acute corner at the mesio-occlusal
angle should be rounded slightly, and the same corner on the lingual
plate should be cut freely away so that the outline of the filling is a
gentle curve from the proximate to the occlusal surface.
This form of filling provides an adequate protection for the end
of the tooth, and does away with what is ordinarily a vulnerable
point in most fillings of this class when constructed in the usual
way, viz., the junction between gold and enamel at the occlusal
surface. The slightest chipping away of the enamel at this point is
often disastrous, and results in final destruction of the filling. Again^
there is opportunity for deeper and firmer anchorage without danger
of approaching the pulp than where an undercut is drilled into the
axial wall. The cavity is rendered free of access for the insertion of
the filling, and while more gold is used, it is more readily inserted
and is hidden from anterior view by the labial plate of enamel. A
filling of this form therefore looks no more conspicuous in front than
where the occlusal surface is left intact. — C. N. Johnson, in Dental
Review.
The dental RECORD.
Vol. XVI. MAY 1st, 1896. No. 5.
©rtgtnal Cnmmimiratxans.
NOTES ON THE TREATMENT AND FILLING OF TEETH.
By W. Cass Grayston, L.D.S.
( Continued from page 1 54.)
Small round or oblong cavities thai are surrounded by walls and
are freely exposed by bev^elling away the approximal surfaces can be
filled as if they were crown cavities, using, of course, instruments
sufficiently curved to reach them easily. If they are not freely
exposed, the cavity must be extended in the direction of either the
lingual or labial wall, and filled as above described, with the
exception that it is usually more convenient to pack the first pellets
against either the labial or lingual wall, depending on the opening.
Where both the lingual and labial walls are badly brokeii down,
there is usually! plenty of room to work the gold partly from the front
and partly from the back. It is impossible to prevent the gold from
showing, and cutting for access can usually be freely done. In
these cases the gold must first be very solidly packed into as deep
retainage as can with safety be made at the cervical edge, and care-
fully carried over this border, and a thick layer of gold made at this
part. It is then carried downwards over the floor and to the cutting
edge, and then the contour built up by working directly on to this
mass of gold. It is very important for all the gold in a case of this
kind to be thoroughly cohesive, and worked with great care into
whatever grooves or undercuts can with safety be made at the sides
and cutting edge. In filling cavities cut from the back, it is
frequently necessary and often a great convenience to work by
reflection in the mouth mirror. This should present no diflBculty to
any one who has had a little experience in its use. To fill these
cavities with non cohesive gold from the back use as large a pellet
as can be conveniently introduced, and press it well up to the
cervical wall, place another against the labial wall and press it up to
the cervical, taking care that the side of the pellet in contact with
the labial wall is well condensed. Proceed in this manner until the
cutting edge is reached, then firmly press a pellet between the gold
N
194 THE DENTAL RECORD.
already packed and the cutting edge, and work it well into the
undercut at this part. If preferred, a pellet may be placed at the
cutting edge so that a little space is left between it and the rest of
the gold, and the keying piece introduced between the gold thus
placed in the cutting edge and the rest of the filling. Take care also
that the gold projects beyond the orifice of the cavity at the cervical,
labial and cutting edges. Now press all the gold in the direction of
the labial wall, and condense it with lateral pressure as much as
possible. This will usually leave an oblong trench like space still to
be filled at the lingual wall (in using non-cohesive gold the cavity
should always be so prepared that it is surrounded by walls).
Personally, I think it is much batter to fill this space with cohesive
gold, but if it is desired to use only non-cohesive, a pellet of suitable
size should be introduced and pressed towards the cervical part of
this space, and the cavity in this manner filled about half way down.
Then commence at the cutting edge and in like manner work upwards
until the centre is nearly reached, one or two pellets then wedged
between these two masses of gold will key them in place. All the gold
at this part must be very carefully condensed down with fine points,
and if any holes can be made in it they must be filled up by driving
small pellets into them.
Be careful to work the protruding gold over the cervical and
Itbial edges as previously described. In filling from the front the
method is the same, treating the lingual wall as if it were the labial.
The labial wall must not be sloped outwards, as for cohesive gold, but
any undercutting here into which the gold cannot be pressed with
B —
[ — A
Fig. 12. Fig. 13.
Fig. 12. — A. Gold packed from the back. B. The space at the lingual
surface to be finally filled.
Fig. 13. — A. Gold packed from the front. B. Space at labial surface to be
finally filled.
THE DENTAL RECORD.
195
ease and certainty is best avoided. The trench-like space will in
this case be at the labial wall and filled as above described. If,
however, there is room, a layer of gold may be first packed agains^
this wall and the filling completed by wedging pellets between this
layer and the rest of the filling. (Figs. 12 & 13.)
In filling the incisors and cuspids, as well as all shallow cavities
vrith non-cohesive gold, the pellets and cylinders must not be too
dense, or it will be difficult to make them stay in place while they are
being packed.
The above descriptions, in addition to those given for the filling
of crown cavities, will render unnecessary any detailed explanation of
the filling of smaller cavities between these teeth.
Molars and Bicuspids. — To fill an approximal cavity in a molar
or bicuspid, opened through the crown as already described, a pellet
of unannealed, or soft foil may be placed in the angle formed by the
juncture of the cervical and one of the lateral walls, first making a
little undercut to deepen this angle if necessary. Another one may
be placed in the opposite angle and a third wedged between them,
or a large pellet may be placed directly against the cervical wall and
held in place with an instrument in the left hand, while smaller ones
are wedged between it and the lateral walls and into the angles on
both sides. This gold is then condensed and made solid at all parts,
working it principally towards the angle formed by the cervical wall
and the floor. (Fig. 14.) It is important for the gold to be worked
Fig. 14. Fig. 15. Fig. 16. Fig. 17.*
in this manner, for if it should extend in a thin layer over the
margin it will be apt to curl up or be drawn away during the
* The above sketches are not intended, nor are many of the others, to be actual
representations of teeth during the process of filling. They are merely diagrams
to illustrate the text. The arrows show the directions of force in building the
old.
N2
196
THE DENTAL RECORD.
subsequent manipulation, and either a slight space or a depression
left at this part, causing in all probability rapid failure of the fiUing.
On to this foundation cohesive gold is packed, being careful to work
it in the same direction until the cervical wall is thickly covered and
the gold well wrapped over it. (Fig. 15.) Now build up the filling
crown wards, preferably with a small foot plugger, if thin tape is
used, in such a manner that the gold is worked with the point or
toe well against the walls and into any undercut that may have been
made here, and then by placing the heel in the cavity and the toe
outwards, work the gold carefully up to and over the edges and build
up the external surface convex so as to restore the contour, thoroughly
consolidating the whole of the gold, including the surface as the
woik proceeds. (Figs. 16 & 17.) If there is any difficulty in
wrapping the gold over the edges, use for this purpose a hand
plugger with broad condensing surface. (Figs. 18 & 19.) When
the filling reaches the crown carry it well across the floor of the
coronal cavity, and then carefully and solidly fill the retaining under-
cut at this part, and then complete the filling by working backwards
to the approximal surface.
In cases where it is difficult or impossible to start the filling at
the cervical wall without undue or undesirable undercutting,
commence at the coronal undercut, work along the floor of the
crown cavity, then carry the gold over the approximal floor until
the cervical wall is reached, carry it along this and pack the gold
here as above described until a firm strong border is made, and then
complete the filling by working crownwards.
If desired, a starting point can be made at one or both of the
cervical angles, and the filling commenced with annealed gold,
gradually working small pieces from one angle to the other across
the cervical wall until a firm foundation is made.
!
Fig. 18.
Fig. 19.
THE DENTAL RECORD.
197
When it is necessary to use hand pressure in posterior cavities
owing to diflficulties of access, the gold is best packed with small and
medium sized points, and the wrapping over the edges may be done
with suitable surface pluggers. These instruments should also be
used in connection with the points for consolidating and giving
form to the surface as the contour building proceeds. In addition
to the two already illustrated (Figs. i8 & 19), Nos. 25, 26,29 and 30
of the Darby Perry set will be found useful. With non-cohesive
gold place cylinders in position at the cervical wall in the manner
described for starting with unannealed gold, but take care that the
ends project somewhat beyond the walls. Proceed in this manner
using a fine point against the wails until the crown is nearly
reached, and then commence at the coronal undercut and work
backwards until the approximal gold is approached, then wedge
cylinders firmly between these two masses of gold to key them in
place, and finally condense the protruding gold as nmch as
possible. (Fig. 20).
- — E
Fig. 20.
A. — Gold packed in the coronal part. B, — Gold packed in the approximal
part. C. — Space left between the two masses of gold. D. — Pellets or cylinders
wedged between the two masses of gold, commencing at either end of the space,
and finally introducing the keying piece E in the centre.
Matrices. — In filling cavities on the mesial and distal surfaces of
bicuspids and molars prepared as already described, many dentists
use a matrix, and consider it enables the filling to be more rapidly
and easily packed ; others think it is of no value, and some hold
that it is a distinct disadvantage. It is considered by many that it
interferes with freedom of manipulation, and that any saving of
time and trouble is obtained at the expense of the work : imperfect
198
THE Dental record.
margins usually resulting. It appears to me that if the filling is
made entirely, or almost entirely, of cohesive gold, it will prove
of no advantage — rather the contrary — while if soft gold is used
until the masticating surface is nearly reached, there are many cases
where it can be used with excellent results, and often time is saved.
After fixing the matrix, pellets of soft gold should be wedged to
place as previously described, and carefully worked against the
cervical wall and lateral walls and against the matrix, being very
careful to pack the gold accurately into the joint formed by the
matrix and the walls. When the masticating surface is reached
cohesive gold is used, and if it is well anchored into the coronal part
of the cavity there is no fear of the filling standing any ordinary
strain. It is advisable, however, to notice the articulation before
putting on the rubber dam ; it is necessary for the soft gold to be
protected with a certain thickness of the cohesive, and if the
opposing tooth should have long cusps, and this should not have been
observed, it may be necessary to cut away so much gold in order to
adjust the bite that the softer portion of the filling is exposed to the
force of mastication and may consequently break down. On the re-
moval of the matrix the soft gold will be found to ''give " somewhat
under the burnisher, but will besuflBciently hard to take a nice finish,
and a well contoured filling is obtained. The Lennox matrix is
scientifically constructed, easy to adjust, and answers all requirements.
Instruments for Packing Gold. — The pluggers used for filling
teeth with gold are many and various. Such a great number have
been designed that it is hard to make a selection. The difficulty is
not so much in knowing what to choose as what to reject, for it is
impracticable to regularly use more than a certain number. The
following are all useful.
Fig. 21.
The point of this instrument should be in the same line as its shaft.
tHE DENTAL RECdRD. 199
Two or three sizes of point of each instrument should be used,
varying from about one thirty-second to one sixty-fourth part of an
inch in diameter. A small foot plugger, such as No. 12
of the Ladmore set, should be added (Fig. 22), and also
some of the surface pluggers already alluded to. One or two
ball-ended burnishers for exposed surfaces, and one or two
thin flat ones for use between the teeth will complete the
set. In packing gold it is of great importance to adapt
it as accurately as possible to the walls of the cavities.
It is rarely that an absolutely moisture-tight filling is
produced, but the more nearly perfection is attained in
Fig. 22. ^-his respect the better for the preservation of the teeth.
The best adaptation is produced by working the gold directly
against the walls. In filling a crown cavity of medium size for
instance, with cohesive gold, the best adaptation will always be
found to be against the floor, because this is the only part that the
point of the plugger works directly against. In very many cases
working directly against the walls is principally a question of using
suitable instruments, and I beg to call attention to Nos. 6 and 7
(Fig. 21) as being very valuable instruments for this purpose. They
are long well curved corkscrew pluggers, and are taken from the
Libbey set.
Finishing Gold Fillings. — When the filling of a cavity is
completed, the surface of the gold should be further consolidated
and rubbed somewhat smooth with a burnisher, using firm pressure.
The gold is then to be trimmed to the desired shape, the edges
brought to fine lines and the filling generally made fairly smooth
with files, fine cut burrs, stones, emery or sand paper strips and discs,
etc., using one or more of the above as necessary. The burnisher is
again to be thoroughly used, and if desired, the filling may be
finally made as smooth as possible with a suitable polishing powder
applied in any convenient manner. Some dentists are opposed to
the use of a burnisher, they consider it unnecessary if the filling is
of solidly packed cohesive gold, and that it has a tendency to give
the surface a wavy or slightly furrowed appearance, and imparts a
lustre to the gold very undesirable in exposed positions.
A burnisher will, however, consolidate and harden the surface of
solid metal. I am informed by a silversmith that the burnishing of
silver goods hardens the surface a^d adds greatly to their durability.
In order to obtain a fine finish they are also always polished after-
200 THE DENTAL RKCORt).
wards. If a burnished gold filling is afterwards carefully polished,
the esthetic objection falls to the ground. The finishing of gold
fillings is often tedious, and takes up much time; there is usually
very little space to work in, and freedom in the use of the
methods employed is in many cases impossible. It may, however,
be laid down as an axiom that extra care and time spent in preparing
a cavity will facilitate and improve the filhng, and that extra care and
time spent on the filling will reduce the time and labour necessary
to spend on the finishing.
Mallets. — Before leaving the subject of filling teeth with gold a
brief consideration of some of the various mallets that are used in
connection with cohesive gold may be useful.
It is probable that no better work has ever been accomplished
than that which is done by means of the old fashioned hand mallet.
No other percussive instrument enables the dentist to feel so exactly
what he is doing, and to vary the force so accurately and delicately.
In order to use the hand mallet with ease and precision, it is
necessary to employ an assistant. Very few operators are ambi-
dextrous, and, even if a dentist is equally skilled in the use
of both hands, an assistant is often necessary to hold back the
cheeks of the patient and to throw light into the cavity with the
mouth mirror. The necessity therefore for a skilled assistant will
always prevent its general adoption, more especially so as some very
efficient substitutes have been invented. These substitutes are the
automatic, engine, electric and pneumatic mallets, all of which are
so well known that a detailed description of each one is unnecessary.
The improved automatic mallet is a very efficient instrument :
as a condenser it is as good, if not better, than the hand mallet ;
its action is, however, slow, and its use takes up a great deal of time.
The Electric Mallet (Dr. Bonwill's) is an extremely rapid striking
instrument. It is very popular with many of the most skilful
operators. Personally, judging by tests made out of the mouth, I
have never been able to make an absolutely cohesive filling with it.
I should not like to say however that in certain hands the results
obtained by it are anything but satisfactory.
Of the various engine mallets the Bon will is the best known.
This is also a fast striking instrument, and in favourable cases more
rapid work has been accomplished by its use than by any other
means. The cohesion and solidity produced by it are excellent. To
use it satisfactorily, a Bonwill engine, or some other engine, by
tHE DENTAL RECORD. 201
means of which the mallet is practically suspended, is necessary.
If it is used with either the S.S. White's Cable Engine or the Shaw
(even with a slip joint) there is " a pull on the hand " that is very
disagreeable.
A good pneumatic mallet more nearly approaches the action of
the hand mallet than any other substitute. For some reason or
other this kind of mallet has never received the appreciation that I
think it deserves, and I take this opportunity of saying a good word
for it. Whether it is useful or not greatly depends on the principle
of its construction. If the plugger point is screwed into the hand-
piece so that they form one rigid plugger, and the blow is given
above the hand-piece so that it receives the full force of it, the
operator knows what he is doing and can regulate the force of the
impact far better than when he has to hold a case in which the
plunger works.
I have used a pneumatic mallet constructed on this principle for
some years with great satisfaction. The Lennox-Thomas Pneumatic
Mallet, worked with a foot bellows, gives a rapid continuous
succession of blows similar to the electric and engine mallets. It
appears to be a very good instrument, but I have had no practical
experience in its use.
The Manipulation of Plastic Materials.
Amalgam. — The directions given by the manufacturers of
amalgams, many of whom either are or were dentists, are often
contradictory and confusing. The method that appears to give the
best results, and which is adopted by many dentists, is to insert the
amalgam in a fairly plastic condition, varying according to the case,
but always sufficiently soft to be easily and thoroughly well adapted
to all the walls.
When the cavity is lined and partly or wholly filled with the
plastic mass a much drier mix is made, squeezing it, if desired, into
a wafer like form. This is added to and incorporated with that
already in place until the cavity is over filled. The surplus is then
scraped away, and if the surface of the filling is found to be
sufficiently hard, it is trimmed with suitable instruments, and finally
smoothed and condensed with light burnishing. If the surface is
not sufficiently hard, it is again alternately built up and scraped
away until sufficient quicksilver has been drawn from the filling
into the overlap to admit of proper finishing.
202 THE DENTAL RECORt».
The quicksilver is worked up to the surface by pressure, and
this method of absorbing it with surplus amalgam is a convenient
means of obtaining as good results as are possible with amalgams.
It is advisable to go round the edges of all masticating surfaces with
a spoon excavator to remove any thin overlap that would probably
soon chip or break away. Straight edges are preferable to bevelled
ones in using all plastic materials. Many operators use a matrix in
filling all compound approximal cavities in molars and bicuspids
with amalgam ; they claim, and with good reason, that greater
pressure can be brought to bear on the filling, and consequently
more of the quicksilver is absorbed than if it is dispensed with.
Tin Foil. — Tin foil is usually prepared and manipulated like
non-cohesive gold. To work it cohesively, use a flat instrument
with the edge rounded into a segment of a circle and made sharp by
bevelling in one direction. Press the pellets firmly to place one by
one with the bevelled side, and then work each one into the greatest
possible solidity with the sharp edge.
Phosphate Cements. — The manipulation of phosphate cement
varies somewhat according to the preparation that is used. A
method that is the best for one kind will probably give very bad
results with another. All agree that the powder should be worked
gradually and thoroughly into the liquid ; it is the question of the
thickness of the mix and whether the desired consistency shall be
attained by addition of the powder solely, or by continuing to
manipulate a thin mix on the slab (without adding more powder)
until it becomes sufficiently putty like to be placed in the cavity.
Everything probably depends on the manufacture of the ingredients
themselves. I find that following the directions sent out with the
phosphate cement I use enables me to obtain the best results with
it, viz., to make a mix of about the consistency of softened gutta-
percha, and, if desired, to add as much powder as can be done
without making the cement crumble ; kneading it with the thumb
and fingers before insertion. A cement filling should be pressed to
place at once with a flat spatula like instrument, and if necessary
worked well up to all the walls with blunt points. In some cases,
especially if the retainage is doubtful, it is well to plaster a soft mix
in the cavity at first, and then to press in as stiff a mass as can be
made without crumbling
{To he continued^
THE DENTAL RECORD. 203
Kepnrts al ^atittus,
THE ODONTOLOGICAL SOCIETY OF GREAT BRITAIN.
The Ordinary Monthly Meeting of the above Society was held
at 40, Leicester Square, on the 13th ultimo, the President
(Mr. David Hepburn, L.D.S.Eng.), in the Chair.
The minutes of the previous meeting having been read and
confirmed, Mr. E. L. Dudley and Mr. H. D. Matthews were
admitted members of the Society.
Mr. C. S. de Prideaux, of Dorchester, was proposed for member-
ship. Mr. G. H. Bowden, of Reigate, and Mr. D. Rubery Chambers
were ballotted for and elected members.
The Curator (Mr. Storer Bennett) stated that Mr. W. F. Forsyth
had presented to the Society two specimens of old bone work, one a
very beautiful specimen, showing the insertion of natural teeth in
front of the case. This specimen, although it looked so clean, had
been worn for some months, and was an instance of work which
nowadays one never had an opportunity of seeing. In the other
specimen tube teeth instead of natural teeth were used, and two pins
were to be seen, showing that swivels had been employed.
Mr. Forsyth had also presented an ancient instrument for the
extraction of teeth. Though clumsy in appearance it was a very
ingeniously constructed and beautifully carried out piece of
mechanism. By closing the handles of the instrument the outer
blade which ought to lie on the buccal side was driven forward and
firmly grasped the tooth for a certain distance, but not to such an
extent as to close up entirely and crush the tooth. After a certain
amount of closing had been arrived at the whole blades are bodily
raised and the tooth drawn out of its socket. Mr. Whatford, of
Eastbourne, had sent an interesting model showing a large geminated
mass between the normal left upper central and the normal left
upper lateral incisor.
Mr. Charles A. Clark presented a photograph of a second
lower molar taken by the Rontgen rays. It would be seen that
the roots were shown as well as the pulp and the enamel. It
was taken by carefully covering the plate in the mouth with black
204 THE DENTAL RECORD.
paper to protect it from the ordinary light, and rubber-dam was used
to protect the plate from moisture. The bulb was held close against
the tooth and the exposure was four minutes.
Mr. Marmaduke Shield then read a paper on " A Case of
Aneurism by Anastomosis involving the Vessels of the Hard
Palate." The patient was a retired officer, aged 57, and had suffered
from liver affections, but never from malaria. In 1893 he had an
accidental fall and broke his nose. He had repeatedly suffered from
severe epistaxis referred to the congested condition of his liver. On
January 15th last bleeding occurred into the mouth, and he lost
about half a pint of bright blood. Considerable bleeding also
occurred on the two succeeding days. An ulcer the size of a three-
penny piece on the left side of the hard palate was noticed about
opposite the second molar tooth and close to the alveolus. Arterial
blood was spurting in a jet from the centre of this, and the patient
was losing a quantity of blood, his mouth being filled with clot.
Mr. Shield on being called in made a very gentle examination and
found a pulsatile swelling the size of a filbert occupying the tissues
at the base of the alveolar basis. Its margins were not defined, but
faded away imperceptibly. The pulsations were so strong as to lift
the examining finger, and felt exactly like those of an aneurism.
There was one large pulsating vessel posteriorly, the compression of
which did not alter the pulsation of the tumour. The teeth were
quite sound, and the morbid swelling, whatever its nature, termi-
nated abruptly at the base of the gums. The ulcer was quite
superficial, and devoid of any induration or distinct margins ; it
looked like an accidental abrasion from hot food or a piece of bone.
There was nothing to be seen on inspection of the nares, and there
was no bulging of the palate generally to indicate a protruding
antral tumour. After reflection, seeing the inevitable uncertainty
of an exact diagnosis, the great hazard of cutting into or cauter-
ising the growth, and the desirability of definitely stopping the
bleeding by some proceeding which would be sure and certain,
Mr, Shield advised that a portion of the maxilla should be removed
so as to ensure complete extirpation of the growth. The patient at
once acceded to the suggestion. The operation was performed on
the 20th of the same month with saw and cutting bone forceps.
The lip and side of the nose being incised, and the tissues reflected.
There was no unusual bleeding. A portion of the upper jaw was
THE DENTAL RECORD. 205
removed, comprising the whole alveolar margin from the second
incisor tooth, and the hard palate as far as the middle line. The
posterior palatine artery spurted persistently, and was only restrained
by plugging the canal with a spicule of wood. Mr. Shield drew
special attention to the advantage of the lateral posture in all these
operations, with the head well hanging over the edge of the table.
The horse hair sutures were removed in a week, and union of the
lip was proved firm and good, the cicatrix scarcely showing. All
this time the mouth had constantly been kept washed with benzoin
and chlorinated soda mouth wash. The recovery was uneventful.
The highly vascular nature of the tumour was apparent after
removal, and the portion of the bone — for it subsided and contracted
so that what was once a prominent pulsating mass was now only a
flattened thickened area of sponge-like tissue -with a small super-
ficial ulcer in the centre. The microscopic examination fully bore
out the appearances during the life of the haemorrhage and free
pulsation. The only case at all similar which Mr. Shield had been
able to find recorded was that described by Mr. Salter, from whom
he quoted at considerable length. In conclusion, he justified what
he said might be regarded as needlessly severe and extensive treat-
ment, on the ground that the patient had already been much
weakened by the serious loss of blood, and the uncertainty as to the
true nature of the swelling. The prognosis was highly satisfactory,
and there was every hope that a definite cure was ensured.
Mr. Albert mentioned a case seen by himself at the London
Hospital, in which a distinctly periosteal tumour on the upper
alveolus was removed, as far as he remembered, without extirpation
of the bone. He also remembered a case at St. George's Hospital of
a young man with a perfectly healthy set of teeth who had, what
was found subsequently to be a sub-periosteal haemorrhage on the
cheek inside the mouth. The surgeon, at his (Mr. Albert's)
suggestion, tapped the growth with a trochar and cannula but got
nothing out. The subsequent history of the case fully bore out
Mr. Shield's remarks. Inadvertently — not guessing for a momen^-
that it was vascular, or even a growth at all — the growth was
opened, and the poor fellow ultimately practically bled to death. It
was a very peculiar case. After the operation was performed the
growth increased enormously, and finally a large fungating sarcoma
appeared. A very few days after the original trochar and cannula
206 THE DENTAL RECORD.
had been inserted, a similar swelling occurred on the upper j aw in
exactly a similar position, and either a trochar or cannula or probe
was passed into it with exactly similar results followed by an attack
of haemorrhage, and from that date haemorrhages recurred at varying
intervals. During the progress of the case, in one night the patient
got a group of secondary deposits over the abdomen and chest, and
one or two on the scalp. They varied in size from a filbert to a pea
They were all in the subcutaneous tissue. He put an ink mark
round some of them to see what would happen, and some got smaller,
one disappearing entirely. It was very unusual for a sarcomatous
tumour to form a secondary deposit or to disappear in that way.
Ultimately the patient died from loss of blood, exhaustion, and pain.
Mr. W. B. Paterson had treated one case of adenoma situated
on the outer side of the alveolus above the incisor tooth. Its small
size tempted him to break the rule of surgery not to cut into a
tumour which could be made to disappear by pressure. He cut into
it expecting bleeding, and was prepared with an actual cautery. It
bled furiously for a small thing. He was able, however, with the
actual cautery, to check it. The only result of the case was necrosis
of a portion of the outer palate which he freely destroyed with the
periosteum by the process of cauterisation. He subsequently met
with a case somewhat larger in size and was not tempted to
deal with it in at all the same way. Hearing Mr. Shield's case
described it occurred to him whether, if it had been a case simply of
pulsating tumour, and Mr. Shield could have felt perfectly certain in
his mind that it was a simple adenoma with no sarcomatous tendency
about it, he could have got at the course of the posterior
dental, particularly in its exit from the foramen at the back of the
palate ; possibly by a little carpentery it might have been plugged
with wood, such a thing had been done before — he would not refer
Mr. Shield to cases, but no doubt he knew perfectly well that it had
been done ; that a case might be treated by extirpation, and pressure
by means of a plate applied to the surface of the extirpated growth
and fastened to the teeth. Such a plate would have been easily
capable of adjustment, and pressure could be kept up to quite a
sufficient extent to check haemorrhage. Had the case been a simple
one such a treatment might have been successful, but he quite saw
the difficuly of Mr. Shield's case, which was certainly of a suspicious
nature.
1
THE DENTAL RECORD. 207
Mr. Shield, in reply, said the criticism offered by Mr. Paterson
was a perfectly just one. Of course, the possibility of plugging
the posterior dental foramen occurred to him at once. It was very
easy to talk about, but very difficult to do. He had seen it attempted
in operations for cleft palate by distinguished anatomists and
surgeons on several occasions, and had always seen them fail.
Howev^er, it was recommended in the books and it ought to be
possible to do it. The reason for its rejection on this occasion was
that he felt a large pulsating artery. The moment he went to press
upon it with the finger there was no pulsation in the growth. The
growth was evidently supplied by arteries from every direction, as
these aneurisms by anastomos generally were. He thought if he
has seen the case before there had been much loss of blood, and
whilst the patient was in a fairly good condition, it would have been
quite justifiable to have attempted to have removed the whole growth
and so apply some mechanical pressure such as Mr. Paterson
suggested, but the difficulty to be encountered was the serious loss
of blood the patient had already undergone. He would only just add
one word with regard to one point noticed in his paper, where he
had spoken of a slight recurring haemorrhage which was checked
by making the patient sit up, immersing the lower extremities
in hot water, and injecting the buttocks with ergotine. There
was no process so valuable as that for checking haemorrhage
in the mouth, and it was one of their most useful means in dealing
with those terribly troublesome cases which members of the Society
must have met with of recurring haemorrhage into the tooth-
socket.
Mr. Storer Bennett gave a Casual Communication illustrated
by lantern slides. He said it would be remembered that in
December, 1888, Mr. W. C. Harding presented to this Society an
upper incisor which had been fractured across the crewn, and which
he had extracted from the mouth of a girl 17 years of age only three
or four days before he presented it. The history of the patient was
that some ten months previously she had fallen down, striking the
tooth and driving it high up into its socket. It became impacted,
and remained fixed in its position causing more and more irritation
up to the time that Mr. Harding saw it. The pain then became so
intense that he considered there was nothing to do but to remove it.
He then discovered that the tooth had been fractured across the
208 THE DENTAL RECORD.
crown in a direction obliquely upwards and backwards. He (Mr.
Bennett) was asked to make a microscopic examination of the
specimen, and he therefore cut a section perpendicularly from front
to back. The slide now exhibited showed the two outer halves after
the section had been removed. It would be seen that the broken
halves of the specimen were firmly knit together by some calcified
material which occupied the central position of this gap, but the
bulk of the tissue beyond this space that occupied the outer
portions and edges of the fracture were of a tough and leathery
consistence, not calcified at all. Having taken the section from the
tooth, the appearances presented were as follows : in the middle
half between the fragments there was a calcified mass of material
which was of a spongy or cavernous character, largely made up of
blood vessels. There were numerous blood ve'^sels, as shown on the
slide, ramifying through the whole of the tissue. Also in the
cavernous spaces there were masses of some material somewhat
resembling pulp, but he did not wish it to be understood that these
were pulp. A further enlargement showed in various positions
absorption of the normal dentine. One little patch was shown on
the slide, but the amount of absorption was very slight. There
were also patches of absorption shown, and in these patches of
absorption might be seen lacunae and canaliculi. The amount of
cementum was very great. Of course, an examination of subsequent
specimens suggested to one's mind two different sources for the new
material, either pulp or periosteum, extravasated blood, and so forth.
The pulp was exposed, but only to a very small extent. A very
small opening led from the other side of this specimen into the
middle, and of course it was possible to imagine that enlargement
took place ; that the over growth of the pulp filled up the spaces
between the two fragments, somewhat similarly to the chronic
enlargement seen in cases of polypus of the pulp, and that ultimately
this calcified. On the other hand, they had evidence that there was a
cementum in the section with lacunae and canaliculi present in certain
parts in rather large numbers ; there was an absence of evidence
of any definite dentine structure being present. They had here,
he thought, a case in which, haemorrhage having taken place, a natural
capping of exposed pulp had occurred, somewhat similar to the case
of a wound which has healed under a scab. The blood, being poured
out between the fragments, became organised blood vessels, evidently
tHK DKNtAL RECORD. 209
largely extravasated, calcification took place, and eventually, if it had
been left long enough, he thought the whole of the space would have
been filled up with calcified material more or less resembling bone,
or bone and cementum together. But the specimen was unlike any
other he knew of, in so far as the cementum had been deposited
between the fractured portions of the crown. There were many
specimens described where cementum had united a fractured tooth in
the root. He regretted that the exhibition of the specimens had
been so 'long delayed, but perhaps it was fortunate inasmuch as
Mr. Tomes had come across a specimen of a fractured tooth which
would compare with his, and no doubt they would listen to some
very interesting remarks from him.
Mr. ToMFS then read a paper on ** A Case of Calcification of a
Widely Exposed Pulp." He said the specimen to which he would
call attention was so remarkable and so instructive from several
points of view as to fully repay somewhat close examination. The
tooth, though broken right across its pulp cavity, had nevertheless
succeeded in repairing the damage and sealing itself up again — an
event of such rarity that he only knew of one other recorded case.
The tooth was either a lower wisdom or a small second molar, the
loss of the neighbouring teeth rendering its exact determination im-
possible. The patient was brought to him on account of very severe
intermittent pain of a neuralgic type, recurring most days, but not
every day. He found a tiny opening in the gum which was other-
wise of healthy appearance. A probe introduced disclosed the
presence of what felt like a complete but rather rough surfaced
tooth. The history was that some three years previously an attempt
had been made to extract a tooth in this situation, but that it had
been broken off. It was exquisitely tender, and occasionally very
painful for a long time afterwards, but it gradually got better and
healed over, though it never remained absolutely comfortable for long
together. The severe paroxysmal pain which brought her to him
was only of a few weeks' standing. With the aid of cocaine he re-
flected the gum from over it, and subsequently had no diflSculty in
removing it with an elevator. He then found that it had been
transversely fractured a little way above its neck, and that what
should have been an open pulp cavity was occupied by a cauliflower-
shaped mass of shining polished ivory, projecting up above the
original surface of fracture, and overflowing on to it. By cutting it
O
210 THE DKNTAL RECORD.
carefully with a hair saw he was able to get four good longitudinal
sections, and found that the pulp was not wholly calcified, but that a
residue of the pulp chamber was still occupied by living pulp. On
examining it with a low power the large mass of secondary dentine
was found not only to project a good way above the general level of
the fractured surface, but also to have, so to speak, overflowed it all
round the orifice of the pulp cavity, and to be everywhere closely
adherent — indeed, continuous with the old dentine. Roughly speak-
ing, its structure might be thus described : its free or upper surface
presented distinct lamination parallel with the surface, next came
irregular lacunal spaces, then sparse dentinal tubes, and finally, in
its deepest portion — which was inside the original pulp cavity —
abundant dentinal tubes, which were in places continuous, though
oftentimes joining by an abrupt bend with the dentinal tubes of the
original dentine. The overflow on to the fractured upper surface of
the original tooth in places was slight, in other places it extended in
a gradually thinning layer out to the very edge of the tooth ; but
what was especially noteworthy was that there were included in the
new calcified growth quite a number of entirely detached and dis-
placed splinters of the old dentine. Mr. Tomes then proceeded,
aided by some beautiful photo-micrographs thrown on a screen, to
describe in minute detailtbecharacter of the new tissue. Continuing,
he thought that his astonishment at the extraordinary vitality of
this pulp, and its amazing success in repairing damages, would be
shared by everyone present, and some speculations as to the condi-
tions under which it took place would not be thrown away. The
whole roof and a little of the sides of the pulp cavity had been torn
off, and the pulp thus widel}^ exposed apparently a little below the
edge of the gum. This must have been temporarily protected by
the formation of a coagulum, and ultimately by the contraction of
the edges of the gum and its almost complete healing over it, and
under these conditions its astonishingly successful calcification went
on. Was there not a practical hint to be derived from this ? Here was
a lacerated pulp with loose fragments of sharp splintered dentine
jammed into it, coated over only with coagulum, and which did not
die or inflame, but calcified. He thought that in capping a pulp,
and especially a traumatic exposure^ they would probably do better
to carefully not wipe away any blood, but leave the effused blood to
coagulate ; they could put nothing better upon the pulp surface.
The nRNTAL record. 211
And probably, when they did commence to cover it, they would do
best to put something organic — sterilised fibrin or gelatine for
instance. He should certainly try such a course of procedure when
the opportunity offers, and refrain from placing in contact with the
pulp either inorganic materials or strong medicaments. But there was
another and less hopeful side to the suggestions presented by this
case ; there was almost absolute success in the formation of secondary
dentine, with absolutely no loose nodules or irregular encroachment
on the pulp, in fact, precisely the condition which they hoped to
obtain when a pulp is capped ; and yet it was not comfortable.
Notwithstanding its full protection under the gum it became the site
of characteristic pulp irritation, and consequent neuralgic pain.
Was this an accident ? or was the capping of pulps to end in this
way usually? Clearly they could hope for no better results in the
way of repair, yet why did it become so painful ? For all that they
could see post mortem, the immediate surroundings of this pulp had
become almost exactly those of a healthy pulp with its dentinal
tubes radiating from it. Another set of speculations of a more
theoretical kind arose, how was the calcification done ? Ordinarily,
the odontoblasts would be torn off and remain adherent to the
portion of the tooth which was broken away in the attempted ex-
traction. Were they not torn off? or were they reformed ? or was it
done without odontoblasts ? If so, then dentinal tubes could be
manufactured without odontoblasts, which, from what they knew of
the process, did not seem likely. But in any case, the first formed,
or outer layers, were laminated, unlike anything which happens in
normal tooth formation. Were these laminated layers a plastic
exudation? shed out from the wounded pulp, subsequently
organised, and finally calcified. He confessed that this idea
rather commended itself to him, as it would give an easy ex-
planation of the way in which the new tissue flows over
the fractured surfaces exactly as if it had got there in a fluid
form. One section seemed to afford clinical proof that the material
which subsequently calcified was originally fluid. A piece of
old dentine has been raised at one end, but left attached at the other,
just as happens if a chisel is driven into wood nearly parallel with
its surface, but the chip not detached. This had been glued on by
something which ran in right under the raised dentine with a
degree of completeness which strongly suggested its original fluidity.
02
212 THE DENTAL RECORD.
The same idea was equally strongly suggested by the manner in
which the overflow, subsequently calcified, ran out in places over
the whole fractured top of the tooth, reaching even to its very
outside in a gradually thinning out layer. So far as it was possible
to read the history of events, this appeared to have happened : the
roof and part of the sides of the pulp were torn off, the exposed part
probably retaining its odontoblast layer, swelled out somewhat from
the orifice, and shed out plastic exudation over its whole surface,
which flowed out over the top of the tooth left. The plastic
exudation became permeated by migrating leucocytes, and in and
under by the healing over of the gum, &c. After the fibrillation
and organisation of the effused plastic exudation, the pulp itself
commenced to calcify in the ordinary way, its odontoblast layer
determining the number and form of its tube systems. That this was
the case was indicated by the fact that though the area was larger
there were not more tubes, but only larger interspaces between the
tubes on its expanded portion, and so far it pointed to there being
neither a fresh formation nor multiplication of the odontoblasts.
They were stretched apart, and so, in the stretched portion, the tubes
were far apart, becoming dense in the more expanded portion.
Thus, so far as it went, it was a strong confirmation of the view that
dentine tubes are a consequence of the presence of an odontoblast.
The fragments of dentine, with the exception of a few small pieces
which were driven in more deeply, lay on the surface of the pulp,
and were stuck to it by the plastic exudation. Hence the dentinal
tubes commence under them (with trivial exception), and mark the
limits of pulp tissue and exudation tissue.
Mr. Tomes next read a paper entitled " Further Notes upon
Amalgams," being a record of the continuation of investigations
communicated to the Odontological Society (and reported in the
Dental Record for February, 1895. Mr. Tomes did not put
forward his notes as in any way completing the investigation of the
subject, but it was so large and complex a one that it seemed to him
better to communicate his results in instalments, and thus contribute
something for other observers to work upon. By spreading a thin
layer of Welch's amalgam (which was used throughout the
experiments because it is one of simple and known composition
containing 51*52 tin and 48-48 silver) upon a microscopic slide he
was able to examine its surface by illumination from above ; it had
THE DENTAL RECORD. 213
a smeary semi-fluid appearance, with numerous spherical or hemi-
spherical projections, which look like, and doubtless were, beads of
mercury. After a time these beads wholly disappeared, and their
place was occupied by crystalline forms of metallic lustre. These
crystals were sometimes cubes, sometimes six sided rhombs, and,
apparently, sometimes flat plates with six sides. From this it
would appear that the process of setting in amalgam was one
of crystallisation. Further, if a slide which had thus become
crystalline were heated, the beaded appearance returned, but the
crystals reappeared in a few minutes, almost as soon as it had
cooled. Again, if a slide of freshly mixed amalgam were heated
crystals appeared at once instead of taking some hours to form.
Heat brought about the immediate setting of the amalgam, but not
until it had cooled. The examination of four slides, one prepared
with amalgam mixed so as to be just plastic, a second with more
mercury, a third mixed with a considerable excess of mercury, and
then squeezed till only just plastic, and a fourth with the expressed
mercury squeezed flat under a cover glass, showed no material
difference in the size or appearance of the crystals formed except
with regard to the fourth in which no rhombs appeared, but only
foliacious forms similar to those in which tin crystallises. This
crystallisation is the reason why an amalgam ordinarily used gets
a mat surface when it has set, though left with the burnish on it.
The crystals on the slides were for the most part rhombs. The
driest of the samples had not so lustrous a surface as the others,
even the under surface which was in contact with the glass being
less bright, and this was seen to be due to the presence of a certain
amount of dull granular-looking material. The tendency of thin
slabs to curl as they set which had been described by several
observers could hardly be detected in any of them. These facts
contained an intelligible explanation of the addition of old amalgam
reheated and mixed with fresh amalgam, causing very rapid setting
of the whole. Not only did the old amalgam, tend to re-crystallise
as soon as it cooled but it caused the new to do likewise. What
was the practical application of these facts ? In the first place, with
any freshly mixed amalgam it was impossible to control the surface,
however smooth it might be at first. It would soon become covered
with small crystals, and this roughening of the surface was not a
change in the right direction. But the crystals are not dead hard,
214 THE DENTAL RECORD.
and if an amalgam setting with inconvenient rapidity be burnished
in, it remains smooth and to a great extent retains its burnish.
Mr. Tomes was able to confirm Dr. Black as to what Dr. Black termed
the " flow '' of amalgams, viz. : that with a steady pressure of a strong
spring a foreign body could be squeezed into an amalgam which
would set without any apparent breakage occurring. In other
words, the crystals are plastic, and the hard amalgam is capable of
taking an impression to a degree of delicacy which it would not
when fresh. Another point of importance was that the size of the
crystals differ much in different amalsjams. With regard to
manipulation, if a fresh mix of amalgam be put upon a hot plate
and heated till it just begins to swell it sets almost instantly, and
can be used almost like fusible metal with a hot burnisher. If a
fresh amalgam is to be used Mr. Tomes is of opinion that there
is no method which in its results approaches that advocated by
Dr. Bonwill, viz. : to squeeze the amalgam when in the cavity, in other
words, using it fairly plastic and forcibly squeezing out the excess
of mercury by means of little pledgets of wool or bibulous paper.
In conclusion, there were one or two pitfalls to be avoided.
Unless the cavity be a simple one there would be a danger if
every part were not thoroughly burnished of leaving crumbly
places, especially under undercuts. Old pieces of amalgam being
uncertain in their composition, Mr. Tomes advocated a specially
prepared old amalgam. For the intelligent use of amalgams it
should be borne in mind that even when fully set it has a certain
sort of plasticity.
Mr. F. J. Bennett wished to know whether Mr. Tomes had
investigated anything beyond amalgam. Professor Roberts Austen
had been working on alloys at different temperatures in the fluid
and also the solid state, and had obtained most remarkable results.
The Professor took cylinders of lead about three inches long,
attaching to the end of them a small cylinder of gold of similar
diameter. Keeping these two cylinders at a temperature far below
the melting point of lead in three days he found ihe astonishing
result that particles of gold had found their way right up to the top
of the lead cylinder in considerable quantity. Mr. Bennett had not
teen able to find a full and accurate account of these experiments, a
short notice of which appeared in the scientific column of The
Graphic.
THE DENTAL RECORD. 215
Mr. H. Baldwin regarded this migration of metals as a confirma-
tion of the correctness of the view of Mr. Amos Kirby as to the
alteration that amalgams undergo. Mr. Kirby had always attributed
the alteration in amalgam to a warpage, not necessarily to a
contraction ; in other words, more mercury being in one part of the
amaloam than another it would redistribute itself evenly over the
whole mass, and the portions of the amalgam from which the
mercury went, shrank, and those to which it migrated, expanded.
Mr. George Cunningham thought that in reading the excellent
paper of Professor Black they ought not to forget the wonderful
work done by Mr. Kirby. It was to be regretted that Professor
Black himself seemed unaware of what Mr. Kirby had done. With
regard to the heating of copper amalgam, Mr. Lrcnnox had suggested
taking two masses of copper amalgam and mixing them at two
different temperatures, then fusing them together with the crucible
and mixing them up. This certainly gave an amalgam which
would set with considerable rapidity.
Mr. Reinhardt, with reference to the rapid ^setting of amalgam,
asked if Mr. Tomes remembered that many years ago it was
suggested that the proper way of using amalgam was to use it very
dry — in a sort of powder — and pack it with hot instruments.
Mr. Storer Bennett wished to be allowed to correct a
misapprehension. In speaking of the blood clot he did not mean
liieraliy that the blood clot itself was organised, but spoke of healing
under the clot, intended simply to imply that blood was poured out
and that organisation took place over the periosteum. Mr. Tomes
had attributed to him the suggestion with regard to the treatment
of exposed pulps, but Mr. Tomes himself was absolutely the author
of the idea, and Mr. Bennett did not wish it to appear that he
claimed the notion as his own.
Mr. C. S. Tomes in reply said he never had believed in amalgams
taking on a spheroid form, and he still less believed it now.
Mr. Cunningham seemed rather to accept Dr. Black's idea that what
was found in amalgams was due to flow. The flow of amalgams
was an extremely interesting thing, and bore very much upon the
investigation of the subject, but he doubted if it had anything to do
with what happened in the mouth.
The usual votes of thanks concluded the Meeting.
216 THE DENTAL RECORD.
It is with extreme regret that we hear of the death of
Mr. P. Dubois, who was knocked off his bic3'cle and run over by a
coach when turning a corner of a Parisian street. Pie recovered
consciousness, but died within twenty-tour hours. Mr. Dubois was
Editor of L' Qdontologie,, President of the Association of Dentists in
France, and a Professor gin I'Ecole Dentaire. An influential and
representative Committee has been forrred to collect subscriptions for
the Widow and Children. The Treasurer's address is M. G. Vian,
47, Coul Haussmann, Paris.
We have received a copy of the Pictorial Menu of the Twelth
Annual Dinner of the Edinburgh Dental Hospital and School. We
can simply wonder at and admire the ingenuity and draughtsmanship
of Mr. F. Page, which enables him year by year to produce such
excellent menus. This, if we might be allowed to say so, is more
refined in character than some of its forerunners.
At Preston, on April 21st, Herbert Berry, sixteen, a pupil teacher,
was summoned for assaulting three scholars. It was alleged that the
defendant gave the lads the option of being caned or having their teeth
drawn, and when they elected the latter, he performed the operation
with his own hands. The defendant was fined ^3 and costs in the
first case, and the other cases were withdrawn on payment of costs.
Dr. J. Hume sends the following report the British Medical
Journal: ** On March 17th, J. B., aged 10 years, died in my hands
while under chloroform for tooth extraction. The boy's teeth were
abnormally strong, and he had been suffering for some weeks from
abscesses at the roots. The chloroform was administered on a hand-
kerchief in the recumbent position, and he took it well. The dentist
extracted three teeth, when the boy suddenly became pallid and the
heart's action stopped. Artificial breathing was resorted to and
ether injected, but without avail ; not more than half an ounce of
chloroform was used. I learned afterwards that the boy had been
restless and excited for some nights previously. He had chloroform
for tooth extraction some time ago and stood it quite well. He was
a strong healthy boy.
THE DENTAL RECORD. 217
At the instance of the British Dental Association, H. W. Shellard,
of High Street, Cardiff, was summoned before the local stipendiary
on March 23rd for practising as a dentist, not being registered under
the Act of 1878. The chief witnesses were a private detective named
Oxley and his wife. The latter visited the defendant, who said she
wanted some new teeth. He examined her mouth and advised her
to have a new set. She ordered them, paying 5s. on account. She
admitted in cross-examination, that, in giving her name as
Hackman, she told a professional lie, as also when she said she would
call again. The stipendiary imposed a fine of 40s. and costs, but
disallowed the expenses of Oxley and his wife. In another similar case
in which Osborne White, of Charles Street, was the defendant, a
like penalty was imposed.
Mr. R. Ley presided al the Annual Meeting of the Devon and
Exeter Dental Hospital. During the year 5,214 cases had received
attention, making a grand total of 81,123 since the opening of the
institution. The receipts for the past year had been ;^i4i 13s., and the
payments ^141 2s. The committee recorded with regret the death
of one of their oldest subscribers, Mr. Winslow Jones, who had left
them a legacy of ^100. That sum had been placed on deposit to
form the nucleus of a reserve fund. An urgent appeal was made for
further support and sympathy. It was recommended that the
president, Mr. R. Ley, the retiring members of the Committee
of Management, Messrs. R. T. Campion and W. S. Mortimer?
and the hon. treasurer, Mr. J. M. Ackland, be re-elected,
and the Rev. E. Chatterton Orpen's name be added to the
j^ommittee. The Chairman moved the adoption of the report.
Their institution did an immense amount of good for the
deserving poor, and the public owed a deep debt of gratitude to
the medical officers for the work they were doing gratuitously. He
regretted they were only to receive £'^ from the Hospital Saturday
Fund this year instead of ^10. That grant would also have to be
received as a subscription and not as a donation, so that 25 recom-
mends would have to be given away, making them poorer instead of
richer for the amount. Their first duty, however, was to think of the
poor who would be benefited, and he hoped another year the grant
would be increased. Mr. G. Franklin, in seconding, suggested that
the needs of the institution should be brought before the clergy.
218 THE DENTAL RECORD.
Mr. Browne-Mason, replying to Mr. Railing, said although there
were many patients from the country districts, about nine-tenths of
those treated were from the city.
If it be possible to accentuate the sadness of the death of
Lavinia Sawdon during the administration of chloroform, the
following details of the family history will do so : — Her father is a
farm labourer on Sir Tatton Sykes's estate among the Yorkshire
Wolds, and with a full week's employment, earns the princely salary
often shiUings a week ! Upon this he has been compelled, up to a
recent period, to maintain a wife and eight little ones. During the
last eighteen months he has lost three children. One was run over
and killed, another was burnt to death, and the fate of the third, a
bright and intelligent girl of fourteen, was decided last Friday
afternoon. She was only permitted to accept an engagement so
far from home because her parents were acquainted with Mrs. Sykes,
who was formerly a schoolmistress at Weaverthorpe, where the
deceased was one of her scholars.
THE DEATH UNDER CHLOROFORM AT IDLE.
Coroner's Inquiry.
On Saturday, April i8th, before District Coroner Major Taylor,
an inquiry was held, at the Alexandra Hotel, Idle, on the death of
Lavinia Sawdon, whilst under the influence of chloroform, admini-
stered by Joseph Priestley for the extraction of teeth. Mr, W. I.
Crabtree, solicitor, watched the case for Priestley, whilst the police
were represented by Superintendent Crawshaw.
Formal evidence of identification was first given. Thomas
Sawdon, a farm labourer, of Weaverthorpe, near Malton, stated that
the deceased, who was fourteen years of age, left home early in last
December to enter the service of Mr. Lister Sykes, insurance agent,
of 9, Howgate, Idle. She was then in good health, and he had
never heard her complain of any illness. On Friday he received a
telegram informing him of her death, and he arrived at Idle on the
Saturday afternoon.
Mrs. Sykes, the employer of the deceased, deposed that the girl
entered into her service on December 3rd of last year. She ap-
peared to be in good health, but she had suffered from toothache
for several weeks. At about half-past ten on Saturday morning the
girl went to have the tooth extracted, but Mr, Priestley was away
THE DENTAL RECORD. 219
in Bradford at the time. She went a second time at about a quarter
past eleven o'clock, but he had not returned. Witness afterwards
sent a message, in response to which Mr. Priestley came to her
house about one o'clock. The deceased had had dinner about half
an hour previously. Witness told him that the girl wanted to have
'a tooth drawn. He examined her mouth and ascertained which
tooth it was.
The Coroner : What did he say ? Witness : He said that he
could get it out easily, or all right — I forget which of the two
phrases he used. He went into his shop to fetch his instruments?
and then they both went into another room.
Did you all go into another room? — No ; I stayed with my
children in the kitchen. When they came out, after an interval of
two or three minutes, the girl was the first to make any remark.
She said that Mr. Priestley had only managed to get a piece of the
broken tooth out. The deceased asked him if she could '' have it
out by gas," as she suffered from it very much, and she was afraid of
the pain of another attempt. He said it would cost from 3s. to
3s. 6d., and I thought it was too much, so I asked her if she would
wait and see if the tooth got better, as it had done before. She
begged very hard to have it taken out at once. I asked Mr. Priestley
if it would pain her at all if gas were administered, and he replied
that she would, perhaps, feel a little light-headed afterwards, but
there would be no further inconvenience. The deceased asked my
consent three times to the operation being performed with gas, in
order to avoid further pain, and at length 1 said she might go. She
went into Mr. Priestley's house, and as she had not returned at ten
minutes to two, I went there, thinking that she might be sick. I
saw Miss Priestley, and asked, " Is Vinnie all right ? " The girl
was being operated on in the shop, and I waited for a few minutes
in the kitchen. Miss Priestley went into the shop several times, and
then said that her brother was afraid that Vinnie was dying. I ran
and called my husband, and we went into the shop. He then went
for Dr. Honeyburne, and that gentleman arrived a minute or two
afterwards, but the girl was dead. Mr. Priestley seemed very much
surprised and upset at the occurrence, and hardly seemed to know
what to say about it. The body remained there until eight o'clock
at night, and it was then conveyed to my house.
Mr. Crabtree : How long have you known Mr. Priestley ?
220 THE DENTAL RECORD.
The Coroner (interposing) : Has that point anything to do with
the purposes of this inquiry ?
Mr. Crabtree : I would Hke the fact of his having been in practice
here for seven years to appear on the depositions.
The Coroner : It does not matter if he has been practising for a
thousand years. He is not on the Ust.
Mr. Crabtree : He does not contend that he is on the Hst.
The Coroner : Then he is not a registered dentist, and he cannot
practice.
Mr. Crabtree : He does not say he is registered.
The Coroner : He is, therefore, an unquaUfied man.
Cross-examined by Mr. Crabtree, Mrs. Sykes said that the girl
told Mr. Priestley that the tooth was on the right-hand side of the
lower jaw. It was only the stump of a tooth.
Miss Sarah Priestley, dressmaker, of ii, Howgate, Idle, stated that
she kept house for her brother, Mr. Joseph Priestley, who was, she
said, a herbalist and dentist. The deceased came to the house at about
a quarter past ten on Friday morning, but Mr. Priestley was away at
the time. The girl came in wiih him about half-past one or two
o'clock. They went into the shop, and ten minutes or a quarter of
an hour later he called for witness to bring a bowl, as the girl was
sick. When witness went into the shop the girl was sitting in a
chair, and was leaning slightly forward. A moment or two after-
wards he said there was a change, and that the girl was not breath-
ing quite naturally. Witness fetched Miss Scott, a neighbour, and
by her brother's instructions they chafed the girl's hands and applied
cotton wool soaked in amyl nitrate to her nostrils.
The Coroner : Did the girl make any movement ? — Witness :
She appeared to be breathing.
Did she seem to breathe differently after the application of the
restorative ? — I think she breathed more regularly after my brother
had worked her arms.
Did you see her move ? — I don't remember.
Didn't you take any notice or care anything at all about it ? —
Well, I didn't remain in the room very long.
The witness went on to say that after Miss Scott came in she
informed Mrs. Sykes what had occurred.
The Coroner : When were you told that the girl was dead ? —
Witness : When Dr. Honeyburne came.
THE DENTAL RECORD. 221
How many bottles did you see about the shop ? — Only two ; the
bottle containing the chloroform and that containing the amyl
nitrate. They were both on a glass case near the chair.
Superintendent Crawshaw : What was the girl's condition when
you were called in — was she conscious or unconscious ? — Witness :
She was unconscious ; at least, it seemed so to me, but she was
beginning to be sick.
Did you see anything applied to her face except from the amyl
nitrate bottle ? — No.
'':'' Was anything being applied to her face when you went in ?
— I really cannot say whether there was anything but a towel or
not.
The next witness was Miss Hannah Scott, a riressmaker, of 20,
Howgate, Idle. She said that she was called in at about ten minutes
to two on Friday afternoon.
The Coroner : What state was the deceased in then ? — Witness :
She was making a breathing or sobbing noise occasionally.
Did she seem to recognise you ? — Oh, no ; not at all. She was
insensible.
Did Mr. Priestley say anything about her ? — I asked him if a
doctor had been sent for, and he said no. He was then using restora-
tives, and doing all he could for the poor girl.
Did he give any reason why he had not summoned medical aid ?
— He said that it was not necessary to fetch a doctor just then, but
I thought it was.
You did not ask him anything ? — No, sir. I understood what
was the matter. When I went in he was working her arms about,
and he asked me to hold the restorative to her nose.
Where did he get it from ? — It was in a bottle containing some
rather yellowish liquid.
And did she seem to get any better or worse under the treat-
ment ? — She seemed to bieathe.
For how long after you got there ? — It would be about a quarter
of an hour afterwards.
Did she seem to die very quietly ? — Yes, sir.
In reply to Mr. Crabtree, Miss Scott stated that when she asked
if a doctor had been sent for the deceased had not begun to be sick.
Police-sergeant Arthur Inman, of 13, Marlborough Road, Idle,
said : In consequence of information received, I believe from
222 THE DENtAL RECORD.
Mr. Priestley, I went down to his shop in Howgate at a quarter to
eight on Friday night. He said : I have some very bad news to give
you. About half-past one o'clock the girl Sawdon came to the shop
to have two teeth drawn, and requested me to use chloroform. I
accordingly used a quantity of chloroform, and drew one tooth out.
I then gave her a second dose, with the intention of drawing another.
Immediately I gave her this I saw that she was dying, and at once
sent for Dr. Honeyburne. He arrived about two o'clock, and found
her dead." Priestley further stated that he had used about half an
ounce of chloroform. T took charge of the bottle, which contained
a small quantity. It is labelled '' Poison." I afterwards removed
the body to Mr. Sykes's house.
The Coroner : Did he make the statement without any question
from you ? — Witness : Oh, yes, quite voluntarily.
Mr. Crabtree : Did he tell you that before administering the
chloroform he measured it in a graduated glass phial ? — No.
Did you ask about any measure ? — No.
And have you asked for it since ? — No.
Dr. Richard Honeyburne, of Greenfield, Bradford Road, Idle,
gave evidence to the effect that he arrived at Mr. Priestley's house
about two o'clock on the previous afternoon in response to a
summons.
The Coroner : Did -he say anything to you about the girl ? —
Witness : No. I looked at her, and saw that she was dead. I said,
" What have you been giving >er ? " and he replied, " Chloroform."
I then unfastened her dress, 4'd found that her heart has ceased
beating. There were two or it ee buttons at the top of her dress
unfastened, but the remainder of her clothing had not been dis-
turbed. I turned round to Mr. Priestley and said that she was dead.
He asked, " What had I better do ? " and I replied that it would be
best for him to report the matter to the police. When I got to the
house the girl had apparently been dead about ten minutes or a
quarter of an hour, and the extremities were beginning to grow cold-
Dr. Honeyburne proceeded to give the result of a post-mortem
examination which he had made of the body. Externally there
was nothing unusual except a small bruise on the forehead, over the
left eye. There was intense venous congestion in both lungs and
other parts of the body. The heart was quite empty, but perfectly
healthy. There was no obstruction in the larynx, but the stomach
THE DENTAL RECORD. 2^3
contained a large quantity of undigested food. Upon examining
the mouth he perceived that the first left lower molar had been
recently extracted, and one fang of the corresponding tooth on the
other side appeared to have been broken off some time ago.
The Coroner : In your opinion, what was the cause of death ? —
Witness : I should think the chloroform.
Was there anything besides that to account for death ? — Nothing
whatever.
There could hardly be a healthier person ? — No, she was perfectly
healthy. There was no disease of any kind about her.
And chloroform is, of course, a poison ? — A deadly poison.
For the purpose of an operation under chloroform is it necessary
to have more than one person in charge ? — It is usual to have some-
one else to administer the anaesthetic. A medical man would never
both admi lister chloroform and perform the operation.
It is a well-known practice, I suppose, to have a second person ? —
Unless circumstances of extreme urgency occur to prevent it.
Can such an operation be performed by one person properly ? —
No ; though we are sometimes compelled to ignore the custom in
cases of absolute necessity.
Superintendent Crawshaw : Is it proper to administer chloroform
to a patient in a sitting position ? — Witness : No ; it is not.
Is it usual to administer it after a good meal ? — No.
What was the general condition of the girl ? — She was well
grown and very well nourished. She certainly looked older than
fourteen years.
Was it a proper thing to have all her clothes fastened up during
the operation ? — No, it was not. The corsets and bodice should
always be unfastened, so as to allow perfect freedom in breathing.
Mr. Crabtree : Although she might appear to be quite healthy
T suppose it is just possible that she might have some local weakness
which could have escaped observation ? — Witness : I think not.
No weakness of the heart ? — No.
What are the usual symptoms in cases of this character? Is it
usual for the patient to vomit ? — Yes, if there is anything in the
stomach.
Having regard to the healthy condition of the deceased and the
quantity of chloroform administered, are you not rather surprised at
the result ? — No ; I cannot say that I am.
^^4 TttE DENtAL RECORD.
Do you complain at all of the quantity ? — T don't complain of
anything.
The Coroner : It is the way in which it is given.
Mr. Crabtree : The quantity of chloroform to be administered
varies with different people, I suppose ?— Witness : Yes.
But with a healthy person would you consider the dose mentioned
to be unreasonable or excessive ?
The Coroner (interposing) : I don't think you can tell that.
The question can be raised some other time.
In addressing the jury at the conclusion of the evidence, the
Coroner said that he did not think it necessary for him to carry the
inquiry any further. They had heard the medical evidence, and no
one, he felt sure, could have the slightest doubt that the unfortunate
girl met with her death in consequence of the administration of
chloroform. Anybody might draw a person's teeth, and if the
person wished to take chloroform it could be administered, but it
was of the greatest importance that reasonable precautions should
be taken to prevent any mishap. No man had a right to conduct
an operation with chloroform by himself, especially if he were not
qualified, though it might be done in cases of special urgency. There
could be no such necessity in the case of Lavinia Sawdon. The
girl was willing to place herself under the dentist's care, and to some
extent this might possibly be considered an extenuating circum-
stance ; but at the same time she was probably unaware of the
dangerous nature of the drug. Even if she had full knowledge of
the risks of taking the poison, she would have no right to put her-
self in a position of danger. That would aff :>rd no adequate excuse
for the person undertaking the operation. Mr. Priestley attempted
to draw the girl's teeth. According to his own admissions he used
chloroform, and the girl died under the operation. If the jury con-
sidered that there was no necessity whatever for Priestley to ad-
minister the anaesthetic, that he neglected to take the necessary
precaution of obtaining the services of a medical man, and that he
had been guilty of a grossly rash and improper act, they would have
no alternative but to bring in a verdict of ''Manslaughter." But if
they were of opinion that it could not have been avoided the verdict
would merely be, ''Death by misadventure." Even with the exercise
of the greatest care, patients undergoing operations at the hands of
properly-qualified practitioners sometimes died while under the
THE DENTAL RErORD.
225
influence of anccsthetics, but a case which was treated by a person
comparatively ignorant, and in which a doctor was not sent for
immediately serious symptoms were discerned, was upon an entirely
different footing. If a properly-qualified medical man had per-
formed the operation without assistance, with similar results, it
would doubtless be deemed to amount to manslaughter. A person
who persisted in dangerous work of this character without taking
due precautions, in the absence of circumstances of special urgency
and absolute necessity, ran very grave risks.
The jury, after a lengthy consultation in private, returned a
verdict of " Manslaughter " against Priestley, who was immediately
placed under arrest.
In reply to Mr. Crabtree, the Coroner intimated that bail would
be granted in the sum of ;^5o and two sureties of £2^ each.
On Monday, April 20th, at the West Riding Court, the prisoner
pleaded guilty, but reserved his defence. He was committed for trial
at the West Riding Assizes. Bail was allowed.
^bairarts anir ^Bkrttons-
THE NEXT GREAT ADVANCE IN ANESTHESIA;
INCLUDING A NEW EXPOSITION OF COMMON
SENSIBILITY.
By Sir Bknjamtn Ward Richardson, M.D., F.R.C.P.Lond., F.R.S.
Mr. President and Gentlemen, — I remember no event in the
course of this century that ever filled the public mind with greater
wonder than did the discovery of anaesthesia fifty years ago. It was
not altogether an unexpected discovery, for many men in the back-
ground of history, as we may say, had for ages been working at it ;
but the general mind had become primed with the idea that pain
was a necessary part of creation ; that it entered the scheme of
nature as a necessity ; and that to try to abolish it would sure to
be a failure. The first part of this objection was urged after the
discovery of the abolition of pain had become a successful fact, and
An Address delivered before the Society of Anaesthetists, on March 19th, 1896.
P
226 THE DENTAL RECORD.
the wonder, altogether, has not passed absolutely away even in the
present hour. At this time, however, we are confronted by a new
difficulty ; we are hearing week by week about the deaths that are
taking place through anaesthesia. At first the deaths were very few^
and had it been otherwise, that is to say, had there been many
deaths previous to that of Hannah Greener, which occurred at
Winlaton, near Newcastle, on January 28th, 1848, anaesthesia would
probably have died out as a practical part of surgical science. As it
happened, a rare death from it did not materially affect the process of
anaesthesia, and it is not until now, when the process of administra-
tion has become all but universal, that we find the public, as well as the
professional, mind becoming astonished and perplexed at reading of
the frequency of the occurrence. I do not know that there are more
deaths now amongst those who take chloroform than there were in
the early days of which I have spoken, for I remember very well, at
the time when Hannah Greener died, a practitioner named Mr.
Robinson, who lived at Haverhill, in Essex, telling me privately of a
similar disaster that occurred to him^ in his own practice and that
was never made public, the tendency in those days being less strong
in the matter of publicity. As time passed away the tendency to
publish such details as those noted above became more and more
marked, so that in the time of Dr. Snow we had such a number of
deaths collected that he was able to announce no fewer than fifty, a
number which included all that he was himself acquainted with from
administration, but which did not account for two deaths, which he
himself saw, from amylene. Snow collected his facts about the year
1857, and I pubHshed them from his manuscript in the following
year, 1858, anaesthesia having been in use in England for a period of
about twelve years. It looks, therefore, as if we only recorded five
chloroform deaths a year for ten years, or a tenth part of those
recorded in the year 1895.
A few years after the death of Snow I made a tour through
England and collected facts of the deaths which had occurred in
various parts. I visited hospitals in which not less than 17,000
administrations had occurred without a death, but as I went on the
deaths continued to increase on my register, not depending, as far as
I then understood, on the hospital, the operator, the patient, or the
mode of administration, but on accumulation of numbers of cases, so
that I was brought to the conclusion in the years 1865-66 that
tHE DENTAL RECORD. 227
death ought to be reckoned as one in every 2,500, a figure has been
very particularly relied upon since I calculated it out, and which, I
take it, is very close to the truth up to that date. It is not extremely
difficult to account for this figure, quite apart from its having been
based originally upon recorded facts, for it seems that there is always
in a community a certain number of persons who, from one cause or
another, are ready to die under unfavourable circumstances. I have
named this class of mankind the " morituri," because of this readiness
to die, and I estimate that there never exists a collection of 3,000
middle-aged people but that there is sure to be one who is possessed
of some fatal tendency which might lead to the occurence of death,
so that the administration of anaesthetics does not necessarily modify
or intensify the chances of death amongst them. This is satisfactory
as far as it goes, but at the same time as all are not " morituri," it
does not do away with the necessity of inquiry as to why death
appears in the proportion named from anaesthesia. Neither does it
hmit our investigations into a mode of kiUing pain that could not
possibly at the same time kill the person who would have to be
anaesthetised. Dr. E. Andrews, the Professor of Principles and
Practice of Surgery in Chicago Medical College, summed up his
observations in 1870 almost in similar figures as mine. He calcu-
lated the deaths from chloroform as one in 2,723, but he added other
figures. He said that the deaths from sulphuric ether were one in
23,204 administrations ; from mixture of chloroform and ether one
in 5,588 ; from bichloride of methylene one in 7,000 ; while to
nitrous oxide he gave the credit of not one death in 75,000
administrations.
Without staying to enter into any analysis of these figures we are
obliged, as practical men, to ask the reason why there should be any
deaths at all from anaesthesia, in which question we shall include
why there are so many deaths from one anaesthetic and so few from
others. If it be true that there are no deaths in 75,000 administra-
tions of nitrous oxide there can be no reason, whatever may be our
theoretical generalisations, why there should be so many from other
anaesthetics, except there be some error either in the anaesthetic
employed or in the mode of giving it. Some will argue that season,
temperature and all the meteorological conditions are favourable to
death in the case of one anaesthetic and not in another ; but this is
hardly fair, because we calculate, or rather include, the same facts in
228 THE DENTAL RECORD.
one anaesthetic as we do in another, and we, therefore, ought to have
the same results from one as from another. If I administer nitrous
oxide as many times to 2,500 different people and have no death, and
administer chloroform to the same number of people and have one
death, it is clear that, ceteris paribus^ there is something in the
nature of the anaesthetic that determines the result ; or if I
administer ether to 23,000 persons with one death, and administer
chloroform the same number of times with more than nine deaths,
which is about the estimate, it must turn out there is something in
the composition of the two substances — ether and chloroform — which
determines the result. It may be urged by other argumentatists
that whilst there is a distinction between the composition of the two
substances which yield such varying conclusions, a great deal has to
be said in favour of the worst of them because of other virtues they
possess. Thus the most fatal of the anaesthetics may have the virtue
of being rapid in its action, convenient in its administration, and
while the patient is unconcious, certain in its effect. I have heard
this urged ever since lean remember, and I recall, as if they were only
at this moment spoken, the words of Snow himself to the effect that
chloroform was to ether like the lucifer match to flint and steel ; he
preferred its readier application and accepted its risks. But this, I
think, is not a good argument, for the reason that it only requires
more industrious examination and consideration to obtain an agent
which shall be just as safe as ether, or even as nitrons oxide, and yet
shall possess all the qualities and characteristics in administration
that chloroform possesses ; that shall be as rapid as chloroform, as
convenient, as certain, and at the same time, as safe as any other.
This particular thought has been on my mind for half a century
and though I have not been able to solve the difficulties as I could
have wished, they are what I would still like to press forward, and
which I would rejoice to leave to the investigation and exposition of
the future man who shall solve the problem. I perhaps cannot do
better in this place and at this moment than point out what these
difficulties are, and the mode in which I have laboured to overcome
them, because in so doing I may lead someone else in the direction
in which I have not had time to continue myself.
In promoting anaesthesia the thing we do is to make the person
about to be anaesthetised imbibe and take into his blood and nervous
system an atmosphere which shall so entirely change his whole
THE DENTAL RECORD. 229
nature that he shall go to sleep, and shall lose all that sensitiveness
of his nervous system, which, under ordinary circumstances, causes
what is known as sensation, and in extreme circumstances produces
what is called pain. A double or duplicate action is thus implied
— one of sleep and one of insensibilitv. According to our present
knowledge sleep and insensibility happen to be united, but there is
no definite reason why there should be such unity. It is not
absolutely nccessaiy that there should be sleep, and impossible as it
seems to be that a human body should have no consciousness of the
surgeon's knife and yet be awake, there is no absolute reason why
consciousness and insensibility should not be separated. We see, in
fact, this phenomenon. I have known a person suffering from what
is termed anaesthetic hysteria, who had no sensitiveness in any part
of the skin, and who was yet able to carry on a conversation and to
take food the same as if it was perfect sensitiveness. Moreover I
have had under my observation a patient suffering from partial
paralysis, motory and sensory, who would not have suffered at all
if the affected part of his body had been cut away, but who yet would
have been conscious of all that was going on round about him. I
have also met with some drugs which produce a partial insensibility
and yet do not materially affect consciousness and vice versa. It
is, therefore, not too much to expect that we may find agents which
do really destroy sensibility without materially interfering with con-
sciousness, and this is the direction in which we have to explore, a
direction T have myself been constantly on the look-out for. but
have never perfectly succeeded incompleting. What the atmosphere
is we want to introduce into the body which shall destroy sensibility
and at the same time sustain consciousness, is the thing we have to
look for, and we have also to consider what condition of the nervous
system is induced which interferes with one function and does not
interfere with the other, or vice versa.
The first and most telling effect is that we can put the body in
such a condition as absolutely to destroy all feeling and yet apparently
not to touch so as to injure those centres by which we think and
act. This is precisely what we do under the influence of cold ; we
put a part of the body into such a condition that there shall
apparently be nothing going on in it whatever in the way of
chemical change ; we freeze such a part and we say that it fails to
receive those vibrations which we call sensory or sensational. We
280 THE DENTAL RECORD.
see a surgeon put a knife into such a part, and though we be the
patient ourselves we do nothing but look on, nor do we from any
local manifestat'.on become aware of the most refined dissection or
manipulation which the surgeon is effecting. When this is the
fact it is certain that we are rendering benumbed or practically dead
those parts of the nervous system which ordinarily are the seats of
impressions which signify the person's sensibiHty, while there has
been no injury to the other parts of the nervous system which convey
to us intelligence of the vibrations leading to the manifestations of
consciousness. This is a most singular circumstance, showing as
clearly as can possibly be shown the duality of the animal system ; the
truth that duality can be distinctly separated, and that what we
actually want to do is to find out how, through the whole system, to
make such a duality and to let life, however low, continue in progress.
In hibernating animals nature, who is cleverer than we are, is appa-
rently carrying on the very process which I would define — that is to
say, she is maintaining life without the necessary connection of
sensibility, for I have seen a hibernating animal which did not feel
and I suspect that hibernation will be the final triumph of anaes-
thesia. I have also seen an animal become insensible during the
ichalation of oxygen condensed by cold, and if we could, by any
lortunate method, discover a plan of making perfectly cold oxygen
pass into the body the ends we have in view would for the time be
completely attained.
While we wait for so grand an attainment we are bound to
endeavour to produce a similar result by submitting the organisation
o a series of gaseous or vaporous substances, which, by their presence,
shall have the power of performing the task that might come from
mere cold.
Nature of Common Sensibility.
I feel it will be best in this paper to place before the society the
conclusions to which I have been led after a period longer than>
perhaps, has been known to any other man and attended with more
experimental research. I know that in what is about to be stated I
am breaking" completely away from the common dogmas of a
physiological kind and am advancing entirely on new ground, but
this I cannot help because I am merely following the facts that have
been put before me by Nature herself in the course of my work. I
THE DENTAL RECORD. 2^1
hold, then, that we live obedient to the outer world and that we live
from the outer world and from nothing else, and are always picking
up its vibrations as we do its food and drink. It is usually conceived
that in the body the cerebro-spinal system is a kind of independent
organisation, and that all impressions are received by it and all
commands are given forth from it ; and this, no doubt, may be held in
a certain way as the fact. But it is commonly assumed that the brain
is fed by the blood and upon such feeding it exercises its own
independent functions. I do not myself accept this reading. I
conceive that as we own nervous expansions like the retina, which seizes
impressions from without by a very simple mechanism, so we have
distributed over the whole surface of the body an impressionable
nervous root or expansion which receives vibrations from all the
universe ; that enter us in the same way that the retina receives special
impressions ; that the nervous expanse distributed over us is made
up of, and concentrated into nervous fibres, and that nerves thus
formed carry to the brain the impressions we have received just in
the same way as the the optic nerve carries the picture. Thus every
vibration made upon the outer surface of our bodies — from the mere
vibration incident to heat and cold, from the vibration incident to
the merest touch, or the vibration incident to the surgeon's knife^
are all gathered up by the nerves from the nervous expanse and so
conveyed to the central organ of the nervous system. This
universal expansion from which sensitive nerves spring is, in my
opinion, everywhere in the body where blood can penetrate, where
blood can burn, and where, by burning, animal heat is generated,
and can not only find its way in nerve tracts, but can also yield the
substance out of which the tracts themselves are formed. That the
natural brain or mass of nervous matter so carefully sealed up can
receive all the impressions given to it, and, receiving such, make the
body the companion and — it may be said — a part of all the universe,
is a clear and simple proposition. It is not strange that centres
which can thus receive impressions can lie by and give them out in
their turn — acts that the nervous system performs, taking in
whatever vibration is presented to the nervous expansion by which
it receives sensation, and giving back that with which it is
surcharged in the form of motion. The explanation given tells
with special effect in regard to anaesthesia because it conveys that
whenever through the blood current we diffuse over the whole
232 THE DENTAL RECORD.
nervous expanse, in which vibrations arise, som3 substance possessing
the power of modifying natural vibration, we, by necessity, get an
effect. To my mind, therefore, when with ths air in the blood we
spread, to every part of the body the air can reach, a foreign
substance like chloroform or any of its allies, we so modify vibration
that the sense is lost to the full extent of the diffusion of the
substance we have introduced.
In the course of my life I have tested the effects of over thirty-
five different substances which are capable of passing by diffusion
with the blood over the universal nervous surface, and I have
divided these substances according to their nature, or rather
according to their constitution. Starting with what I have
considered an anaesthetic base, or basic element, I have followed the
action of each substance and placed it under what seemed to be its
true head ; thus, taking carbon as a base, I have followed it through
tha amyl, the butyl, the benzine, the true carbon, the ethyl and
ethene series, the methyl and methene series, and the turpene series.
I have also taken nitrogen and hydrogen as bases, followed the series
apparently depending upon it, and by this increase have learned so
truly the nature of results, that, if the chemist can place before me
any substance he may possess, telling me its composition, weight,
solubility in water, vapour density, and boiling point, I can on pure
grounds of calculation tell whether it is or is not an anaesthetic, and
if it is an anaesthetic, how much, according to the weight of the
animal, it will take to produce narcotism, how long it would take
in a given quantity, and what would be the termination of the
phenomena before it escaped from the organism. I need not trouble
the society with the details of these researches, but I may indicate
that they have been repeatedly stated in the various papers I have
read at different times ; but what I would say is that no group of
phenomena has ever occurred to me that has not to some degree
resembled the effects arising from cold — that model anaesthetic
which has already been referred to, and which seems to prevent the
nervous expansion, either locally or generally, from absorbing and
transmitting to the nervous fibres, which spring from it, vibrations
of sensibility.
From these observations I am led to infer that anaesthesia
whether local or general depends always upon the same condition,
namely, the suppression of vibrations from the origins, or expansion.
THE DENTAI- RECORD.
33
of the peripheral nervous fibres spread out in the membranous
structures ; nerves— according to my interpretation — commencing
there, not terminating, and forming afterwards the nervous cords
that pass and carry direct vibrations to the brain.
It seems to me also that there is a special arrangement for the
commencement of the vibration, as in the act of vision, where the
picture is directly imposed upon a special surface like the retina.
Again, as in the case of hearing, the impression is made upon a
vibratory membrane and is thus communicated to a nervous surface.
Again, in regard to smell, the membrane is a nervous surface, the
Schneiderian, and the impression is conveyed by special nerves rising
from it ; but the sensation we call feeling, which, indeed, is a sense
as certainly as is seeing and smelling, is that common sensibility
which springs from the vibration in the extreme termination of
nerves in all parts ; the vibratory movement which usually excites
it being the oxidation which is taking place at every point between
the oxygen of the blood and the structures it laves, a vibration
easily communicable to all parts and easily transmissible from all
parts to the centre through the nerves which originate in the
periphery, to be reflected back again in the centre, when it is
necessary in the form of motion.
Under these observations we must consider every anaesthetic the
same in action ; if we freeze a part we stop peripheral vibration ; if
we abstract all the blood from a part we stop peripheral vibration ;
if we make extreme pressure we stop peripheral vibration ; if we
introduce some other agent locally we stop peripheral vibration ; if
we divide the filaments of nerves which conduct vibration we do the
same thing ; and, to crown the whole, if we introduce into the
blood by the lungs some vaporous substance which the blood can
absorb, and get that vaporous substance carried into the peripheral
surface, we stop vibration everywhere and create universal anaesthesia.
This proposition brings us direct to the agents which, being absorbed
by the blood and carried by it over the whole system, interfere with
the animal fire, and suppress the vibratory origin of feeling — creating
anaesthesia. It is this I have ever had in mind in considering what
a true anaesthetic should be. Nitrous oxide is for a moment an
anaesthetic simply, because it replaces oxygen and does not sustain
universal vibration — is, in fact, an asphyxiated substance. Carbonic
acid holds precisely a similar place. Ether stands practically in the
234 THE DENTAL RECORD.
same position, but with the difference that a little oxygen travels
with it, so that vibratory phenomena are reduced rather than checked
and in the long list of anaesthetics which have passed through my
hands I have seen not one the quality of which cannot be read off in
a similar manner. Turning to chloroform, which we may still
consider the king of anaesthetics, though it may be the most fatal,
its action admits of ready explanation. It is quite certain to those
of us who remember its origin that it came in first as ether — the
so-called " chloric ether." It did not come from any theory as to
mode of action, but simply from observ^ation of effects ; as a vapour
it has the power of being slightly absorbed by blood ; the blood
does not take up a great deal of it, the whole mass of blood being
able to absorb not more than twenty grains of chloroform so as to
make a uniform diffusion. If more than this be introduced into the
blood the chloroform begins to separate ; its molecules begin to
attract one another, and form minute points or blocks, which refuse
to make the complete round of the circulation, and which I have
actually found in the blood as direct modifiers of its course through
the minutest vessels. But when it is simply homogeneously diffused
through blood itseff, its properties are those of suppressing heat and
interfering with the vibration which springs from the chemical
change in progress. The way in which chloroform acts in this
particular is, I think, not difficult to explain; and is due to one of its
elements w^hich is too heavy for the quick vibration which constitutes
feeling ; that element is chlorine, which forms a large part of the
fluid, which is as thirty-two to twelve compared with the carbon,
and thirty-two to one compared with hydrogen in the same quantity
of fluid. No wonder, therefore, that it stops sensation and that in
its presence the surgeon's knife or the burning cautery are not
detected.
I have at all times seen that the chlorine has been the danger in
regard to chloroform, and I once traced the direct action of chlorine
in a specimen which I was administering to the subject. Fortunately,
I saw this in time, and inhaling a little of the chlorine myself
detected the cause of danger and did no further mischief. I have
also observed that in tetrachloride of carbon, where the hydrogen is
entirely removed, there were always signs of the influence of
chlorine, and a great many years ago I was so impressed at these
effects, that I thought it would be possible to remove certain portions
THE DENTAL RECORD. 235
of the chlorine and to make a lighter compound. This led me to
the employment of bichloride of methylene, which means a fluid
from which one atom of the chlorine is extracted from the chloro-
form. The extraction is made by the action of zinc, which, in
contact with chloroform, takes up a particle of the chlorine in the
presence of a little alcohol, producing chloride of zinc and leaving a
fluid containing a trace of alcohol with bichloride of methylene.
In the first of these experiments I succeeded very remarkably, and
from that time T hav^e always administered methylene, instead of
chloroform, with success. I treat with the silence it deserves the
continental rumour that the great French chemist Regnault — who
died on January 19th, 1878 — made a specimen of the bichloride,
from which, in my opinion, the chlorine could not have been
properly removed, and which was, therefore, fatal. T treat also with
the same silence the widespread absurdity that bichloride of
methylene is a mixture of chloroform and alcohol. At the same
time I would never unduly press forward bichloride of methylene
first, because it is rather a difiicult product to make, and secondly,
because it contains chlorine, which always has been, and is, a
dangerous element. Chloride of methylene would, in fact, be a
better compound to use than the bichloride, as it gets rid of two of
the chlorine elements ; but it is a gas, is managed with difficulty,
and again, it has the objection of containing chlorine. You will
gather from these observations that the temporary introduction of a
member of the chlorine series into the anaesthetic series has been
from the first a mistake — a mistake which must by necessity be met
in the future by the exclusion of so objectionable an element. What
then, you will say, ought to be put in its place ? This is the grand
question which is left to be solved. Many think that ether is
suflBcient ; many do not think so, and it must of necessity be slower
in its action because it contains oxygen. Bromine and iodine,
which in many points play the part of chlorine, are objectionable on
the same grounds, and all the amyl series, in which hydrogen is an
important element, are objectionable because they are not easily
soluble, but separate in the blood, and producing minute globules of
themselves are obstructive to the course of the blood, and though I
have tried them all, as well as the hydrides and olefiant gas — which
is a pure hydro-carbon — I have found one or other objection against
their use.
236 THE DENTAL RECORD.
The body that has seemed to me to present the best qualities for
general anaesthesia is what is called methylic ether, a substance on
which I have reported several times and have administered over
thirty times in surgical operations. It has an objection that it is a
gas. I discovered it in 1867, and I repeat what I then said— namely,
that it may be considered the safest anaesthetic that has yet been
discovered, although it is troublesome to administer and would have
to be condensed hke laughing-gas if it were to be brought into use.
It has a curious faculty of destroying sensibility before it destroys
consciousness, and recovery from it is exceedingly rapid. Its effects
were very well manifested in a patient to whom I once administered
the gas for Mr. Brudenell Carter. The patient, though feehng
nothing, was quite conscious of all that went on during the operation.
I observed also— and reported— that the gas is so safe that an animal
under its influence may remain breathing it for twelve minutes
without dying, and if allowed apparently to die, may be recovered
by artificial respiration so long as seven minutes after the cessation
of respiration— that is to say after what appears to be actual death.
Consciousness and Common Sensation.
It is time now that I concluded this paper and I do not think I
can do so at any better point. Thirty years ago I showed that it
was quite possible to destroy common sensation and yet not
destroy consciousness, and I press this matter once again as of vital
importance. In several cases where I administered the methylic
ether for removing pain in surgical operations, the patients, when
quite insensible to pain, were so conscious that they were able to obey
every request asked of them, and in some instances were even
anxious to reason, stating that they knew what was going on, and
arguing that they were not ready for the operation because they
were sure they should feel pain. Nevertheless in this state of
mental activity they were operated upon, and afterwards, while
remembering every incident, were firm in their assertion that they
felt no pain whatever during the operation. One patient who sat
for the extraction of two teeth selected the tooth to be first extracted
putting her finger to it, and afterwards rearranging her position for
the second removal. To the looker-on it seemed, in fact, as though
no change in her life had occurred, yet she aflBrmed that she was
THE DENTAL RECORD. 237
sensible of no pain whatever ; and several other less striking, but
hardly less sinorular, examples came before me. We may then, I
think, fairly assume that in course of time we shall discover
manageable and certain anaesthetic substances which will paralyse
sensation only, leaving the muscular power unaltered, and the
mental little disturbed ; and we gather from this either that in the
cerebral hemisphere there is some distinct and simple centre of
common sensation which may be acted upon by certain agents
without involving all the cerebral mass, or that the peripheral
nervous matter may be influenced withont involving the other
portions of the nervous system. On the whole I incline to the view
that the action of those agents which destroy pain before they
remove consciousness is primarily on the peripheral system ; for we
know from the process of local anaesthesia that it is easy to destroy
sensation at the extremities without distroying or even interfering with
consciousness, while those who have inhaled the vapours which
destroy common sensation before interfering with consciousness
describe the experience of a numbness and insensibility in the
extreme parts of the body.
That which we medical men most require is an agent that shall
be easily applied, and shall admit of being so applied generally as to
induce insensibility to pain with or without destruction of
consciousness, as the case before us may demand. There are many
minor surgical operations for which consciousness need not be
destroyed, although pain ought to be ; there are other operations in
which the consciousness of the person operated upon is of great
service to the operator ; and there is a third class of cases in which
it is essential to suspend both sensation and consciousness. Now
those agents which first destroy common sensation can always be
pushed to the extent of destroying consciousness, so that if we could
get a perfect agent of the kind we should have the full requirements
in our hand. Up to the present moment we have been content with
two classes of agents, one which destroys consciousness and sensation
at the same time, the other which locally destroys sensation and has
no further influence. I look hopefully for a method in which, by
means of a single agent, we shall be able at will to suspend common
sensation alone, or to exalt the process into suspension ol conscious-
ness. When this object is attained with safety and facility the
science of anaesthesia may be considered as perfect.
238 the dental record.
Postscript.
As I peruse the above MS. on this day, March i8th, 1896, I
recall with great regret that the fatality from the administration of
chloroform does not show any signs of decrease, and that the patients
in whom the deaths occur are, as heretofore, often sufferers from
trifling ailments. I also notice that the symptoms of deaths are
very rapid ; that the amounts of chloroform administered are
exceedingly varied, and that the mode of death seems usually to be
the same as that in which Hannah Greener — who was the first to
succumb to chloroform — died, some fifty years ago. I observe,
further, that in one of the deaths from chloroform, which took
place at Dudley, the patient was a healthy young man who sub-
mitted himself to the narcotic for the operation of tooth extraction ;
that he was fully examined beforehand and gave no indications of
disease ; that he inhaled with readiness ; that the operation was
performed dexterously ; that the chloroform was perfectly pure ;
and that the post-mortem appearances afforded no evidence of the
cause of the collapse. These frequent recurrences of death support
the conclusions already advanced as to the danger attendant upon
the reception of all bodies of the chlorine series, and they also
suggest that every specimen of that series should be administered
slowly in small quantities, so that narcotism should be induced by
eighteen to twenty minims at the most. The question of small and
slow administrations is one of the most critical, and makes a dis-
tinction between surgery proper and anaesthesia, which is of vital
importance. When there was no anaesthesia, surgical art was, of
necessity, predominant. The surgeon was the most brilliant man
who could operate most quickly, and, with a steady nerve, could
perform any possible operation. As a result of the work of ages it
became natural that surgery should still in our days hold the first
place, and that although in nineteen cases out of twenty the
surgical operations might be mere bagatelles as compared with the
production of unconsciousness by a narcotic agent, it has required a
long time and a hecatomb of deaths for the fact to be demonstrated
that the work of the anaesthetist calls for the first and most serious
consideration. The old conception has continued to keep surgery
in its original state and to cause anaesthesia to be looked upon as a
mere adjunct. There is another element of danger in respect to the
THE DENTAL RECORD. 289
question of time. As |in surgery brevity was the primary process,
it came to be expected, both by the public and by the profession,
that brevity in anaesthesia ought to keep pace. Thus during an
operation the surgeon expects the completest insensibihty, and, not
gettmg it, spurs on the anaesthetist to be as brief as he wishes to be
himself — a direction which the administrator, by habit, is as willing
to obey as if he were simply an adjunctive aid. In the future all
this must be changed. The anaesthetist must know and feel that he
must be left quite independent in producing painlessness, while the
surgeon, however brilliant, must follow his lead and not think of
operating until the patient has been pronounced by the administrator
safe, senseless, and ready for the knife. — Lancet.
CORRESPONDENCE.
[We do not hold ourselves responsible in any way for the opinions expressed by our
correspondents.]
CHLOROFORM IN DENTISTRY.
To the Editor of the " Dental Record."
Sir, — It would probably have been better for a certain class of
your readers if, instead of interpolating in your article merely a few
phrases from my letter to the Lancet you had published that letter
in full, and in order to afford you the opportunity of now doing so I
enclose a copy.
Surely it is merely playing with the question to suggest that,
manoeuvered as it may be, a dentist's chair can be made to subserve
the same purpose as a couch, and to pretend that when chloroform
is given in the chair the patient is, as a rule — if even recumbent —
undressed and under the conditions considered essential in general
surgery. It is also most dangerously misleading to suppress the fact
that the mortality from chloroform, compared with that from nitrous
oxide, is so great, not to say appalling, that on this ground alone
chloroform is forbidden in ordinary dentistry. The cases in which
it is defensible to risk life in order to spare the pain of tooth extrac-
tion are so rare that if no safer anaesthetic existed the employment
of chloroform would be under all common circumstances un-
justifiable.
240 THE DENTAL RECORt)*
In the event of occurrence of deaths from chloroform in a
dentist's chair in the future — the anaesthetic being administered in
the reckless fashion sometimes lately adopted — it is extremely
probable that a verdict of manslaughter may be recorded against
the operator, or the anaesthetist, or both. The verdict does not, as
you seem to suppose, depend in the first instance upon a "judge,"
but upon a coroner and a jury, and as many coroners are medical
men, fully acquainted with what has been in late years written on
this subject, it is certain that a jury will be before long instructed to
bring home responsibility to those who display culpable negligence
in safeguarding the lives of patients placed in their hands.
I am, &c.,
9A, Cavendish Square, Henry Sewill.
April \6fth^ 1896.
Mr. Sewill's Enclosure.
Commenting in The Lancet of December 8th, 1894, on a fatality from chloroform ni a dentist's
chair, I ventured emphatically to affirm that the cases of dental operation in which chloroform
or ether could be considered indispensable were so rare that practically the use of these always
dangerous agents in ordinary dental surgery was unjustifiable. I pointed out that nitrous oxide
gas was par excellence the dental aucesthetic ; that the cases in which it did inot in every way
suffice were highly exceptional ; and I explained that much more could be done with it than
seemed commonly supposed. The several deaths from chloroform during tooth extraction which
have occurred since I expressed these opinions— opinions in entire accord with those you now
put forth— have strengthened my conviction. I think this view will be supported by the bulk of
dental surgeons as well as by the great majority of speciahsts in anaesthesia, and I believe they
will go with me when I further declare that it is highly culpable to give chloroform in dental
cases without clearly explaining to the patient or his friends the risk incurred, and that hence-
forth, after the warnings which have been lately published, administration of chloroform for
tooth extraction in a dentist's chair— the most dangerous of positions — without every preliminary
preparation and precaution usually taken in serious operations, will, when death ensues, deserve
a verdict of "Manslaughter" against the operator.
How serious is the mortality aitending chloroform anaesthesia seems frequently forgotten.
It is doubtful if that mortality has been decreased since, after collection of a great mass of
statistics many years ago. Sir B. W. Richardson proved that deaths averaged not less than one in
four thousand cases. Deaths continue to occur, and in the hands of highly skilled administrators,
and as often as not in cases in which no organic disease is discoverable either during life or after
death to 1 account for the fatal issue. This is the practical fact, in spite of the teachings
of Dr. Lawrie and of his strenuous contention— of which I express no opinion — that chloroform
can be administered in every case with perfect safety. On the other hand, the mortality of nitrous
oxide gas anagsthesia is so slight that the gas in skilled hands may be almost said to be perfectly
safe. A few deaths, it is true, taken place during its employment, but from these rnust be
deducted a considerable proportion not actually due to the effects of the gas, in which the
operator, working by rule of thumb and knowing but very little about the nature of compli-
cations likety to arise, has had no resource on appearance of untoward symptoms than to
" run for the doctor." and the doctor on arrival has not infrequently found the patient dying or
dead, perhaps with a foreign body in the glottis or suffering from some similar mishap
which timely assistance might have averted. Deaths under gas do not commonly occur even
from preventable accidents in the hands of ignorant operators ; deaths frorn chloroform do
frequently follow its use, even where the utmost vigilance and the highest skill are brought to
bear. Whatever justification of its employment in other departments of minor surgery may be
possible, chloroform is surely forbidden in the ordinary practice of dentistry.^ — The Lancet.
ANSWER TO CORRESPONDENT.
A. P. Paterson. — Your letter should be addressed to the Chair
man of the Company.
The dental RECORD.
Vol. XVI. JUNE 1st, 189G. No. 6.
Original fflnmmuntcatinns.
SOME EFFECTS OF THE SPECIFIC INFECTIOUS FEVERS
UPON THE MOUTH*
By Harold Austin, M.D., B.S (Lond.), M.R.C.S., L.R.C.P.
Mr. President and Gentlemen,
As students of dentistry and dental practitioners we are
concerned with diseases and injuries of the teeth. Diseases of the
teeth, equally with diseases of other parts of the body, may be
classified into congenital and acquired. Acquired diseases of the
teeth may be apparently idiopathic or primary, or secondary, either
more or less obviously to some defined local lesion, or, in a
more imperfectly understood way, to some general constitutional
disturbance, inducing modifications in arterial and nervous supply
which are undoubtedly connected with the general vitality of
the tooth and its power of resistance to external adverse influences :
such constitutional disturbance frequently inducing abnormal
conditions of the oral secretions and mucous membranes.
Good examples of such effects are found in the eroded teeth of
the gouty, the carious teeth of the diabetic and of pregnancy ; wh^e
no student can work long at this hospital without coming across
instances of pitted or honeycombed teeth, which are ascribed to
either benevolent mercurial poisoning during the first year or two of
life or an attack of exanthematous disease occurring about this
period. This brings me to the subject of my few clinical remarks
on '' Some of the Effects of the Specific Infectious Fevers upon the
Mouth."
* A Paper read before the Students' Society, Dental Hospital of London.
Q
242 THE DENTAL RECORD.
Although as dental surgeons we shall probably seldom or never
be called upon to treat the mouths of patients suffering from acute
infectious disease, yet I venture to claim your attention this evening
to some of the pathological conditions arising^ during its course.
Some of these" conditions having certainly, others probably, an
immediate or a remote effect which will eventually bring the patient
to seek our advice. Many abnormal conditions of the mouth, and
indirectly of the teeth, occur during the course of the specific fevers.
Some of these are specific manifestations of the particular kind of
fever, others again merely a result of general conditions which are
common to the fevers and to other disorders of the body. Thus,
concurrently with the symptom of pyrexia, or raising of the bodily
temperature, a familiar enough symptom, and one met with in many
disorders, will be found almost invariably some alteration in the
normal conditions of the mouih. The quantity of saliva secreted is
found to be diminished, gwing rise to a dryness of the mouth ; the
mucous of the buccal glands, no longer kept in a state of partial
solution, becomes sticky and adheres to the teeth, undergoing an
acid fermentation, this acid reaction of the mouth may be intensified
by some degree of dyspepsia, which often occurs. Partly as a result
of diminution of secretions, and partly fjom disinclination of the
patient to take and masticate solid food, the tongue becomes furred,
and an unpleasant odour of the breath gives evidence of decomposi-
tion— due to micro-organisms — taking place in the mouth. We have,
then, in the mouth of a patient in a condition of fever or pyrexia,
two conditions which modern pathology regards as pre-eminently
favourable to the occurrence of dental caries, namely, increased
acidity, and a nidus favouring the growth of micro-organisms
which are not there in health.
With the subsidence of pyrexia the mouth gradually recovers
its normal condition of alkalinity and comparative cleanliness, but
should the temperature chart show a rise above normal during even
a portion of the 24 hours (as in intermittent and remittent types of
pyrexia), the before mentioned conditions will tend to persist, while
if the pyrexia be of the continued t) pe, the effects may be aggravated.
This aggravation assumes its most severe form in diseases which
assume a typhoid type. Hereto prevent confusion I must explain to
any who do not knew the meaning of a *' typhoid " condition. The
term "typhus" has been employed from the time of Hippocrates
THE DENTAL RECORD. 5^43
to denote a confused state of the intellect with a tendency
to stupor : it was subsequently applied to a group of maladies
characterised by continued fever and pro'^ound constitutional
disturbance, and ultimately by the recognition of the specifically
distinct nature of the various diseases was restricted to the
disease now called typhoid fever. From "typhus" was derived
the word " typhoid," to denote a group of symptoms similar to those
occurring in the later stages of typhus, and met with in severe
forms of many other diseases (other fevers, pneumonia, severe
inflammation, erysipelas, &c.) Unfortunately the word typhoid
has become with the public and some of the medical profession a
synonym for enteric fever, a disease in which typhoid symptoms,
although common, by no means invariably occur. A "typhoid"
condition of the patient, ihough^occurring in many different diseases,
is, I think, encountered most frequently in the severer forms of
scarlet fever, small pox, typhus, enteric and other specific fevers, It
is then that we see the most terribly unhealthy conditions of the
mouth occur unless active measures be taken for the prevention of
such. We see the lips dry, black and cracked, the teeth covered
with flakes of dried decomposing mucous, and the tongue dry and
discoloured, often cracked and fissured, a condition causing painful
ulceration during convalescence. The breath is horribly offensive
and the gums have a strong tendency to bleed, the blood becoming
dried and clinging about the necks of the teeth. Actual stomatitis
may arise, or an aphthoid condition. Acute parotitis sometimes
occurs. Such a condition as just described is frequently seen in
severe cases of enteric fever and typhus (though the latter disease is
fortunately seldom met with at the present day in the south of
England). This state of the mouth may also be present to a greater
or less extent independently of a typically "typhoid" condition.
In enteric fever the pyrexia is of a continued type, and its course a
long one.* Relapses of the disease, one or more in number, are
very prone to occur. In some cases of enteric fever under my care
at the Western Fever Hospital I have known the occurrence of
subintrant relapses to keep the patient in a state of continued fever
* During the acute stage the staple diet of the pationt is milk ; this is a
point worth noticing, as milk is \'ery liable to undergo fermentation and to set
free lactic acid, a substance very destructive to the teeth. That it should often
undergo such fermentation in the dry state in the month of enteric patients is
only what would be anticipated.
Q 2
244 THE DENTAL RECORD.
for six or eight weeks.* An interesting question to the dentist thus
arises. What effects upon the teeth have been observed as the
result of such protracted illnesses ? While in charge of the enteric
wards at the Western Hospital my attention was directed to this
point by a member of the dental profession, and I investigated the
mouths of a number of convalescent patients. Although, not
unnaturally, many carious teeth were present in their mouths, there
was but few in which the caries could be referred with any degree of
probability to the illness. In three or four cases, however, I found
caries of the teeth, close to the gum margin, attacking several of
the molars and bicuspids, and in one case (a girl of twenty-three,
detained for nearly eight months in hospital owing to postenteric
neuritis) such caries resulted in exposure of the nerve in two molars
(lower). I have since then been informed by a dental practitioner
of wide experience that such cases frequently occur, and that the
teeth frequently suffer great injury from caries after an attack of
enteric fever, even when they are apparently quite sound, on the
restoration of the patient to health. The latter fact may account
for so few cases being met with in fever hospital practice, where the
patients are'so soon lost sight of. But while mentioning the meagre
results of my own experience, let me hasten to add that careful
attention to the state of the mouth was part of the routine treat-
ment in the enteric wards of the Western Hospital, as indeed it
should always be in cases of continued fever. The tongues of the
patients should be cleansed regularly, cracks and fissures carefully
dressed (with borax and glycerine), sordes removed from the teeth
as far as possible ; and mildly antiseptic mouth washes frequently
employed. Such measures unaoubtedly add to the comfort of patients.
I have endeavoured to describe conditions of the mouth which
may be supposed to act injuriously upon fully formed teeth. Such
conditions, occurring at a sufficiently early age, may also cause
arrest of development of these organs.
The specific fevers from which children are especially liable to
suffer comprise certain members of the exanthematous group
(scarlet fever, measles, rothelu, varicella) also diphtheria. It has
been suggestedt '' that there is strong probability that the eruptive
* Continued or remittent pyrexia during protracted periods ^though shorter
than that just mentioned) is often met with in severe cases of the exanthematous
fevers, being then due to superadded comphcations.
f Smale and Colyer.
THE DENTAL RECORD. 245
fevers (exanthemata), which expend their force principally upon the
skin and epithelial structures, should affect all epithelial structures,
including the teeth." Though unable to agree with the use of the
word " principally," I think there is force in the observation. In
all cases of the specific fevers there is a tendency, particularly if the
course be severe or protracted, to desquamation of the skin during
convalescence; in other words a necrosis of the superficial epithelial
structures. Transverse groovings of the finger nails are of frequent
occurrence. These phenomena are most frequently met with in
cases of scarlet fever, in which the desquamation is almost (if not
quite) invariable, of a remarkable and pathognomonic type ; while
grooving of the nails occurs, in my experience, in one case out of
every five or six. The general bodily desquamation following scarlet
fever is preceded by a similar, though vary much more transient,
process in the mouth, the moist condition of the latter causing it to
appear here first. It is best seen on the dorsum cf the tongue
which on the third to sixth day of disease sheds its surface epithelium
from before backwards, leaving a bright red, raw- looking surface
with pale prominent fungiform papillae, aptly named the " straw-
berry tongue."
Now, it is, perhaps, conceivable that a physiologically func-
tional enamel organ, itself practically a part of the mucous
membrane of the mouth, should be affected in such cases. But I
think this \vill apply in a much greater degree to other pathological
conditions of the mouth met with in scarlet fever. Severe inflam-
matory conditions of the mucous membrane occur as the result of
direct extension of inflammation from the throat in the severely
" anginose " cases of the septic and necrobic varieties. Inflamma-
tion of a catarrhal or a pseudo-diphtheric type is often seen involving
the hard and F,oft palate and extending to the gums in the upper
jaw during a protracted acute stage in children. Severe ulcerative
stomatitis is by no means uncommon in young subjects, attacking
the gums and buccal mucous membrane ; in the former situation
occasionally exposing the bone of the alveoli. A milder and more
superficial apthoid form is very common in the second and third
weeks of the disease, appearing suddenly and soon yielding to
appropriate treatment. A third variety of an ulcerative and
sloughy type, though not very acute, is seen amongst convalescent
children — in the third to the sixth weeks. It need not therefore
^tb THE DENTAL RECORD.
surprise us, reflecting upon these various pathological conditions,
that aberrations of function on the part of the enamel organ should
occur, leaving indelible traces upon the permanent teeth of many
persons who have suffered from scarlet fever during the first five
years of life, and this even if we disregard the arrest in development
occasioned by lowered physiological activity m all severe constitu-
tional disturbance. Regarding the exact anatomical lesion that
takes place in the enamel organ, we recollect that, at a recent meet-
ing of this Society, Mr. F. Bennett informed us that in several
cases of scarlet fever he investigated, the injury was most appa-
rent in the stellate reticulum, the external and internal epithelial
layers being comparatively unaffected.
Diphtheria is a disease the mouth symptoms of which present in
many cases an analogy to those of scarlet fever. Thus, stomatitis is
rather apt to arise during convalesence. True diphtheritic inflamma-
tion of the tongue, gums and buccal mucous membrane is never
seen except in conjunction or with the presence of false membrane
on the tonsils and soft palate. Such cases are not common, and are,
in my experience, invariably fatal when occurring in children. In
the fatal haemorrhagic form of the disease the gums are frequently
spongy, and bleed readily and freely ; in many cases of this terribly
malignant type the state of the mouth is so positively appalling that
I shrink from attempting any description, feeling that no words of
mine can bring the reality^ before you. But in these cases again we
can, as dental students, take merely an academic interest, as the
mortality is cent, per cent.
The effects of measles on the mouth, as far as local inflammations
go, are much less marked than in scarlet fever and diphtheria. The
throat lesions are slight and transitory, except in cases complicated
with one of the latter diseases. Simple or ulceration stomatitis
sometimes occurs during convalescence, and in w^eakly debilitated
children the terrible malignant stomatitis, or cancrun oris. The
text-books state that measles seems more prone to the production of
honeycombed teeth than scarlet fever. This observation, though
seemingly somewhat at variance with the facts just mentioned, may
be however partly accounted for by the much greater prevalence of
the former disease amongst very young children (one to two years),
and a correspondingly graver constitutional disturbance, shown by
its greater mortality at these ages.
THE DENTAL RECORD. "241
In rothcJu and varicella the effects on the mouth, if any, are
slight and transitory.
In addition to the various ways already described in which the
specific fevers may be supposed to act directly or indirectly upon the
teeth, another must v\o\\ be mentioned. I allude to necrosis of the
jaw, a disease said to follow many of the specific fevers, but more
especially scarlet fever. It is in connection with the latter disease
that I shall alone dwell upon it, having never met with a case clini-
cally in the other levers. Necrosis of the iaw is not a common
complication of scarlet fever. It occurs in only about one case out
of two or three hundred treated at the Metropolitan Asylums Board
Fever Hospitals. It is most commonly met with in cases of a severe
type, in which the throat symptoms are prominent, and is usually
first clinically recognised in the second or third week of illness, at
which time the patients, in these severe cases, are still acutely ill.
Children between the ages of four and six are the most frequent
sufferers, though it is occasionally met with in younger patients. I
have never seen it attack adults.
Scarlatinal necrosis of the jaw is most frequent in the lower
incisor region on the labial side. It is, however, often seen in the
bicuspid and molar regions on the buccal aspect. To the former
situation it is usually symmetrical, less frequently so in the latter.
In one case, under the care of a colleague, necrosis occurred on the
inside of the ramus, well behind the last molar tooth, and not
involving the alveolus in any way. The necrosis may involve the bone
forming the sockets of the temporary teeth only, or more rarely and
. especially m the lower incisor region cause destruction of the bone en-
closing the sacs of the permanent teeth.* The sequestrum usually takes
two or three weeks to separate. The mortality of the cases in which
necrosis of the jaw takes place is high, partly from the usually intrin-
sically severe nature of these cases, partly from aggravation of the
symptoms caused by the necrosis. In the worst cases the mouth
becomes horribly foul, and the patient soon dies of pyaemia or septic
broncho pneumonia. Two causes maybe clinically recognised for this
necrosis of the jaw in scarlet fever. Firstly, exposure of the bone by
ulceration of the gum, seen in severe stomatitis, already alluded to.
* The fact that so many of these cases die probably accounts for some cases
of destruction of the permanent tooth sacs being overlooked.
248 THE DENTAL RECORD.
Secondly, and more frequently, injury. The latter cause may appear
a somewhat remarkable one to anyone not acquainted clinically with
this disease.
For the efficient treatment of the very severe throat conditions
present in so may cases of scarlet fever, constant applications to the
fauces (of antiseptics, &c.,) becomes necessary, with removnl of any
secretions likely to decompose or lead to injury. This is done by
syringing, spraying, or swabbing, the latter procedure being most
effective. These methods however necessitate the introduction into
the mouth of bone or vulcanite syringe nozzles, spatulas to depress
the tongue, occasionally a cork wrapped with lint to gag the mouth
open temporarily. However great be the care employed it is almost
impossible in some children to avoid injury to the temporary teeth.
They will bite the spatula or the nozzle of the feeding vessel, &c.,
until the teeth become quite loose and fall out, the septic state of the
mouth then causing ulceration and ultimately necrosis of some part
of the socket. I have been many times surprised at the very slight
pressure with a spatula, or other implement used in examining the
throat will loosen or extract the teeth in these cases, even when
employed with the greatest care and gentleness. Even short of
extraction of these teeth I am convinced from clinical observation
that necrosis of the alveolus often arises merely from pressure on the
crowns and that not undue in amount ; thus one is often between
the Scylla of an untreated septic throat and the Charybdis of a jaw
necrosis. In severe cases in which extensive necrosis appears I am
convinced that it is best to leave the fauces entirely alone, and to
feed the child solely with the nasal tube, as if the treatment be
persevered in the case will only go from bad to worse.
I have mentioned two causes for this jaw necrosis in scarlet fever.
Other cases arise, not admitting of such explanation. Under this
heading must be grouped the cases in which necrosis is said to arise
during convalescence, appearing de novo in the fourth to eighth
week of disease.
This is the form of exanthematous necrosis described originally
by Mr. Salter. Its occurrence during convalescence from scarlet
fever, as a phenomenon altogether distinct from the acute stage of
the disease, must, I think, be very rare. During my tenure of office
at the Western Fever Hospital nearly 5,000 cases of scarlet fever
were treated. All these cases (with the exception of the fatal ones)
THE DENTAL RECORD. 249
were under observation for eight weeks, many, owing to chronic ear
discharge, albuminasia, &c., for a longer period. I never, however
saw a case of necrosis of the jaw arise during convalescence, or one in
which this pathological condition, when it occurred, could not be
referred to the acute stage of the illness ; and this had also been the
experience of the medical superintendent of the hospital during a
much longer tenure of office than my own.
I would venture to suggest that in many cases of this apparently
secondary jaw necrosis, the mischief has taken place really during the
acute stage of the illness. One can readily imagine that a small
piece of necrosed bone might remain hidden beneath the gum for
some time, any discharges finding their way into the mouth un-
noticed, at the necks of teeth, and the true condition only becoming
manifest after the lapse of some weeks when the overlying tissues
by a process of ulceration. The theory that this necrosis is a true
secondary specific sequel would thus seem to be unnecessary.
I must now conclude these remarks, which aim at nothing more
than a brief clinical account of some aspects of the subject ; ex-
pressing regret at having no exact pathological observations to
record, or indeed any at all save those which he who ran might read.
NOTES ON THE TREATMENT AND FILLING OF TEETH.
By W. Cass Grayston, L.D.S.
(^Continued from page 202.)
GtUtapercha. — In using guttapercha I have discarded the various
heaters that are considered necessary to prevent overheating and
consequently spoiling the material. I simply warm the shank of
the instrument, and when the heat is conducted to the point pick up
a piece of guttapercha with it and at once place it in the cavity and
pack it. A good deal of the softening of the pellet taking place in
the cavity. This is simple, and gives me as good, if not better,
results than I formerly obtained by the use of an elaborate apparatus.
I endeavour to work the guttapercha at the lowest possible heat, and
often hold a piece in the cavity with an instrument in the left hand
while it is softened and worked to place with another one in the
right. It is principally a question of convenience and the size of
the cavity whether one or more pieces are used to fill it. If several
250 THE DENTAL RECORD.
pieces are used, it is advisable to work them somewhat on the non-
cohesive gold principle. Sufficient heat to make one piece intimately
cohere with another would in all probability injure the guttapercha.
Large, medium, and fine pointed pluggers may be used as desired,
and are all useful, the surface being finished by trimming and
smoothing with thin flat instruments, heated just sufficiently for the
purpose.
Separation of the Teeth.
In filling cavities on the approximal surfaces, more especially if
gold is to be used, it is necessary to press the teeth apart somewhat
in order to obtain room to work and to admit of the filling being
sufficiently contoured in the molar and bicuspid region to prevent food
being wedged between them. If space is not made by pressure, the
cutting away of the gold in finishing will reduce the contour
sufficiently to leave a space between the teeth.
To separate the incisors make what is known as a tent of cotton
wool, using a tough variety (Lawton's Asorbent Cotton Wool is
excellent), roll the fine end very tightly and force it up between the
teeth, keeping this end outwards, then pull it forward with either
the fingers or pliers until the thicker part is tightly wedged between
the teeth, then cut off the protruding cotton wool back and front
with scissors. The Quinby Gum Scissors are very convenient for
this purpose. As a rule the fingers are preferable to pliers for pull-
ing the cotton wool forward ; with the latter too great pressure may
result, and some soreness of the teeth may follow. Manipulated with
discretion this method of using cotton wool is convenient and
answers all requirements, and the teeth rarely become sore. If a wide
separation is desired this operation may be repeated every two or
three days until sufficient space has been secured. If the edges of
the cavity are ragged and cut the cotton wool, they may be smoothed
by passing a fine saw between the teeth. If the teeth are so close
together and so firmly set in the alveolus that it is impossible to
press the cotton wool between them, a strip of rubber dam may be
used instead, and on the following day the cotton wool can be easily
inserted.
In separating the molars and bicuspids it is advisable to open and
partly or wholly prepare the cavities, and then to wedge one or
more balls of cotton wool into them and between the teeth. If the
THE DENTAL RECORD. 251
cotton wool, instead of being packed into cavities in these teeth is
drawn between them, as in the incisors, it will be found that it works
its way down into the triangular space at the neck, and sets up
considerable irritation, without effecting any separation. It is often
useful, particularly in molar and bicuspid cavities, to saturate the
wool after insertion with chloropercha. Some dentists, after parti-
ally preparing cavities in this region, fill them with a guttapercha'
such as the red base plate, which expands somewhat, and by wedging
it between the teeth obtain gradually and conveniently a wide
space. The objection to this, speaking generally, is that ic takes
several months to produce the space, and patients are apt to forget
all about it, and as long as they are comfortable carefully avoid the
dentist. The Perry Separators are very useful instruments in many
cases for immediately securing space ; used on the incisors they are
rather in the way, and if the cavities in the molars and bicuspids
are large, extending down to the cementum, and well cut away at
the sides to secure free edges, the points of these instruments extend
right into the cavity and completely interfere with the filling at this
part.
To secure space immediately between the incisors, first paint the
gum with cocaine on both sides, work it also well on to the gum
between the teeth, then trim a long stick of orange wood to a
tapering round point, soap it and insert it between the teeth at
their necks, pressing it in until the patient flinches, then wait a
short time and press in still further, and again stop as before, then
firmly press it in as far as possible, using considerable force. The
object of using a long and preferably a thick stick is to admit of its
being readily grasped in applying the pressure. Never hammer
a wedge of wood between the incisors, the shock of the blow is
most disagreeable.
Treatment of Diseased Conditions of the Teeth Preparatory
TO Filling.
Exposed Pulp. — If a carious tooth is left unfilled, sooner or later
the decay progresses until the pulp chamber is encroached upon and
a portion of the pulp becomes exposed. Previous to the exposure
the pulp has probably been irritated, but there is a likelihood of its
recovering under treatment, unless the chamber is actually opened.
It is impossible to know the extent of the irritation and whether or
252 THE DENTAL RECORD.
not it will lead to uncontrollable inflammation. All that can be
done is to form a judgment from the patient's description of the
duration and severity of the pain, and act accordingly.
Experience seems to point out the probability of saving many
pulps that are not actually exposed, particularly if only slight pain
has been suffered. The application of soothing remedies and
temporary fillings may enable the tooth to be subsequently satis-
factorily filled without having to resort to " pulp killing." Ex-
perience also seems to show that the probabilities of success are very
slight if the pulp is actually exposed. Many cases of satisfactory
pulp capping may be quoted. I have had two exposed pulps in my
own mouth satisfactorily capped, the last one being done eight years
ago, but the proportion of failures to successes is so large that, as a
general practice, it is hardly wise to attempt conservative treatment.
]t is as a rule (except, perhaps, for patients with very strong teeth
and robust constitutions) preferable to waste no time and run no
risks of future annoyance, but at once to apply the minute quantity
of arsenic necessary to destroy the pulp. In applying the arsenic
the usual directions are to make a free exposure and apply the
devitalising agent directly to the pulp, having previously soothed it if
necessary by appropriate dressing. If pain is caused by the
arsenical application it is considered to be due, as a rule, either to
imperfect exposure or to pressure in sealing it in. I have never
been able (except in exceptional cases) to freely expose a pulp with-
out causing the patient great pain, even with the lightest manipu-
lation, and I have therefore been obliged to content myself with
such exposure as might exist after the removal of loose debris and
whatever excavation I felt justified in making, preferring (except as a
last resource, short of extraction) to apply the arsenic then, and if
pain followed (which is by no means the rule) to make the exposure
when the first application had obtunded the surface of the pulp.
One of my friends, who practices abroad, informed me that he never
had any trouble after applying arsenic, his method being to freely
expose a pulp and then give it a good cut with an excavator to make
it bleed well. This may commend itself to heroic practitioners, but
I have never had the hardihood to attempt it myself.
The resistance of pulps to the action of arsenic varies consider-
ably. It is often a very diflRcult matter to succeed in destroying
some pulps by the ordinary method in anything like a reasonable
THE DENTAL RECORD. 253
time. Time after time a patient will return ; the tooth will be
redressed, and although the superficial sensitiveness may be
sufficiently obtunded to admit of the freest exposure, deeper explora-
tion produces pain, and eventually the arsenic is removed, the
tooth temporarily filled, and the patient told to return in six months,
or earlier, if painful symptoms develop. If a large quantity of
arsenic is used, and the dressirig frequently repeated, or left in the
tooth a long time, in all probability severe periosteal inflammation
of an almost uncontrollable nature wull be set up, and extraction
will usually follow. This resistance of pulps to arsenic may be the
exception rather than the rule, but it occurred so frequently in my
practice that I had serious thoughts of giving up its uss and capping
all pulps that could be made comfortable, not with any expectation
of preserving them, but to save my own and my patient's time. It
appeared to me to be just as useful to remove a temporary filling
some months after insertion and find the pulp had died a natural
death as to spend considerable time in applying arsenical dressings,
and then to be obliged to dismiss the patient with the same advice as
to returning, and to eventually obtain precisely similar results. In the
text books allusion is made to the occ^^^bw^!/ resistance of a pulp to the
action of arsenic, but as far as I know Mr. Arthur King was the first to
call attention to its h^xwg frequently met with in practice.* The method
of applying arsenic advocated by Dr. N. T. Shields, of New York,
appears, however, to be an improvement on the usual practice, and
I have used it for some time past with excellent results. Briefly, the
procedure is to cut or drill a small hole in the sound dentine remote
from the pulp, place the arsenic in it and seal it up, leaving the arsenic
in contact with freshly cut dentine, a soothing application is placed on
or over the pulp (Dr. Shields uses cocaine), and the tooth temporarily
filled. At the end of a week the dentine may be painlessly drilled
nearly to the pulp, and in the bottom of this deepened hole another
application of arsenic is placed. At the end of another week the
pulp will be found perfectly dead and can be painlessly removed.
Dr. Shields claims that by this method the arsenic is kept from
direct contact with the pulp, and consequently no periosteal inflam-
mation will be produced and that the whole operation is painless.
I find that should pain occur it is easy to reapply the soothing
application without disturbing the arsenic ; that there is no fear of
* Journal of the British Dental Association, April, 1894.
254 THE DENTAL RECORD.
the devitalising dressing being disturbed by the patient ; and that it
is usually a painless and, as far as my experience goes, generally
a certain operation.
Where a pulp is completely dead, which is readily ascertained by
delicately inserting a fine Donaldson's bristle down the canals, it is
necessary to remove it. The bulbous portion in the crown is
readily cut out with an engine burr and the prolongations down the
roots are extracted by means of the ordinary " nerve extractors," if
the canals are fairly large, and with the fine Donaldson canal cleansers
if they are small, scraping the dead pulp out bit by bit if necessary.
If it is necessary for a great deal of the tooth to be cut away in
order to enable the pulp extractor or cleanser to be used, and it is
desired, if possible, to avoid this, the dead pulp may be thoroughly
dried up with the Evans Root Canal Drier. The insertion of this
instrument will cause no pain at first, but some little pain will be
felt if it is held in the root for any length of time. The patient
may be instructed to give notice of this, and it should be at once
withdrawn and reinserted when the pain has passed away, repeating
this until the pulp is considered to be thoroughly mummified. If,
after the extraction of the pulp, there is no flow of blood down the
canal the roots may be at once filled if desired and the case completed.
The careful and thorough removal of pulps from the roots of
teeth (after the application of arsenic) is often difficult, and frequently
takes up a great deal of time. In order to save time and trouble,
and also in many cases to avoid cutting away a good deal of sound
tooth structure, it has been suggested that the bulbous portion of
the pulp should alone be remo\ed, and the cavity thus made filled
up with an antiseptic paste that will have the effect of mummifying
the pulp that is left in the roots, so that it will remain in a permanent
antiseptic condition, and form in itself an excellent root filling.
Drs. Witzel, Miller, and Herbst, are the most prominent pioneers in
this new treatment, which is still in the experimental stage. In the
Dental Cosmos for November, 1895, appears an interesting article
on this subject by Mr. Soderberg, who advises the use of a paste
made of equal parts of alum, thymol and glycerol, with zinc oxide
sufficient to make a stiff paste. Whether this new procedure will
prove an advance on the older methods time alone can prove. It
certainly appears worthy of the attention of all progressive
dentists.
THE DENTAL RECORD. 255
The Treatment of Terth Containing Putrid PiU p. — When a pulp
has died a "natural death" it will usually be found in a putrid
condition. If it has been long dead the roots will be filled with fou^
debris^ in a more or less liquefied condition, and owing to the irrita-
tion caused by the absorption of the products of putrefaction the
peridental membrane will be usually in a more or less inflamed and
diseased condition.
The treatment consists in gently scraping out all the contents of
the canals, being very careful to avoid forcing anything through the
apices, in flooding the canals with some powerful germicide, and
either at ones or at some subsequent sitting filling the roots, having,
if necessary, sufficiently reduced any active inflammation which
might interfere with this.
The irritation and inflammation of the peridental membrane,
whether acute or chronic, is caused and kept up by the septic condi-
tion of the root canals, and by removing the cause nature is often
enabled to aff"ect a cure.
When there is much degeneration of the mem.brane, and when
pus has formed, producing what is known as an alveolar abscess, the
removal of the cause is not sufficient in many cases to eff'ect a cure,
and it is necessary to cauterize or stimulate the parts to healthy
action.
This can usually be accomplished by pumping the remedy
through the apex, using an old " nerve extractor " (perfectly clean)
wrapped round with a few fibres of cotton wool. Some operators
use a small syringe for this purpose, personally, I much prefer the
former method. It is, of course, necessary for the canal to be
perfectly freed from all debris before an attempt is made to force
anything through the apex. Carbolic acid (full strength) is generally
efficent for this purpose. In obstinate cases, sulphuric acid (20 to 50
per cent.) may be used, and in a few cases where everything else has
failed, I'have had happy results from the use of nitrate of silver —
bearing in mind that it may cause disagreeable discolouration. Should
a fistulous opening exist, and remain open after the roots are filled, the
remedy may be applied to the diseased parts through this opening,
enlarging it if necessary. In cases of blind abscess an o[)ening may
be made to the root by cutting or drilling through the alveolus.
This latter heroic procedure is not recommended as a method of
general practice, owing to its being usually very painful. Many
256 THE DENTAL RECORD.
dentists think it is unnecessary and even inadvisable to postpone
the filling of roots providing there is no flow of either blood or pus
down them to interfere with the operation. They trust to mechanical
cleansing, and to the use during and immediately after this of some
powerful germicide, and consider the result to be quite as good, if
not better, than if the filHng operation was delayed. Others, on the
contrary, hold that the dentine has absorbed products of putrefac-
tion, and can only be sterilised by thoroughly soaking it with a
germicide, and that this cannot be accomplished at one sitting.
They are aware that the seaUng of the apex by root fiUing, if
thoroughly accomplished, will prevent the passage of anything
through it, and that a barrier is thus set up which may prevent any
further trouble. Some, amongst whom I include myself, have not
much faith in their own ability, or in the ability of others, to fill all
root canals in such a manner that the filling always extends to and
never beyond the apex, and with materials that can be packed tight
and will remain tight without either shrinkage or absorption.
The experiments made by Dr. Kirk, of Philadelphia, to prove
whether the coagulation of albumen produced by certain remedies
(such as chloride of zinc) prevented their absorption, certainly show
that the dentine and cementum are more permeable than is generally
supposed, giving good grounds for the fear always felt by the present
writer that sooner or later (granting the apex is perfectly sealed),
products of putrefaction absorbed by the dentine will find their way
to and irritate the dental periosteum through the solid structure of
the tooth.*
There is no doubt that excellent results have been attained and
are being attained by immeaiate root filling ; whether they will be as
permanently successful in the majority of cases as the older methods
time alone will prove, and beyond saying that I have a decided
preference ifor what has been termed " the dressing method " I do
not think it is advisable, with our present knowledge, or* want of
knowledge, for anyone to be dogmatic on this subject.
A Method of Immediate Root Filling. — A method of immediate
root filling that I have practised with success is a modification of
Dr. Richmond's method. First of all flood the cavity with carbolic
acid, then with a Donaldson Canal Cleanser, dipped in the carbolic,
* Dental Cosmos, March, 1894.
THE DENTAL RECORD. 257
proceed to remove the contents of the canals. It will be found that
carbolic acid acts somewhat as a lubricant, and enables the instru-
ment to be more readily inserted and manipulated in fine canals.
After removing, with great care and delicacy, all the putrid contents,
continue the scraping until any softened dentine is also removed.
Scrape the canals until the walls feel hard and nothing but a white
powder is to be seen on the withdrawal of the instrument, and at
once fill them.
The Dressing Method. — This consists in flooding the canals with
a germicide, and either at the first or at some subsequent sitting,
removing their contents, the germicide being sealed in the tooth
with a temporary filling. This is repeated until it is considered that
not only the canal but the whole of the infected dentine is sterilised.
Then, and not until then, the roots are filled.
In the Dental Cosmos of April, 1889, is published a very
important table giving the value of various Essential Oils,
and some other well-known remedies as germicides and antiseptics
in the treatment of root canals. These tables, drawn up by Dr.
G. V. Black from his own experiments, give great value to the oils
of cassia and cinnamon, i in 4,000 of the former and i in 2,000 of
the latter proving effective. Since that time I have regularly
used one or the other of these oils in the treatment of pulp canals
containing putrescent pulp or dehrh.
Dr. Harlan on Essential Oils.
In the Dental Cosmos^ October, 1889, appears a very interesting
paper on certain of the Essential Oils, by Dr. Harlan, in which he
alludes to the valuable properties of the oils of Cassia, Cinnamon,
etc., and from which the following is taken : —
'' The most remarkable property possessed by the essential oils is
one that has heretofore escaped general attention. The writer first
pointed this out in a paper read before the Odontological Society of
Great Britain in 1887. Essential oils of the varieties mentioned
above and a few others not necessary here to particularize, when
introduced into a cavity of a living tooth and sealed therein slowly
deposit vaporizable camphors, which are potent antiseptics. These
camphors are very sparingly soluble in water, and in consequence of
this are not easily dissipated by moisture should the cavity be not
hermetically sealed. The same vaporizable camphors are likewise
deposited when the oils are sealed within the roots of a tooth. It is
on this account that they so readily and certainly disinfect polluted
R
258 THE DENTAL RECORD.
dentine. The writer (Dr. Harlan) wishes it distinctly understood
that he beUeves that the dentine of a pulpless tooth — long dead, and
in which the pulp or other vegetable or animal matter has decom-
posed— must be disinfected in order to prevent a gradual deteriora-
tion of the cementum and pericementum. This is a necessity to
to insure a feeling of comfort in a pulpless tooth after the root and
crown have been filled. Many pulpless teeth filled and treated by
purely mechanical methods, without respect to the complete dis-
infection of the dentine, are a permanent source of discomfort to
their possessors.
" Of the many agents and processes for the disinfection of the
dentine of a pulpless tooth, none possess so few disadvantages in the
handling as the essential oils. They do not act with the instan-
taneous rapidity that some forms of mercury do, or even with the
rapidity of hydrogen peroxide, but their action, if slower, is more
perfect and continuous. The oils do not lose their property by
exposure, they do not deteriorate, and their eflficacy has been
established clinically as well as in laboratory experiment. To sum
up their advantages in dental practice I would say : —
*' I. They possess local anaesthetic properties.
'' 2. They are stimulants.
" 3. They are non-coagulants.
"4. They are sparingly soluble in water, and on this account
are not contaminated by saliva, food, or other foreign substances.
" 5. They are diifusible.
" 6. The camphors which are deposited when brought in contact
with the slightest quantity of water, saliva, or blood serum, are
vaporizable as soon as formed. At a temperature of about 94*^ F.
their extreme volatility permits them to thoroughly impregnate the
dentine. The camphors are disinfectants in full strength, as was
shown by their deposition on the sides of tubes coated with broth in
which various forms of bacteria were planted. In the ends of the
tubes, where the camphors were not deposited, a vigorous growth
was invariably observed.
" 7. The vaporizable camphors are the agents which disinfect the
so-called blind abscesses, even when the oil is not introduced into
the root of a tooth further than the pulp-chamber, where it is
sealed only moderately tight.
8. The foul contents of a root canal, after being in contact
with the oil of cinnamon, oil of cassia, and eugenol for two days,
THE DENTAL RECORD. 259
when planted in sterilized beef-broth failed to show any sign of life
or development at the end of fourteen days. Repetition of this
experiment by planting a fresh tube daily for fourteen days failed to
show any sign of bacterial life."
My general method of procedure (based on Dr. Harlan's) is at
the first sitting to open up the troth, clear out the bulbous portion
of the pulp chamber, place in it a ball of cotton wool saturated with
the oil and fill with temporary gutta percha, making two or three
small holes through the filling to the cotton wool for the escape
of the gases of putrefaction.
At the second sitting the canals are partially or wholly cleaned
out and the oil worked down them, taking care to avoid pumping it
through the apex, as it is irritating, and proceed as before. At the
third sitting complete the cleansing of the canals (if it has not been
done at the previous sitting), place twists of cotton wool saturated
with the oil loosely in them (if the canals are large enough)
and complete as before, only this time make no holes in the
filling. If the tooth is perfectly comfortable for three days the
roots may be filled and the case finished. Should any trouble
arise (which will rarely happen unless the oil is forced
through the apex) making two or three holes through the gutta
percha gives relief. This simply means that the tooth is not
thoroughly sterilized, and one or two more dressings will be
necessary. One great advantage of these oils is that they appear to
be more permanent and persistent in their action than many other
remedies. Many germicides act while they are being applied and
for a short time afterwards, but practically for a ten minutes appli-
cation a ten minutes result is attained, while with these oils the
action seem to continue for several days, and it is comforting to put
something in a tooth that will be working of its own accord during
the time that intervenes between the sittings.
The oils of cassia and cinnamon have a tendency to sometimes
discolour teeth, and it is therefore unwise to use them in the incisors,
for even a slight change of colour that would be unnoticed in the
bicuspids and molars is here very apparent.
In the treatment of pulpless teeth there is still much to be
desired, and that there is a great field here for new and improved
remedies is shown by the eagerness with which dentists fly to new
antiseptics and germicides. To allude to all tlie remedies that have
been used in this connection wiih more or less success would be
R 2
260 THE DENTAL RECORD.
beyond the scope of " these notes." Many of the newer germicides
have only had an ephemeral existence, others have '' come to stay."
Amongst those that have found favour of late years may be men-
tioned Dr. Schreier's Kalum-Natrium ; sodium peroxide and the
various strengths of pyrozone (the 25 per cent, etherial solution
being an efficient bleacher of discoloured teeth).
Many experienced dentists believe that the old-fashioned creosote
is quite as good, if not better, than any of the more modern pro-
ductions. It is not as powerful a germicide as some (Black's tables
give I in 400 as being efficient), but, perhaps, combines in itself more
valuable properties than any other single remedy. It is an excel-
lent cauterant for an [alveolar abscess, and if accidentally forced
through the apical foramen when not needed is less irritating than
the oils of Cassia and Cinnamon, &c. ; it appears to be fairly
persistent in its action, and also appears to possess some local
anaesthetic properties ; its odour is, however, strong, and is con-
sidered disagreeable by many patients. Wood creosote is considered
to be the best. The quaHty of many germicides, drugs, &c., pro-
bably varies somewhat, and this doubtless accounts for the different
results obtained at times by different dentists.
Every dentist who gives much attention to this work probably
has his favourite remedy, but success will always depend more on
its application than on the remedy itself. Time, patience, care and
finger skill are the main requirements, and although different
conditions may demand variations of treatment, the best results
will always be obtained by the intelligent selection and skilful use of
a few medicaments.
Filling Roots. — The most satisfactory method of filling roots
appears to consist in first introducing some liquid or semi-liquid
material that can be readily worked in, and which if accidentally
forced through the apex will not be very irritating, and then to
ensure its being driven to place and also to prevent as far as possible
any shrinkage, to introduce some solid material prepared in a form
that will admit of its ready insertion.
The introduction of chloropercha and then guttapercha points
appears to fill the requirements better than anything else in the
majority of cases. This is readily accomplished by first filling or
lining the root canal with chloropercha, introducing and pumping
it in with a fine steel bristle, and then pressing into the canal one or
more of the guttapercha points that are made for the purpose.
THE DENTAL RECORD. 261
There is, however, some slight shrinkage in this filling, and the
addition of rosin to the chloropercha, suggested by Dr. Goble, is
doubtless a very valuable improvement. Dr. Goble states that the
rosin prevents shrinkage, produces an absolutely tight filling, and is
in itself an antiseptic* It is important to introduce the gutta-
percha points with as little pressure as possible, to avoid forcing the
liquid through the apex, and if they do not quite reach the ends of
the roots the solution will probably fill the small space efficiently.
A root should never be solidly filled unless it has been thoroughly
well scraped out, for fear of forcing some of the debris through the
apex and setting up inflammation by either septic or mechanical
irritation.
The scraping of roots with the Donaldson Canal Cleansers
usually enlarges them sufficiently to admit of their being filled, and
there are much safer instruments with which to enlarge canals than
drills and reamers. Very fine canals that cannot be thoroughly
scraped out may be sterilised as far as possible and left unfilled.
Dr. Callahan's method of applying a 50 per cent, aqueous solution
of sulfuric acid and pumping it down fine canals with suitable probes
(Dr. Flagg advises iridium-platinum and platinum-gold probes)
enables many apparently inaccessible roots to be cleaned out and
filled.! It is often advisable to fill roots with an antiseptic pa^te.
Many fine or tortuous canals cannot be solidly filled, and there are
many cases where, owing to the impossibility of thoroughly removing
all the contents of the canals, it is unwise to attempt solid filling.
In what may be called doubtful cases in general, a paste root filling
is also indicated. Anyone who has laboured many hours to remove
guttapercha and other solid root fillings — sometimes vainly — and
who recognises that a recurrence of trouble usually necessitates
venting the canals, will become inclined to pick his cases for solid
filling. In the majority of cases the solid filling is doubtless the
best practice, but there are many cases in which the more cautious
procedure is advisable. This must be left to the iudgment and
experience of the operator. Iodoform mixed with glycerine or
vaseline is probably as useful as anything, nothwithstanding that
iodoform is now considered to have no antiseptic properties. The
addition of oxide of zinc powder to the above makes a smooth
paste, and probably adds to its stability. If remnants of unde-
* Items oj Interest, April, 1894. "^ Dental Cosmos, April and December, 1894.
262 THE DENTAL RECORD.
composed pulp are left in a canal, the addition of a little tannin to
the above will be advantageous. In fairly large canals cotton wool
may be saturated with the paste and then packed into the roots in
the usual way. The great objection to these pastes is that they may
become absorbed, and that unless the apex is solidly filled moisture
may find its way into the canal from the tissues surrounding the
end of the root and a septic condition be again produced. I am
inclined to think (unless the apical foramen is large) there is just as
much chance of moisture finding its way to the root canal owing to
defects or leakage of a filling, and it is therefore always advisable to
cover the coronal ends of the canals with oxychloride or phosphate
cement. Almost everything that can be used for the purpose has
been tried for filling roots, and different methods in different hands
may give equally good results. The perfect root filling has yet to
be discovered — unless salol should prove to be the one thing desired.
It melts at a low heat and is said to be readily pumped or injected
into canals, which on cooling it fills solidly. It promises well, but
has yet to stand the test of time.
If much degeneration of the peridental membrane has taken
place the use ef germicides and cauterants and the most thorough
cleansing and careful root filling will fail to restore the parts to
health. An improvement in the conditions is all that can be hoped
for. It is astonishing, however, how long a badly diseased tooth
may be comfortably and usefully retained in the mouth owing to the
above treatment, although sooner or later it will be lost.
Dr. Thomas, of Philadelphia, who practices extraction as a
speciality, finds that sooner or later all " so-called dead teeth " fall a
prey to the forceps, but that careful treatment postpones this in the
majority of cases for a long time. Much depends on the constitution
of the patient. The exact condition of the affected parts cannot be
ascertained while the tooth is in the mouth. All that can be done
is simply to apply remedies, and if the tooth readily becomes
comfortable and can be satisfactorily used for mastication, a cure
may be considered to be effected. Those dentists who treat and fill
all pulpless teeth that appear to be worth saving find that a very
great majority are by means of the treatment usually retained for a
long time, and although it is impossible to accurately guage the life
of any individual pulpless tooth, or to hope every case will respond
to treatment, the success and practical value of root treatment and
filling is beyond question.
THE DENTAL RECORD.
265
Jl^p0ria 0f ^0rieiiej5.
THE ODONTOLOGICAL SOCIETY OF GREAT BRITAIN.
The Ordinary Monthly Meeting of the above Society was held
on the 4th ultimo, at 40, Leicester Square, the President, Mr.
David Hepburn, L.D.S.Eng., in the Chair.
The minutes of the previous meeting were read and confirmed.
Messrs. Northcroft and Bateman were elected auditors for the
ensuing year.
Mr. Robert Stephen Fairbank was proposed for membership.
Mr. G. H. Bowden and Mr. D. Rubery Chambers were formally
admitted members of the Society.
Mr. George Brunton gave an account of his experiments in
colouring porcelain for teeth and gum bodies or enamels. The
porcelain he had used was a low fusing one, I045^C being the
melting point. It was more like glass in appearance, and would be
more correctly described as enamel.
The analysis of his porcelain was as follows : —
Silica
...
6544
per cent.
Alumina
..
4-57
»»
Magnesia
...
2*26
> >
Lime ...
...
i3'52
1 1
Soda
...
9-96
>•
Potash
... .,,
066
M
Sulphuric Acid
...
0-53
1)
Loss on ignition
..
1-66
>t
Protoxide of iron
023
98-83
>?
This he compared with the analyses
And with gl
iss: —
of the three porcelains, viz. : (i)
Window.
Crown.
Sheet
Chinese: (2) BerHn ; (3) English: —
I. II. III.
Silica
69-0 .
•• 677 .
• 56*0
Silica ... 7104 ... 7296 ... 3988
Lime
12-5 .
.. 99 ..
. —
Alumina... 2246 ... 2478 ... 21-48
Alumina ...
7*4 •
.. 1-4 .
I'O
Lime ... 3*82 ... 104 ... io'o6
Soda
ii-i .
.. —
—
Bone earth — ... — ... 26-44
Potash ...
—
.. 21-0 .
. 8-6
Alkalies ... 268 ... i 22 ... 2-14
Lead oxide
—
— .
• 34 '4
The metals which produced very little in the porcelain when used
alone seemed to answer best for the purpose of producing the delicate
264 THE DENTAL RECORD.
gradations of colour. He had endeavoured to produce a more natural
gum by mixing a high fusing gum body with the low fusing plain un-
coloured body and obtaining the desired shade with metallic chlorides ;
but this plan resulted in raising the fusing point, which was, of course,
a drawback in using the mixture on a low fusing body. The high
fusing gum from which he had obtained the best results was
John Allen's body, using equal parts of the high and low fusing
bodies. Mr. Brunton exhibited specimens of the results he had
obtained, and remarked that it would be observed he had not yet
got beyond the experimental stage. Mr. Brunton also showed a
simple method of applying rubber dam by stretching it on a thin
wire frame. The rubber was sewn on to a piece of calico by which
it was kept off the patient's face. It had only three fastenings, and
though somewhat similar to Fernald's holder, he thought it would
be found lighter.
Mr. Reinhardt asked if Mr. Brunton had tried mixing chloride
of tin with chloride of gold ? He would also like to know what
were the strengths of the colouring solutions Mr. Brunton used.
Mr. Brunton : The gold chloride was a 2 per cent, solution, and
most of the others were 10 per cent, solutions. A mixture of tin
and gold would be seen by daylight to produce a slightly purple
pink. In mixing silver and gold care should be taken to put only
a small quantity of silver, otherwise a yellow tinge would result ;
the same remark applied to zinc, cadmium, and the other metals
which were used for white porcelain.
Mr. Oswald Furgess presented a framed photograph of '' Long
Calderwood," famous as the birthplace of William Hunter and John
Hunter. He asked the Society to accept the picture because
John Hunter's first published work was his article on " The Natural
History of the Human Teeth." When it was remembered that
John Hunter had not the modern microscope to aid his researches
they would feel a sense of wonder that he accomplished so much.
Mr. J. F. CoLYER then opened a discussion on the " Early Treat-
ment of Crowded Mouths." He strongly advocated early treatment,
and claimed the advantage that if adopted as soon as it became
evident that a crowded mouth at a later period would otherwise
inevitably result, the case, when all the teeth were erupted, would
simply resolve itself into one of a misplaced canine or bicuspid — a
condition comparatively easy to remedy. Whereas, if the case were
left untreated, the difficulty of remedial measures would be increased
THE DENTAL RECORD. 265
by the fact that the teeth had become more fixed in their irregular
position and more teeth had become involved. Having weighed
the advantages and disadvantages of extraction in comparison with
expansion, Mr. Colyer passed on to consider the treatment of
individual examples under the two heads: — (i) Cases where the
first permanent molar is unsavable. (2) Cases where the first
permanent molar is savable. For the former class he recommended
the removal of the temporary canines directly crowding seemed
inevitable, by this means enabling the incisors to come into a regular
line at the expense of the space left by the removal of the temporary
canine. The bicuspids are then able to erupt in the normal way?
leaving the mouth fairly regular, with the exception of the small
space between the lateral incisor and the first bicuspid, so that the
canine erupts external to the arch. The first permanent molars are
removed directly the second permanent are sufficiently through to
permit being held in place by a plate. Space having been made
for the bicuspids, they move back, generally without further
mechanical treatment, and the canine falls into place. The
extraction of the unerupted first bicuspid was recommended by
Mr. Colyer as the most satisfactory method of dealing with cases of
the latter class, and, in support of his theoretical contention, he
exhibited on the screen photographs of twelve cases in which this
treatment had been adopted, in most of them with excellent results.
In conclusion, he enumerated the following points as a suggestion
of the limits and scope of the discussion : (i) Is it advisable to
treat a crowded mouth directly such a condition in the future seems
inevitable? (2) What are the comparative merits of extraction
and expansion ? (3) In cases where the first permanent molars are
savable, is extraction of the unerupted bicuspid a good form of
treatment in the majority of cases ? (4) In cases where the first
permanent molar is unsavable what is the best course of treatment ?
(5) At what age should the first permanent molar be removed in
crowded mouths ?
Mr. R. H. WooDHOUSE regarded himself as particularly unsuited
to criticise the chief feature of the paper because he had never him-
self adopted the treatment recommended. He would be very
unwilling to subject to any form of treatment for prospective
irregularity the cases brought forward by the opener, because the
longer he practised the more he was convinced of the immense
power of nature to correct irregularities that appeared early, and he
266 THE DENTAL RECORD.
preferred to give her every chance. With the one exception of the
lower teeth not biting in any way inside the upper ones, he would
not himself attempt to regulate any of the mouths that Mr. Colyer
had thrown on the screen. With regard to the others, he did not
think it was advisable to treat a crowded mouth directly such a
condition seemed inevitable, because he felt that it was impossible
in such an early stage to say what the future of the mouth would be.
It could not be really foreseen what teeth might become decayed in
the course of three or four years ; it must be at the best only
conjecture. Owing to the introduction of carborundum discs,
mouths which formerly he would have been very anxious about
could now be treated with much greater prospect of success by free
divisions between the molars. He adopted that treatment with
much greater heroism than he ever did before because it could be
done with much less suffering to the patient. By nursing a mouth
up to the age of 14 they would be able to see what the future of the
mouth was likely to be, all the teeth would be fully erupted and in
their places, and they could then decide with much greater con-
fidence which teeth it would be best to sacrifice. With regard to
the second question, if any treatment must be adopted, in his
opinion extraction was the best ; it was speedy, it saved the patient
an immense deal of trouble, and it enabled them to meet a large
number of cases that could not be met in any other way. They
were all confronted with the difficulty of boys and girls attending
school, and the consequent impossibility of obtaining the frequent
visits necessary for treatment by the expansion method, so that he
was more and more inclined to adopt extraction as the best remedy
for crowded mouths. With respect to the third question, he felt it
necessary to be careful in offering any criticism, for he thought that
at present they knew very Httle about it. He did not think they
knew enough to recommend it to their patients, and it seemed to
him a little cruel. The operation was needlessly severe. And,
again, they really lost the very centre of masticating strength by
removing the temporary molars in the way suggested. With
reference to the fourth question he would certainly unhesitatingly
take out the six-year old molars if a mouth of the age of 14
needed thinning, though in many cases he had deferred doing so
until a later date, and had then taken out the second bicuspid
instead of the six-year old molar. He thought they should make
their operations as merciful as possible to their patients. Exceptions
THE DENTAL RECORD. 267
might arise where they got hopelessly crowded mouths, but as a
broad principle he would never operate for the relief of overcrowding
until all the teeth were well established in position.
Mr. H, Baldwin thought the profession had not really made up
its mind as to whether it was better to extract unerupted bicuspids
or not ; and it had not made up its mind, in cases where six-year
molars had to be extracted, whether it was better to extract them
before the eruption of the 12 -year old molars or after. He had been
looking at Mr. Colyer's models and he thought the results of his
treatment in most cases were satisfactory. In those cases where
Mr. Colyer thought he had not got too much room, he (Mr.
Baldwin) was inclined to think it was otherwise. The patients
were still at a very early age, and in time those spaces would
entirely close up. With regard to the second question, it seemed
to him that it depended very largely on the condition of the lower
arch. In cases of general crowding of both upper and lower it
would certainly seem better to extract, and so put the teeth straight;
but if the lower teeth seemed to be fairly regular and the upper
teeth crowded, and at the same time the upper jaw distinctly con-
tracted, showing the outer cuspids, that would seem to him a typical
case for expansion of the upper jaw. Question number three was
one on which they would all be glad to hear individual opinions^
With regard to question five, personally, he thought it was better to
wait until the second molars were erupted, because then they got
the full benefit of the extraction ; they got the full amount of room
without the tilting of the second lower molars which they otherwise
would get if they were extracted very early. If the six-year molars
were extracted very early a good deal of the space was frequently
lost by the coming forward of the second molars. As to whether
it was better to extract a savable six-year molar or a bicuspid, it
seemed to him that there were nearly a dozen reasons why the
bicuspids should be chosen instead of the molars.
Mr. George Brunton said that his own experience coincided
rather with Mr. Woodhouse than with Mr. Colyer, but Mr. Colyer's
method was comparatively a new one. With reference to expansion
plates, he thought that most of them capped the molars, but
although he had made a good many, he only remembered having
capped the molars once ; he could generally manage to expand
without doing so, thereby saving the teeth from premature decay.
Mr. Sidney Spokes was content to say "no "to Mr. Colyer's
268 THE DENTAL RECORD.
first question. With regard to the second, speaking generally, he
was in favour of extraction as against expansion. The third question
contained the crux of Mr. Colyer's communication. He would
suggest to Mr. Colyer, if he wanted more room in some of his cases,
and felt obliged to do something, he should extract the temporary
molars and leave the first bicuspid alone. In some of his cases it
appeared that the extracting of the temporary molar alone would
have given him quite sufficient room. The extraction of both the
temporary molars would be another way out of the difficulty. The
larger size of the temporary molars had not been referred to by
Mr. Colyer, although no doubt the matter had occurred to him. In
nearly every one of Mr. Colyer's cases there was an approach to a
V-shaped arch, was this the result of his treatment ? In the case
of the permanent canines he should leave them to become a case of
outstanding canines, and deal with them at the usual period and in
the usual way, taking into consideration the question of whether
the first permanent molar had to be lost or whether the first bicus-
pid— he generally removed the first bicuspid. One of the strongest
arguments that Mr. Colyer had brought forward was with regard to
the crowded condition of the teeth producing caries. They knew
that that was one of the predisposing causes of caries, but at the
same time he thought it was rather unusual, unless in a very severe
case of overcrowding, where the incisors were overlapping one
another to a large extent, to find any large amount of caries before
the age of 12, when the second permanent molar was coming up.
He thought the two permanent molars should be left to come
in contact before the first permanent molars Were removed if they
wanted to keep the space. Mr. Colyer had said that the case might
be treated as soon as the second permanent molars appeared through
the gum, but he (Mr. Spokes) would be disposed to wait a little
longer and let the bicuspids interlock thoroughly.
Mr. George Cunningham regarded the questions of function,
mastication, and articulation as fundamental essentials in discussing
the subject under consideration, and he looked upon the failure of the
opener to refer to them as an important omission. He recognised the
coming man's idea about the extraction of the unerupted bicuspid.
He had never yet had an opportunity of removing the bicuspid, and
in all his experience of cases of treatment of irregularity he had
never yet had to extract a lateral tooth. He could not really under-
stand how the author ever countenanced marring one of the main
I
THE DENTAL RECORD. 269
objects he evidently had in view because he regarded the aesthetic
function as being extremely important. As to the form of treatment
in the majority of cases, extraction or expansion, he supposed that
by expansion the author meant large repjulating plate that covered
the teeth. He thought there was a great deal in the newer methods
where, by means of bands, caps, and springs they could get rid of
some of the objectionable features of the older methods. There was
no doubt that the plate, especially when it was uncared for, led to
disastrous results. He knew of one very serious case of innumer-
able points of caries caused by using the ordinary expansion plate
with piano wire. With regard to question three, it was evident
that they must have some method of treatment, but any treatment
which did not retain as a principle and a major factor the function
of mastication in the first permanent molar was not worthy of con-
sideration. Therefore he rather endorsed what the author had said
in his paper. Question four was one which nobody had settled. He
had had a case in which most men would have said, and he himself
would have said at one time, that the four molars were unsavable.
He had kept those four molars and treated them by other means
than extraction, and although it would be ten years before he would
be able to tell definitely what the result of his operation was, yet
in the meantime the case had been going on well, and it was still
full of hope. With regard to the fifth question, notwithstanding
the many authorities who had never repented taking out six-year
molars, he had repented several, and was convinced that he could
have done much better by other methods.
Mr. RoBBiNS was somewhat surprised that Dr. Cunningham,
with his vast experience, had never seen a case in which he was
justified in removing a lateral tooth. He could show him two or
three models in which he thought he had been more than justified,
and in which he thought it was the only thing that could be done
for that individual patient. Those cases were all cases in which
the mouth had been somewhat neglected. In one case the lateral
had permanently locked inside the lower bite before he saw it, and
the compression had been very great. The removal of the lateral
gave a very good result indeed ; the central and the canine came
together without any apparatus, and by just tipping off the canine
teeth, he did not think a casual observer would notice it much in
the mouth. With reference to the heroic treatment of Mr. Colyer's
method — they always admired Mr. Colyer's heroism — a little while
270 THE DENTAL RECORD.
ago he (Mr. Robbins) performed the same operation, with, he
thought, fairly good results, but, on the whole, he would Hke to
strike the midway distance between Mr. Colyer and Mr. Woodhouse,
and he agreed with Mr. Woodhouse entirely as to the necessity of
waiting until most of the teeth were well in. He should make the
age 13 rather than 15, provided, as Mr. Woodhouse said, there was
no instanding laterals to work upon. He gave parents three good
reasons why they should not be in a hurry : First, it was generally
a great inconvenience ; secondly, it was a great expense to the
parents ; and thirdly, there was no doubt about it that a frame, if
worn for any length of time (even though kept clean) did more or
less injury to the perm.anent teeth.
Mr. HuMBY asked Mr. Colyer on what grounds he supposed
that the apex of the root of the teeth was the centre of the circle
from which the crown moved. His own experience was different.
He thought, as Mr. Cunningham had mentioned, that in all the
cases Mr. Colyer had shown one factor had been left out of con-
sideration. He thought they limited their observation too much to
the look of the model, that was to say, they saw the result that the
surrounding conditions had on the dentition, but did not take into
consideration the surrounding conditions. He thought there were
many surrounding conditions which modified considerably the
eruption of the teeth, and he thought it would be well if they were
to consider what those conditions were. One condition which he
found had never been touched upon in any of the works on the
articulation of teeth, was the effect of a thick muscular con-
tractile lip upon a crowded condition of the mouth. He did not
see that could be regulated by any apparatus. There was another
thing which would bring about a crowded condition, viz., tonsilitis.
He thought those two conditions were only the beginning of a long
list that might be made up in connection with things they should
consider with regard to crowded mouths. The size, even, of the
tongue, should be considered, because they were taught that the
tongue formed the inner boundary and the lips the outer boundary.
If that was the case they had to consider that an abnormally small
tongue or abnormally thick lips would materially influence the
question. There was another matter that he was very pleased to
see one gentleman seemed to have met with in his practice, cases in
relation to the tilting of the second permanent molar in consequence
of the extraction of the first permanent molar. He himself had
THE DENTAL RECORD. 271
seen a considerable number of cases, and the cases where he had
the most tilting had been with the late extractions. In late
extraction the wisdom tooth had a greater forward pressure upon
the second molar, and by extraction they were taking away a
forward support of the second molar after it was fully erupted.
There was, in fact, nothing whatever in front of the second
permanent molar, except the septum and alveolus, which bordered
on the medial aspect. He thought when the first permanent molar
was taken away at an early age there was a greater quantity of tissue
in advance of the second molar, and the leverage exerted for the
adv^ancement of the wisdom tooth was considerably less.
Mr. D. Pedley said there was one point which had not been
dealt with by the previous speakers, namely, Mr. Colyer's proposed
removal of the first bicuspid with the temporary molar. It seemed
to him that if any use was to be found for this operation, it would
be in those extremely difficult cases of anterior protrusion ; it would
be agreed they were most difficult cases to deal with, and he would
ask Mr. Colyer whether it was not advisable, in addition to removing
the first bicuspid with a temporary molar, to raise the bite some-
what ? His experience with anterior protrusion was that in the
majority of such cases the lower incisors pointed right inside, either
on the necks of the central and laterals, or else the upper centrals
were quite outside the bite-
Mr. Storer Bennett : Had he known that Mr. Colyer intended
showing the lantern slides would have brought down two slides
from the museum of a very valuable specimen, a skull from which
the outer alveolar plate had been removed on both sides ; it was a
very unusual specimen, because, while on one side of the mouth the
second temporary molar had been retained, on the other side it had
been removed, and that too a considerable time anterior to the death
of its owner, so that they had the opportunity of seeing the result
of premature extraction on the one side, and the result of leaving
the tooth in on the other. On the side of the extraction the first
molar had travelled far forwards, had pressed on the unerupted
bicuspids, and had driven them forward, and they in turn had driven
forward the canines, so that the canines on that side of the mouth
were considerably over the situation of the lateral and pressing on
its root. Had the second temporary molar been retained for its due
time the first temporary molar could not have so travelled forward.
He would like to point out what he had never seen noted in any of
272 THE DENTAL RECORD.
the text-books, namely, if anyone would examine a skull at the age,
say, of five or six, a skull where the outer alveolar plate was re-
moved, so that one was able to see the roots of the temporary molars,
they would see that they diverged to such a considerable extent that
they extended further back than the posterior surface of the crown
of the permanent molars, so that they must have a very large
influence in keeping back the six-year old molar and preventing it
becoming too prominent. With regard to the removal of the six-
year old molar, he cordially agreed with Mr. Woodhouse, first for the
reason he gave, and, secondly, because by taking out the six -year old
molar before the 12-year old molar was in position, all the bite
came on the front of the mouth, and he felt sure that was one of the
frequent factors producing superior protrusion. He was distinctly
of opinion that they ought never to extract the six-year old molar
for the purpose of regulation until the 12 -year old molar had
erupted.
Mr. Storey thought the Rontgen rays alone would enable them
to settle the question of treatment, which must depend upon the
circumstances of each individual case. He had in his mind the
cases of two sisters. One of them was brought to him with her
mouth crowded when she was about 11 years old. He postponed on
several occasions the anxiety of the parents to have the case dealt
with, and when she was about 13 he dealt with the case by the
extraction of the second bicuspid, and the adoption of a regulation
plate which was worn and kept pretty clean : that treatment was
exceedingly successful. The parents thought that what was good
for one was good for another, and they accordingly kept the other
sister from him until she was some 15 or 16 years old, in con-
sequence he had just now been obliged to take out the lateral
incisors. Whh regard to the general course of treatment, he had for
a long time past been taking out the six-year molars when necessary,
at, roughly speaking, the age of 12, just before the occlusion of the
12-year old molars, aud he had found in that way, and by watching
them, and sometimes grinding down the cusps, he obtained pretty
good results in regard to regulation. He also found great benefit
from getting at the inside, and great help in the treatment of such
cases from the split model.
Mr. J. F. CoLYER, in reply, said that as far as the form of
treatment went, he was perfectly open-minded on the question. He
had used the treatment wherever he thought it advisable, simply and
THE DENTAL RECORD. 278
purely with the object of learning, he failed to see unless that was
done how they were going to learn at all ; he had had the pluck to
do it in private practice, and should do it again to-morrow if the
case came before him. With regard to irregularities of the teeth,
of course they were quite in the infancy of knowing anything about
the subject : they did not understand sufficiently what he might
term the anatomy of irregularities — they did not seem to understand
the relation that one t oth bore to another in a crowded m mth.
What he found with irregularities was, that, given a crowded mouth,
given the incisors crowding, it was invariably due to the pressure
of ihe canine. The whole gist of the treatment seemed to be that
they must find room for the canine. One speaker referred to the
question of taking out a first temporary molar to get that room. If
they would look at a skull they would find that by taking out the
first temporary molar they did not give the permanent canine anv
room at all. The only way to make room for it was by taking out
the first bicuspid then the permanent canine was able to move back
bodily and the pressure was removed from the lateral. That was a
result he did not think could be obtained if they waited until all the
teeth were in position. Mr. Woodhouse said he would not treat a
crowded mouth at an early stage ; he (Mr. Colyer) would. The
older the patient became the more fixed became the teeth, and the less
chance there was of getting them right. With regard to the free
division between the molars, he endeavoured to avoid these spaces,
and every day found the necessity of trying to contour ; directly
they began to leave a space between the teeth, they were simply
inviting decay, and were likely to get periodontal mischief. With
regard to the wound caused by the operation that was not so bad as
might be thought. If the patient was given an antiseptic moulh
wash there would be very little after pain. He disagreed with Mr.
Woodhouse as to the value of the first temporary molar as the centre
of mastication. He (Mr. Colyer) regarded the first permanent molar
as the centre of mastication ; it was in the very part of the jaw
where the muscles played with the greatest power. As a matter of
fact, he thought the first temporary molar, and in adults the first
bicuspid, had really very little to do with mastication. Then, with
regard to extraction or expansion, it seemed to him that the whole
question of whether they should expand an arch or not depended
simply on the direction of the teeth. If the cusps were sloping
s
274 THE DENTAL RECORD.
slightly inwards it was a case for expansion, if outwards, it was
not. In answer to Mr. Spokes, he would say with regard to the
temporary molar, that if Mr. Spokes would examine the skull he
had mentioned he thought he would come round to his way of
thinking. With regard to the V-shaped tendency, ascribed to the
treatment, he believed the tendency would be seen in the original
models, and consequently was not the result of treatment. Where
there was a V-shaped appearance afterwards they would find that
tendency originally in the patient. Mr. Spokes had referred to the
fact that he preferred to leave the canines until they erupted, and
then adopt mechanical treatment, if necessary. That was the very
point he (Mr. Colyer) wanted to hear about. He found when
canines were externally erupted they were by no means easy to
bring into place. With respect to Mr. Cunningham's criticism, his
penchant for the question of " function in mastication " was well
known, but the aim and object of regulation was not, Mr. Colyer
thought, to procure a perfect bite ; directly they attempted to do
that they left out the question of the tendency of the teeth to
decay, and he thought that was the principal thing they had to
fight against. He would ask Mr. Cunningham how he was going
to treat a case of canines erupted over the laterals, with the lateral
internal to the bite ? If that case was not to be treated by the
extraction of the lateral he really did not know how it was to be
treated.
Mr. Cunningham : By extraction of the bicuspid.
Mr. Colyer regarded that as another sweeping statement, if he
might say so. There were many cases that came to them where it
was absolutely necessary to take out a decayed molar. There were
plenty of cases that came to them with first permanent molars
decayed below the gum, and causing chronic periostitis. In reply
to Mr. Humby, he would say he had never yet seen a tooth moved
by mechanical means where the tooth moved bodily ; in his opinion
it rotated on its apex. With regard to lip action on the teeth, he
thought that was well known, but he did not think that tonsilitis
had anything whatever to do with causing irregularities. It was
airgued that by tonsilitis and by the mouth breathing that went
with it, the mouth was kept open, and the buccinator muscle
pressed on the bicuspids. Against that argument they had to
consider the following facts : The buccinator muscle lay along the
THE DENTAL RECORD. 275
surface of those molar teeth, and those teeth were not in all cases
symmetrical, the majority of them being asymmetrical. If they
put their finger into a child's mouth they would not find any
more pressure in the region of the bicuspid than in the region of
the molar teeth. If the saddle shaped arch was due to the pressure
of the buccinator one would expect to find more pressure certainly
on placing the finger in the mouth. All saddle shaped arches — the
majority of them, at any rate— could be accounted for by crowding.
In reply to Mr. Storer Bennett, he would say he was very much
opposed to taking out the second temporary molar at an early age,
but he did not think the extraction of a first temporary molar had
the same effect. He failed to find the second temporary molar
moving forward. That was what he expected to find, but he had
failed to find it. He quite agreed with Mr. Storey in thinking that
the X rays might be brought into operation.
The usual votes of thanks concluded the meeting.
DENTAL STUDENTS' SOCIETY, DENTAL HOSPITAL OF LONDON.
An Ordinary General Meeting of the above Society was
held on Monday, May nth, the President, Mr. J. F. Colyer, in the
Chair.
The Librarian and Curator (Mr. Douglas) said that although
he had nothing new in the way of books or specimens to record this
evening, they would probably be pleased to hear that since the
reconstruction of the library greater interest had been taken in it
by the members, who had borrowed a number of the books.
On casual ccmmunications being called for —
Mr. May brought forward a case of syphilitic temporary incisor
teeth occurring in a child. At first the child was not thought to be
the subject of congenital syphilis, but owing to the discovery of bosses
of bone upon its head and its subsequent improvement under
mercury little doubt was felt. Only one case of this kind was
recorded, namely, by Mr. Oakley many years ago.
The President then called upon Dr. Austin for his paper on
" Some Effects of the Specific Infectious Fevers upon the Mouth."
(See p. 241.)
In the discussion that followed : —
Mr. Gahell thanked Dr. Austin for his most excellent paper, but
felt that the subject was beyond him as far as discussion went.
s 2
276 THE DENTAL RECORD.
Mr. W. J. May wished to thank Dr. Austin for his paper,
which was the more valuable as it was the outcome of his own
observations. He remarked that the idea that exanthematous
necrosis was " the result of the local application of other specific
poisons to the vascular parts of the teeth " was originally Salter's.
Dr. Austin had not mentioned any case of death of the pulps
of adult sound teeth following fevers, this he believed was fairly
common. He had recently attended a medical man who, during an
attack of influenza, suffered severe pain in an upper central that had
a small cavity in it which had been filled many years. This pain
soon passed away, but in about two months, when Mr. May first saw
the patient, he was suffering from periostitis around the root of
the same tooth. On drilling into the pulp it was found to be
dead and decomposing, its death being clearly the result of the
influenza. He had also had a similar case in which the patient was
suffering from typhoid. The tooth affected was a healthy lower
incisor, suppuration took place within a week, and, although the
patient was very ill, extraction was deemed advisable : the patient
subsequently recovering.
Mr. Barnard said that in all the cases of necrosis he had seen it
was the bicuspid and never the incisor region that was affected ;
the necrosed portion always coming away in masses and bringing
the temporary teeth with it.
Mr. N. G. Bennet said that for some time he had been working
on the subject of the relation of lamellar cataract to honeycombed
teeth, but he had at present come to no satisfactory conclusion. He
considered that there was prima facie probability that the eruptive
fevers that spent their force on epethelial structure should affect
the enamel of the forming teeth.
The President, after thanking the author for his interesting
paper, went on to urge the necessity of investigations bearing upon
honeycombed teeth. He pointed out the peculiar advantages offered
to students at this hospital for such research if only they would
take the opportunities. His mind, he said, was not yet made up on
the relation between the fever and its effects upon the teeth, he was
rather inclined to think, however, that the fever itself had no specific
action on them, but rather that it acted by lowering the general
vitality of the whole body. It was not only the epithelial structure,
namely, the enamel of the tooth that was affected, but also the
THE DENTAL RECORD. 27 7
dentine, which, upon microscopical examination, would be found
most imperfectly developed. He was interested in Dr. Austin's
statement that necrosis generally occurred in the incisor region,
although his experience rather coincided with Mr. Barnard's ; also in
his opinion that necrosis then originated in the acute stage of the
illness.
Dr. Austin, in reply to Mr. May, concerning the production of
honeycombed teeth by attacks of the specific fevers, I wished merely to
point out some of the local conditions of the mouth which might tend
to aberration of the enamel organ. I should agree with Mr. Colyer
that the general lowering of the vitality in these diseases is probably
a great factor in their causation. Messrs. Colyer and Barnard's
experience of the greater frequency of jaw-necrusis in the molar
and bicuspid regions is interesting, but opposed to our experience
at the Western Hospital, where this condition occurred twice in
the lower incisor region for once in the former situation. If, as I
have suggested, injury be a frequent cause, an explanation of a
greater liability of the lower incisor region is simple. Upon
such a point clinical experience doubtless varies much, and this
emphasises the need for avoiding dogmatic statements, unless sup-
ported by many observations extending over a number of years.
In reply to Mr. Bennett, I know of no statistical tables bearing on
the subject he alludes to, and should imagine that in hospital practice
it would be difficult or impossible to obtain them, owing to patients
being so soon lost sight of. With reference to the occurrence of
jaw-necrosis originating during convalescence, touched on by Mr.
Colyer, local periostitis of the long bones is sometimes met with during
convalescence from enteric and scarlet fever, measles, &c., and many
cases end in suppuration with extensive destruction of bone. If a
case could be found of such a local periostitis of the alveolus of the
jaw arising liLe in the disease, an analogous pathological process
might be assumed to occur.
278 THE DENTAL RECORD.
THE DENTAL RECORD, LONDON : JUNE 1, 1S96.
SHOCK AND STRAIN.
The extraction of teeth is so common an operation, and
is usually p2rformed with so little preliminary investigation
into the physical condition of the patient, that it maj almost
be a matter of surprise that death — the result of shcck
following this operation — is not a fairly common occurrence.
So great a rarity is it, however, that we do not remember
to have met with the record of such a case till the present
month. Doubtless some have previously occurred, and
may probably be found mentioned in dental literature,
but the untoward event is fortunately rare enough to
merit more than passing comment. This patient had
suffered severe toothache for some weeks, and finally
decided to have the tooth, a molar, extracted. Two
minutes after the extraction she became "collapsed, and
died.'^ No chloroform or other drug was u^ ed, and the post-
mortem examination showed that there was iatty degenera-
tion of the heart, and that the death wrs due to syncope.
Such is the brief report to hand, and it may well suggest to
each the thought, is such an event likely to occur in many
instances ? Experience proves that it is not, but still it
does teach us that the use of a safe anaesthetic, such
as nitrous oxide, which undoubtedly lessens shock, is
not so purely a luxury as is sometimes thought. That
the wrench occasioned by the removal of a tooth is
followed by a certain amount ol shock is the personal
experience of most, but it is usually slight and transitory
in healthy subjects; still, in those diseased or debili-
tated, we may learn from the foregoing case that the result
may be serious. In others, though the result is not so
lamentable, shock is not transitory, and this is the explana-
tion, doubtless, of those complaints, not rarely made by sickly
THE DENTAL RECORD. 279
patients, that for days or weeks they felt the effect of the
operation. In some cases this may have been ascribed
wrongly to the anaesthetic which was employed, for,
although this doubtless lessens the effect, yet it does
not always entirely prevent it, especially when the
anaesthesia is partial. It is, indeed, a question how large a
part shock may have played in the large number of deaths
which have occurred unfortunately during the administration
of drugs for anaesthetic purposes. This is suggestive of the
query, Whether, in sickly patients, the removal of a
large number of teeth — granting, for the sake of argument,
this is sometimes required — is a wise proceeding. The
effects of shock, as everyone knows, are commonly
due to stimulation of the Vagus nerve, so bringing into
play an inhibitory force. But there is another class of cases
which are not so easily explained, and which may be,
perhaps, more correctly referred to as nerve strain rather
than as shock. When this condition follows dental opera-
tions, these have usually been prolonged, continuous, and
probably painful. It is no rare thing to have patients refer
to some past time, when they were having their teeth put
in order, as an experience they would never again repeat,
and which had made them feel nervous and worn out for
months. Inquiry usually elicits the fact that they had sat
in the chair for hours consecutively, and had attended day
after day. Well may we ask is this a desired result ? Is
there no simpler way, no quicker way, no less wearing
method of treating the teeth of such delicate highly strung
patients r Is it wise practice to attempt elaborate work,
lasting for a few years, at the risk of letting the teeth be
Tieglected for many years ? Has not the practitioner rather
overlooked the fact that he is not dealing with an inanimate
object, and that it is as important to read correctly the
character and endurance of hW patient as it is tD aim at
mechanical perfection ?
280 THE DENTAL RECORD.
Royal College of Surgeons in Ireland, Dental Examina-
tion.— The following gentlemen having passed the necessiry exami-
nation have been admitted Licentiates in Dental Surgery cf the
Royal College of Surgeons in Ireland : — Mr. E. C. H. Jessop
(Oxford) ; Mr. A. D. Miller (Birmingham) ; Mr. F. Sievers (Lon-
don) ; Mr. J. W. Turner (Birmingham) ; Mr. S. G. Yates (Ross).
During the April Examinations the following gentlemen passed
the first professional examination for the licence in Dental Surgery
of the College of Surgeons, Edinburgh : — William Alexander
Stewart, Perth ; Alfred William Wellings, Salop ; Alexander
Ballantyne Mackenzie, Inverness ; Carl Lotinga, Newcastle ; Robert
Charles Hillman, Ilkley ; Edwin Robinson, South Shields ; James
Irvine Wilson, Glasgow ; Victor Hippolyte Blane, Edinburgh ;
Charles Nelson Park, Campbeltown ; George Herbert Harding,
Liverpool ; Louis Anderson Dunn, Edinburgh ; William Henry
Menmuir, Montr jse ; Alfred Branson, Rotherham, and Robert
William Markham, London. The following gentlemen having
passed the final examination were admitted L.D.S. Edinburgh : —
John William Edward Stewart, Dundee ; Herbert Percival Friend,
Farley ; John Morris Stewart, Edinburgh ; John Kirke Nash.
Edinburgh ; Edward William Albert Jeffery, Hastings ; Robert
Anderson Dickson, Glasgow ; Samuel Homer, Stourbridge ;
Frederick Stephen Gregory, Edinburgh ; Charles Albert Lightfoot?
Newcastle-on-Tyne ; Robert Jones, Pen y Bwleh ; Tom Tinley
Tinley, Whitby ; and Archibald Roland Maclean, Portobello.
Strong glass plates, says the Scie7itific American^ can be bored
through by means of rotating brass tubes of a certain diameter,
which are filled with water during boring. Finely pulverised emery
is added to the water, and the boring solution is put into motion by
a drill or bow drill. Weaker glass can be provided with holes by
simply pressing a disc of wet clay upon the glass and making the
hole through the clay of the width desired, so that the surface of the
glass is laid bare. Molten lead is then poured into the hole and the
lead and the glass drop down at once. The cutting of glass tubes,
cylinders, &c., in the factories is based upon this same principle.
THE DENTAL RECORD. 281
On May 6th, before Judge Whithorse, Samuel Darby, labourer,
living at 12, Chestnut Place, Highgate Road, Birmingham, brought
an action against Josiah Blackvvell, chemist, Moseley Road, to
recover damages for illness caused — so he alleged — by the negligence
of defendant's assistant during the extraction of a tooth. Mr.
Vachell told the jury that the tooth was a double one, on the right of
the lower jaw. The assistant applied the forceps, and, after a severe
struggle, snapped a piece off. Plaintiff complained vigorously, and
declined the assistant's invitation to let him have "another go."
He went home, and as his sufferings increased, he consulted Dr.
McKie, and remained under his care for five weeks, during which
time he was unable to work. Dr. McKie found that he was
suffering from necrosis, or rotting away of the jaw, in consequence
of splintering of the bone. Acting on the doctor's suggestion,
plaintiff first became an out-patient and then an in-patient of the
Queen's Hospital, where a large number of operations were
performed on him. It was not until March loth that the doctor
pronounced him practically cured, and he was unable to obtain
work until April 15th, having been in enforced idleness for 41^
weeks. The mere loss in wages was ^49 i^^. The plaintiff bore
out this statement in the box. Dr. McKie, of Anderton Road,
described the state of plaintiff's mouth when he examined it. He
came to the conclusion that a piece of bone had broken off the jaw
and necrosed. Cross-examined, witness said that a splinter of bone
separated from the jaw would necr 3se. He noticed no such splinter
in plaintiff's case. Walter Chapman, house surgeon at the Queen's
Hospital during plaintiff's attendance there, said he found plaintiff
suffering from an abscess in the side of the neck, protruding into
the mouth. Two months afterwards he found a piece of loose dead
bone by the side of the lower jaw. Damage by forceps would have
accounted for what he saw, so would disease. The mere breaking
of the crown of the tooth did not imply negligence, and the most
skilful operator might damage the alveolar margin of the jaw in
extracting a tooth. In a case of alveolar fracture he would not
expect to find the condition of things he found in plaintiff's jaw.
Mr. E. Bland Place, who attempted to draw plaintiff's tooth, said
he was an associate of the Pharmaceutical Society of Great Britain.
That did not necessarily include a training in dentistry, and he had
not passed any examination in that subject. He did not claim to be
282 THE DENTAL RECORD.
a dentist ; but he was capable of extracting teeth. He used the
proper forceps, and gripped the tooth fairly, but the crown came
away, and he did not choose to try and extract the stump, but
advised plaintiff to go to a dentist and have it taken out with gas.
His experience in pulling teeth was of 15 years' standing, and he
drew about 200 a year, more or less, and did not break more than
one in 200. Mr. Charles Jevons Fowler, Newhall Street, dental
surgeon at the Dental Hospital, said he had seen Mr. Place operate
on several occasions, and had no fault to find. Necrosis of the jaw
might be the result of hereditary taint or violence. In defence, Mr,
Young said it was not only lawful but right that a chemist should
draw teeth, and he could not be held liable for an accident, provided
that a reasonable amount of skill was experienced. This necessary
amount of care had, he pleaded, been exercised. The jury found for
the defendant.
The Idle Prosecution. — Joseph Priestley (31), herbalist, was
indicted for the manslaughter of Lavinia Sawdon, domestic
servant, of Idle, on April 1 7th. Mr. Edmondson prosecuted ;
Mr. C. Mellor and Mr. Marshall defended; and Mr. Glasgow
watched the case on behalf of the British Dental Association. —
Mr. Edmondson said that the prisoner had been in business
for some years at Idle as a herbalist and tooth-maker. He
was not a qualified dentist. In December last the girl Sawdon left
her home, at Weaverthorpe, near Malton, and entered the service
of Mr. Sykes, an insurance agent, at Idle. On April 17th she was
suffering from very acute toothache, and the prisoner was accordingly
sent for. He was not at home in the morning, when the first
request was made for his services, but in the afternoon he performed
the operation of extracting the affected tooth. The girl was taken
into his front sitting-room, and prisoner attempted to extract the
tooth, but it broke. He then suggested the use of gas, which
would cost about 3s. or 3s. 6d., adding that the girl would only feel
a little light headed. The deceased had dinner at half-past twelve,
and afterwards went to the prisoner's place of business, where,
instead of gas, she was placed under the influence of chloroform.
She became sick, and the prisoner remarked to his sister that there
was a change in the girl's condition. The sister fetched a Miss
Scott, who noticed the smell of chloroform, and thought the girl
THE DENTAL RECORD.
288
was dying. The girl's master (Mr. Sykes) at once obtained medical
aid, but Dr. Honeyburn, whom he called in, found that the girl
had been dead ten or fifteen minutes before he had been sent for.
The girl's dress was found to be quite tight. — Miss Sarah Priestley
sister of the prisoner, who gave evidence, said the girl was in a
semi-recumbeni position, and one or two of the buttons of her
dress were unfastened. The prisoner had been three years with
Dr. Pollard Mitchell, a well known dental surgeon, and he had
previously administered chloroform. — Dr. Honeyburn said the
clothing of the deceased was in a normal condition. That was not
the proper condition for the administration of chloroform. In
answer to the judge, witness said he thought if artificial respiration
had been properly resorted to the girl's Hfe might have been
saved. — Dr. Lodge, police surgeon, Bradford, considered the
conditions under which the chloroform had been administered
were improper, and that death was due to asphyxia. — Mr. Matthews,
dental surgeon to the Bradford Infirmary, said the use of chloroform
in dental surgery had practically passed away. — Mr. Ladmore,
dental surgeon, Manningham, also gave evidence. — For the defence
no witnesses were called, but Mr. Mellor contended that the prisoner
had acted with reasonable care, and that he had taken all the
precautions which a man in his position might be expected to take. —
His Lordship pointed out to the jury that, while the case was a very
serious one, they should remember that the prisoner did a work for
poor people, in the relief of pain, which they could not get done
elsewhere, except at much greater cost. Had he taken in this case
all the precautions which he knew should be taken ? — The jury
retired at a quarter-past one, and after two hours' consultation,
returned into court, stating that they were unable to agree. — His
Lordship said if they were not strongly in favour of conviction,
they should express in English fashion what was expressed differently
In Scotland. It would be a hardship to the prisoner if the case were
to be postponed until August for a new trial. — The jury then found
the prisoner " not guilty," and his lordship, discharging him, said
the verdict was a merciful one. The prisoner had had a very
narrow escape from conviction on a very serious charge, and he
hoped it would be a warning to him and to all whom it might
concern.
284 THE DENTAL RECORD.
North of England Odontological Society. — The Second
Annual Meeting of the above Society was held on April 22nd, in
the Newcastle Dental Hospital. An election of officers for the en-
suing session took place with the following result : President, Mr.
W. Sommerville-Woodiwis ; Vice-Presidents, Messrs. J. A. Fothergill
and R. L. Markham ; Hon. Treas., Mr. W. G. Routledge ; Hon.
Sees., Messrs. J. T. Jameson and W. D. Moon ; Council, Messrs. J.
F. Kekwick, W. J. Mason, John Kekwick, J. G. Ranken, J. W.
Daniels and S. Brown. Mr. J. W. Daniels was appointed Curator
of Museum and Librarian. The First Annual Dinner was held
after the meeting, and was well attended.
On May 27th the City Coroner held an inquiry with reference to
the de th of Rosina Elizabeth Foster, aged 14^ years, a boxmaker,
lately living at 27, Shaftesbury Place, Aldersgate Street. Sarah Ann
Foster, the mother, stated that for some weeks the deceased had
suffered terrible pain through the decaying of a bad tooth. On
Monday week she became so bad that she went to the hospital with
the intention of having the tooth extracted. She was detained in
the hospital, and the following day witness heard she was dead.
Dr. John Michel, house physician, stated that the deceased was
placed under gas and the tooth satisfactorily removed, but it was
considered advisable to keep her in the hospital, and death took
place very suddenly the following day. The autopsy showed that
death was due to inflammation of the brain of very rapid develop-
ment, but whether it was caused through the operation or the gas
was uncertain. Several physicians saw the deceased just before her
death, but not one of them could diagnose the case, and inflamma-
tion of the brain was not at all visible during life. It was the most
extraordinary case that had ever come under the notice of the
hospital staff. The general impression of all was that the inflamma-
tion was not set up by the tooth, but there was absolutely nothing
to show any other cause. The jury returned a verdict that the
deceased died from inflammation of the brain, but how caused the
evidence failed to show.
THE DENTAL RECORD. 285
Pathologie des Dents et de la Bouche. By Dr. Leon Frey.
Published by J. B. Bailliere et Fils, Paris.
This excellent little book forms one of the series of five which
have been prepared under the direction of M. Ch. Godon, for the
benefit of the students of I'E'cole Dentaire de Paris, at the small
price of 3 francs each. This volume deals with the pathology of
the teeth and mouth in a comprehensive and lucid manner. Indeed,
we are unaquainted with any other book which describes the patho-
logy of the diseases of the mouth so briefly and yet so completely.
Catching's Compendium of Practical Dentistry for 1895.
This volume fully equals its forerunners of the same series, and
that is saying much. A new section ''Science in Dentistry" has
been added. We really know of no book which enables a busy man
to find and keep ready to hand valuable facts as does this " Com-
pendium."
Dental Pathology and Practice. By Frank Abbott, M.D.^
Philadelphia. The S. S. White Dental Manufacturing Co.,
1896.
Since the views expressed on the development of teeth and dental
caries are practically the same as those of Bodecker, which we have but
recently criticised, we pass over the earlier chapters of this work, and
pioceeJ to those which treat of Operative Dental Surgery. We aie
first, given a retrospective sketch of gold filling, and the evolution
of the automatic and engine mallets. Immediate separation is
discountenanced ; death of the tooth pulp and necrosis of the
alveolus being cited as frequent sequelae. We quite agree with the
author in recommending slow separation, but consider that separa-
tion sufficient to produce the effects spoken of above is never
requisite. As regards sensitive dentine. Dr. Abbott (consistent with
his "inflammatory" theory) says that if the pulp be alive, "the
tooth is inflamed and its sensitiveness increased throughout its entire
substance, the intensity of the action being somewhat dependent
upon the size of the carious cavity and upon whether the caries is of
the acute or chronic variety. The larger the cavity and the more
acute the disease the more intense \viU be the inflammation
286 THE DENTAL RECORD.
and soreness, and the more generally will they be diffused
throughout the tooth structure." Now, while admitting that the
tooth is more sensitive in acute than in chronic caries, we cannot
endorse Dr. Abbott's statement that the larger the cavity the more
sensitive the tooth. It is a matter of every day experience that some
of the most sensitive cavities with which we have to deal are
shallow — situated about the region of the '' granular layer." On the
other hand, we daily see large cavities from which the patient has
received no warning pain symptoms, The excavation of these, too,
often causes little or no pain. Some might think that the author — -
having committed himself to the theory that the dentine (and
enamel too) becomes inflamed by caries, and pain being a necessary
concomitant of inflammation, ergo the more caries there is present
the more pain there ought to be — too easily persuades himself.-that,
that is, which, by his theory, should be.
As regards the author's method of obtunding sensitive dentine,
it seems both tedious and extraordinary. The treatment takes four
days, and is also based upon a theory. The theory is this : that
normal dentine is alkaline, and only slightly sensitive when cut, that
carious dentine is sensitive, that this sensitiveness is caused by acid,
that this acid condition should be neutralised to bring the tooth
back to its normal alkilinity. The first day's treatment is washing
the mouth out with a solution of bicarbonate of soda every hour,
the second day the solution is doubled in strength, the third day the
dry soda is packed into the cavities six or eight times and last thing
at night, and the fourth day finds the patient's dentine " in most
cases almost without sensation." Presuming this somewhat qualified
result can be assured, is life long enough for this treatment, or is the
game worth the candle ? In addition to the above, more alkalinity
may be engendered by the internal administration of soda, potash,
lime, magnesia, &c.
Dr. Abbott, finding that " the use of the rubber dam is a strain
upon the operator which none but those with extraordinary nerves
can stand without detriment," uses a system of small napkins
seemingly in the ordinary way, but in operations on the lower jaw,
makes use of his patient's finger to assist him in keeping the " doyly "
in its place. In this manner he can keep the mouth dry for forty-five
minutes or an hour. No mention is made of that invaluable adjunct
(when properly fitted and used) the saliva pump.
THE DENTAL RECORD. 287
When saliva invades a cavity being filled with gold, ihe layers f f
gold fail to come into sufficiently intimate contact with one another
to make a homogeneous filling. This we have experienced on more
than one unhappy occasion, but it is interesting and novel to find
that this result is due to the presence of salivary corpuscles. We
fancy that moisture of any kind even without corpuscles is usually
fatal.
Dr. Abbot highly commends the Herbst system of burnishing
gold into the cavity, but prefers hand burnishers to engine bur-
nishers, as the latter being necessarily straight are unable to reach
all portions of all cavit es. It is especially useful " when the walls
are so frail that malleting the gold would be likely to fracture
them."
As regards filling teeth with amalgam, we warmly endorse the
remarks of the author about the careful preparation of the cavity,
believing with him that a good deal of abuse lavished upon the
filling is due to imperfect preparation of the cavity. On the other
hand we regret that instructions for making a ''perfect paste " are
not granted to us, and it might be urged that the author's direction
to squeeze out the excess of mercury alters the composition of any
compound amalgam. We are also told if an amalgam is left rough,
mercurial poisoning is likely to follow. And it happens on this
wise : " Food will lodge upon and around such rough and projecting
masses, and one of the products of its fermentation is hydrochloric
acid, which, acting upon the mercury, converts it into the mild chloride
of mercury (calomel), an active poison, and in some instances a very
dangerous one." Now in the first place we cannot understand how
decomposition of food can cause the formation of hydrochloric acid,
nor does Dr. Abbott explain, and in the second place even if it did,
mercury is absolutely unacted upon b}^ it. The wasting of phosphate
fillings at the cervical margins is said to be due to excessive alkalinity
of the saliva in that region. This requires proof. Dr. Abbott
condemns devitilization both in traumatic and carious exposures of
the pulp, but he makes no mention of his procedure in cases of acute
inflammation of that organ when extraction cannot be resorted
to.
Dr. Abbott thinks that pyorrhoea alveolaris should hardly be called
a disease ; it is a condition. If so, it is a very unpleasant condition.
He describes mercury as a very prevalent cause,
288 THE DENTAL RECORD.
Dr. Abbott's conviction is that hyperostosis of the cementum
(exotosis) of a diffused character is in most instances not the w rk of
the pericementum in late life, but a foetal malformation. In reply to
this we ask, Has an exostosed tooth of a diffused character ever been
extracted from a child ? We know of none. The classification of
h3^perostosis we consider unscientific, and the division of inflamma-
tion of the gum into gingivitis and ulitis is mere hair-splitting.
The work is liberally illustrated, though the woodcuts are not so
valuable as the reproduction of the photo-micrographs would have
been. There are a few of the latter, which are well done. Due
acknowledgment must be made to the printers and publishers, the
type being good and the book excellently turned out.
CORRESPONDENCE.
[We do not hold ourselves responsible in any way for the opinions expressed by our
correspondents.]
THE DIFFERENCE.
To the Editor of the " Dental Record."
Dear Sir, — My attention has been drawn to a paragraph in your
issue concerning my votes at the meetings held at Beckenham and
Leicester Square.
Had full reports been correctly placed before you, you would
have doubtless seen that at Beckenham the question was purposely
narrowed down to the limit as to whether we as a branch were
satisfied, that having approval. At the metropolitan meeting a
much wider question was before us, viz., whether any change was
advisable^ not limiting the question to our branch, but taking the
broad question, irrespective of the branch, and I believe my resolu-
tion was so worded that it could only be understood in the wider
sense, but I am sure those at the meeting understood me, and I can
scarcely be blamed if the reports in journals are so abbreviated that
one scarcely recognises the account again unless they see their name
aflfixed thereunto.
I am, dear Sir,
Yours truly,
H. Beadnell-Gill.
Upper Norwood,
\^th May^ 1896.
s Paper,
Fig. 4
Showing absorption of cen
layer
Fig. 3.
I. Alveolar dental membrane, showing increase of
cells upon cemental side of the membrane.
The outlines of giant cells are also shown.
<.** ..^ * .,
Fig. 6.
Lacunae small and new tissue continuous, absence
of lines, the membrane much thickened.
Illustrations of Mr. Douglas E. Caush's Paper.
Fig. I
Alveolus.
I. Thickened alveolar dental membrane. 2. Cementum.
3. Intergranular layer.
Fig. 3.
Alveolar dental membrane, showing
cells upon cemental side of the membrane.
The outlines of giant cells are also sho\vn.
Fig. 4.
•showing absorption of cementum and intergranular
layer.
Shows absorption of original layers of cementum and
intergranular layer with deposition of new tissue.
Lacunae small and new tissue continuous, absence
of lines, the membrane much thickenetl.
The dental RECORD.
Vol. XVI. JULY 1st, 1896. No. 7.
©rtgtnal ((t0mmutttcatt0ns.
EXOSTOSIS.
By Douglas E. Caush, L. D.S.I.
In examining the microscopic preparations of exostosed teeth we
can but admire the varieties of shape and size, as well as the great
difference in the appearance of these sections. Yet, underlyin ; these
variations, however greatly they differ in appearance, there is to
be seen by the microscopist a definite plan whereby this new tissue has
been deposited, and in most cases these sections tell their own tale of the
changes that have taken place during its development. Each time of
rest, as well as each time of activity, is so definitely marked upon
the section that it is impossible to misunderstand the changes here
shown, and in the same section it is not at all unusual to find there
has been times of rest as well as times of activity, times when there
has been acute, and times when chronic inflammation of the alveolar
dental membrane has been manifested, while the more acute alveolar
abscess has not forgotten to leave its marks upon the tissue under
examination.
To better understand the various changes that take place in the
exostosed tooth we will commence our paper by illustrating a section
of a tooth with the structures in a normal condition, at, or about,
the point where these variations occur.
In this section is to be seen, in order from the outside towards
the pulp canal, the following tissues : —
1. Alveolus.
2. Alveolar dental membrane.
3. Cementum.
4. Intergranular layer of dentine.
5. Dentine.
6 Pulp canal with lining membrane.
u
290 THE DENTAL RECORD.
The first change that takes place is almost, if not quite, unknown
to the patient, as it usually produces little or no discomfort, and
consists of the thickening of the alveolar dental membrane from
some cause or causes unknown, perhaps irritation from a filling, or
alteration of the articulation produced by decay, or the loss of other
teeth, or from some similar cause, an increased blood supply is
brought to this membrane and thus causing increased activity in
the cells of the membrane, as a result of the increased amount of
formative material, and as a consequence the various changes take
place in this tissue.
Should we at any time be successful in obtaining a section of a
tooth in this condition the following changes would be noticed : The
membrane covering the tooth will be more highly coloured than is
usual in the normal condition, the intensity of the colour depending
upon the amount of blood brought to the tissue, and in a short
time after this change we should find that the membrane would be
not only more highly coloured, but it would be also increased in
thickness, the thickening taking place as follows : — The layer of
cells in that portion of the membrane attached to the cementum
becomes more and more active, breaking up into new cells, these
new cells dividing and sub-dividing until there is a much larger
number of cells at this point than is to be found in the membrane
in a normal condition, and, as a consequence, these cells press upon
the cementum. As the pressure increases with the development 'of
the new cells, they change their character from that of an ordinary
nucleated cell to that of an osteoclast, or giant cell, having the
power of absorbing the cementum at the point of contact. If the
blood supply becomes normal at this stage no further change takes
place, and but slight or no discomfort will have been felt by the
patient, but should the irritation be kept up, the cells will continue
their activity ; or if the slight inflammation becomes chronic, the
result will be the same. The giant cells thus formed will continue
to absorb the cementum, until the whole of it is absorbed away,
after which the giant cells pass into the inter-granular layer of the
dentine, and there continue their work until a portion, or the whole,
of the intergranular layer is absorbed. This absorption takes place
in an irregular manner owing to the difference in the density of the
tissue it is absorbing, this difference of density being caused by the
more or less perfect calcification of the dentine ; the osteoclasts
THE DENTAL RECORD. 291
having arrived at the more dense portion of the dentine, the
absorption ceases and another change takes place in the giant cells
developed in the alveolar dental membrane, the osteoclasts in this
membrane are changed into cementoblasts, and begin their function
of depositing cementum into the spaces produced by the absorption
previously carried on.
It is not at all an unusual thing to find (especially in the layer
next the dentine) a number of these cells retaining their soft
structure, surrounded by cementum, as if some of the osteoclasts
had been slow to change their character, and thus leaving portions
of soft tissue in the newly deposited cementum. The new tissue is
usually deposited in layers differing from the original cemental tissue
in that it contains a large number of lacunae and canaliculi, these
frequently occupying the position previously occupied by the original
layer of cementum, the new layer of cementum continues to be
deposited as long as the blood brings to the cells material in the
form of food for the development of new tissue. The amount
deposited varies much, it may be but a very thin layer, not much
thicker than the thickness of the original cemental layer, or it may
be continuously deposited until it is many times as thick as the
original layer.
At this point I must differ from the conclusions drawn by
Dr. Bodecker in his work " The Anatomy and Pathology of the
Teeth." On page 329 he says : " The question, however, is, can a
diffused enlargement of the cementum occur in consequence of
pericementitus, either of a local or a constitutional origin, after the
cementum has once been fully formed ? " This question I feel
constrained to answer in the negative, and I base my opinions uj)on
microscopical structure of such tumours.
My conviciion is that hyperostosis of the cementum of a diffused
character is, in most instances, a foetal malformation^ and, again, on
page 330, he says : " Whenever a tooth bc^comes deprived of its
nourishment from the pulp, I doubt the possibility of an osseous
new formation upon the cementum, and further, should new forma-
tion have existed previously, its growth has undoubtedly ceased the
moment the life of the pulp was gone."
My microscopic examination of about 1,500 (fifteen hundred)
exostosed teeth leads, me to suppose that Dr. Bodecker has misunder-
stood the development of cemental tissue as seen in exostosis. From
u 2
292 THE DENTAL RECORD.
those I have been able to examine, I have arrived at the conclusion
that the development of cemental tissue as seen in exostosis is
just the opposite to that described by him. I believe that wherever
exostosis has taken place it is after the development of the tooth,
and in no case is it produced during foetal life. And further, the
examination of some teeth show that it is probable that these
changes have taken place after the death of the pulp, and correspond
to certain changes that take place in the pulp canal, to which we
will draw attention later on.*
That the development of this tissue is not always continuous
after it has once commenced may be shown by the fact that we
frequently find a number of lines in the section, portions where
there are no canaliculi or lacunae, and where the calcification of the
new tissue is evidently much more perfect than in the rest of the
tissue (see Fig. 5), thus showing that during the time of rest,
which evidently occurred at this period of the development, due
probably to the condition of the alveolar dental membrane becoming
normal, the cementoblasts were turned into true cementum as
seen in the original layer of cemental tissue, slow but perfect calcifi-
cation having taken place, leaving a structureless mass of cementum.
When these lines exist they are most irregularly placed, varying
v«ry much in their distance one from another, and not infrequently
being absent, as seen in those cases where there has been a continuous
deposition of new tissue. It is not an unusual thing to find in some
sections that a portion of the outer edge of the new tissue has been
absorbed away, tissue corresponding with that deposited at a later
date filling up the excavations previously made, here is a great proof
that the development of this tissue is of a much later date than
suggested by Dr. Bodecker. If the development of this tissue is
rapid we usually find a number of large lacunae with canaliculi
anastomosing with canaliculi of the surrounding lacunae, and not
infrequently being grouped together and surrounded by more
or less structureless tissue. If, on the other hand, the deposition of
this tissue has been slow, but still continuous, the lacunae are much
smaller, and fewer in number, with, as a rule smaller canaliculi, and
under such circumstances the lacunae may be isolated and surrounded
by tissue structureless in character, more perfectly calcified, and in
appearance like the original layer of cemental tissue.
* Reference is made to a second paper by Mr. Caush, which we shal publish
in our next issue. — Editor.]
THE DENTAL RECORD. 293
ORAL HYGIENE.
By John G. Ranken, L.D.S.
The science of hygiene treats of the preservation of health, and
of the proper means for its continuance. Oral hygiene is the appH-
cation of this science to the mouth and its contents.
We must firstly consider what are the contents of a normally
healthy mouth which predispose towards decay of the teeth.
The Saliva^ as it is found in the healthy mouth, is mixed with
mucous and epithelial scales from the mucous glands and the mouth
surface. It is colourless, and consists mainly of water and alkaline
salts. The acid mucous often renders this alkalinity neutral, and
sometimes, even acid.
The chemical action of the saliva is to convert starchy materials
into sugar, which is of a less sticky nature than starch and more
easily absorbed.
An alkaline saliva is said to hasten the action of ptyalin, the
ferment of saliva, whilst an acid condition retards this process and
thus tends to allow starchy materials to hang about the mouth.
Micro-or ganisms. — Certain organisms whose function is of a pep-
tonising nature inhabit the human mouth, these are principally :
baciUi, micrococci, and leptothrix bucallis.
Forms of the Teeth. — Pits, fissures and prominences in the teeth
themselves are a favourable site for the lodgment of foodstuffs.
Proximity , — The crowding of teeth greatly favours the retention
of foodstuffs, which are difficult to dissolve or dislodge.
Nature or Strength. — Owing to infantile disorders during the
developing period, or to a want of lime salts, or to the action of
heredity, the nature or strength of the teeth may be such as to not
easily resist the attacks of caries levelled against them.
It is the foodstuffs, especially those of the nature of carbo-
hydrates, whose decomposition gives rise to the formation of lactic
and acetic acids, which decalcify the teeth. The micro-organisms
follow this and dissolve the decalcified remainder, the saliva
washing the dissolved portion away. This is, according to Miller,
the process by which caries of the teeth is produced, the most
formidable of the diseases we have to combat.
204 THE DENTAL RECORD.
When albuminous substances, such as meat, putrify in the mouth,
acids are not formed, this accounting for the fine white colour and
general absence of caries in the mouths of true carnivora.
Again, the alkaline lime salts are often deposited from the saliva,
especially in the neighbourhood of the salivary ducts, over the six
year upper molars and also at the backs of the lower front teeth. A
constant growth in amount of this tartar brings about the absorption
of the gums and alveolus supporting the teeth, and as it is of a
brittle nature, the tartar frequently falls away, leaving the teeth, which
it has previously supported, loose and oftentimes with an exposed
periosteum. This is frequently the cause of severe periostitis and
even neuralgia. The tartar present in Rigg's disease is said to be
derived from the periosteal secretion, and although tartar may be a
predisposing cause of pyorrhoea, it is, in some cases of this disease,
entirely absent.
Now arises the question — What means can be adopted for the
continuance of a hygienic state ?
The cleansing of the mouth after every meal by the patients
themselves is, without doubt, the most important factor, tending
towards keeping of the mouth and its contents healthy. Now let
us consider the best methods by which we can properly carry out
this thorough cleansing process.
Cold Water used to rinse the mouth with, or, better still, applietl
to the teeth on a brush. I am speaking now of water at a tempera-
ture of lo" to 1 5*^ centigrade. It is claimed by M. Joseph that this
not only stimulates the leucocytes to successful action against the
bacteria of the mouth, but actually re-awakens the nutritive activit\-
of the dental pulp, and thus favours the formation of a denser and
more perfect tooth substance, acting in direct antagonism to what
he so ably terms " the excesses of modern refinement."
Toothhnishes. — Innumerable are the ideal or rather pet shapes
and forms of toothbrushes recommended by most able and worthy
members of our profession, and rather than seem to favour any special
pet cr crank would I recommend that patients should use a tooth-
brush of a small size, that is to say of a size they find most easily
workable in their own mouths, with the bristles not too close
together and, what is still more important, impress upon them that
it is to be used not only in a lateral but also in a vertical direction,
and that the backs of the teeth also require attention.
THE DENTAL RECORD. 5i95
To prevent the escape of bristles from a brush it is advisable
to tap it before use to see if any of the bristles are loose, after
use again tap it and put it away, not in a closely shut tray,
as this causes a bad odour to arise from the brush, but rather in
such a position as a pen rack affords, thus leaving it free to drain
and out of reach of noxious materials, except the small percentage
afloat in the air.
For use on the teeth of very young children I would recommend
a camelhair pencil.
There are two types of toothbrush, the waxed back and the tre-
panned, it is claimed that the bristles can be more effectually
fastened by the workpeople in the waxed back variety, but of this I
am unable to judge.
The price of a toothbrush is not exorbitant, and if patients were
to get a new one more frequently and not wait until one is
thoroughly worn out before renewing, I believe they would derive
greater advantages from this most effective weapon.
Dentifrices. — These exist in the form of powders, pastes and
soaps.
Taking soaps first, one disadvantage attending their use is that
they turn the teeth brown in time. A distinct advantage is that
the brush can be rubbed upon the soap and a sufficiency gathered
therefrom to ensure the desired effect upon the teeth, whereas with
powders it often happens that more of the powder is sprinkled upon
surround'.ng objects and a totally insufficient quantity carried into
the mouth itself.
The disadvantages of pastes is that they require, very frequently,
a longer time in their conveyance to the mouth, than the majority of
people pive to this most important function, and it is very desirable,
I think, that we should recommend our patients only that which we
think they will constantly practice and not means which they will
adopt upon one or two occasions and then forever forsake.
Gentlemen, — I have no ideal dentifrice, I have enquired of
good authorities and all agree that the most suitable base is Creta
Prepurata (prepared chalk), it is of a fineness that will not scratch
like pumice, and in fact it is the finest of the official chalks. It is
of an alkaline reaction, and thus counteracts the fermentations of
foodstuffs, and the evil effects of germs already existing in the
mouth.
296 THE DENTAL RBOORD.
As to antiseptics, Miller places Oil of Cassia vtstly ahead of any
other for this purpose, it is of a pleasant taste and odour and very
effective.
Of one of the so-called antiseptics I would urgently ask you to
beware. I speak of carbolic. You have only to enquire amongst
your patients to verify my statement that this carbolic has a great
deal more to answer for in softening, whilst at the same time
whitening the teeth, than any other of the extensively advertised
enemies of conservative dentisty.
If it be acids and their action we are fighting against, why should
we introduce a stronger one into the mouth ? Chemists claim and
prove by formulae that carbolic is not an acid. I maintain that
where danger exists, whatever be the name applied to it, it is best
to avoid it, and this can be done by putting cassia in the place of
carbolic.
Cassia is an essential oil, and it is necessary that the dentrifice
should not be got in large quantities, and as often renewed as the
tooth brush itself.
Charcoal when used as a base is apt to leave marks along the
gum, which simulate one of the symptoms of lead poisoning, and it
is not every patient who would care for its delicate flavour or dingy
appearance.
Mouth washes are of most use in a mouth not typically healthy,
still where the patient evinces a preference for a mouthwash over
the ordinary dentifrices, the cold water treatment recommended
by M. Joseph, or a prescription written to suit the case is to be
recommended.
Toothpicks are to be had of almost every variety of metal,
beautiful to look upon and costly in price. None are better, none
are cheaper than the ordinary quill, encased in a piece of tin. This
is necessary to prevent the collection on the quill of debris, which
may be carried to the mouth ; it also allows the toothpick to be
more easily carried, enabling one to avoid the unenviable position of
that tourist, who, after dinner in a Scottish inn, asked for a tooth-
pick. He was supplied, but had scarce started on his dental organs'
when the maid returned to ask if he was finished, as the local
farmers' club was sitting that evening, and the toothpick was the
club's property, paid for out of club funds, for the general use of
members only, after each fortnightly supper. Again, the case can
THE DENTAL RECORD. 297
quickly and easily be refilled, and it prevents the quill from
destroying the linings of one's pocket. These points, together with
their great flexibility and less liability to break, are points possessed
by no other variety of toothpick.
Tobacco. — How does smoking affect the teeth is a question, in
one form or another, we are often called upon to answer.
Dr. Richardson holds that there are certain substances common
to all varieties of tobacco smoke.
Firstly, a certain amount of watery vapour.
Secondly, a small quantity of free carbon. Tt is this free carbon
that gives the peculiar dark yellowish tinge to smokers' teeth, and
which, when found in out of the way places during the examination
of a mouth, may be mistaken for decay beginning.
Thirdly, a certain quantity of ammonia, which gives an alkaline
reaction to the smoke and partly excites the saHvary glands. This
it is which gives to tobacco smoke its prophylactic properties in the
mouth, and it is for this reason that we find in the mouths of
smokers who brush their teeth so few decayed teeth in comparison
with non-smokers of a similar age.
Carbonic acid and oil of tobacco, made up of nicotine, which is an
alkaloid, a volatile substance and a resinous extract are also lesser
constituents of tobacco smoke, these substances affect the nervous
system and other organs of the body rather than the teeth.
Scaling and Brushing. — This operation I believe to be one of
the most important we are called upon to perform, and one which
we should impress upon our patients, as conservative dentists,
it is absolutely necessary to have performed at stated intervals of
time.
Upon the thorough cleansing of the teeth by means which the
patients are not themselves able to adopt efficiently, depends not only
the health and comfort of this generation, but also the health, strength
and comfort of succeeding generations.
The instruments to be used in this operation for the removal of
tartar and other debris from the necks and surfaces of the teeth
are, firstly, scalers, of which those known as How's hold, I believe,
a favoured position with many operators, whilst scalers of other
hands makes, shapes, and sizes are equally successful in the practised
of the operators using them.
These How's scalers, backed up by a spoon-shaped excavator,
298 THE DENTAL RECORD.
should be used upon the teeth from the lower back ones, working
gradually round the jaw, so as to avoid any blood obscuring the
vision of the operator.
Particular regard should be paid to the necks of all teeth,
internally and externally, special attention being paid to the backs
ot the lower incisors and the buccal surfaces of the six-year superior
molars.
Having removed all tartar and debris from the teeth by means
of scalers, the next step is to render perfectly smooth the roughened
surfaces of all teeth, this is done with a brush, either straight or
wheel-shaped, or a rubber cup or wheel, on which has been taken
up fine flowers of pumice, and each tooth carefully gone over by the
brush or rubber revolved in the dental engine.
This we should follow up by a process which patients can
themselves, with advantage, adopt. I mean the passing of sterilized
floss silk between each contiguous tooth, after which, those operators
who have not previously followed this method with their patients
will be themselves surprised at the great difference and markedly
changed aspect which the teeth before operation bore to the teeth
after operation.
Diet. — As d means of natural den|tal hygiene, diet holds a
premier place. A well arranged diet, together with plenty of open
air exercise, would tend towards helping both young and adult
patients to keep their own teeth.
Occasioaally we are asked by patients what are the best foodsuifs
to eat which afford a hope of preserving the teeth ; or, are certain
foodstuffs injurious to the teeth ? No foodstuff is better suited for
cleansing the teeth than the muscular fibre, connective tissue and
tough skin eaten by carnivora. Oar patients, however, are not true
carnivora, and such a diet would be anything but palatable to many
people. An American writer points out how inconsistent with
hygienic laws it seems that foodstuffs most useful for cleansing the
teeth, such as meat and well cooked bread, are served first at meal
times, whilst dessert, containing so many free acids and the
hydro-carbons so well suited to the life of micro-organisms, come
last.
A person, young or old, subsisting upon the present day good
living system, and being fed mainly upon the products of fine white
flour, such as fancy pastries and the like, loose their teeth in spite of
THE DENTAL RECORD. 299
the Strictest vigilance and the most careful dentistry, simply because
the preparation of this white iiour necessitates the elimination of the
necessary elements which are contained in good wheat bread, and
without which life of a healthy nature is impossible.
Hands and Inatnimciits. — I do not think that this paper would
be complete without some mention being made of the hands and
instruments which are the main agents in the prophylactic work
upon which we are engaged.
Hands. — Dr. Miller, of Berlin, says : " Before beginning work in
the morning I cleanse my nails, which are kept short, with a pen-
knife. Then brush my hands, and nails especially, in a warm i or 2
per cent, lysol solution. Then rinse in hydrant water and dry
thoroughly. Between operations I wash my hands and brush my
nails in soap water. After attending a filthy mouth I again use the
lysol solution." He further states that '' he makes special appoint-
ments, generally at the close of the day, for syphilitic patients, and
that " it is not permissible to handle old teeth or money, or to dive
into the trousers pockets in search of jack-knife, nor to hold
instruments between the teeth or behind the ear during
operations."
Instruments. — These convey infectious materials by their entr}'
into wounds much more elTectually than the hands are able to do
during dental operations, and it is thus absolutely necessary that
their sterilization should be of the most effectual kind.
To boil instruments in water containing carbonate of soda, to
prevent rusting, is a method much in vogue, and it seems to answer
well, care being taken to afterwards thoroughly dry and polish
excavators and forceps with chalk and chamois or buff" stick.
Dr. Miller keeps two sets of instruments going and has one set
sterilized whilst the other is in use. He uses a lysol or thymul
solution adding a few drops of oil of cassia. Mouth mirrors should
be most carefully treated, and as hot water tends to loosen the glass,
it is better to brush them in some cold antiseptic solution, such as
those above mentioned, or to steep them in peroxide of hydrogen or
Hg. B. Fl.
The small cost of rubber dam per patient is such that no one
ought ever to use the same piece twice, and to sterilize removes to a
great extent the elasticity from the rubber.
Serviettes, glasses, and burs should be well looked attjr, burs
300 THE DENTAL RECORD.
should be first brushed with a wire brush and then boiled or left in
peroxide of hydrogen for some time, especially after use in a fou
pulp canal.
Gentlemen, my paper draws to a close, and I thank you for
listening so patiently to what, I trust, may benefit some and prove a
source of contention for others. My paper covers so wide an area
that the errors of omission and commission predominate, and for this
reason I hope to derive benefit and pleasure from your discussion.
supports 0f ^acieim.
THE ODONTOLOGICAL SOCIETY OF GREAT BRITAIN.
The Annual Meeting of the above Society was held at
40, Leicester Square, on the ist ultimo, the President (Mr. David
Hepburn), in the chair.
The minutes of the previous meeting having been read and
confirmed, Messrs. Badcock and Brunton were appointed scrutineers
for the ballot.
Mr. W. A. Maggs (the Librarian), presented his Annual Report,
in which he stated that 32 members had used the Library during
the year, while the number ot visitors was 42. Fourty-four books
had been borrowed in the same period.
Mr. S. J. Hutchinson (the Treasurer), in his Annual Report,
stated that the gross receipts for the year, from November ist, 1894,
to October 31SU, 1895, were ^648, and the gross expenditure /461,
leaving a balance of ^^iSj. The amount of the Society's invest-
ments was ^4,327. In the course of his remarks Mr. Hutchinson
alluded to the difficulty arising from the Society's financial year
commencing and concluding at a different date to its official year.
Mr. Storer Bennett (the Curator), in the course of his Annual
Report, stated that, following the precedent of former years, he had
placed on the table all the specimens presented to the museum
during the twelve months, and he thought they illustrated a very
fair range of subjects in comparative pathology as well as human,
and if the museum progressed as satisfactorily in the future as it
had done in the past, they might all be proud of possessing a
THE DENTAL RECORD. 301
perfectly unique collection, unrivalled by any other museum with
which he was acquainted. With regard to the work of the year,
the specimens added numbered 39. Thirty visitors and nine
members had attended the museum, as against thirty-six and seven
respectively in the previous year.
Mr. Storer Bennett also exhibited two specimens of comparative
dental pathology, presented by Mr. Morton Smale, adding that they
were much indebted to Mr. Morton Smale for several very valuable
specimens presented during the year. These two were interesting,
though not so remarkable as some others received from him. The
first was the skull of a female gorilla, showing on the inner side of
the mandible a certain amount of absorption in the alveolus. The
other specimen was also one of a female gorilla, showing on one
side the loss of two molars, with a very large cavity of absorption
of the alveolus, while on the other side the first and second molar
had been lost. There was also considerable loss of bone on the
right side, the result of previous prolonged inflammation. As
gorillas had never been kept in captivity these losses of tissue could
not be the result of confinement. He should mention that the
second specimen showed a tilting of the right lower pre-molar ; the
result of the loss of the first and second molars suggested that early
extraction had been performed. Here was an illustration of what
they were told must result from improper extraction of the second
molar found in one of the lower animals which had not been
subjected to captivity at any time.
Mr. Boyd-Wallis exhibited an Electrical Annealer constructed
under his directions. The lamp was specially prepared for him by
Messrs. Edison & Swan, and was a 100 v. 32 c. p. lamp. He
was inclined to regard electricity as the only satisfactory agent for
annealing sponge gold. He had used a similar lamp for the last two
or three years, and, as demonstrating its heating power, might
mention that it would boil water in twelve or fifteen minutes.
A paper prepared by Dr. Washbourn and Mr. Goadby, entitled
"Some points in connection with the Bacteria of the Mouth," was
then read by Dr. Washbourn. Its statement?, inferences and
conclusions might be summed up as follows : —
The authors had examined 24 mouths in all, 16 with perfectly
sound teeth and eight with one or more carious teeth. Any-
one who had studied this subject would be struck with certain
302 THE DENTAL RECORD.
facts. In the first place, bacteria are found in all mouths,
whether the teeth are sound or carious, and whether the individual
is well or ill. Secondly, when the teeth are carious, there are
generally many more bacteria present in the mouth than when the
teeth are sound. Thirdly, in acute diseases more bacteria are
present than in health. Lastly, a systematic cleansing of the teeth
with the tooth-brush greatly diminishes the number of the bacteria
present. An example which came under the notice of the authors
well illustrated this point. They made a series of examinations of
the mouth of a boy with sound teeth, on account of the number of
spirilla which were constantly present. One day, to their surprise,
the spirilla had completely disappeared, and on inquiry it turned
out that the boy had taken to the use of a tooth-brush, as he was
getting tired of the repeated examinations. An overgrowth of
bacteria in the mouth was checked by certain natural processes
Firstly, the saliva acted not only by mechanically removing the
bacteria, but also in virtue of its bactericidal properties. Sanarelli
had shown that fresh saliva destroys some bacteria and hinders
the growth of others. In this respect it was similar to the
blood serum and to other fluids of the body. Secondly,
the cells which are contained in the lymphoid tissue of the
tonsils act as phagocytes, englobing and destroying bacteria.
There are many species of bacteria which will produce caries, just as
there are many kinds of bacteria which will produce inflammation
and suppuration in various parts of the body. Many of these
bacteria are only occasional visitors, which have been introduced wiih
the food or air. They remain for a short time in the mouth and
then disappear, the conditions not being favourable for their develop-
ment. But apart from the bacteria that are, so to speak, accidentally
present, the mouth contains certain species which constitute its
normal flora. Some of the constant inhabitants of the mouth
appear to be incapable of multiplying outside the body under the
ordinary conditions of nature, and indeed some species have resisted
all attempts at cultivation in artificial media. Some, on the other
hand, can be cultivated in the various media generally employed.
Caries, they held, does not occur without the agency of bacteria,
though imperfect development or deficient calcification were pre-
disposing causes. Bacteria pathogenic to the human subject had
frequently been found in healthy mouths, including the diplococcus
THE DENTAL RECORD. 303
of pneumonia, the diphtheria bacillus, the streptococcus pyogenes
aureous and the streptococcus pyogenes. The presence of patho-
genic bacteria in healthy mouths threw light on the conveyance of
disease from one person to another, and pointed to the importance
of their carefully disinfecting all dental instruments. A virulent
bacterium might remain in the mouth of a healthy individual
without causing disease, because it is dependent upon the suscepti-
bility of the individual for its pathogenic effect. The most virulent
bacteria might prove inocuous to an individual in sound health,
while the same bacterium would produce disease to a person in weak
health. With regard to the presence of pathogenic streptococci in
the mouth, they had made a number of observations and microscopic
examinations, and their conclusions were that while virulent strepto-
cocci were occasionally present in healthy mouths they were net
constantly so, and that the virulent are a different species to the
inocuous streptococci, capable of being distinguished in the following
manner. The streptococcus brevis (harmless) is (i) non-patholo-
genic when tested upon rabbits ; (2) it produced a uniform turbidity
in broth cultivations ; (3) it clots mild and produces much more
acid than the streptococcus longus (pathogenic) ; (4) the individual
chains are smaller, and the chains, especially in broth cultivations,
are shorter, though the length of the chain is not an absolutely
reliable criterion. The general characters of the streptococcus
longus, are : It grows best at 37 C, but will grow at the ordinary
temperature of the air. On agar and gelatine the colonies are
minute and semi-transparent, the htter medium is not liquified.
The growth in broth is rather characteristic ; flocculent masses
stick to the sides and fall to the bottom of the tube, while the rest
of the broth remains clear and transparent. A slight amount of
acidity is produced in the cultivations. The microscopical appearance
of the broth cultivations is characterised by the length of the chains,
some consisting of as many as 40 members. Hence the name
streptococcus longus. In other media the chains arc often much
shorter, and in the tissues of infected animals only diplolocci forms
may be met with. The streptococcus brevis of Fingelstein must be
looked upon as a distinct species for the present, although ultimately
this view might be proved incorrect, for it was possible that further
researches might enable the streptococcus brevis to be converted into
streptococcus longus, though it had not yet been accomplished. The
304 THE DENTAL RECORD.
authors were of opinion that the discrepancies of different observers
who had investigated the streptococci of the mouth were partially
due to the fact that the streptococcus longus is sometimes accident-
ally present, and has been mistaken for the normal streptococcus of
the mouth.
Dr. Durham said the society would be aware that serum prepared
by means of streptococci had already been largely used. A certain
number of cases treated had not responded at all, but in other cases
the effect of an interjection of anti-streptococcic serum had been most
marvellous, and he thought it clearly pointed to the fact that the
streptococci which Avere present in various pathogenic conditions in
man were not of one and the same species, and therefore the further
classification and codification of the various kinds of streptococci was
distinctly an advance. He was afraid that serum treatment would
never reach the pitch of protecting people against acid-forming
streptococci.
Mr. Packes agreed with the reader of the paper in thinking that
gentlemen were not all as careful as they should be in properly
sterilizing their instruments.
Mr. Howard Mummery said with regard to the pathogenic
effect of the streptococci on the mouth, there was a paper by
Mons. Gallipe, published in Paris, in which he described a case of
endocarditis, which he distinctly traced to the mouth. Mr. Mummery
thought that too much attention could not be drawn to the question
of the antiseptic treatment of instruments. The only safe method
to his mind was to put the instruments into boiling water as soon as
they were done with. He would like to know whether the alteration
of the appearance of the cocci, the oval and round cocci, was not due
to the alteration in the nutrient condition of the medium in the
mouth. Sometimes there was diminution of the nutritive power,
and then transition forms were obtained and not typical forms. He
thought that Dr. Miller had stated with regard to the pneumonia
bacillus that it was nearly always present in the mouth, but very
easily killed. It succumbed much more easily to certain antiseptics
than most of the other organisms. In experiments with saccharine
and benzoic acid Dr. Miller found that that was one of the first
organisms destroyed.
Dr. St. Clair Thomson was very anxious to hear what became
of all the bacteria in the mouth. Referring to the bacteria in the
THE DENTAL RECORD. 305
nose, he found the majority inhaled were stopped at the entrance of
the nose, and the remainder stuck to the crhiey mucous lining the
cavity, whence they were rapidly turned out by the ciliated
epithelium. Some continental observers claimed the mucous of the
nose to be distinctly bactericidal. It had even been asserted that it
could kill the spores of anthrax, but though he and his colleague,
Dr. Hewlett, tried over and over again to confirm that fact, they
had completely failed. But it had one distinct virtue, viz., that it
inhibited the growth of bacteria, which was, of course, something
in the same direction, though it was not bactericidal action. It
seemed to him that there was no need for the mucous to be bacteri-
cidal, because the germs, as they landed on the mucous of the nose,
were prevented from developing and then expelled by the ciliated
epithelium. While studying the bacteria of the nose he had been
astonished at the swarms of organisms that were met with in the
cleanest of mouths. Dr. Washbourn had said that the saliva was
germicidal; he should like to know whether the saliva was sufficient
to meet those hordes of bacteria ? He would suggest that the
bacteria were wrapped up in the saliva, and when thus rendered
inoffensive were swallowed. He was anxious to learn Dr. Washbourn's
views as to the fate of all the organisms in the mouth. He would
also like to know if it had occurred to Dr. Washbourn whether the
bacteria were present in greater quantities in mouth breathers ?
Mr. Storer Bennett thought it must be obvious to all who
were familiar with the researches of Dr. Miller and others working
in connection with caries of the teeth that much more was necessary
to produce caries than these streptococci, even though it might be
true they had the power of generating acid.
Mr. Sidney Spokes gathered that Dr. Washbourn considered the
saliva bactericidal, notwithstanding he compared it to serum.
Serum was one of the media that was used for the cultivation of
bacteria ; he, however, cauld not quite reconcile the two statements.
Mr. GoADBY, in reply, said that Mr. Durham had given him
personally a good deal of help in the matter. With regard to the
classification of the s.rcptococci, the point was that in various
common media the streptococcus brevis gave a good many different
reactions. They could not simply take the morphology of the two
streptococci and say one was the brevis and the other the longus.
They must cultivate on all the various media and get the different
X
306 THE DENTAL RECORD.
reactions — clotting of the milk, the growth on the gelatine, &c.
They jJiew very badly on gelatine and on potato. On potato both
of them involuted a great deal, but he thought the streptococcus
longus involuted the least. Mr. Peters had said something about
the acid production, and Mr. Storer Bennett, he thought, had the
idea that he (Mr. Goadby) meant that caries was produced by the
acid of the streptococci alone.
Mr. Storer Bennett said that was what he inferred from the
earlier remarks.
Mr. GoADY said with regard to that point nine-tenths of the
•bacteria produced acid, and all they wished to point out was that the
streptococci found in the mouth did produce acid and the pathogenic
ones did not.
Dr. Washbourn also replied, he said that Dr. Durham had
referred to the serum treatment of streptococcal infections. A very
good case came under his care, the case of a boy who shortly after
the removal of a tooth was taken with severe symptoms of septicaemia
and cerebral disturbance. They felt quite satisfied that he had some
commencing meningitis, and also that the probability was that it
was due to a streptococcal infection. A little of the pus from the
tooth was examined and streptococci were found. Unfortunately
they did not test the virulence, nor did they make a careful series of
cultivations in order to see whether it was the streptococcus longus
or some of the streptococci from the mouth which had accidentally
entered into the tubes. They treated the case with serum, with
most remarkable results ; very soon after the injections the boy got
better, and ultimately completely recovered. With regard to the
case of ulcerative endocarditis, that occurred from infection through
the mouth. He had no doubt that the pathogenic streptococci were
sometimes present in the mouth and that septicaemia might be
produced in that way when any wound of the mouth occurred. As
to the shape of the cocci, they varied according to the medium in
which they were cultivated. In comparing any micro-organisms,
of course the cultivation should be made under ■ exactly similar
circumstances, and when they stated that the individual cocci were
smaller in the streptococci brevis than in the streptococci longus,
they meant when they were cultivated upon broth having exactly
the same composition As a matter of fact, if the streptococci were
cultivated upon potato, the cocci became elongated and looked like
THE DENTAL RECORD. 307
bacilli. With regard to the presence of pneumococcus in the mouth,
there were very many observers who said it was almost constantly
present, but he had some doubts as to whether those observers had
not sometimes mistaken the streptococcus for the pneumococcus.
Dr. Thomson asked what became of the bacteria of the mouth. He
(Dr. Washbourn) had no doubt that some of them were destroyed
by the saliva, and that others were swallowed and were destroyed by
the gastric juice. The gastric juice had faiily good antiseptic
properties. As to whether there were more bacteria in the mouths
of those who breathe with their mouths open no experiments had
been made. Puerperal fever might arise from any septicaemic
conditions such as the one which had been referred to ; in an alveolar
abscess there were virulent streptococci, and those might very well
have produced the disease.
The follow members were elected officers and councillors for the
ensuing year : — President — R. H. Woodhouse. Vice-Presidents —
(Resident) — John Fairbank, C. J. B. Wallis, John Ackery. (Non-
resident)— George Henry (Hastings), J. F. Cole (Ipswich), Malcolm
Macgregor (Edinburgh). Jreasiirer — W.H.Woodruff. Librarian —
W. A. Maggs. Curator — Storer Bennett. Editor of Transactions
J. F. Colyer. Honorary Secretaries — J. H. Mummery (Foreign),
C. Woodhouse (Council), H. Baldwin (Society). Councillors —
(Resident) — J. Gartley, C. Robbins, S. Spokes, A. Smith, G. D.
Curnock, H. J. Gould, J. O. Butcher, H. L. Albert, H. J. Kluht.
(Non-resident) — T. Arkovy (Budapest), A. W. W. Baker (Dublin),
F. E. Huxley (Birmingham), G. Cunningham (Cambridge), C. B.
Mason (Scarborough), J. J. Andrew (Belfast), E. N. W .- bourne
(Ripon), J. S. Amoore (Edinburgh), W. R. Ackland (Bri=-Lo ).
The President then delivered his valedictory ad Ircss, in the
course of which he expressed his feeling of gratitude for the unfailing
support that had been accorded to him and his colleagues during
the official year. At the commencement of the session he ventured
to express a hope that it might be one of profit, not only to them-
selves but to the profession at large, and that hope he felt bound to
say had been amply realised. He then proceeded to pa^^s in review
the work of the year, dealing individually with the papers that had
been read ; he specially emphasised Dr. Dudley Buxton's paper on
the " Nature of Anaesthesia," which he described as " a classic,"
and Mr. Tomes' contributions on '' The Chemical Composition of
X 2
308 THE DENTAL RECORD.
Enamel," and ** Experiments in Amalgam." In conclusion
Mr. Hepburn stated that three days ago he had determined to say
nothing but a word cf farewell, but in spite of his better self he had
been tempted into offering a few desultory remarks. They must be
taken merely as an evidence of the lingering regret which attached
to the severance of pleasant ties and the reliquishing of an honour-
able position. In vacating this chair he carried with him a legacy
of never-to-be-forgotten memories, and the recollection of many
evenings profitably spent. He had only one legacy to bequeath in
return, but it was one which he felt sure they would be glad to receive.
It was an ancient volume containing a copy of the invitation signed
by Mr. Thos. Arnold Rogers, and some 50 autograph letters, written
in response thereto by the early members joining this society prior to
the adoption of the election by ballot in 1856. It moreover, contained
fragments of the correspondence with the Royal College of Surgeons,
which led up to the foundation of the Dental Diploma. It contained
also some original and amended drafts of that diploma and many
other documents of historic interest. Its fitting home was the
library of this society, and in the hands of their trusty librarian,
Mr. Maggs, it would be in safe keeping. It was with great pleasure
that he he entrusted it to his care. Having thus recalled the
foundation of the Odontological Society of Great Britain, which took
place 40 years ago, he would express his parting wish that it may
long continue to flourish and prosper.
Mr. Hutchinson proposed a vote of thanks to the President for
his address and for his services in the chair during the past session.
He said that Mr. Hepburn was so well known to all of them, and so
deservedly and universally popular, that any words of his would be
superfluous, but it was only right that their sincere congratulations
should be offered, not only to the President, but to the Hon. Secre-
taries for the very interesting and valuable series of papers and
communications which had been provided, especially as they
embraced almost every branch of practical and scientific dental
surgery, and besides this, several papers had dealt more particularly
with collateral surgical matters of much importance. Mr. Hutchinson
alluded to the interesting fact that so many presidents of the society
had been followed in due course in the chair by their sons ; and he
was proud to say that no charge of nepotism could be laid at their
doors, as all the sons had richly earned their high position, ind^-
THE DENTAL RECORD.
309
pendently of their distinguished fathers ; and of these he would
mention Mr. Cartwright, Mr. Rogers, Mr. Tomes, Mr. Mummery,
and lastly Mr. Hepburn, also Mr. Woodhouse, whose uncle had been
a well-known president. In conclusion, Mr. Hutchinson made
feeling reference to his first visit to the society when a student,
iMr. Hepburn's father then being President.
The resolution was carried by acclamation.
The President briefly responded.
Mr. Mummery moved that a hearty vote of thanks should be
aiven to Mr. Hutchinson for all he had done for the society.
Mr. Hutchinson had been really holding office for many years. He
began as Secretary in 1879, was Curator from 1881 to 1885, Vice-
President till 1888, President in 1 89 1, and had been Treasurer for
the last three years.
The motion was carried with acclamation.
Mr. Hutchinson thanked the members.
Mr. Brunton moved that the best thanks of the society should
be given to the Council and the officers, which motion was also
carried with acclamation.
Mr. CoLYER replied.
At the fortnightly meeting of the Beverley Board of Guardians,
held on Saturday, May 30th, in the Board-room, the chairman
(Alderman Sample) moved : " That £'^ per annum be offered to
Mr. Willis, dental surgeon, to look after the teeth of children in the
workhoube. Mr. Abram (vice-chairman) seconded. The Master
stated there were about 14 children with bad teeth at present in the
house. Mr. Whitehead asked if the nurses could not look after the
teeth. Not one family in a 1,000 had a dentist to look after their
children's teeth. The Chairman replied that the poor-law inspector
(Mr. Kennedy) had reported on the subject, and said the children's
teeth ought to be looked after. Mr. Abram pointed out that the fee
was very moderate, only 2s. per week. Mr. Riby thought the nurses
and the medical officer could attend to this matter. Mr. Whitehead
remarked that it was a pity Sequah was not in the neighbourhood at
present. If the children had a tooth pulled out every week they'
would soon have none in their heads. After further discussion the
resolution was put and carried.
310 THE DENTAL RECORD.
THE DENTAL RECORD, LONDON : JULY 1, 1896.
THE EXTRACTION OF UNERUPTED FIRST BICUSPIDS.
The method of treating cases of impending crowding, or
irregularity, of the teeth bj early extraction of the first
bicuspids is not new, but none the less we are indebted to
;Mr. F. J. Colyer for having put this idea to the test ot
practical experience and for giving this experience
to the Odontological Society at the May meeting.
Such methods naturally suffer from the tendency to call
operations heroic when they are unusual or when they
present some little difficulty in their performance. It is
therefore nece^^sary to fr-ee one's mind from such prejudice
if we are to arrive at a just conclusion regarding the value
of this operation. It will probably require a much larger
experience of this treatment before a final opinion can be
formed ; but it is certain that a careful perusal of the debats
which followed the reading of the paper shov s that the
method therein advocated suffered but little from real
criticism. We take it that the question at issue is : given
a ^ase, in which it'is evident that there will be crowding and
irregularity, is it advisable to adopt this operation, or to
wait, and, later, to treat the case on some one of t^^e accepted
lin-^s : But few of the speakers confined themselves to this
point, but rather set themselves to discuss some of the
other questions which Mr. Col}er unwisely, as it seems to
us, also propounded. Surely each one of these questions
raises issues which would al3ne suffice for an evening's
discussion. The points of which we want to be sure when
adopting this procedure in cases of crowding, in wh?cn we
presume the unerupted canine to be well above the arch,
are whether this tooth will drop back into the space gained
without mechanical aid and whether the crowding of the
front teeth will be relieved. If we are assured that these
things will happen, then the advantages oi this operation
THE DENTAL RECORD. 311
seem to us many and unanswerable. If, on the other hand,
subsequent mechanical aid be needed, then we altogether
fail to see that the operation is justifiable. The experience
in other regulation work would lead one a priori to expect
a favourable result, and the experience gained by
Mr. Colyer reassures us. It may be well to enumerate some
of the advantages that this treatment may be expected to
yield. Firstly, it will obviate the need for long, wearying
and expensive, mechanical methods, which, to put it mildly,
often tend to damage the permanent teeth. Secondly, by
early relieving th? pressure of the front teeth and, to a less
extent of the back teeth, one against another it will lessen
or do away with approximal decay. Whilst we agree with
the remark of Mr. Sidney Spokes that iti ^ '* rather unusual,
unless in a very severe case of neglect or overcrowding,
where the incisors were overlapping one another to a
large extent to find any great amount of caries amongst
the incisors before the age of 12,'^ yet, having regard to
the difficulty of permanently arresting approximal decay
in a child, even when of a small extent, remembering the
unsightliness of filled front teeth, and the difficulty of
finding the cavities on the approximal surfaces of back
teeth, whilst they are yet small, we do not believe this
criticism in any way be-littles this advantage. Moreover,
the very cases which he expressly excludes from his
general statement are those for which we should regard
this operation as expressly indicated. So too with regard
to Mr. R. H. Woodhouse^s remark that *' it could not be
really foreseen what teeth might become decayed in the
course of three or four years. ^' Surely the very motive
of the operation is that w^e may foresee that none will
decay, at any rate on their approximal surfaces. Approximal
decay is, for the m(3st part, a very distinct thing from
crown decay, lor wh<=reas the latter is alm-^st a necessary
sequel to a pit or fissure, the former rarely occurs unless
the surface be damaged by rubbing against its nei^rhbours
or be prevented by undue crowding from the cleansing action
312 THE DENTAL RECORD.
of food and tongue. The farmer, thinking to pooh-pooh
the need of tooth brushes by the remark, that he never used
one, but cleansed his teeth on three-quarters of a pound of
beef-steak, may have been coarse in his expression and
unreasoning in his thoughts, but at lea^t he " voiced ^^ a
fact. The mastication of food by a well arranged set of
teeth is in itself a cleansing process which is absent or
deficient when teeth are crowded and irregular. We may
not be able to say which tooth will decay but we can
with certainty prophecy that some will. Thirdly, this
method, as against extraction later, will not involve any
disturbance of the normal articulation of the back teeth.
We regard this as a minor point, but still one to take into
account. These are some of the advantages, others may
occur to readers, but it will be necessary in performing this
operation to remember that we are not likely to adopt
this as a routine practice for every dentition, but rather
to reserve it for those cases in which it is apparent
that there is no space into which the canine can erupt
and in which the eruption of this will further accentuate
the already crowded state of the front teeth. To practise
promiscuous extraction of unerupted first bicuspids would
be just as unreasonable as to bridge a set on a root and a
half.
Rtbj^ attb ilot^s.
At the ordinary meeting of the Council of the Royal College of
Surgeons of England, held on June nth, the following gentlemen
having passed the necessary examinations were admitted Licentiates
in Dental Surgery : — Edgar Ashley, Ernest Dare Bascombe, Luther
Bidlake, Wallace Watson Briant, Ernesc Coltman, Hector Charles
Cowles, Harold Sugden Crapper, Alfred Edward Binnington Crosby,
Albert De Mierra, Joseph Elford Dupigny, George Russell Edeyr
Harold Octavius Whitfield Harris, Edwin Ernest Darley Heeson,
Charles John Hinchliff, Albert Frederick Alonzo Howe, William
THK DHNTAL RECORD. :^la
John Mark Lacey, Norman Henry Oliver, Arthur George Grant
Luinley, Arthur Read, Norris Snell, Richard Henry Stevens, Leopold
Ta Bois, Benjamin George Tasker, Ernest Reginal Tebbitt, students
of Guy's Hospital. Walter Burrows Barnard, L.R.C.P. Lond.,
Edgar Athelstan Blom field, Harold Conder, James Kendred Day,
Harry Dunlop, Frederick Hemsted, Sydney Angelo Knaggy,
Frederick William Mardon, Osbert Mordaunt, Walter Mudie,
Ernest Arthur Newberry, Alfred Edward Horton Orridge, Frank
Jostrph Padgett, Harry Hamilton Staton, students of Charing Cross
and the Dental Hospitals. George Washington Connor, M.R.C.S.
Eng., Walter Sexton, students of the Middlesex and Dental
Hospitals. William Edmund Hill, Charles John Hurry Riches,
students of the Middlesex and National Dental Hospitals. Hubert
William Moore, student of Glasgow University, Middlesex and the
National Dental Hospitals. Charles Mullord, student of the London
and National Dental Hospitals. Thomas Wafer Bryne, Arthur
Percival Nixon, John Walter Skae, students of University College,
Royal Infirmary and Dental Hospital, Liverpool. Ctuart Cartel,
Sydney Bailey Fisher, Arthur Malcolm Robey, students of Mason
College, Queen's and General and De.ital Hospital, Birmingham.
Ernest Fritz Bertram Beyer, student of Owen's College, Ro}al
Lifirmary and Victoria Dental Hospital, Manchester. . Sixteen
candidates were referred back to their professional studies.
J. Flax, of i, Victoria-place, Eastbourne, appeared un June 22nd,
before the Eastbourne Borough B^nch, in answer to a lummons foi
carrying on a practice of dentistry, on June 8th, he not beii^g
registered under the Dentists Act, 1878, and not being a LgalK-
qualified medical practitioner, and that he used the letters " D.D.S.,"
implying that he was registered under the Act, or was specially
qualified to practice dentistry. He pleaded not guilty. Mr. R. W.
Turner prosecuted, Mr. Ritchie Macoun defending. Mr. Turner
said this was a prosecution by the British Dental Association.
Defendant had been carrying on business in Eastbourne, and the
circumstances he submitted showed an ingenious attempt to evade
the sections of the Act. He detailed the evidence to be called, and
with reference zo the American diplomas, Mr. Turner mentioned
that no American diploma was recognised in England under the
314 THE DENTAL RECORD.
Act. He specially pointed out that under Section 3 of the Act of
1878 as amended by Section 26 of the Medical Act of 1886, a person
was denied the right to use the name or title of dentist, or hold
himself out as a person qualified to practice dental surgery, by the
addition to his name of either words or letters so signifying unless
he was registered under the Act ; and as to the use of the term
American — which he (Mr. Turner) interpreted as a confession of an.
offence against the law — it was, he submitted, no defence to this
action. William Fletcher Thomas Brown, solicitor's clerk, of 21,
Bedford-road, London, stated that in consequence of instructions
which he received, and acting on. behalf of ihe solicitors of the
British Dental Association, he, on the 8th inst., went to the premises
of the defendant in Victoria-place, Eastbourne. Outside the
piemises on the house he saw aboard in the Seaside-road " American
Artificial Teeth Company ; Specialist, J. Flax, D.D.S.," and there
were other similar boards and paintings on the door post, &c. He
went up to the first floor of the premises, and there saw the
defendant, who was very frank with him. Witness said to him, " I
have called from the solicitors of the British Dental Association, with
reference to the boards you have downstairs and particularly the
letters you have on them 'D.D.S.' I said, we take them to mean
Doctor of Dental Surgery, and I presume that is what you mean by
them." The defendant replied, "Yes, I am entitled to use these
letters. I have my diploma as a doctor of dental surgery. You
may see it if you l:k°." Witness told the defendant that the
Association would prosecute him for using these letters, and the
defendant said " I am perfectly competent. I can do any class of
work. I don't wish to deceive the public or anyone." In proof of
this latter statement the defendant pointed out a no'. ice hanging on
the wall of the consulting-room, which set forth that the defendant
was duly qualified in America, and that he was also registered in
France, but that he was not registered under the Dentists Act of 1878.
The defendant then asked witness to go into the operating-room —
the " Chamber of Horrors," as Mr. Turner suggested — where
witness found a similar notice posted, and where there were an
operating chair, a case of instruments, and the usual appliances.
The defendant further said here that he had been a dentist in one
of the Parisian hospitals, and that he had been in Eastbourne about
six months. He also remarked that they used in England to
THE DENTAL RECORD. 315
recognise the diplomas of Howard and Michigan, but that they
didn't now. In cross-examination witness said he was not deceived
by the letters D.D.S. On the window was the word in large white
letters ''American.'' Mr. Macoun : Is not American dentistry far
and away above English dentistry ? Witness : I have no experience.
Mr. Macoun : Are you aware that every dentist, or nearly every
dentist, goes to America to study dentistry ? Witness : I do not
know. Mr. Turner : You admit that he is not on the register ?
Mr. Macoun : Oh, yes. In defence, Mr. Macoun pointed out that
the Act was passed for the protection of the public ; not for the
protection of registered dentists, because at the time the Act was
passed there was no profession of dentistry. The Bench also must
have evidence that the letters did actually deceive someone, and Mr.
Brown admitted that he was not deceived. Who was to be a judge
of what " D.D.S." implied. The Bench retired for a short time, and
on returning the Mayer said the case had been made out, and
defendant would be fined £^ and costs. Mr. Macoun gave notice of
appeal.
The following note on the use of Corrosive Sublimate as a fixing
reagent is published by Mr. S. E. Denyer, in the Giiyh Hospital
Gazette. — A saturated solution should be used ; this is best made by
putting excess of HgCl, into boiling distilled water, allowing it to
cool and crystallize, which ensures complete saturation at the then
temperature and pressure. It will be found that the addition of a
small quantity of sodium chloride — about one-eighth that of
HgCL — gives rather better results than the HgCL, alone. The
tissue should be cut into pieces not more than four mm. in thickness,
as the penetrating power of the HgClj is rnly two mm., or thereabouts.
Allow it to remain in the solution for from six to twenty-four hours,
according to the nature of the tissue. Those tissues which include
skin should not be left more than six hours, as they tend to become
/ery hard, and this causes trouble in cutting. Wash thoroughly in
water for twenty-four hours, then transfer to a mixture of Sp.
Vin. Meth. and water, equal parts, for twelve or twenty-four hours,
then to Sp. Vin. Meth. for two or three days. After this, dehydrate
with absolute alcohol, clear with toluol, and embed in paraffin.
316
THE DENTAL RECORD.
GENERAL MEDICAL COUNCIL.
Sir Richard Quain, President, in the Chair.
June ist, 1896.
The Registrar reported that — the prescribed conditions having
been duly fulfilled in each case — the names of the undermentioned
persons had been restored to the Dentists' Register, from which they
had been erased in conformity with the provisions of Section 12 of
the Dentists Act (1878) : —
Adams, William Gay, Daniel
Marston, Samuel
The following students were allowed to antedate their com-
mencement of professional study, their preliminary examination
having been fully completed before they commenced : —
Name.
Date of
Preliminary
Examination.
Date of
Commencment
of Professional
Study.
Date of
Registration.
Date to which
Student desired
to le
Antedated.
Blair, Daniel
Grewcock, William J.
Griffin, Robert Wm. ..
Henderson, Tliomas . .
Hodge, Edward H
Law, William J
McKendrick, Geo. B...
Millett, Robert Percy..
Rathbun, Charles J. ..
Searle, William R
Seccombe, Charles W.
Shearer, Walter C
Smith, Bernard
Talbot, Francis
Tomarinson, Maurice G
Uttley, Edgar P
Wilkinson, Charles E.
Oct.,
Dec.
June.
April,
Dec,
Jan.,
Sept.
Exempt
Exempt
Dec, '95
Sept., 'gi
March, '95
Dec, '92
95
93
95
93
95
93
93
June,
June,
June,
July,
95
•90
'95
'94
Jan. 6,
June 30,
Sept. 22,
June 14,
April 21,
June 6,
Oct. 18,
July 3,
May I,
Oct. I,
Nov. 9,
Mar. 18,
May I,
Oct., I,
Jan. 31,
Dec. 23,
Oct. I,
'96
'90
'94
'94
'84
'94
'93
'78
'73
'95
■95
'93
'90
'95
'93
'93
'94
April 13, '96
June 13, '94
Aug., 8, '95
Mar. 6, '96
May 30, '96
Oct. 3, '95
Jan. 15, '95
Jan. 16, '96
May 7. '96
May II, '96
April 29, "96
Dec. 6, '95
Feb. 21, '93
Mar. ti, 96
Dec 6, '95
Jan. 23, '96
May 8, '96
Jan. 6, '96
Dec. I, '93
June I, '95
June 14, '94
Dec. I, '95
June 6, '94
Oct. 18, '93
Jan. I, '94
May I, '91
Dec. r,
Nov. 9,
March,
Dec
Oct. 1,
Jan. 31, '93
June I, '95
Oct. I, '94
'95
95
95
92
95
/tine 6th, 1896.
Mr. Saunders had been summoned to appear before the Council
on Saturday, June 6th, at 1.30 o'clock p.m., to answer the following
charge as formulated by the Council's solicitor : —
*' That, being a duly registered dental practitioner, you act as
cover of and by lending your name and assistance enable an
unqualified and unregistered person named Miiller to carry on a
dental practice and to practise dentistry and dental surgery in all
respects as if he were a duly qualified dental practitioner."
THE DENTAL RECORD. 317
The Registrar read the following report received from the
Dental Committee on the facts in regard to this case : —
The case of Clement Henry Sanders having been referred to
them by the Executive Committee to ascertain the facts in regard
to such case, the Dental Committee find the facts to be as follows : —
(a) That Clement Henry Sanders was registered in the Dentists'
Register on August 13th, 1884, as having been in practice before
July 22nd, 1878, and his address in the Dentists' Register is 88,
Queen Street, Exeter.
(d) That a practice of dentistry for gain is carried on at S?>y
Queen Street, Exeter, in the name cf the said Clement Henry
Sanders.
(c) That Clement Henry Sanders has a dental surgery at
Okehampton.
{d) That Clement Henry Sanders canies on a dental practice
at Aldershot.
(e) That Clement Henry Sanders visits Exeter once every ten
days or a fortnight, where he sometimes remains for two or three
days at a time ; and that the practice at Exeter is carried on in his
absence by an unqualified person named Miiller.
(/) Mr. Sanders gave an undertaking to place a qualified
assistant in charge of the practice at Exeter and Okehampton at once.
Mr. Johnston Watson : I appear for Mr. Sanders. Mr. Sanders
is not here ; he has made a further affidavit. Possibly the better
way would be for me to make a few observations upon the report as
it was entered to the General Medical Council, as, of course, you
are all aware that report in fact is binding and conclusive, and the
facts which are found by the Committee are those facts upon which
this Council is asked to act. Now the charge which was preferred
against Mr. Sanders was a charge which was called covering
The President : May I interrupt you ? Are you going into the
merits of the case ?
Mr. Watson : No ; I cannot do that.
The President : Because if you are it may ultimately lead to a
very different result from what is here. It would be much more to
the point if you could tell us whether Mr. Sanders has carried out
the promise he made us at that m eting.
Mr. Watson : I will with pleasure. He has done so. I must
ask your forbearance for one monieiit. 1 do not propose occupying
318 THE DENTAL RECORD.
the time of the Council at any length. I was goirg to point out
that the charge which was preferred agains'. Mr. Sanders is nut the
charge which the Committee have found to be proved. I rrust
ask the Council kindly to bear that in mind when they come to
deal with the facts. The charge preferred against him was that
he permitted an unqualified and unregistered person named Miiller
to carry on a dental practice, and to practise dentistry and dental
surgery in all respects as if he were a duly qualified dental practi-
tioner. Now what the Committee have in fact found is not that
that charge is proved, or that the charge is true in fact against
him, but they have found that he did carry on himself, which is a
different thing to permitting anybody else to do it, a practice at
88, Queen Street, Exeter, and then in sub-section {e) of the report
that he himself visited Exeter once in every ten days or a fort-
night, where he sometimes remained for two or three days at a
time, and that the practice at Exeter was carried on in his absence
by an unqualified person named Miiller. I take it not that the
practice was ever carried on by Miiller for his own benefit, and
therefore he was not sheltered in any way by Mr. Sanders, but
that while Mr. Sanders was carrying on his business in Aldershot
or somewhere else, as he says he did part of the week, he permitted
Miiller, his assistant, who was unqualified, to take some part in the
business. I do not desire to say anything else on that. I wish to
draw your attention to another part of the report. I have here two
affidavits, one of which probably has been already before the Council,
filed by a page boy, Charles Avery, as to what occurred since the
hearing before the Committee. Members of the Committee may
remember that T, on the part of Mr. Sanders, who was in the room,
gave an undertaking that he would place a qualified assistant in
charge of the practice at Exeter and Oke' ampton at once, and I
think I am in a position to satisfy the Council, if any question arises
upon it, that he has done so. Of course, whether he did so or
whether he did not, cannot, I presume, affect his position except if
ihe Council think that the charge of infamous conduct is proved
against him when they might desire to know what his conduct has
since been for the purpose of giving him indulgence. Otherwise I,
of course, do not abandon the contention that there is nothing in
the report which, in the judgment of the Council, can amount to
infamous conduct in a professional respect in the finding. Now,
THE DENTAL RECORD. 319
then, as to what has occurred, which is only a question of fact,
Perhaps I had better refer first of ail to an affidavit filed by the
page boy, which shows there has been some delay, and, as to that
I have a reason for it. There has no doubt been delay, but Avery,
who was an errand boy at Exeter, made an affidavit on May 22nd
1896, which reached our hands very shortly afterwards, to the effect
that for ten weeks he was employed as page boy at 88, Queen Street.
Exeter, where Mr. C. H. Sanders carries on business as a dentist
" I left there on the i8th day of April last." May I remind the
Council that the hearing of this case was on February 25th ?
"During the whole of the time" — the boy apparently remained
there till April i8th, and had been there ten weeks before — " during
the whole of the time I was there the only persons engaged there
in connection with the business in addition to Mr. Sanders were
his assistant, Mr. Miiller, and his apprentice, William Delve, who
told me one day that he had been there about three years. There
was another apprentice there called Mr. Mann, but he left when I
had been there about a week. During the time I was employed at
No. 88, Queen Street, Mr. Sanders did not attend there on more
than four separate occasions, and on neither occasion did he stay
more than four days. I used to go to No. 88, Queen Street at
8 o'clock in the morning, and was employed there all day, leaving at
about 7 o'clock in the evening.
Upon that affidavit reaching the hands of the gentleman who
instructs me, Mr. Sanders was communicated with, and he has made
out an affidavit in which he sets out what he has done since
February 25th, and the difficulty he had in finding a registered
practitioner who was prepared to take his place at Exeter. That is
an affidavit sworn yesterday by Mr. Sanders, who is at Exeter, June 5th.
He is now at Exeter engaged in his {practice there. He says :
" Immediately after February 25th last, I took every step which is
usual and proper to carry out my undertaking. I at once entered
my name in the books of the Dental Manufacturing Company as
being in want of a qualified assistant, with the result that after the
lapse of about a week I had three or four names sent me, with whom
I at once communicated. The letters from the Dental Manufacturing
Company from the said gentlemen whf) appHed to me are at my house
in Aldershot, otherwise I should exhibit them to this my affidavit.
Within a fortnight or thereabouts I was in correspondence with a
320 THE DENTAL RECORD.
gentleman residing in Rochester, with a view of his joining me as a
partner to work the practice here and at Okehampton. That having
fallen through I carried on correspondence with Mr. George Gilbert
Liversidge, of 7, Romary Terrace, Greenwich, a registered dentist,
whose registration was effected in 1878, and ultimately engaged him
as an assistant here, to come on at the earliest possible moment,
which was on April 29th last, and on that day he entered upon his
duties here as my assistant, and continued to manage my practice
here and at Okehampton from that day until May 17th, when he left
to manage my practice at Aldershot, and I came to Exeter on May 1 8th
last, to manage and conduct my said practice here personally, and
have continued to do so during the whole period, and am no'v, and
have since the said May i8th, in my said house and premises, 88,
Queen Street, Exeter, and intend to so remain.
*' From February 25th to March 2nd I was in London or Aldershot,
endeavouring to engage a duly qualified assistant. On March 3rd " —
this is important because it apparently shows that the boy Avery's
affidavit is incorrect in this particular — " on March 3rd I came to
Exeter to manage my practice here in person, and from that time to
April 29th, I was in residence at 88, Queen Street, Exeter, on the
average of four days in each week personally attending and
managing my said practice here." You will remember that there
was a practice at Okehampton which he conducted at the same time
as the Exeter practice. ''I say that I have used every endeavour to
honestly and bond fide carry out my said undertaking, and have done
so and shall continue to do so in the future."
That is the affidavit which he has made, and as to the fact I
think there can be no dispute that at any rate since April 29th he has
had a properly qualified person carrying on his business there. Now
he has explained the short delay which arose between February 25th
and March 3rd. You will remember that the terms of the undertaking
weie that he would at once act, but of course he would have a
reasonable time given him to find a capable assistant within his means,
and a person who was properly recommended. On March 3rd he went
down himself, and he says between that date and April 29th he always
spent four days in each week on the average at Exeter. It was in
the contemplation of the Committee, I believe, but certainly in the
contemplation of the parties, that if he did put a person in at Exeter
he would also carry on business at Okehampton. Now T am upon
THE DENTAL RECORD. 321
that question of indulgence to which I made reference before, even
if the Committee were to think this report would justify their
taking proceedings against this gentleman, and striking him off the
Register, they would probably think under the circumstances that
he was entitled to have that indulgence which his legal advisers
certainly thought the Committee held out to him to some extent.
I suppose they would not have said a word about an undertaking
unless they were prepared to give due effect to any conduct on his
part since the 25th February. Under those circumstances I ask this
Council to extend to him any indnlorence which they think he is
entitled to, remembering that now he has acted in the way in which
the Council desires, that according to his affidavit there has been no
such delay as would disentitle him to have indulgence, and that
under those circumstances the Council would be properly advised
not to take any further steps against this gentleman.
Mr. R. W. Turner : In this case I appeared before the
Committee, and the case was brought before the Committee of the
Council by the British Dental Association, who at the time stated that
they did not desire to press in any way unduly the charge, but to lay
the facts before the Council in order that these dentists might learn
that the resolutions of the Council were not to be treated as a dead
letter. Now as to the facts of the case, I need not go into them, for
with all respect to my learned friend's argument there is ample on
the finding for the Council to find covering, if they desire to do so,
and to find infamous or disgraceful conduct. But I now come to the
question of the undertaking, because my friend has pointed out my
clients procured an affidavit from an errand-boy employed at Exeter,
which stated that this gentleman, Mr. Sanders, had not been there
in practice, but had left MuUer to do the pra:tice until he, the
errand-boy, left, on April i8th. In answer thereto it is extraordinary
that Mr. Sanders should have only filed this affidavit and should not
have been here to-day to attend to a case which must affect him so
materially ; and I think it will be within the recollection of the
Committee and those gentlemen who were there, that Mr. Sanders
stated that there and then there was somebody ready to go down into
the practice, and that person would go down there on the following
Monday. If they were the facts, why on earth should the
Committee find that he undertook to do this at once, if he wanted
reasonable time to hun»^ round for sotne assistant ? Those members
Y
322 THE DENTAL RECORD.
of the Committee who were there will bear in mind what was in fsct
said, and the Committee has found that he was going to do this at
once. What does he do ? He does not do it until April 29th, and
I beg to call the attention of the Committee to this fact, that his
solicitors wrote saying he was advised to give an undertaking to
employ a qualified man.
Mr. Johnston Watson : It is very awkward to go outside the
report. I have no knowledge of this letter.
Mr. R. W. Turner : With regard to Mr. Sanders' zeal to
employ a qualified man, this case was originally fixed to be heard by
the Council on November 25th, and was then adjourned till February
25th. Nothing was done in the meantime, and nothing has been
done until April 29th. It is a matter, of course, for this Council to
say whether this was complying at once, and whether or not, as I
understand is generally the case in these cases, an undertaking
would be given that such a person would in future conduct himself
in an honourable and professional manner — whether or not the
Committee can be satisfied with any such undertaking they might
have from Mr. Sanders, when it has taken him all that time to get a
qualified man, when one knows how many qualified men there are
about.
Strangers then, by the directions of the Council, withdrew ; on
their re-admission,
The President : I have to announce to the representative of
Mr. Sanders that the charge made against Mr. Clement Henry Sanders
has been proved to the satisfaction of the Council ; and the second
is, that the Council could take one of two courses — either at once
pronounce judgment, or postpone judgment until next session. It
is resolved that the further consideration of the charge against
Mr. Clement Henry Sanders be adjourned until the next session
of the Council in November, and the Council will then expect
Mr. Sanders to appear in person and give them a satisfactory
explanation of his past and present conduct.
June 8th, i8g6.
The Registrar read the following communication from the
Privy Council Oflfice in regard to the application of Mr. A. P. Merrill
for registration as a dentist, together with observations prepared in
reply :
THE DENTAL RECORD. 32»'^
(a) Letter from the Clerk of the Privy Council.
76,556. "Whitehall,
** February 2isf, 1896.
" Sir, — I am directed by the Lords of the Council to transmit to
you the accompanying copy of a petition of Mr. Alfred Perkin
Merrill, a dentist,. practising in Melbourne, in the Colony of Victoria,
appealing to the Privy Council against the decision of the General
Council of Medical Education and Registration of the United
Kingdom, not to place his name on the Dentists' Register, together
with a copy of an affidavit sworn by Mr. Merrill in regard to his
qualifications as a dentist, and I am to request that, in laying the
same before the General Medical Council, you will move that body
to furnish their lordships with any observations they may desire to
offer upon the appeal of Mr. Merrill.
" I am, Sir,
Your obedient Servant,
'* T/tc Registrar of the C. L. PEEL.
** General Medical Council."
{J}) Petition to the Privy Council.
." (Co//).
"To Her Majesty Queen Victoria, Her Heirs and Successors in
Her Majesty's Privy Council.
" The NiJith day of January^ 1896.
*' May it please your Majesty and the Right Honourable the Lords
of the Judicial Committee of the Privy Council.
'*THE HUMBLE PETITION of the undersigned Alfred Perkin
Merrill, of 52, Collins Street, Melbourne, in the Colony of
Victoria, Dentist, setteth forth : —
1. "That I am a registered dentist of the Colony of Victoria,
and I also hold the Diploma of D.D.S. of the Philadelphia Dental
College, U.S.A.
2. "I obtained the said diploma in the year 1866, and I was,
moreover, practising in the British Colonies years before the English
Dental Act came into operation, viz., for some months in Canada in
the year 1862, and in the Barbadoc^ in the year 1864.
3 " After obtaining the diploma of Doctor of Dental Surgery
(D.D.S.) at the Philadelphia Dental College, I practised as a dentist
at Montreal, Canada, for three months. Therce T wert to New
^' 2
824 THE DENTAL RECORD.
York, U.S.A., where I practised as a dentist for some years. I
became Secretary of the Odontological Society of New York, and I
was also Professor of Operative Dentistry and Dental Histology in
the North Western Dental College, Chicago. I resigned this
position on account of ill health.
4. "Though I am an American citizen by birth, I have spent
many years of my life in the British Colonies. I have lived for
years in Canada, and am fully acquainted with all English modes of
dentistry. I now hold a leading position as a dentist in Melbourne,
Victoria.
5. "Being desirous of being registered as a dentist in Great
Britain, I applied to the General Medical Council of Great Britain
for registration, and forwarded an affidavit (of which paper marked
' A ' is an exact copy) in support of my claims.
" 6. The General Medical Council refused my application, and I
forward herewith an exact copy of their reply (which was addressed
to my Solicitor, Mr. Ernest Joske), on paper marked ' B.'
7. "And I do myself the great honour to appeal against this
decision of the General Medical Council, and humbly pray that you
will in your wisdom and goodness direct such General Medical
Council to recognise my diploma and to register me accordingly as
a dentist of the United Kingdom.
" And your Majesty's humble servant will for ever pray.
"(Signed) ALFRED PERKIN MERRILL, D.D.S.
" Melbourne, Victoria,
^''January c^th^ 1896."
(c) Copy of Affidavit.
" I, Alfred Perkin Merrill, of 52, Collins Street East, Mel-
bourne, Victoria, make oath and say,
" That I am ^ Registered Victorian Dentist, and hold the
Diploma of D.D.S. of the Philadelphia Dental College, U.S.A.
"I obtained my diploma in the year 1866, but I was previously
to that year practising as a dentist in the British Colonies, viz. :— In
the Barbadoes, where I followed my profession as a dentist for close
on twelve months, and previously to that I was for some months
practising as a dentist in Canada.
"Upon obtaining my diploma of D.D.S., I practised as a dentist
in Montreal, Canada, for three m.onths I proceeded thence to New
THE DENTAL RECORD. 325
York, where I practised as a dentist for some years. I was formerly
Secretary of the Odontological Society of New York, and I was also
appointed Professor of Operative Dentistry and Dental Histology in
ihe North Western Dental College, Chicago. I resigned this
position owing to ill-health.
'* I have spent many years of my Hfe in the British Colonies, and
am fully acquainted with all English modes of dentistry. I conduct
my practice in a strictly professional manner.
"■ I am a naturalised subject in Victoria of Her Majesty, Queen
Victoria.
" (Signed) ALFRED PERKIN MERRILL.
Sworn before me this
20th day of February, 1894.
'* Signed) William Francis, J.P "
(r/) Observations in Reply, by the Council's Legal Adviser.
" (i) The 8th Section of the Dentists Act, 1878 provides that a
person who is not domiciled in the United Kingdom, and shows that
he holds some recognised certificate (as defined in the Act) granted
in a British possession, and that he is of good character, is to be
entitled without examination in the United Kingdom to be registered
as a Colonial dentist.
** (2) The 9th Section of the same Act provides that where a
person who is not a British subject shows that he obtained some
recognised certificate (as defined in the Act) granted in a foreign
country, and that he is of good character and continues to hold such
certificate, is to be entitled without examination in the United
Kingdom to be registered as a foreign dentist in the Dentists'
Register.
" (3) By Section 10 of the Act the certificate granted in a British
possession, or in a foreign country, which is to be deemed such a
recognised certificate as is required for the purposes of registration is
to be such certificate, diploma, membership, degree, &c , or other
title, status or document as may be recognised for the time being by
the General Council, as entitling the holder to practise dentistry or
dental surgery.
'* The following facts, in relation to the application of Mr. Merrill
for registration are materia! for the purposes of inquiring whether
he satisfies the foregoing statutory conditions.
326 THE DENTAL RECORD.
''(4) In the year 1862 and 1864, Mr. Merrill, being at the
time an American citizen, practised dentistry in Canada and
Barbadoes.
'' (5) In 1886 Mr. Merrill obtained from the Philadelphia Dental
College his diploma of D.D.S., and consequently for some years prac-
tised as a dentist in New York.
''(6) In the month of April, 1890, Mr. Merrill was registered in
the Dentists' Register of the Colony of Victoria, and, at same date,
which is not stated in the papers, Mr. Merrill became a naturalised
British subject in Victoria.
" (7) As regards the American diploma held by Mr. Merrill in
the year 1879, the General Council caused very full inquiries to be
made in reference to the courses of study and examinations required
by several of the Foreign and Colonial Dental Colleges and Institu-
tions, with a view of ascertaining whether the certificates or
diplomas of those institutions furnished sufficient guarantees of the
possession of the requisite knowledge and skill for the efficient
practice of dentistry, and amongst the diplomas or certificates which
were the subject of inquiry were those granted by the Dental
College of Philadelphia. The General Council ascertained that in
this institution, as in several others, there was no preliminary
examination, that two years only of professional study were required,
and that the examination in each was conducted solely by the teachers
and officers of the institution. The General Council, therefore,
having regard to the requirements which are necessary for diplomas
in dentistry in the United Kingdom, which comprise a preliminary
examination and four years of professional study, felt unable to
recognise the certificate of the Philadelphia Dental College as one
which ought to entitle the holder to registration as a foreign
dentist in the Dentists' Register.
*' (8) As regards the registration of Mr. Merrill in the Dentists'
Register of Victoria, the General Council have not hitherto been able
to recognise that a person who is so registered, but who does not
possess any Colonial diploma or licence, is the holder of a certificate
which furnishes sufficient guarantees of the possession of the
requisite knowledge and skill for the efficient practice of dentistry
or dental surgery.
" (9) Mr. Merrill apparently is applying for registration as a
Colonial dentist and not as a foreign dentist. The possession of the
THE DENTAL RECORD. 327
foreign diploma, even if it were recognised, would not entitle
Mr. Merrill to be registered under s. 8 of the Act as a Colonial
dentist.
'•(lo) The only qualification therefore which Mr. Merrill
possesses on which he can found an application for registration as a
Colonial dentist, is the fact that he is registered in the Register of
Victoria. But as already stated the General Council have not been
able to, and do not recognise registration in this Colonial Register
as of itself entitling an applicant to be registered under ss. 8 and lo
of the Act.
"March 20th,. 1896."
Sir William Turner : After that statement I have to move the
following motion : — '' That the observations by the Council's legal
adviser on the petition of Mr. Alfred Perkin Merrill, be forwarded
to Her Majesty's Privy Council as the answer of the Council to his
appeal."
Mr. Wheelhouse : I beg to second that.
Dr. MacAlister : I should like to suggest a verbal change, so
that it will read — '' That the observations prepared by the Council's
legal adviser on the application of Mr. Alfred Perkin Merrill, be
adopted and forwarded by the Council to Her Majesty's Privy
Council,"
The resolution as amended was agreed to.
June ()thj 1896.
The following Report was received from the Dental Education
and Examination Committee on a communication from the British
Dental Association, referred by the General Council to that
Committee on November 29th, 1895 {Mimctcs^ vol. xxxii., p. 143).
" British Dental Association,
''^ (^Incorporated June 'i^rd^ 1880),
" 40, Leicester Square, London, W.C.
** November 2^th, 1895.
" Dear Sir, — I beg to submit the following matter of urgency to
the attention of the Medical Council at its present Session.
'* Joseph Stromier, of Glasgow, having obtained the D.D.S.
diploma of Michigan University, U.S.A., presented himself, last
October, for examination at the Faculty of Physicians and Surgeons,
Glasgow, for the L.D.S. Diploma. He submitted as his denial
328 THE DENTAL RECORD.
curriculum that of the Michigan College, and upon that curriculum
he was admitted to the L.D.S. examination of the Faculty. He
failed in the examination, but it is his intention to present himself
again in April next.
" The point I wish to draw the Council's attention to is this —
the Faculty of Physicians and Surgeons, Glasgow, accepted the dental
currictilum of Michigan, a curriculum no longer recognised as satis-
factory by the Medical Council, in lieu of their own, and admitted
Stromier to examination. In doing so, I venture to submit that the
action of the Glasgow Faculty is idtra vires^ and I beg the Council
to take steps, as they may deem necessary, to prevent a recurrence of
such action.
'' I am, dear Sir,
" Yours truly,
" W. B. Patterson,
'' W. J. C. Miller, Esq., Registrar.^' " Hon. Secretary.
In answer to an inquiry sent by the Registrar, the following
explanatory communication was received from the Faculty of
Physicians and Surgeons ot Glasgow in reference thereto : —
" Faculty of Physicians and Surgeons,
'* Glasgow, April 28M, 1896.
'' Sir, — I have to acknowledge receipt of your communication of
yesterday, with a printed copy of a letter from Mr. W. B. Paterson,
Honorary Secretary of the British Dental Association, of date
November 25th, 1895, addressed to you as Registrar of the General
Medical Council, in which complaint is made regarding the alleged
action of this faculty in admitting to the examination for the
Licence in Dental Surgery, Mr. Joseph Stromier, inasmuch as by so
doing they accepted the Dental Curriculum of Michigan University,
such action being stated to be ultra vires.
" The facts of the case, as gleaned from the Faculty records, are as
follow : —
" (i) By letter of d^te August 31st, 1895, Mr. Stromier intimated
to me his intention of entering for the L.D.S. Examination, at the
same time submitting evidence that he had passed a recognised pre-
liminary examination in 1891, and that he had been registered as a
dental student by the General Medical Council in January, 1892.
1
THE DENTAL RECORD. 329
In his letter he applied for exemption from examination in anatomy,
physiology and chemistry, in consideration of his possessing the
dental degree of Michigan University. On September 3rd, 1895, he
was informed by letter that his claim from exemption from any part
of the examination was disallowed ; and on September 28th he
entered for the first examination only, having duly submitted
evidence that he had attended the courses prescribed for the examina-
tion. He failed to satisfy the examiners, and was remitted to his
studies for six months.
" (2) On March 28th, 1896, he re-entered for the first examina-
tion, at the same time entering provisionally for the second
examination, that is, conditionally on his passing the first
examination. In doing so, as required by the regulations, he
submitted the schedule of his entire course of study, of which the
period of three years and nine months were certified as attended at
the school of Ann Arbor, being that of the University of Michigan,
and six months in Glasgow, all the entries being attested by official
signature, in the schedule, or by the production of separate certifi-
cates. The course of study, as thus certified, was in several
particulars in excess of the present requirements of 1882, when he
began study. On this occasion he passed both the first and the
final examinations, and was enrolled as a Dental Licentiate.
'' (3") Mr. Paterson alleges that the action of the Faculty, which
has been here stated in detail, was ttltra vires^ but he does not state
how it was so. The only resolution of the General Medical Council
which may be said to have any bearing on the matter appears to bi
that contained in vol. xxx. (p. 84) of their minutes, suspending till
further notice registration of the certificates of the dental degrees of
two American institutions, one of them bei.ig Michigan University.
But, as I have stated, the candidate in question obtained no advan-
tage at this Board from his possession of the Michigan degree, li
this respect therefore there has been no violation of even the spirit
of the resolution of the General Medical Council. It is true that
the larger portion of his professional education was obtained in the
school of that institution ; but the Faculty are not aware that either
as regards medical or dental education the General Medical Council
have passed any resolution limiting the discretion of the qualifying
bodies in regard to the recognition of schools either outside or
within the United Kingdom. If any such limiting instructions have
330 THE DENTAL RECORD.
been issued, no copy of them appears to have reach the Faculty ;
and the General Medical Council have only to draw the attention of
the Faculty to them to secure their being carried into effect.
"I am, Sir,
'* Yours obediently,
" Alexander Duncan, Secretary,
'' W. J. C. Miller, Esq., B.A.,
'''' Registrar of the General Medical Council.''''
The Dental Education and Examination Committee have
considered the communication from the British Dental Association,
dated November 25th, 1895, respecting the case of Joseph Stromier,
with the explanatory communication of the case received from the
Faculty of Physicians and Surgeons of Glasgow, dated April 28, 1896 ;
and they beg to report that they do not find that there has been any
irregularity in the action of the Faculty with respect to the candidate
named, seeing that he was only admitted to Examination for the
L.D.S. on submitting evidence acceptable to that Faculty that he
had duly attended the courses prescribed for the examination.
Thomas Bryant, Chairman.
Mr. Bryant : There is not much to relate to the Council upon
this. There was a certain letter written to us by the British Dental
Association, which was referred by this Council to the Committee.
It is in respect to the Faculty of Physicians and Surgeons ot
Glasgow, who have been accused of doing what they ought not to
have done, but they gave such a very satisfactory answer that the
Committee report as you see by the print. The accusation was
evidently made in error, so that I hope the report will be accepted.
I move : " That the report from the Dental Education and
Examination Committee in regard to a communication from the
British Dental Association be received, approved, and sent to the
Faculty of Physicians and Surgeons of Glasgow, and to the British
Dental Association."
Sir William Turner seconded.
The motion was agreed to.
The Registrar : The next business is an application from
Mr. J. D. Whittles (registered as Licentiate in Dental Surgery of
the Royal College of Surgeons of England, 1892), who wishes to be
I
THE DENTAL RECORD. 331
present at the dental examination ot the Royal College of Surgeons
in Ireland, in the same way that he has frequently been present at
the examinations of the English College.
" Mason College, Birmingham,
''April 25, 1896.
'' Dear Sir, — You will notice that I have been asking permission
to be present at the dental examination (from the enclosed letter)
to be held in about fourteen days hence in Dublin, and I should feel
grateful if you would send me the necessary permission.
'' I have been in the habit of being present at all the dental
examinations in London for the last four years, and as I hold a
Lectureship at the Birmingham School of Medicine, consider that I
am entitled to be present.
" Your kind attention will be greatly esteemed by,
" Yours faithfully,
" J. Dencer Whittles.
" W. J. C. Miller, Esq., B.A., Registrar ^
'* Royal College of Surgeons in Ireland, Dublin,
''April 20, 1896.
" Dear Sir, — With reference to your letter of April i, I am
directed to inform you that our examinations are only public to our
own Fellows and Licentiates and visitors accredited from the
General Medical Council.
" Yours faithfully,
'^RoB. H. Woods, F.R.C.S.,
" Sec, of Council.
'' Dkncer Whittles, Esq., L.D.S.,
" Mason College, Birmingham.''
The President desired me to lay it before the Council because he
thought it should be answered by the Council and not by the
Registrar him.self.
Sir Wm. Turner : I submit that this is not a case we have any-
thing to do with. It is a matter entirely within the Institution
itself whether it will admit A, B or C to its examination. It has
nothing to do with us.
Mr. Wheelhouse : I will move : " That the subject is one on
which the Council cannot interfere."
Sir William Turner seconded t!ie motion, which was acjreed to.
332 THE DENTAL RECORD.
THE X RAY AND ITS APPLICATION IN DENTISTRY.
By William James Morton, M.D., New York, N.Y.
Historical.
As far back as 1819 the illustrious Faraday, after pointing out the
familiar classification of matter into solid, liquid, and gaseous, ad-
vanced the then remarkable hypothesis that a further and fourth state
existed, and this he termed -'radiant matter." In 1879 Professor
William Crookes recalled this speculation and in a series of epoch-
making papers and experiments demonstrated that, apparently,
matter actually did exist in a fourth state or condition which was as
distinct " from the state of gas as a gas is from a liquid."
Up to Crookes's time vacuum tubes whose vacua were com-
paratively low were in familiar use, they were called Geisler tubes.
Crookes increased the vacuum and rearranged the entering electrodes,
and thus sprung up the now familiar Crookes tubes. He ascertained
by the employment of high vacua these remarkable facts :
That in high vacua the molecules of matter, instead of being so
close together that their mass was practically continuance, were so far
apart and so few that they might be regarded individually. Such
molecules actually seem to have what Crookes termed a " mean free
path." That is to say, they were able to be thrown across the
vacuum tube from the poles with incredible velocity and great force,
moving with but few or no collisions with each other and striking
the sides of the glass to cause it to become heated and to exhibit
vivid fluorescence. The effect of the projection of the molecules of
air may be compared to a hail-storm, or to a bombardment by extra-
ordinary fine shot. Crookes's radiant matter proceeded in straight
lines, cast shadows of interv^ening objects, and could be deflected by
magnets.
The work of Crookes has furnished the splendid inspiration for
all that has followed in relation to the electric phenomena exhibited
in high vacua. Some years later on Hertz restudied the Crookes
tube effects, and Lenard, his pupil, discovered that the radiation
from the tube was capable of exciting fluorescence outside of the tube,
and of showing the presence of opaque objects in closed boxes upoa a
fluorescent screen. But sach purely physical experiments attracted
little attention outside of strictly scientific circles. It remained for
Roentgen to make the sensational announcement that the bones of
the living body might be photographed, so to speak, and at once the
radiation from a Crookes tube became a wonder.
The scientific world is yet at a loss for a theory to account for the
Crookes tube effects. R)antgea himself modestly termed it the
*' X, or unknown ray." Whether it is a ray at all is doubted.
Opinions are divided largely into two camps, the one considering the
X ray to be a vibration, transversal as in the case of light, or longi-
tudinal as partly inclined to by Roentgen ; the other, adopting the
Crookes, or English view, that it is a stream of electrified particles
THE DENTAL REroRD. 383
moving at a high rate of speed. It is on the whole doubted if the
rays are Hght in any ordinary acceptation of the word. Edison and
( thers think it to be of the nature of sound waves.
And thus the battle and conflict of opinion as to the nature
of the X ray progresses. Man chafes under restrictions to his
knowledge, and out of this mental restlessness come the great
achievements of science and the final ameliorations of hardships and
suffering to the entire race.
I will refer very briefly and concisely to the apparatus, — I will
not say necessary to produce the X ray, but to the apparatus which
I personally have found essential to produce it. A great diversity
of opinion exists as to what you need. One man will talk of one
form, and one of another. I am presenting lo you to-night what I
have found to be a good working combination. The X ray may be
produced by the aid of an influence machine, and one might have
been brought here to-night, where it is essential to use it ; but it
seems that we must produce our work with the induction coil. I
was obliged to devise a tube of my own, which worked very well,
because I had no Crookes tube. I put on the cathodic end a disk
of aluminum, and on the anodic end also an aluminum disk. The
anodic aluminum disc did not intercept the ray, and, more than
that, it seemed to direct it and bring it down to a point. I
produced some very good pictures of the hands and feet. I do not
know but some time we may go backward and make use of this
after all. The best form of apparatus is some form of the
Ruhmkorff coil. As you use these vacuum tubes their vacuum
increases, that is to say, it becomes more and more difficult to
induce the current to go by the pathway (ji the inside of the tube,
and after a while the vacuum rises to a point where the current will
jump through the air space rather than go through the tube. It is
well to get a spark coil of about six-inch spark. This one has a
length ot about four and one-half inches.
As to the Crookes tube, it seems many of them can now be
obtained. I have here some interesting ones made by Hicks, of
London. These are of the recent type, known as the focus tube.
When we began and the fluorescence played like a stream of water
against the tube, there was no definite picture, and everything was
blurred. To a certain extent that was obviated by using diaphragms
with apertures made in them ; to another extent it was remedied by
placing the Crookes tube at a greater distance from the object ; but
a greater distance from the object means a vastly increased exercise
of power, and to-day we lack the power to do the work as it should
be done. I have always believed that Mr. Tesla would be the one
to exhibit the Crookes tube or some form of the X ray radiation
with extraordinary power, such power as to extend to great distances,
and so it has proven. He has produced effects with greaier power
than any one else in the world, probably. Mr. Swinton,of London,
has also produced some very powerful effects ; but even with such
limited powers as amateurs like myself possess, we are able now to
see through the huinaii body with absolute ease.
I believe these tubes art; a step in the direction in which we
must all work. They are called in this country " reflecting tubes."
334 THE DENTAL RECORD.
They have two electrodes, one the cathode, a concave mirror, atid
the other the anode, a flat disk of platinum. The cathodic stream
is so arranged that it impinges upon the platinum and intercepts
this stream, and the X ray is thrown off in every direction anterior
to its plane. I call all these tubes '' spatter tubes," simply because
the effect is exactly as if you would turn a hose pipe with a strong
stream of water against a wall. The water scatters in every direction
and some of it comes back. If you look with your fiuoroscope
behind this little piece of platinum, there is a dark area, showing
that the radiation comes off from the plane surface.
I would advise any one who is going to buy the tubes to get the
focus tubes. Wiih them you get a most beautiful definition of your
object.
When I use the term "fiuoroscope" I presume every one is
familiar with what is meant, still a word of explanation mioht be
important. As I mentioned some time ago, it was long since
observed that fluorescent substances outside of the Crookes tube
were excited to activity b}' the radiation from the tube, but it was
not then called the X ray. As soon as the X ray interest spread
over the world people tried to find all the different forms of detection,
and no one was more energetic than Mr. Edison. We all began
with photography, which is only another form of detection of the
X ray. It is supposed that the silver on the plate is excited into a
state of activity in such a way as to set up the chemical action that
is usually set up by light. The fiuoroscope is only another detection
of this ray. In order to bring it to a point where it could be used
in the medical profession, because this X ray seems to be most
useful to doctors, Mr. Edison stated the property of the different
fluorescent substances. He announced that the tungstate of calcium
was the riiost fluorescent substance he found. Some friends and
associates of Mr. Edison at Menlo Park, Messrs. Ailsworth and
Jackson, took up the practical manufacture of the screens, and to
them we are indebted for the us3 of this large screen before you.
The crystals of calcium tungstate were at first coarse. As skill
has progressed the crystals have been produced finer and finer, until
here the surface is almost as smooth as enamel ; and there is a
purpose in getting it as smooth as possible.
In this connection I wish to read a special bulletin that
Mr. Edison sent out from his laboratory when our representative
visited him in the interests of our profession. He says : — ** I find by
manipulating the coil, the break and the rate of break, that the
form of the wave can be changed ; crystals that fluoresce strongly
with one kind of wave are weakened when the wave is changed,
while other crystals increase, notably mercury diphenyl, which
scarcely fluoresces with one form of wave, but comes out strongly
when the wave is changed."
If you give any thought to the effects of the X ray on a photo-
graphic plate or a fluorescent screen, you will find that there is a
great amount of truth in what Mr. Edison has stated in this brief
communication. I often notice in working that I may get a
beautiful effect on the fiuoroscope and a very poor effect on the
bromide of silver plate. Sometimes I think I get a very poor
THE DENTAL RECORD. 335
exposure, but when I develop the plate I f\m\ a very excellent
development. Sometimes apparently the waves are longer and
sometimes shorter. There is a particular ray adapted to certain
substances which are to be excited by them or put into a state of
fluorescence In that connection the sensitive plate that one uses is
of great importance. I have tried nearly all the plates, and am
informed by Professor Goodspeed, of the University of Pennsylvania,
that Mr. Carbutt, of Wayne Junction, near Philadelphia, is making
a plate that is very well adapted to this work. Every one wants to
do this work well, to do it quickly, to get good definition and strong
negatives. The question of speed largely depends on the plate you
use. I have taken different objects and placed them upon a large
plate, and, in my interest to see what the X ray was doing, have
gotten under the table with the fluoroscope and looked through the
plate and the object, and then developed that plate and found
absolutely nothing upon it. The trouble, I think, was in the
sensitive plate itself. I have found films to be very sensitive to the
X ray. That was of particular interest to us, in regard to dental
applications, because in taking manv of these pictures in the mouth
it is important to use the film. For making X ray pictures of
living tissue containing teeth, the film is important. The way I
devised was to cut a pattern in gutta-percha or cardboard, or
anything that the patients could wear in the mouth without gagging
too much ; if they gag too much I use the cocain spray. Having
cut this pattern, I took it into the dark room and cut the film in
the same shape and folded it into three folds of papqf , and then ran
it into a pocket of guttapercha tissue and adjusted it to the roof of
the mouth. The picture could be taken almost instantaneously. I
say " almost " instantaneously, because that depends on the workings
of your tube. Any area of the mouth could be depicted by the
X ray in that simple manner. The use of the glass plate of course
would present considerable difficulty.
Sometimes the vacuum of the Crookes tube is good, and some-
times bad. There are times when its force is wondrous, and thirty
feet away you can detect the X ray ; and at other times you can get
nothing out of it.
You will find that the lithographic princs in publicati >ns are very
inferior to the photographic prints, and what is more pointed still,
the photographic prints are vastly inferior to the negative. The real
beauty of the X ray work is only to be found in the negative itself.
Ai I'LicATiONS IN Dentistry.
And now, gentlemen, a few final words as to the applications of
what we have seen.
The application of the X ray will, I believe, greatly aid the art of
dental surgery. In general surgery it is difficult to over estimate
the importance of ascertaining the exact outlines of imbedded bones,
of foreign bodies, to differentiate between a dislocation or a fracture,
or to ascertairi the co-existence of boih. The X rav already makes
these cardinal issues an open book ; it does more, it locates tuberculous
deposits now known to frequently invadj the osseous tissue and to
be impossible of detention except by exploratory incisions ; it locates
also sarcoma and accompanying erosions of the bone within the
336 THE DENTAL RECORD.
narrow cavities, and it is more than possible that, thanks to the labors
and the practical mind of Edison, these triumphs of localizing and
diagnosticating records upon photographic plates will be supplanted,
at least for quick and ready examinations, by the new art of X ray
fluoroscopy. It was one thing to note that flourescent substances
outside of a tube were excited, it was quite another to find a working
fluorescent substance and build it into a practical screen. This
Edison did, and the efficacy of this screen and its revelations grow
apace ; its definition and degree of illumination increase week by
week. Tesla already reports that he has seen through three men,
that he has seen the great bones of the body, and seen the heart beat.
Again and again I have looked through the human body and seen
not onlv the vertebrae, the ribs, the hip-joint, but also located larger
nnd denser organs like the liver ; nay, more, I have watched the heart
ill its beatings. Who could guess to what lengths the visual explora-
tion of our interior organization may reach when so much is already
possible ?
This enumeration, brief as it is, is a great triumph for the X ray,
and these same questions of diagnosis and of localization are equally
applicable to dental surgery.
The radiographs presented to you here to-night are but a first
step towards taking pictures of the living teeth. They open out to
your view a wondrous field for investigation and study and diagnosis.
Each errant fang is distinctly placed, however deeply embedded
within its aveolar socket ; teeth before their eruption stand forth
in plain view fl an unsuspected exostosis is revealed ; a pocket of
necrosis, of suppuration, or tuberculosis is revealed in its exact
outlines ; the extent and area and location of metallic fillings are
sharply delineated, whether above or below the aveolar line. Most
interesting is the fact that the pulp-chamber is beautifully outlined,
and that erosions and enlargements may be readily detected. A new
method of studying pathology in the living subject is laid before you.
To what perfection, gentlemen, may not the science and art of
dentistry reach if some of the new things which press upon your
attention are fully realised. Already painless dentistry is within your
grasp bv aid of eleclricity and simple anaesthetics, and now the X ray
more than rivals your exploring mirror, your probe, your most
delicate sense of touch, and your keenest powers of hypothetical
diagnosis.
Strange to say, both advances are poured forth to you from the
fertile lap of electricity. It behoves you to be up and doing in this
matter ; and if the seed here sown to-night shall bear fruit I shall be
more than glad that it has been my good fortune to have called to
your attention the new and wondrous field of investigation opened
out to your view by the discovery of the X ray. — Dental Comos.
ANSWER TO CORRESPONDENT.
Geo. a. Sullivan, Albany, New York. — The annual meetincr of
the British Dental Association will beheld in London, August 12th,
13th, 14th, 15th. It is the important meeting of the year of British
dentists. Cataphoresis has not attracted much attention.
Mr
ILLUSTRATIONS OF
DOUGLAS E. CAUSH'S PAPER
Fig. 7.
Section of tooth where tissue has been slowly
deposited. As it is perfectly calcified there
are few lacunae ; a shows point of re-absorption ;
b a similar excavation with osteoclast in situ.
Fig. 8.
This section shows — u thickened alveolar dental
membrane; b new tissue deposited in excava-
tions produced after exostosis has commenced.
Fig. g.
This section shows the way in which inostosis is
produced ; a is osteoclasts in situ.
Fig. qa.
Similar to the last in a later stage with the semi-
lunar spaces ; a filled with cemental tissue ;
b cavity containing softened tissue.
Fig. io.
This section shows inostosis after exostosis has
taken place.
Fig. II.
This section shows absorption of cementum and
dentine by alveolar abscess.
Fig. 12.
Deposition of new tissue at a in large cavity
produced by alveolar abscess.
Fig. 13.
Shows canal passing through the dentine at right
angles to the pulp canal, and lined with
cemental tissue.
The dental RECORD.
Vol. XVI. AUGUST 1st, 1896. No. 8.
Original (Unntmunirations,
EXOSTOSIS.
By Mr. Douglas E. Caush.
( Continued from page 2g2.)
Should the deposition of any one portion of the tissue be more
slow than that of the surrounding tissue the same thing occurs, we
get more perfect calcification of the cementum at that point. It is
not an unusual thing to find a large number of lacunae with their
canaliculi formed immediately after the preceding time of rest,
these gradually becoming less in number until there is another time
of rest, so giving some idea of the way in which the tissue has been
developed. Instead of the new tissue being deposited in this way,
it is sometimes found that there are osteoclasts again developed in
the alveolar dental membrane, and these absorb a portion of the
newly deposited tissue previous to a fresh formation, leaving
semi-lunar markings upon the outer edge of the tooth. Should the
tooth be extracted at this stage of the development and a section
made it will appear somewhat as seen in Fig. 7.
If, instead of the tooth being extracted while in this condition it
continues in the mouth, after the acute attack of periostitis cemento-
blasts are again developed in the membrane, and a fresh layer of
cementum is deposited. (We have a good illustration of this change
as seen in the section Fig. 8.) So these changes may continue for
months, or even years, and leave behind them indelible markings
in the tooth thus affected.
Instead of all or any of these changes taking place the point of
absorption may be very much restricted, or the absorption may
commence at that part of the root where the calcification of the
original tissue has been very imperfect, and as a result of this a deep
yet restricted area of absorption takes place. This goes on until it
z
338 THE DENTAL RECORD.
reaches the intergranular layer of the dentine, and here, frequently
at the point where the absorption has reached the dentine, is a
portion of softened or uncalcified tissue, this is rapidly dissolved
away by the osteoclasts, and a yet deeper and somewhat semiluna-
shaped cavity is produced. As soon as the more dense tissue oppose the
osteoclasts they cease their functions, and after a time new tissue,
cemental in character, having an abundance of lacunae and canaliculi,
is produced, and the whole of the space previously produced by the
absorption is filled with cementum.
The great difference between this and the absorption seen in
the earlier stages of exostosis is the definite line of demarcation
produced thus, both in the cementum and dentine, as contrasted
with the irregular line of absorption as seen in exostosis. Mr. Geo.
Henry,- of Hastings, was, I believe, the first to draw attention
to this alteration of the tissues, and gave to it the name of
Inostosis. Fig. 9.
So far as my microscopic slides show, this foim of absorption
takes place much nearer the neck of the tooth than exostosis usually
commences, and T think this may be one explanation of the cause
of the restricted area of absorption^ all the tissues being more
dense near the neck than at or near the apex of the tooth, it is,
therefore, only when the inflammation of the alveolar dental
membrane occurs over an imperfectly calcified portion of the tooth
that the absorption takes place.
I have also a number of slides showing that this form of
absorption sometimes takes place after there has been a certain
amount of exostosis, the absorption passing through the deposited
cemental tissue into the dentine, and in the space thus produced
another layer of cementum is deposited, similar in character yet
with a perfect line of demarcation, showing that this must have
occurred after the deposition of the tissue called exostosis has taken
place. In some cases I have no doubt this absorption is the result
of a very severe attack of periostitis. Fig. 10.
We must be careful not to confound these markings with those
produced by the more acute form of inflammation and suppuration
known as alveolar abscess. Wherever there is a chronic abscess
near or pressing upon the roots of the tooth we have absorption,
and this absorption is, as a rule, more general and covers a larger
area than in those cases known as inostosis. In these cases it is not
THE DENTAL RECORD. 339
at all unusual to find not only the cementum absorbed away but the
absorption may have gone on into the dencine as in Fig. ii, and in
some extreme cases we have found the absorption has not ceased
until the pulp canal has not only been reached but even a portion
of that has been also absorbed away. Again, in some of these
cases, nature appears to have tried to produce a remedy by depositing
in these extreme cases of absorption new tissue still cemental in
character. Fig. 12.
In exostosed teeth it is not at all an unusual thing to find the
canaliculi of the lacunae of this new tissue anastomosing with
some of the finer branches of the tubuli of the dentine, and thus
forming a network of minute canals from the alveolar dental
membrane to the pulp canal, these canals are I believe used
for the purpose of conveying nourishment to the dentine as
well as to the cementum, where the pulp is either dead or in
that condition that it is unable to supply the necessary nourish-
ment to the tissues ; I have also found in many cases, where there
has been a large deposition of new tissue, that this new tissue has
enclosed within it a number of canals passing in different directions,
these canals usually have living membranes, and to all appearances
are blood vessels of the alveolar dental membrane ; in these cases it
would appear as if it were easier for the new tissue to be deposited
around the vessels than to either stop them up by restrictions or to
get rid of them by the absorption of their walls.
There may also found at times canals of quite another
character, passing directly from the pulp canal, at right or acute
angles to the canal through the dentine into the cementum ; in this
case the contents of the canals are similar in character to the pulp
itself, and may be the cause of grave complications when the pulp is
being destroyed, as it is not at all unusual to find the canals have
large openings on the outer side- of the cementum allowing the
exit of any drugs that may have been placed in a carious tooth for
the purpose of destroying the pulp. In some cases I have seen
these canals enlarged and a layer of cementum lining the cavity
of the pulp and surrounding the canal as in Fig. 13.
To treat of the external contour ot exostosed teeth fully would
not only be out of place, but it would be quite impossible in a paper
of this kind, as the variations are so great, owing to the difference in
the shape of the roots, of the amount of tissue deposited, or of
Z2
340
THE DENTAL RfeCORt).
variations of the deposit. Though we have no two teeth in which
the new tissue is deposited in quite the same manner, yet there are
teeth we may look upon as being in some measure typical in the
deposition of the new tissue ; thus, we may have this tissue deposited
at or around the apex of the root, as in a, Fig. 14, causing destruction
of the pulp by compressing it, and as a consequence though the
deposit may be small in quantity yet the pain would be very acute,
or there may be a gradual expansion of the tissue at the apex and
gradually and evenly spreading in a regular manner towards the
crown of the tooth, but diminishing in thickness as it approaches
the latter, b, Fig. 14, this may form a cap at the apex of the root or
continue to spread until two or more roots of an upper or lower
molar are entirely enclosed by the tissue, c. Fig. 14.
Fig. 14.
" Diagramatic '' a b c way in which the new tissue spreads externally ; d nodular
exostosis.
It is a very unusual thing to find the roots of two teeth united by
exostosis, though the most common form of exostosis is to find two
or more roots of the one tooth united.
I think this may be accounted for by the fact that the changes
taking place in the alveolar dental membrane are usually in that
portion of the membrane nearest the cementum, the portion of the
membrane nearer the alveolus is not so easily acted upon, and is less
active than the surface attached to the cementum ; should the
alveolus, as a result of the large increase of the cemental tissue be
entirely absorbed away between the roots, and as a consequence the
THE DENTAL RECORD. 341
two surfaces touch each other, even at this point there is a double fold
of the membrane which is continuously lubricated, and there is a more
or less continuous movement over each other during the process of
mastication, this, with the continual movement of the teeth in the
jaw, prevents any union of two or more distinct teeth in either
jaw.
Of course, there may be exceptions to this rule, and occasionally
the roots of two adjoining teeth are united by exostosis, but up to
the present time I have had no opportunity of microscopically
examining any such specimens as none have come under my imme-
diate notice during the nine years T have been examining exostosed
teeth, nor have T during that time found any true bony union
between the roots of exostosed teeth and the alveoli ; in all the cases
I have examined microscopically there has been nothing but a
membraneous union as seen in Fig. i.
There is still another form of exostosis, spoken of as nodular,
where we have the surface of the roots more or less covered with
nodules of cementum ; these nodules may not be larger than the head
of an ordinary pin, or may be as large as a split pea. I have found
these nodules from about one-twentieth of an inch to one-eighth of
an inch in diameter, they do not appear to be developed in any
regular or systematic manner, but apparently the nodules are scattered
over the surface of the roots in a most irregular manner, both with
regard to the amount deposited as well as to the position of the
nodules. In these cases it is unusual to find the original layer of
cementum absorbed away so deeply as in some of the other forms
of exostosis, frequently there is only enough absorption to roughen
the surface of the cementum, these roughened depressions are after-
wards refilled, and a certain amount of new tissue built upon the
foundation thus laid. It would appear as if in these cases the point
of irritation had been very restricted, and the time taken for the
absorption probably very short ; but at the same time, the inflammation
of the membrane, though restricted, has been very acute, this form of
exostosis D, Fig. 14, causes much more pain during the time
the changes are taking place than any of the other methods of
deposition, excepting in those cases where we get construction of the
pulp in the earliest stages, caused by the new tissue forming at the
apex of the root, or at that point of the root where the pulp enters
t;he pulp canal.
842 THE DENTAL RECORD.
So far as my examination has shown, teeth are subject to
exostosis in the following order, commencing with those most subject
to the change: — Third molars; second bicuspids ; second molars;
first bicuspids ; first molars ; sup. canines ; sup. central incisors ;
sup. lateral incisors.
In the case of the last three on the list I have found the roots of
those teeth where the crown has been decayed down to the gum line
more frequently exostosed than in those where only a portion of the
crown has been removed by decay, this, with the fact that the roots
of those teeth that have no crowns posterior to the canine have
usually a largs amount of general exostosis, lead one to suppose that
it is not at all unusual for exostosis to continue, or, even commence,
after the death of the pulp.
In my concluding paper I shall draw attention to certain
changes that take place in and around the pulp canals of the
exostosed teeth of man and other animals.
CATAPHORESIS.*
Cataphoresis for obtunding sensitive dentine and bleaching
teeth has recently been attracting a large amount of attention, and
has awakened widespread interest in America, no fewer than seven
articles and papers having been devoted to it in the Dental Cosmos
and five in the International Dental Jonrnal during the present
year, but little or no notice has hitherto been taken of it in the
English dental journals. This is somewhat surprising in view of the
latent conviction that electricity is opening up for us a new era of
splendid possibilities in every department of human life. Though
cataphoresis has only within the past twelve months become a
burning question — even in America — it is nevertheless no newly
discovered method, for as far back as 1833 a Frenchman introduced
iodine in this manner, and in 1859 Richardson used the method ;
coming down to later times, articles at distant intervals have
appeared in the American journals since 1887.
* This article is a compilation from the various articles in the Dental Cosmos
and International Dental Journal, referred to in the first paragraph, to whom the
Compiler expresses his acknowledgments. Its object is to give as pithily as
possible sufficient information to guide those who wish to try the method.
THE DENTAL RECORD. 343
Cataphoresis, or electrical osmosis, may be described shortly as
the passing of a medicinal substance by the aid of electricity
through organic tissues in the directions of the flow of the current.
Dr. Peterson states (in his article on the " International System
of Electro-therapeutics '') : " it seems to be a purely physical process,
and has nothing to do with electrolysis." The term cataphoresis
is derived from two Greek words, " kata " downwards, and
" phoresis " from " phorein," to bear, to carry, to bring : cataphoresis
then is the flow of fluids from the positive to the negative pole.
The method has been employed to a very considerable extent
by men of such acknowledged repute as Prof. W. J. Morton,
Dr. Louis Jack, Dr. Gillett, and others who have reported quite a
long list of successful cases.
Apparatus. — Apparatus which may be used for cataphoresis atother
parts of the body is of little use in the living tooth, because the living
tooth is much less tolerant of the current. It responds promptly to
currents imperceptible in most other tissues. The apparatus must
be so arranged that we may begin by applying an imperceptible
current, and increase it by minute gradations till we reach a point
enabling us to attain our object. This point need not be high ; a
fraction of a milliampere actually passing through the tooth for a
sufficient length of time will accomplish the purpose. If, however,
the subject is not too sensitive to the influence of the electric current,
one or two milliamperes will do the work more quickly, and even
three or four may be used in individual cases without discomfort to
the patient. This quantity of current is reached in only a small pro-
portion of cases, however. Note that the quantity of current specified
is that actually passed through the tooth, the capacity of the apparatus
needs to be much greater in order to force this quantity through the
tooth and other tissues.
Battery. — Having regard to the extreme sensitiveness of a living
tooth and the fact that the street current is a varying one, Professor
Morton prefers a battery. He recommends a Leclanche batter}^ of
30 or 40 cells, but adds, any other good battery will answer every
purpose. Mr. Peter Brown, of Montreal, recommends a chloride of
silver dry battery of 25 cells, stating that it will last two years and
may then be renewed at less than one-third of the original cost.
Dr. Louis Jack also recommends the same form of battery, and
says, " it is well known that the chloride of silver cell is best adapted
344
THE DENTAL RECORD.
to medical purposes as having an agreeable ratio between the
voltage and the amperage, the voltage of each cell being one, and
the amperage between one-fifth and one-fourth. It is always
constant, which means there is no polarization, and that it does not
Box, II in. X gin. x gin., containing 25 dry cells, non-short circuiting dial
collector, milliampererneter, current reverser and cords.
decHne in power until nearly exhausted. No fumes are emitted, and
there is no 'creeping ' of the electrolyte to interfere with the action.
Moreover the cells are * dry.' " Dr. Gillett, on the other hand, uses
the no volt street current with suitable controller. But the street
mains seem objectionable, not only on account of inequality of
pressure, but also because of the liability to short circuit, and the
danger — a very real one — of severe shock from earth currents.
Electrodes. — Those devised and invented by Prof. Morton
consist of an "indifferent," or "dispersing," electrode, and "active"
electrodes. The small dispersing electrode is a circular disc of
carbon three inches in diameter, covered with two layers of amadou,
bound at the edges by an insulated wire pressing into a
groove. This is large enough for anaesthetising the gums
or sensitive dentine. For large areas of skin a larger dispersing
pad electrode, say 6 by 6 inches, should be procured. The active
electrodes vary in shape according to the purpose to which they are
put, but retain the special device of perforations to hold solution, 5^c,
THE DENTAL RECORD.
345
For the skin, flat single plates of carbon or block tin of circular
shape suffice. For the mouth in general, a flat electrode resembling
a mouth mirror is convenient. For the gums, for use during extraction,
implantation, &c., the electrode is made tong-shaped, and, unlike any
electrode of this shape formerly constructed, both plates are of the same
polarity. The carbon, or block tin, in the active electrodes is one-
fourth of an inch thick, and is either perforated freely to about two-
thirds of its depth by drill holes one millimeter in diameter, or is
perforated completely, and a shallow reservoir provided behind it to
hold an excess of solution. The body of the electrode is of ebonite, raised
two to three millimeters at the edges of the plates to form a cup, into
which is inserted a piece of soft and porous blotting paper, cut to fit
exactly, or a soft piece of felt or other absorbent material. For
sensitive dentine the active electrode is a small stiflf piece of platinum
wire, tubular at its end, and perforated from the sides into the tube
in order that it may hold an excess of the solution. Around the end
of this '' applicator " is wrapped a pledget of absorbent cotton. These
constitute in the main all the electrodes necessary, modifications
for special cases will suggest themselves.
Morton's toiig-shaped duplex.
tCECT:Rb-THERA]PEUTiCl;"0.
Morton's mouth cataphoric electrode.
Rheostat or Current Controller. — If the current from the street
mains is to be used, Professor Morton gives preference to the
" Wheeler Fractional Volt Selector.'' This same apparatus is
equally available with a battery current. Its chief utility is in
relation to sensitive dentine, when it is of highest importance that
the initial voltage employed and current strength attained shall
346 THE DENTAL RECORD.
net cause pain. But in relation to the skin and mucous membrane
any ordinary rheostat will answer the purpose. Again, it is quite
possible, to one at all familiar with his " galvanic battery," to use
the ordinary cell selector to bring into circuit a limited number of
cells (thus working with a low voltage), and to regulate the flow of
Volt-selector.
current from this small number of cells by aid of common water
rheostats, provided that ample sponge tips break the strength of the
first water contact. An instrument like the fractional volt selector,
however, saves trouble and annoyance.
Milliamper e meter . — Not only is it necessary to regulate the
voltage employed, but also it is equally essential to have an instru-
ment to record the rate of the flow of the current attained. This of
course varies according to the voltage, or, what is more important,
according to the resistance, which in this case is the tissue. This rate
of flow, termed "current strength," is measured in amperes, and in
medical and dental work in thousandths of an ampere, namely milli-
amperes. A very small fraction of a milliampere causes pain in
sensitive dentine. No reasonable idea of " dosage," nor means of
THE DENTAL RECORD. 347
comparison with other cases, can be had without the record of a
milliamperemeter. It is a constant guide to the administrator.
Any good milHamperemeter will suffice, but its scale should be large
and easily read. An instrument recording from one up to ten
milliamperes is preferable. The following case shows the advantage
of a milliammeter. A clamp was attached to a lower first molar
outside the dam ; a current of three-tenths milliampere was indicated
in the meter. A few minutes later, on glancing at the milliampere-
meter, a current of three and one-half milliamperes was indicated.
This showed a short circuit somewhere ; it was found in a hole in the
rubber dam, made by the point of the clamp.
Solutions and Flnids. — Aqueous solutions of from 4 to 30 per
cent, of hydrochlorate of cocaine may be used. Professor Morton,
by combining guaiacol and anhydrous hydrochlorate of cocaine, has
found what seems to be a new compound rather than a solution.
To secure uniformity of action (for some guaiacols are far more
irritating than others), the solution of compound is termed guaia-
cocaine. It is a lo per cent, mixture of hydrochlorate of cocaine in
pure guaiacol ; this percentage may, if desired, be increased to 30 per
cent. This solution, as above given, answers every purpose for pro-
ducing perfect anaesthesia of dentine and of the skin, but for use
upon mucous membrane it should be diluted to at least one-half, or
otherwise slight and superficial destruction of tissue may ensue.
He uses for dilution a 10 per cent, solution of cocaine in glycerol,
mixing it with guaia-cocaine in equal parts. Professor Morton makes
the following remarks in respect to the combination of guaiacol and
cocaine : — " In my experiments upon soft tissues, as well as upon
dentine, I find that guaiacol to which cocaine is added enables me to
reduce the time ordinarily required to produce anaesthesia about
two-thirds, and, what is still more important, enables me to reduce
the current strength of electricity required also two-thirds. The
important feature of guaiacol in soft tissues is that it unites
chemically with the cocaine and thus prevents quick absorption into
the general circulation and consequent toxic effects. To prove this
assertion, take a 10 per cent, solution of hydrochlorate of cocaine
and shake it for a considerable time with an equal bulk of water.
One-eighth of the cocaine only will be found to have gone to the
water, and seven-eighths to have remained with the guaiacol. This
is a very remarkable fact, and il bids fair to open the way to the
348 THE DENTAL RECORD.
adoption of electro-guaiacol-cocaine anaesthesia as really a prac-
ticable and useful procedure in minor surgery, since aqueous
solutions on large electrodes might allow too much absorption."
Mr. Peter Brown writes of guaiacol-cocaine solution, that in his
experience no better results were obtained by this combination ; it
was also ascertained that guaiacoi was not a preservative of cocaine,
and the solution decomposed. The odour of guaiacoi is also very
objectionable, but Dr. Wendell Phillips states the odour may be
overcome by combining the guaiacoi with oil of pine. A saturated
solution of cocaine Mr. Brown regards as the best agent to employ,
made immediately before using by saturating one-sixth or one-eighth
giain with enough water to dissolve it, and absorbing it on cotton
sufficient to fill the cavity under treatment.
Technique, — Skin, — Using aqueous solutions of cocaine, the skin
must first be thoroughly washed with soap and water. When
guaiacoi is employed this is unessential.
Mucous Membranes, — No preliminary preparation of the mucous
membrane is required. As to the active electrodes, the solution is
first dropped into the perforations until they are full ; the absorbent
material is then fitted to the shallow ebonite cup or wrapped about
the applicator, and a liberal supply of the solution dropped upon it.
They are now ready for use. The flat electrode is applied directly over
the spot to be anaesthetised and pressed with some firmness against
it, as for instance, on a cheek affected by cancrum oris. In the
case of the tongs electrode, some care is requisite to secure a proper
adjustment and to secure uniform action. It is well, after the
electrode is in place, to pack in absorbent cotton, not too wet with
solution, to fill up inequalities of contact, or to bridge over (in
certain cases) the gap between the blades. For dentine, the cavity
is first filled (a rubber dam should be used) with a pledget of
absorbent cotton dipped in the guaia-cocaine solution (avoiding a
surplusage and yet not too dry) ; the applicator itself should then
be dipped in the solution until it holds all it can, and a small layer of
cotton wool be twisted about its end. During treatment the current
may be turned off, possibly twice, and the pledget in the cavity be
freshly dipped in the solution, or if the operator uses his own
appHcator, this pledget may remain in situ and the fresh supply be
furnished by removing and dipping the applicator itself into the
solution ; or, better still, a few drops of fresh solution may be from.
THE DENTAL RECXDRD. 349
time to time dropped on to the tip of the appHcator by aid of a
pipette, thus avoiding entirely, what is certainly objectionable,
any interruption of the flow of the current. The dispersing
electrode may be held in the hand, and placed by the operator
upon the cheek, or beneath the lower jaw, or upon the chest
or back, or, in short, anywhere at a reasonable distance from the
active electrode. The latter, the active electrode, is to constitute a
positive pole, and the former a negative pole. To determine the
polarity, apply a few drops of a saturated solution of iodide of
potassium to a piece of paper and test the two terminals of the
cords ; free iodine will appear at the positive terminal and be recog-
nised by its colour. Or test in the same manner by aid of a piece of
litmus paper wet with water ; the positive terminal will turn the paper
red, the negative will turn it blue. Everything now being ready, the
connections tested and polarity having been carefully determined
beforehand, the current may be " turned'on" most gently and gradually.
In the case of sensitive dentine, skill, carefulness, and experience
are essential. The first onset of the current mav at the best cause a
slight burning pain. To avoid this contingency, it is well to give the
solution five minutes' time to effect superficial anaesthesia prior to
applying current. The applicator is adjusted, and the current, which
cannot be too gradually applied, is then brought into circuit. The
patient will then feel a slight burning sensation, which in a
moment will subside, when more current may be added. Each
accretion of current during the first five minutes will cause the same
sensation. Thus the treatment is to be followed up step by step, con-
sulting the patient as to the slight pain, until, in about five or seven
minutes' time, it will be found that the current strength may be
largely increased without causing any sensation whatever. At this
time Prof. Morton carries the current up from two to two and a
half milliamperes, and, after two or three minutes, at this current
strength, considers the dentine sufficiently benumbed to endure
operative procedures without pain. A point of prime importance
is to avoid movements or removal of the applicator during the
current flow ; for, as is well known, a '' steady " current produces no
reaction of motion or sensation, while a " varying '' current produces
these reactions most unpleasantly to the patient.
With these hints ni mind, and with a little experience, not only
dentine, but the contents of the pulp cavity, and even the tissues
350 THE DENTAL RECORD.
outside of the tooth, may be effectually anaesthetised via the pulp
chamber. And it may be mentioned, in passing, that not only may
anaesthetic substances be thus employed, but also any other
remedy, germicidal, antiseptic, escharotic, etc., which it is desired
to apply to the tissues above named.
Hints. — (i) Dr. G. A. Maxwell relates an unpleasant experience :
A lady patient, who held the electrode in her left hand while not more
than 1 5 volts of current were being applied, complained, after the
operation, of severe pain in the finger, and removed her wedding
ring, when quite a blister was discovered on the back of her finger.
As a longer time than usual was required for the appHcation, possibly
the action under the finger retarded the action in the tooth. There
should be no rings on the hand in which the electrode is placed.
(2) Do not pass the current through metal fillings.
Illustrative Cases. — Patient of extremest hypersesthetic state.
, Experiment i. — Deep crown cavity in second superior right
molar, almost to the horns of the pulp of the buccal root. Very
sensitive, especially as it approached the horn of the pulp. Electro-
guaiacol-cocaine anaesthesia, seven minutes in two applications.
Result, perfect anaesthesia to hand excavation. Patient experienced
no oain from the current. Experiment 2. — First right superior
bicuspid, posterior approximal and crown cavity. Had been attempted
to prepare the tooth at a previous sitting, but on account of the extreme
sensitiveness, work had been abandoned before the cavity had been
entirely excavated ; the bottom of the cavity was covered with asbestos
paper, over which was packed a filling of gutta-percha. On removal
of the filling, after having been in place about six weeks, the tooth
was exquisitely sensitive to the slightest touch.
Electro-guaiacol-cocaine anaesthesia. The first approaches of the
current (not noted on the milliamperemeter) gave severe pain,
which gradually subsided, and each subsequent increase of current
caused pain. Thre-^ applications of cotton were made. After seven
minutes of about one-tenth of one milliampere, Dr. Morton was
able to carry the current up to two-thirds of a milliampere without
pain. Complete anaesthesia.
(Taken from the Report of Meeting of First District Dental
Society, State of New York.)
Dr. H. W. F. Cady : It seems to be my duty to make a few
remarks on this subject. You heard Dr. Phillips speak about the
THE DENTAL RECORD.
351
beautiful experiment made in his oflfice. I was the patient on whom
the experiment was made. I had a cavity in the buccal surface of
a third molar, which I could not allow anything to touch. Putting
ray finger nail into the cavity would cause excruciating pain,
I was a little shy of having cocaine used, because T have always been
very sensitive to the effect of it. I remember onze having placed a
four per cent, solution on the tip of my tongue, and in a short time
it produced a very irregular action of my heart ; in fact, the heart
seemed to miss every third beat, and I feel sure that the hypodermic
injection of cocaine would kill me. Dr. Gillett performed the
experiment on this sensitive cavity in the third molar. He placed a
pledget of cotton, saturated with a ten or twenty per cent, solution
in the cavity, which was so sensitive that even the cold (it was a
cold solution) irritated it very much. He applied the current, and
the effect was marvellous. I could feel the vibrations of the current
on the tooth. It was similar to the flickerings we notice in the
electric light in the street. When Dr. Gillett would ease the
current a little, the pain was not so great. The pain was similar to
the blowing of cold air into the tooth from an air syringe. I could
feel the current, and it was quite painful when it was applied with
force. In about fifteen minutes the cavity was obtunded to such an
extent that the doctor went in with an excavator where I could
not allow him to touch it before, and excavated with a great deal of
force. It had the same sensation as when one trims a finger nail,
and did not hurt me at all. I believe that cataphoresis will revolu-
tionise the practice of dentistry, and one of the best ways for a
doctor to prove it is to have it tried on himself, if he has a sensitive
tooth. I think in a short time all dentists will have to have this
apparatus in their offices.
Mr. B., aged twenty, highly nervous, presented a first left
superior bicuspid anterior approximal cavity. History of toothache
for two days, on examination pulp was found exposed ; the dam was
applied and cavity wiped dry. At this time the tooth was giving
severe pain. A pledget of cotton, saturated with the cocaine
solution, was applied, and the current turned on. In less than one
minute the pain had ceased ; the current was allowed to pass
through for fifteen minutes. At the end of this time the application
was removed and the pulp was found completely an3esthetised ; it
was removed with broach and drill, and the cavity immediately filled.
352 The dental HECoRfi.
Mr. H., aged eighteen, approximal cavity in central incisor,
exceedingly sensitive, could not bear the slightest touch of excavator
or bur. At this time a water rheostat was being used, and the
current was derived from a ten volt dynamo ; by reducing the
speed a current of five volts was attainable. This was the voltage of
the current first used on this case. With the rheostat set at its
highest resistance the patient could not stand the current, giving
marked evidence of pain on the first contact. Later, a dry current
controller was procured, and the current taken from a storage battery
of ten cells. This battery was provided with a cell selector or switch
board, by which the voltage could be varied from two to twenty
volts. The same case was then treated ; the current had to be first
reduced to the pressure from one cell or two volts, then again
reduced by the rheostat. This current was easily tolerated by the
patient, and was increased, after ten minutes' application, to ten
volts. It was found necessary to treat this tooth for thirty
minutes before the dentine was anaesthetised. Six cavities were filled
for this patient, and each one of them required the same treatment.
Miss M., cavities in both superior left bicuspids. After the dam
was applied to these teeth only, a clamp was put on the first molar.
To this clamp was soldered a wire having two branches from its
end ; these were tipped with platinum. After cutting away the
edges of the cavities and placing the cocaine in them, the two ends
of the wire were arranged so as to have a tip in each cavity. By
this means both teeth were treated at once, and much time saved.
A FURTHER prosecution under the Dentists Act has been under-
taken by the British Dental Association at Cardiff. The defendant
was Templar MaHns, of Woodville Road, Cardiff, who carried on
business as a chemist at 107, Woodville Road, and exhibited outside
his shop the words, '* Popular Dentistry." A member of the
Dental Association had been given at the shop a card bearing
defendant's charges for extracting teeth with and without gas. The
facts were admitted by the defence, and in mitigation, Mr. Jackson
urged that there was no desire on the part of Malins to 'make his
clients believe that he was a fully-qualified dentist. Defendant was
fined £^ and costs, or in default one month's imprisonment.
THE DENTAL RECORD. 353
THE DENTAL RECORD, LONDON: ALfG. 1,1596.
THE NEW REGULATION FOR THE L.D.S.ENG.
The new regulations for dental students who may
register after January ist, 1897, passed by the Council of
the Royal College of Surgeons oi England at its meeting
on July 9th, present, perhaps, more radical changes than
have previously been made. It has long been felt that the
Dental Examination of the English College was inferior in
arrangement to that of the other British Colleges, for,
while they have for many years divided the examination into
part?, the English board has contented itself with making
the one examination more complicated and, in some senses,
more unsatisfactory. An examination which, in theory at
least, pretends, at one and the same time, to test a man's
knowledge in surgery, anatom;^, dental theory and practice,
operative and mechanical, is bound either to be a hollow
sham in whole or in part, or else to present an absolutely
impassable barrier to the ordinary student. Nor can we
pretend that the new regulations will remedy this condition
of affairs. It is true the examination in Dental Mechanics
is to be separately taken in conjunction with a new
subject, dental metallurgy; but as this need not be
passed till within six months of the final it can scarcely
do much to ensure a more prolonged period of prepara-
tion for this latter examination, indeed, is more than
likely to limit the average student's work to precisely this
period. In our opinion the interval between the two
examinations should have been at least twice as long. It is
possible, perhaps we may even say probable, that many may
take this first examination at an earlier period, but it must
not be overlooked that the introduction of a Preliminary
Science Examination, which we presume, though this is not
stated, must precede the professional examinations, will
AA
354 THE DENTAL RECORD.
tend to delay the preparation for the theoretical portion of
the first of these. It is true this may and really should be
taken during the three years of pupilage, but we believe
that it will be difficult for many to obtain the certificates
required under Section II. unless many more institutions
are recognised than is now the case. Thus, though we
welcome the steps which the Council have seen fit to take,
we cannot regard the matter as finally settled : the final
examination remains, as it has always been, a farce, in that
it pre-supposes and on paper requires an adequate know-
ledge in general subjects, while the condition of the curri-
culum and the mixed nature of the examination render the
attainment of thi-^ almost an impossibility. This examina-
tion must be divided ; General and Dental Anatomy should
precede the surgical subjects by at least six months. Nor
need this require any alteration of the existing requirements
nor increase of expenditure. Whether the examiners take one
man in four different subjects or two men in two different
subjects does not appear to an ordinary mortal to make any
difference.
With regard to the additions to the curriculum it is
rather early to pass comment. In themselves they appear
useful, but the extent of the usefulness depends largely on
the synopses which have yet to be published. Incidentally
the whole of the alterations raise the question of lengthening
the period of study. To take full advantage of this curri-
culum two years' hospital work seems insufficient.
ift^tua antr ^aU^.
Wm. Rushton, L.D.S.Eng., has been appointed to be Dental
Surgeon to the National Dental Hospital.
J. HiLDiTCH Matthews, L.D.S.Eng., has been reappointed
House Surgeon of the Birmingham Dental Hospital.
THE DENTAL RECORD. 355
The Annual Distribution of Prizes of the Charing Cross Hospital,
took place on the 15th ultimo. The Desn, in the course of his report,
stated that 86 students had joined School during the past year, of
whom 20 had been ''general," 21 *' dental," and 43 "occasional."
The average daily attendance had been about 180. Mr. Justice
Vaughan Williams presided and delivered an interesting address,
comparing and contrasting law and medicine. In the list of awards
we are glad to notice the names of several dental students.
ANNUAL MEETING OF BRITISH DENTAL ASSOCIATION.
PROGRAMME OF PROCEEDINGS.
Tuesday Evening^ August 1 1 .
9 p.m. — Conversazione at the Whitehall Rooms, Hotel Metropole,
Music, &c.
Wednesday^ August 12.
9.30 a.m. — Meeting of the Representative Board in the Council
Chamber of the Examination Hall.
II a.m. — First General Meeting in the Theatre of the Examina-
tion Hall. Presidential Addresses.
Reports and business.
1.20 p.m. — Adjournment.
The London members will entertain the Provincial members and
ladies at luncheon at the Hotel Metropole.
2.30 p.m. to 5 p.m. — Reading and discussion of Papers.
9 p.m. — Reception by the President of the Association and
Mrs. Canton at the Royal College of Surgeons of England, Lincoln's
Inn Fields.
Thursday^ August 13.
9.30 a.m. — Annual Meeting of the Dental Benevolent Fund in
the Council Chamber of the Examination Hall.
10.30 a.m. — Second General Meeting in the Theatre for the
reading and discussion of Papers.
Microscopical Section in Theatre. Papers. &c.
1 p.m. — Adjournment.
The same arrangements for luncheon as on the previous day.
2 p.m. for 2.30 p.m. precisely. — Demonstrations at the Examina-
tion Hall. [Second floor suite of rooms.]
AA 2
356 THE DENTAL RECORD.
4 p.m. — Adjournment.
5 p.m. to 7.30 p.m. — Garden party given by Mr. and Mrs. J.
Howard Mummery at Manor House, Southall, Middlesex.
Friday^ August 14.
10 a.m. — Excursion for Ladies to Knockholt Beeches at invitation
of Dr. and Mrs. Walker.
10 a.m. for 10.30 a.m. precisely — Demonstrations at the Exami-
nation Hall.
1.20 p.m. — Adjournment.
The same arrangements for luncheon as on the previous day.
2.30 p.m. — Third General Meeting. Papers. Discussions.
Concluding business.
7.15 p.m. — The Annual Dinner at the Whitehall Rooms, Hotel
Metropole.
9 p.m. — Ladies' Entertainment in the Whitehall Drawing Room.
Saturday^ August 15.
Excursion by saloon Steamer " Queen Elizabeth," at 10 a.m., from
Westminster Pier for a short trip down river to view the Tower
Bridge, the Tower of London, Customs House, and shipping in the
Pool. At 10.30 a.m. to Twickenham and Richmond, where
luncheon will be served at 1.45 p.m. at the Star and Garter Hotel.
Returning to Westminster at 7.30 p.m.
ROYAL COLLEGE OF SURGEONS OF ENGLAND.
New Regulations for the License in Dental Surgery.
A Quarterly Meeting of the Council was held on July 9th,
the President (Mr. Christopher Heath), being in the chair.
Mr. Bryant, Mr. Davies-CoUey, and Mr. Pick were introduced
and made a declaration in the terms of the oath prescribed by the
Charter of 1800, and took their seats as members of the Council.
The third, and final, report of the Committee on the Dental
Surgery Regulations was presented and approved. The report
recommended the adoption of the following regulations, and that
they should be made applicable to all candidates who may register
as dental students on or after January ist, 1897.
THE DENTAL RECORD. H57
Regulations.
I. There shall be a PreUminary Science Examination and two
Professional Examinations for the License. The Prehminary
Science Examination shall consist of chemistry, physics, and
practical Chemistry. The First Professional Examination for the
License shall consist of mechanical dentistry and dental metallurgy ;
and the second of dental anatomy and physiology, dental pathology
and surgery, including operative work, human anatomy and
physiology, and surgery, including pathology. (Candidates will be
required to show a general knowledge of the anatomy of the whole
human body.)
IL Candidates will be required to produce certificates of having
received instruction at an institution recognised for the purpose in
chemistry, physics, and practical chemistry before entering for the
Preliminary Science Examination. (This instruction may be taken
prior to the date of registration as a dental student.)
in. Candidates will be required to produce the following certifi-
cates before entering for the First Professional Examination, viz. :
I. Of having been engaged, during a period of not less than three
years, in acquiring a practical familiarity with the details of
mechanical dentistry under the instruction of a competent prac-
titioner or under the direction of the superintendent of the mechanical
department of a recognised dental hospital where the arrangements
for teaching mechanical dentistry are satisfactory to the Board of
Examiners in dental surgery. In the case of qualified surgeons
evidence of a period of not less than two instead of three years of
such instruction will be suflBcient. (This instruction may be taken
prior to the date of registration as a dental student). 2. Of having
attended at a recognised dental hospital and school : (a) a course of
lectures on dental metallurgy ; {d) a course of practical dental
metallurgy ; (c) a course of lectures on dental mechanics ; (r/) a
course of practical dental mechanics, including the manufacture and
adjustment of six dentures and six crowns.
IV. Candidates will be required to produce the following certifi-
cates before entering for the Second Professional Examination,
viz. : I. Of having attended at a recognised dental hospital and
school : {a) a course of dental anatomy and physiology ; (d) a
358 THE DENTAL RECORD.
separate course of dental histology, including the preparation of
microscopical sections ; (c) a course of dental surgery ; (d) a separate
course of practical dental surgery ; (e) a course of not less than five
lectures on the surgery of the mouth. (These lectures may be given
either at a recognised dental hospital and school, in which case the
lecturer must be a qualified surgeon practising surgery, or they may
be given at a recognised medical school and may form part of the
course required by Section IV., Clause 3 (d). 2. Of having attended
at a recognised dental hospital or in the dental department of a
recognised general hospital the practice of dental surgery during two
years. 3. Of having attended at a recognised medical school — (a) a
course of lectures on anatomy ; (d) a course of lectures on physiology ;
(<;) a separate practical course of physiology ; (d) a. course of lectures
on surgery ; {e) a course of lectures on medicine. 4. Of having
performed dissections at a recognised medical school during not less
than twelve months. 5. Of having attended, at a recognised
hospital or hospitals, the practice of surgery and clinical lectures on
surgery during two winter sessions. 6. Of being twenty-one years
of age. (The certificates of professional study will be required to
show that students have attended the courses of professional study
to the satisfaction of their teachers.)
V. Candidates may present themselves for the Preliminary
Science Examination before entering at a dental school on produc-
tion of the certificates required under Section II. This examination
will be identical with Part I. of the First Examination of the
Examining Board in England.
VI. Candidates may present themselves for the First Professional
Examination for the License after the completion of six months'
attendance at a recognised dental hospital and school, on production
of the certificates required under Section III.
VII. Candidates may present themselves for the Second Profes-
sional Examination on production of the certificates required under
Section IV., after the completion of four years' professional study
from the date of registration as a dental student and after the lapse
of not less than six months from the date of passing the First
Professional Examination -
VIII. Synopses of the examination in chemistry, physics, and
practical chemistry, and dental metallurgy will be issued with the
regulations.
the dental record. 359
Fees to be Paid by Candidates.
The fee for the diploma of the Hcense in Dental Surgery is
twenty guineas, and must be paid in the following manner : —
Preliminary Science Examination, each admission £2^ 3 o
First Professional „ „ ,, 220
Second „ „ „ „ S "^ ^
The balance, if any, of the total fee of twenty guineas to be paid on
the completion of the examinations.
After other business a letter was read from the President and
Honorary Secretary of the British Dental Association asking the
Council to permit the association to hold a reception at the College
on August 1 2th. Permission was granted.
Mr. J. H. Targett was re-appointed Pathological Curator for the
ensuing year.
The election of President then took place, and Sir William
McCormac was elected ; and Mr. N. C. Macnamara and Mr. J. Langton
were appointed Vice-Presidents.
THE DENTAL HOSPITAL OF LONDON.
A Conversazione, which was also the occasion of the Annual
Distribution of Prizes, was held on the 24th ultimo, at the Royal
Institute Galleries, Piccadilly, Sir James Crichton Browne
presiding.
The Dean read his report, in which he spoke of the continued
success of the School, and referred to the various changes in the
appointments, specially alluding to the election of Mr. James Smith
Turner as Consulting Dental Surgeon in the place of the late Sir
John Tomes, and the acceptation of the Lectureship on Dental
Anatomy by Mr. Charles Tomes.
Sir James Crichton Browne distributed the prizes as follows : —
Saunders Scholar^ Mr. R. L. Young. Ash^s Prize^ Mr. T. W.
Thew ; Certificate of Honour, Mr. A. R. Heath. Dental Mechanics^
1st prize, Mr. F. J. Padgett, Mr. R. L. Young ; 2nd prize, Mr. A.
R. Heath ; Certificates of Honour, Mr. T. C. Myers, Mr. P. R.
Cooper, Mr. H. Dunlop, Mr. J. H. Robertson and Mr. J. C. Douglas.
360 THE DENTAL RECORD.
Metallurgy^ ist prize, Mr. A. R. Heath ; 2nd prize, Mr. R, L.
Young ; Certificates of Honour, Mr. T. C. Myers and Mr. F. W. S.
Metcalfe. Operative Dental Stirj^ery^ ist prize, Mr. R. L. Young ;
2nd prize, Mr. J. Humphries ; Certificate of Honour, Mr. A. R.
Heath. Dental Anatomy^ ist prize, Mr. T. W. Thewand Mr. A. R.
Heath ; 2nd prize, Mr. R. L. Young ; Certificates of Honour, Mr.
T. H. Miller, Mr. H. Westron and Mr. W. W. James. Dental
Surgery^ ist prize, Mr. R. L. Young ; 2nd prize, Mr. N. Miller ;
Certificates of Honour, Mr. A. R. Heath, Mr. T. H. Thew, Mr. E.
H. J. Smart, Mr. H. Westron, Mr. E. Joseph, Mr. J. L. Roper, Mr.
J. C. Douglas and Mr. W. W. James. Students^ Society Prize, Mr.
W. F. Forsyth, Jun. Prize presented by the President of the
Students' Society for the best Casual Communication^ Mr. F. J.
Padgett.
Sir James Crichton-Browne then delivered the following-
address : Ladies and Gentlemen, — It has been to me a great satisfaction
to respond to the invitation of the Staff of the Dental Hospital of
London to take part in these interesting proceedings, and to present
the prizes to the deserving students in the school connected with the
hospital, and in doing so I am sure it is not necessary for me, as is often
done on an occasion like this, to remind the students to whom prizes
have been awarded that these present successes are but incentives to
further efforts, for I am a student of physiognomy, I have seen in
their faces as they have passed this platform sufficient indication
that they are not likely to stand still or rest on their laurels, but are
determined to push forward, and are more likely to require counsels
of restraint than words of exhortation. Nor is it necessary that I
should endeavour to console those students whose names do not
figure on the prize list this evening, by reminding them, as is often
done on occasions like this, that it is impossible for everybody to be
a first, second or even third where a great number are engaged in
competition, for it is indeed my conviction that it is possible for
everyone to be first, second or third, not perhaps in any one
particular race, but in some race. I mean by that, that every man
and woman has some gift, quality, or endowment which, properly
cultivated and used, will secure to him or her success at some point
in the course of life, and that best of all prizes, the consciousness of
not having lived in vain, and, therefore, I would suggest to the
students who have not been successful, that their reward is only
THE DENTAL RECORD. 361
postponed, it will come to them a little later on if they will but
persevere and use their opportunities. I would say to all the
students here, whether prize winners or not, that they are taking
upon themselves great responsibilities and obligations^ for they are
entering on an honourable profession — a profession that is both
ancient and progressive — the dignity of which they must uphold.
The dental profession is an ancient and rapidly progressive one.
That it is an ancient profession is undoubted, for, if I recollect
aright, the laws of the Twelve Tables of the 5th century before
Christ, provided for the care of the teeth bound with gold, and
made it lawful that the gold in this connection might be burnt or
buried with the body of a deceased person, and only a few years ago
an Etruscan skull was found with a set of enamel teeth artificially
fitted in it. That the dental profession is a progressive one, and a
rapidly progressive one, cannot be doubted by anyone who has his
eyes open or has any knowledge of the subject. The number of
dentists has increased prodigiously, and dental aid, which was at one
time restricted to the affluent, is now sought by all classes of the
community. And not only is the number of dentists increasing,
but their status and qualifications have advanced in a more than
proportionate degree. Up to 1878 your profession was comparatively
a lawless one, and was open to the just and the unjust, the
competent and the incompetent, but now, although it is still
impracticable to prevent the practice of dentistry by unworthy and
unskilled persons, you have at any rate by your Register given the
public the means of distinguishing between the white sheep and the
black, and if the public still chooses to employ the black it is their
affair, and they must take the consequences ; and the satisfactory
reflection is that year by year, gradually, by the efflux of time, the
character and position of your profession are being raised. The old
school is dying out and the new school is taking its place. Now I
do not mean to say anything disrespectful of the old school, for I
know that it included a great number of able and accomplished
men, who did admirable work in their day and generation, and
helped to promote the welfare and advance the status of the
profession ; but I know that it embraces also a large number of
imperfectly educated and empirical practitioners, and it is certainly
a matter of congratulation that the younger dental practitioners
who are now joining the ranks are thoroughly prepared for their
362 THE DENTAL RECORD.
work in all departments, and have a sound preliminary and scientific
education. Well, now gentlemen, for it is the students I am address-
ing to-night, it is for you, if you value your profession, to raise its
standard more and more ; it is for you to cut it adrift from trade
associations and to approximate it more and more with the medical
profession, of which it is a branch. It is for you to banish quackery
in all its protean forms and advertising and false pretences and
unscrupulous competition from your ranks, and to cultivate that
spirit of moderation and magnanimity and dignity and generosity
that distinguishes a profession from a trade. Much, very much, no
doubt, has already been done in this direction, and taking the
recognised body of your profession in this country to-day, I would
affirm that it is unsurpassed, nay, I would say it is unequalled in
skill, attainments, or in probity, by the dental profession of any other
country in the world. It may be admitted for the moment that our
brethren in America have a certain genius for invention and
contrivance, but I will not for one moment allow that we have not
in England, engaged in dental work, as great mechanical skill, as
much judgment, as much honesty of purpose as are to be found
amongst dental practitioners in the United States of America or in
any other part of the world. We, of course, welcome our brethren
from America — those of them I mean who are duly qualified — and
there are, no doubt, many able and conscientious men among them,
and we give them a fair field and fair play, but at the same time I
unhesitatingly declare that the popular notion that there is some sort of
magic about " American Dentistry " is a popular myth, and the sooner
it is exploded the better. It is unfortunately the fashion with us
Britishers just now to depreciate ourselves and to predict the ruin
of our industries, but for my part I still believe in English brains
and English hands, and am confident that —
" Nought shall make us rue,
If England to herself do rest but true."
I still prefer an English made watch to a Swiss one, or even a
Waterbury (laughter), and I trust the day will come when no
patriotic Englishman will be content to walk about with American
made teeth in his mouth. But in order to encounter foreign com-
petition in dentistry as in other industries, it is essential that we
should perfect our own work, and therefore I have said to you
students a great responsibility lies with you ; you are to be the
THE DENTAL RECORD. 363
gladiators to exhibit in the future your prowess in the ivory amphi-
theatre of the mouth, and you must diligently prepare yourselves in
order that you may acquit yourselves brilliantly in that arena, and,
gentlemen, these responsibilities are certain to grow, for the
importance of dentistry is day by day becoming more and more
recognised, and I do not hesitate to affirm that dentistry is becoming
a question of national importance, and if England is to retain her
place in the world she must look to her teeth as well as her iron-
clads. There is conclusive evidence, which I need not quote to you,
that our teeth in these modern times are more fragile, delicate, and
prone to decay than were the teeth of our ancestors a few generations
ago. There is convincing evidence that dental caries is working
more widespread havoc, greater ravages, than we have previously
had any knowledge of, so that we must view the future with some
apprehension. I do not entertain the idea that in the progress of
evolution our race is destined to lose its teeth and be left with only
gums ; but I do believe that very serious and deplorable con-
sequences will ensue if the teeth are neglected, and therefore I so
often urge the importance of care of the teeth in the young. It is
in conservative dentistry your greatest achievements in the future
will take place. I admire the exquisite nicety with which you
supply dental losses, but the mouth that contains artificial teeth>
no matter how artistic or deceptive they may be, is but a whited
sepulchre after all, and in the future I am convinced it will be your
chief mission to preserve to us the teeth with which we have been
endowed by nature. I am constantly advocating in the most
earnest manner the regular periodical examination of children's
teeth by the dentist, and the apotheosis of the hand tooth-brush in
the nursery. Every child should be sent to the dentist at least
twice a year to have its teeth examined, children with delicate
teeth apt to decay much oftener. To young people more particularly
I would say —
" Brush thy teeth faithfully night and morning,
That their days might be long in thy head."
1 hold that that is an eleventh commandment, and it is also a
commandment with promise. We are always hearing of model and
exemplary parents, well you have an infallible test ready at hand.
Look at their children's teeth. If these are regular, clean, sound,
and healthy, then the encomium on the parents is well deserved ;
364 THE DENTAL RECORD.
but if, on the other hand, the teeth are irregular, dirty, decayed,
then the parents are imposters and have been negligent in their
duty. On a very recent occasion, when speaking on behalf of the
East London Church Fund, Lord Salisbury pointed out as a curious
circumstance that in this country our great objects of philanthropy
and benevolence fail to secure sufficient support unless we associate
our appeals for them with entertainments such as a dinner, a ball,
or a bazaar. Lord Salisbury seemed to deprecate this state of
matters. He deplored the fact that before exercising charity we
should have to eat a bad dinnner and listen to worse speeches, or
buy things one does not want at ridiculously high prices. But
for my part it seems to me that the association of beneficence
with entertainment is not altogether to be condemned, and does
not arise entirely from selfish motives. There is still in the
blood of many of us in this country a strong puritanical leven, which
leads us to look with some suspicion on vain and frivolous amuse-
ments, and it satisfies tender consciences in which this leven works
to combine our amusements with unquestionably good and laudable
objects. A man who would hesitate to go to a ball/^r se goes without
reluctance to a ball that is to benefit a deserving hospital, and takes
the young folks with him, and the sortilege of theraflfle is innocently
employed to support missionary effort. We are an intensely
practical people. It is said we like to take our pleasures sadly. I am
sure we like to take them usefully, and from a business point of view,
and to feel that while we are recreating ourselves we are advancing
civilization and helping our fellow creatures. Then we are also an
intensely domestic people, and it requires powerful and combined
attractions to draw us out of our home-shells for social enjoyment ;
and it is not a bad thing if our charitable instincts are made use of
to draw us together, and so promote friendly intercourse. The
friendly intercourse at a dinner, ball, or bazaar raises an emotional
tone and opens the flood gates of charity, which, again is, as it ever
is, twice-blessed, blessing not merely the institutions that receive the
subscriptions, but also the exhilarated subscribers who bestow them.
Lord Salisbury mentioned specially, dinners, balls, and bazaars, as
charity squeezing machines, but I mean to add another entertain-
ment to the list and to press the conversazione into the service of
beneficence. I mean to improve this opportunity, and, aided by the
pictures around, the music and the refreshments, to book your
THE DENTAL RECORD. 365
sympathies for the Dental Hospital of London, under the auspices of
which we are assembled here this evening, and which is in need of
your kind assistance. I am not going to hold a pistol to your heads
and demand your money. I am not going to send round a collecting
box or subscription list, or even read out a list of provocative
donations, but I will venture to remind you that this excellent
metropolitan institution has entered on an important and necessary
work for the public benefit, and I will ask you, as opportunity offers,
to bring its requirements under the notice of your opulent and open-
handed friends. The Hospital wants funds with which to acquire an
enlarged site, on which to erect new buildings in which to carry on its
truly useful work, at present much cramped and restricted by want
of room. The hospital looked at from Leicester Square has a
somewhat imposing frontage, but, to quote Goldsmith, it is '' all
ruffle, and no shirt." It is all elevation and no depth, and I can
testify from personal examination that its present accommodation
is altogether inadequate and unworthy of our chief London Dental
Hospital and School. A sum for the necessary extension has I
understand been already subscribed, chiefly by the Staff of the
Hospital and in the provinces. London has yet to speak, and she
onlv requires to be awakened to the necessite of the case, and when
she raises her voice the Dental Hospital will speedily rear aloft its
new buildings. It is for you to awaken London. The minor ills of
life make up in multitude what they lack in magnitude, and tooth-
ache causes a larger volume of suffering than many much graver
maladies. For one leg that is amputated one hundred thousand
teeth are extracted, and if for no other reason than the service it
renders in alleviating toothache this Dental Hospital of London
merits public support. I would conjure all of you, who have at any
time suffered from toothache, by the memory of your pangs to
contribute, so that others may be saved from like suffering. The
Hospital is not merely a hospital but a great school of dentistry, and
its improved accommodation will improve its teaching powers, and so
in the long run we shall all benefit by having more experienced and
efficient dentists supplied to us. (Loud cheers.)
Mr. Storer Bennett proposed, and Mr. James Smith Turner
seconded, a vote of thanks to Sir James Crichton Browne, and the
remainder of the evening was very agreeably spent in listening to an
excellent programme of music and theatricals under the direction of
Mr. Schartau.
366 THE DENTAL RECORD.
^bjstrarta antr ^thtiions.
CHLORATE OF POTASH AS AN ANTISEPTIC AND
GERMICIDE FOR THE MOUTH.
By Dr. P. H. Unna, in Notes and Remedies.
Translated from Monatshefte f. Praktische Dermatologie, XVII .
Band, 1893.
In 1884 Professor Miller first published in the Deutsche Medi-
cinische Wochenschrift the results of his experiments as to the action
of various antiseptic agents on bacteria cultures taken from the
cavities of the mouth.
These tests interested me very much, mainly because my atten-
tion had previously been called to the constant activity of the
schizomycetes in the formation of mercurial stomatitis. Having
noticed that -Miller's tables, which had formerly been generally
referred to, made no mention of either chlorate or permanganate of
potash, I suggested to the author the advisability of subjecting to
an examination this class of oxydizing substances, particularly
chlorate of potash, permanganate of potash and peroxide of hydrogen,
in his future experiments. The idea that the bacteria of the mouth,
accustomed to the continuous deoxydation taking place, might
possibly be rendered less harmful by the employment of oxydizing
agents, guided me.
Professor Miller was kind enough to entertain my proposition,
and the following year pubUshed a number of new tables, all of
which contained the three ingredients spoken of. It was noticed,
however, that peroxide of hydrogen alone directly interfered with
the growth of the fungi of the mouth ; its destroying properties
being second to that of corrosive sublimate and nitrate of silver.
Permanganate of potash acted much weaker, and surprisingly weak
was the action of chlorate of potash, mentioned at the end ot the
hst of antiseptics. The latter is detrimental to the growth of
schizomycetes only when used in a solution exceeding the proportion
of I to 8.
THE DENTAL RECORD. 367
The apparently unfavourable showing of Professor Miller's
experiments is evidently responsible for the little importance at
present attached to chlorate of potash in the manufacture of
preparations for the preservation of the gums and the teeth, and I
am confident that modern antisepsis in treatment of the mouth is
fully in accordance with the principles set forth in the valuable and
well known handbook of Miller.
On page 226 Miller says:— "It is noteworthy that such useful
agents as chlorate of potash and permanganate of potash possess
such subordinate antiseptic properties ; like iodoform, the favourable
action of these remedies does not particularly depend upon their
antiseptic value."
Notwithstanding the conclusion drawn from Miller's tables, I was
still so fully convinced of the specific value of chlorate of potash in
diseases of the mouth that I was reluctant to discard my favourite
remedy. My own conclusion was that, if the efficiency of chlorate
of potash as an antiseptic was to be enhanced, a much higher
concentration would have to be used.
From that time on I discarded all solutions and employed pure
chlorate of potash in the form of a tooth-paste containing 50 percent,
of the salt.
In this manner I achieved much better results than before, not
only in mercurial stomatitis, but also in all diseases of the mouth
occasioned by the formation of schizomycetes.
During the past eight years in which I have employed chlorate
of potash in this modified form I never had occasion to look for a
better cleansing agent for the mouth, tonsils and teeth. Naturally,
I fully agree with Miller that the efficacy of this remedy does not
solely depend upon its antiseptic value.
It is my opinion that it possesses marked tonic properties acting
favourably on mercurialized gums and imparting increase circulation.
In many other affections of the mouth and tonsils the property of
chlorate of potash of favouring secretions is particularly commenable.
To obtain this result, the pure chlorate of potash must be used ;
a small quantity is spread on the tooth-brush, applied to the teeth
and gums and rubbed to a paste. After rinsing the mouth with
clear water a somewhat salty but refreshing taste remains.
I know of no other preparation that will remove so quickly and
effectually the foetor oris, which is most apparent after meals and
368 THE DENTAL RECORD.
Upon awakening in the morning. A number of cases in which this
foetor proved sufficiently objectionable to enlist medical aid were
promptly cured by the application of chlorate of potash after the
patients had been treated for internal ailments.
Chlorate of potash, being a neutral salt, has absolutely no detri-
mental effect on the teeth ; if used in the concentrated 50 per cent,
form, it will promptly check the growth of the fungi for a long time,
and in many instances destroy them entirely.
Chlorate of potash having been declared a poisonous chemical,
it is safer to employ it in the form of tooth-paste ; thus the possibility
01 an accident is excluded.
It has been demonstrated that the daily use of chlorate of potash
tooth-paste is the very best prophylactic against caries of the teeth
and affections of the tonsils, including diphtheria. — Western Dental
Journal.
DISEASES OF THE UPPER AIR PASSAGES.
By St. Clair Thomson, M.D., M.R.C.P., F.R.C.S.
In the year 1867 the late Dr. Wilhelm Meyer, of Copenhagen,
was consulted by a very deaf, but otherwise healthy, country-girl
aged twenty. Since childhood she had been a mouth-breather.
The nose was small and the alas collapsed, but neither its bony walls
nor its mucous membrane in any way obstructed the free passage of
air. Examination of the mouth showed no obstruction in the
pharynx, for the tonsils had already boen removed. Evidently the
obstruction to nasal respiration mus: be situated in the naso-pharynx
and it occurred to Dr. Meyer to pass his forefinger up behind the
soft palate and explore that region. Strange to relate, such a simple
and obvious procedure — as, with our present knowledge, it appears
to us — had never entered the mind of any one previously. He found
the post-nasal space full of adenoid vegetations, and their removal
was soon followed by the restoration of the nasal air-way. Since
that date the pathology and treatment of these growths have made
considerable progress, and they are found to be of such common
occurrence that we are very frequently asked by our patients if they
form a new disease ! One of the last publications of their original
discoverer was on the subject of the universality and antiquity of
THE DENTAL RECORD. 369
adenoid vegetations [Hospitals- Tideiide, February 6th and 13th,
1895.) Dr. Meyer collected statistics and information *' from China
to Peru," and, from a large mass of evidence, he was able to conclude
that hypertrophy of Luschka's tonsil occurs in Europe, Asia, and
America in varying frequency, a warm climate appearing to favour
adenoid growths less than a cold one. Among the Esquimaux they are
of common occurrence, and the adenoid facies is not unknown in the
tropics. The physiognomy indicative of naso-pharyngeal obstruction
consists in the habitually open mouth, the laterally compressed nose,
resulting from the permanent inactivity of the alse, and a sort of veiled
look about the eyes, due chiefly to an elevation of the under lid. This
'* veiled look " is thus accounted for : — From the circular muscle of
the eye to the orbicularis oris there pass bands of small muscles^
which when the mouth is kept closed, hold the lower Hd downwards
in a slight degree of tension. When the mouth is habitually kept
open, however, this tension is relaxed, and the lower lid tends to
move a little upwards. Another objective symptom of the affection,
and one that forces itself on even the most unobservant of the laity,
is the altered tone of the voice, the so-called " dead " speech, the
absence of resonance, and the faulty enunciation of the letters
m and //.
With regard to the antiquity of adenoid vegetations, Dr. Meyer
had considerable difficulties to contend with in proving their
prevalence in former times, before the existence of such a condition
was known or even suspected. The Greek authors give no sugges-
tion of it, although it might be thought that such satirists as
Aristophanes and Juvenal would not have missed the opportunity
of making fun of the nasal pronunciation. Post-nasal obstruction
appears to have escaped so many-sided a man as Hippocrates. We
can, therefore, only pick out from cases the description of individual
symptoms now recognised as those of hypertrophy of the pharyngeal
tonsil. The other source of evidence is portraits and busts. Here
we must be careful to avoid certain sources of error. For example,
portraits which are intended to express emotion, especially religious
ecstasy, and those of people with a short upper lip or with pro-
jecting teeth, might lead us to imagine that the subjects were
mouth-breathers. The exclusion of these and other sources of error
reduces the available material down to very narrow limits, but a few
positive instances are sufficient to establish the fact of the existence
370 THE DENTAL RECORD.
of adenoid vegetations in more or less remote periods. Satisfactory
evidence shows that the sculptor Canova (1755 — 1822) must have
had adenoid vegetations ; and going still farther back, the Emperor
Charles V. (1500 — 1558) most probably also suffered from these
growths. The artists of the Renaissance have often depicted a
typical and unmistakable adenoid facies in their paintings and
sculptures. The remains of antiquity present few evidences of the
existence of hypertrophy of Luschka's tonsil among the ancients,
and this is possibly in part due to the tendency of the Greeks to
idealise bodily forms. Still, the author found three typical
physiognomies amongst the busts in the Vatican. One is a young
lady of the upper classes, as evidenced by the drapery and the care-
fully dressed hair. The face is regular, with good features, but is
somewhat disfigured by the partly open mouth — looking as if air
were being drawn in — the veiled look, and the half-stupid, half-
resigned expression. Dr. Meyer's investigations show that adenoid
vegetations are found among the inhabitants of at least three
continents, and that there have been sufferers from the affection
during the greater part of the historical era.
An interesting debate at the Laryngological Society of London on
" Foreign Bodies in the Upper Air and Food Passages " accentuated
many points of practical interest {^Proceedings^ vol. iii., 1896.) Such
accidents are always alarming and are frequently most serious, for,
as the late Mr. Durham said, " life is in peril so long as a foreign
body of appreciable size is retained in any part of the respiratory
tract." These accidents do not occur with sufficient frequency in
the practice of any one practitioner to give him the experience which
will formulate a line of conduct ; it is therefore particularly advan-
tageous to collate the recorded experiences of others, and from them
lay to heart the principles which should guide us. In the nose a
one-sided discharge should always suggest the presence of a foreign
body, particularly in children, in whom a satisfactory diagnosis can
rarely be made without recourse to a general anaesthetic. If the
probe detects a foreign substance, it should be removed with forceps
or crochet, care being taken, with a finger in the naso-pharynx, to
prevent it from falling backwards. While some speakers approved
gentle syringing down the patent nostril — say, by the interrupted
current of a Higginson's syringe — so as to drive the body out from
behind, others had succeeded in certain cases by a similar use of
THE DENTAL RECORD. 371
Politzer's method of air inflation. Dr. Renaud has shown [Revue de
Laryngologie, No. 20, 1895) 'that symptoms simulating typhoid
fever ma}' be caused bv a button in the nose, and that a cherry
stone may during seven years mislead several doctors into a diagnosis
of ozcxna. When the intruding body is lodged in the pharynx the
first nrinciple is to make a careful examination with the eye, the
probe, and the finger before employing the coin-catcher or umbrella
probang, or risking the danger of blindly pushing the substance
downwards. In the majority of patients complaining of a fishbone
in the throat, generally nothing is to be discovered, and their
sensations are as rule nervous, or referable to the scratch in the
pharyngeal wall. Still, it is possible that many bones escape our
defection, and that the cessation of symptoms coincides with the
absorption of the bone at the end of from two to four months. In
one case, where a needle could not be found in the throat, it was
discovered at the autopsy a month afterwards in the tricuspid valve.
Even when the patient states that something is lodged in the wind-
pipe, the post-nasal space should be carefully explored, as sensations
in that region are frequently referred to the larynx. When an
individual feels that a portion of food has lodged in the glottis he
should lean forwards over the back o: a chair, gently draw in a full
inspiration, and then with a forcible expiration the intruding body
can often be expelled. In adults, when the situation of the foreign
body in the larynx has been diagnosed, its removal with forceps may
be attempted if we are prepared for immediate tracheotomy in case
of need ; if the symptoms are too severe or spasm is set up, it is
wiser to do tracheotomy first. In children, examination with the
minor is apt to fail, and then we may try to locaHse the body with
the finger and remove it with forceps, or we may find it necessary to
do tracheotomy before attempting anything. The custom of inversion
and succussion for a foreign body in the trachea or bronchi is fraught
with much risk, and it is wise to be prepared for immediate tracheo-
tomy before entertaining the plan. When there are any symptoms
of a foreign body in the trachea or below it, tracheotomy should be
performed and a tube worn until it is certain that the body has been
entirely expelled. Among foreign bodies which may be enjountered
in the nose we must not forget the possibility of having to do with
pieces of gauze or cotton-wool left there during previous treatment.
In the trachea we must bear in mind the ingress of vomite.i matter
BI5 2
372 THE DENTAL RECORD.
in anaesthesia, the possibility of tissue falling into the larynx in the
operation for adenoids, and the fact that intubation tubes may get
loose land fall into the bronchi. The importance of seeing that
patients who have to wear a tracheotomy tube permanently renew
their cannula at least every two years is shown by Dr. C. Billot
{Aiinales des Maladies de V Oveille et du Larynx ^ No. 3, 1896), who
has collected records of nineteen cases in which the tube became
detached from its plate and fell into the air-passages. When a
foreign body has lodged in the oesophagus we should be very careful
about using any force, either in extracting it or pushing it down,
remembering that in many cases the lesser danger is non-interference,
and that when the symptoms are not urgent a certain amount of
disintegration will take place if we have to do with a bolus of food.
Even when the umbrella probang fails to bring up an offending
piece of food, as it often does, its use is generally a satisfaction to a
nervous patient. — Ihe Practitioner.
COCAINE.
By Samuel A. Hopkins, M.D., Boston, Mass.
Ever since the discovery of anaesthesia the idea of a local
anaesthetic has taken firm hold of the professional mind, and no
amount of failure has been able to shake our belief that some day or
other the ideal local anaesthetic will be forthcoming. It must be
safe, it must be easy to administer, and it must be quick in its
effect.
We need a safe local anaesthetic. There is perhaps no greater
need in modern surgery and dentistry. The mental anguish, as
well as the actual suffering entailed by our daily operations is
appalling. It makes the profession of dentistry the most trying and
exhausting one known. The pain which we are obliged to give is
not only injurious to the health of the patients, but it limits our
usefulness, and even affects the estimation in which our profession
is held by the community at large. So much, therefore, is to be
gained by the use of a local anaesthetic that the temptation is very
great to try everything that may promise an alleviation of pain>
and we are loath to give up anything that seems even in a moderate
THE DENTAL RECORD. 373
degree to give that alleviation, although its use may be attended by
grave risks. Indeed, we sometimes deceive ourselves, so great is the
desire to save pain, and are almost persuaded that any risk is justifi-
able to gain such an end.
This, I am afraid, has been the history of the use of cocaine in
the dental profession. It is a sufficient comment on its doubtful
efficacy in dentistry that after so many years of experimentation
it should still be necessary to publish articles in our dental journals
describing its use and its limitations, and the fact that you are
willing to listen to me to-night indicates that grave doubts still exist
in your minds as to its unrestricted use in dentistry being
justifiable.
In order to get at the facts concerning the use of this drug I
have gone over very carefully a very large amount of literature on
the subject, and have looked up some of the records of the cases
where serious results are reported. I am indebted for valuable
information to Dr. T. W. Hays, who, in March, 1894, before the
Cincinnati Academy of Medicine, read a most interesting paper on
the physiological action of cocaine, citing numerous authorities.
The symptoms of cocaine-poisoning differ materially in different
individuals, and there is probably a disposition or diathesis existing
in some individuals which renders them exceedingly susceptible
to the drug. Great difference exists in regard to the time it takes
for poisoning effects to appear. This may vary from thirty seconds
to three hours, and the time necessary for recovery also varies
greatly. Sometimes recovery is almost immediate, and, on the
other hand, it may take months, and then leave the patient in. a
very anaemic condition. The sex, age, or condition of the patient
does not seem to have any particular influence on the effect.
Strong or weak, young or old, all may be quickly affected. Neither
are habitual users of the drug, those who have formed the cocaine
habit, entirely free from the dangers cf acute poisoning.
The size of the dose and the method of its administration do not
seem to control the effect. There is, however, seemingly a peculiar
susceptibility when the drug is applied or injected in the vicinity
of the fifth nerve or its branches. Woffler, who favours the use of
cocaine, states that in most of the cases that have come under his
observation where serious or fatal results have followed its use the
injections were made in some parts of the head. He claims that
374 THE DENTAL RECORD.
five per cent, solution may be used with impunity in other parts of
the body, but a solution of not greater strength than two per cent-
can safely be used in the region of the head.
In a general way, the symptoms of cocaine-poisoning may be
briefly described as follows : There is an excitation of the mind,
and associated with it an expression of anxiety which may amount
to a fear of approaching death. A feeling of warmth steals over
the patient, which may be followed by a chill. The respiration
becomes fearfully rapid, and later becomes laboured. The pulse-
beat increases to a very marked degree, and the pulse runs up to
150, or even higher. Respiration becomes more difficult, and the
heart grows weak, while the mental disturbance is increased so
that ideas do not follow each other in proper sequence. If the drug
has been administered in the mouth, the tongue becomes numb and
speech is affected ; not always, however, to such a marked degree as
might be expected. If the poisonous effects continue, there seems
to be more general anaesthesia, and the organs so affected have a
decided feeling of cold. Sometimes an irritation along the spine or
back of the neck, a tickling or itching sensation, is present. The
hands are closed in a convulsive manner ; the fingers, legs, and arms
become stiff and tetanic. The muscles of the face partake of the
convulsive movements, and the expression is agonizing to the last
degree. In some cases death occurs while in this tetanic condition.
Sometimes, however, instead of the convulsive symptoms, complete
relaxation takes place. If recovery occurs, severe nervous disturbances
may remain for an indefinite time.
The symptoms I have described as belonging to cocaine poisoning
are subject to wide variation. Indeed, no two cases seem to give
exactly the same train of symptoms. In going over the records I
have been astonished to find how many cases of poisoning are
reported. _ Mannheim reports five cases of poisoning from the sub-
cutaneous use of the drug, and also nine cases in which it was
dropped into the eye ; two where it was used in the ear ; larynx,
three ; mouth, two ; gum, two, &c. Four drops of a two per cent,
solution used by injection produced poisoning in an old lady, who
did not recover for four days. Three drops of a three per cent,
solution was followed in one case by marked restlessness, which
disappeared in four days. 0.05 grain in one case and 0.04 grain in
another injected subcutaneously into the eyelid caused intoxication
THE DENTAL RECORD. 375
lasting many hours. Dr. Hays, among other cases, mentions the
fact that he himself was poisoned by cocaine injected into the gum.
It is but fair to state that the dose was large, but the poisoning was
almost instantaneous.
The March number of the Centralblatt mentions a fatal case of
poisoning following an injection into the urethra. In the October,
November, and December, 1890, numbers of Therapeiitische Monats-
schrift is given a complete list of the reported cases of poisoning up
to that date. The percentage of fatal cases is enormous. Of 176
cases recorded, ic were fatal. Enough has been said of the general
poisoning effects to show that the drug is one to be used with great
caution. We do not yet know what its dangers may prove, nor have
we yet found a physiological antidote. Digitalis, atropine, the nitrite
of amyl, and nitro-glycerin have been suggested, but the efficacy of
these drugs is still a matter of doubt.
I found it a much more difficult matter to get any definite
reports of serious results following the use of cocaine in dental
practice. This was, of course, to be expected, as most of these cases
occur in private practice, and cannot be reported without injury
to the reputation of the practitioner. Consequently, we get only
meagre accounts of the unsuccessful cases, or of those cases which
are attended by fatal or alarming symptoms. Each successful case
is, however, quickly reported, much to the glorification of the
operator, and the temptation to follow in his footsteps leads to many
an accident.
Appreciating this difficulty, I wrote to a number of leading
New York dentists, asking for their experience in the use of the
drug. I also asked, '* What should be considered the maximum
dose for hypodermic injection into the tissues of the mouth ? "
This last question has never been answered, nor can I answer it
myself.
The greatest courtesy was shown me, however, and I received a
large number of replies to my letter, but I will not attempt to read
them, as I have promised to be brief. A large number of those who
so kindly answered my letter frankly said they were unwilling to risk
hypodermic injections in any strength. A few alluded to the alkaloid,
isoatropyl-cocaine, and its dangers, and all expressed the feeling that
great caution should be used in administering the drug hypodermi-
cally. Dr. Delafield, under whom I had the pleasure of studying at
376 THE DENTAL RECORD.
the College of Physicians and Suigeons, wrote that he thought it
should never be used hypodermically. My own experience seems to
bear out this opinion, so far as it relates to injections into the tissues
of the mouth.
I have myself had the scare, and although several years have
now passed, it sends a cold chill down my back whenever I recall my
experience. One case I shall never forget of a man in apparently
perfect physical condition, for whom I had to perform an operation
upon the gum between the lower first and second molars, which
necessitated giving great pain. My syringe was carefully sterilized,
and ten minims of a 4 per cent, solution were taken into the
syringe ; two minims remained after the operation, and at least
two minims were absorbed by the napkins with which I surrounded
the parts, so that it is safe to say that the results following were
produced with a dose of not over six minims. The gum was relaxed
and somewhat torn, and undoubtedly a part of the dose got into
the mouth and may have been swallowed. Be that as it may, in
about ten minutes there was a seeming excitation of the mind, and
all the symptoms which I have previously described soon followed.
I was obliged to get my patient on to a bed, and send for his
physician. By the aid of stimulants — brandy and coffee — the
patient gradually recovered, and was able to be driven to his home
in three or four hours.
In another case, that of a young woman, the patient left the
office in apparently good condition after an operation in which the
drug had been used, but complained that while in the car on her
way home she experienced difficulty in breathing, with palpitation
of the heart, and had to exert all the power of her will to get to
her house. She did not recover fully for several days. In this
case not over four minims of a 4 per cent, solution were used.
A similar case to the above was that of a vigorous young man,
who was a student. He likewise did not feel the effects until on
his way to Cambridge ; but as he had access to several convenient
bar-rooms on his way out, he was able to get sufficient strength to
reach his rooms. In this case not over three minims of a 4 per
cent, solution were injected, and none escaped into the mouth.
While the after effects of this case were not serious, a terror of
similar results was produced that made him willing to submit to the
most painful operations rather than have me make use of the drug again.
THE DENTAL RECORD. 377
I have found hundreds of cases of cocaine poisoning reported in
various medical journals, both in this country and abroad, and shall
be glad to give these references to any one who wishes to investigate
this subject further.
Suggestions of new methods for doing away with the danger
have appeared from time to time during the past fifteen years, and
in the December number of the Dentcil Digest an article from the
pen of a careful observer suggests the combination of cocaine with
morphine and atropine.
Whether we have any safe or reliable substitute for cocaine in
the various combinations that are suggested from time to time has
not yet been determined. There is, however, a substance which
deserves more than passing notice on account of the high character
and scientific standing of the men who have made the investigations
concerning it. Dr. A. P. Chadbourne, of Boston, in 1892, before
the British Medical Association, read a valuable paper on an alkaloid
which had recently been isolated by Giesel from the leaves of a
small-leafed cocoa plant of Java. The chemical constitution and
properties of this substance were studied by Liebermann, who proved
that it was benzovl-pseudo-tropein. Chadbourne gave it the name
of tropa cocaine, and under that name it is now sold by the leading
manufacturers of drugs.
In his paper, a careful study of which I .'would recommend to
any one who contemplates using this drug. Dr. Chadbourne relates
a series of carefully performed experiments with tropa cocaine?
using cocaine of equal strength upon the control animals. I
cannot, of course, give these experiments in detail, but the
conclusions drawn, which were amply supported by the evidence,
were as follows :
1. Tropa cocaine is less than one-half as toxic as cocaine.
2. The depressing action both on the cardiac motor ganglion
and the heart muscle, especially the latter, is much greater with
cocaine.
3. Local anaesthesia, both of the eye and of the skin, is much
more complete with tropa cocaine, and is possibly of longer
duration.
4. Solutions of tropa cocaine are moderately antiseptic, and
retain their strength for at least two or three months, while cocaine
solutions begin to deteriorate in as many days.
378 THE DENTAL RECORD.
Experimentation on the human subject confirmed the above
conclusions and seemed to demonstrate that tropa cocaine was
twice as strong and half as toxic as cocaine. There is, however,
one possible source of error in using tropa cocaine, viz., the possibility
of obtaining an impure sample of the drug. Dr. Chadbourne, in his
experiments, procured one sample that was much more toxic than
the others ; not more toxic than cocaine, however. But after
purification by recrystallization the difference disappeared.
It is also rather expensive, and the supply of small leafed coca
plants is naturally limited. One other diflference might be considered
an objection. Cocaine has a contractile action on the small blood
vessels, which tends to arrest haemorrhage ; tropa cocaine has no
such action.
After writing the above, I took the liberty of calling upon
Dr. Chadbourne, and asked him if he had seen any reason to modify
his views on the subject of the two drugs. He assured me that the
experience of those who had made use of tropa cocaine only tended
to confirm the conclusions he had drawn from his experiments. In
the course of our conversation he gave me an important point in
the treatment of cocaine poisoning, which I have not seen referred
to elsewhere. He found that with the animals experimented upon
a much larger dose of cocaine could be used if the temperature of
the room were lowered, and the animal recovered from the toxic
effects more quickly when the body temperature was lowered by
exposure to cold. This suggests that an ice pack or exposure to the
cold air in winter might give considerable relief in these unfortunate
cases of cocaine poisoning. He also confirmed the statement I
have already made, that an injection in any part of the head is
more liable to be attended by toxic symptoms than m other parts of
the body.
I do not wish to be understood as advocating the hypodermic
injection of this new drug into the gum for the extraction of teeth,
or other operations. I merely wish to affirm that if a local ansesthetic
is to be used in this way that there is some scientific basis for
experimentation with tropa cocaine, and it will probably be found
much more effective and a thousand times safer than any of the
nostrums that are offered to the public as substitutes for cocaine.
One other method of local anaesthesia I must refer to, as it is
now before the public, supported by men of recognized skill and
THE DENTAL RECORD. 379
intelligence, namely, the use of the electric current in connection
with cocaine and guaiacol, or cocaine alone. For a more detailed
account I would refer you to Dr. W. J. Morton's article in the
January number of the Dental Cosmos^ to Dr. Gillett's article in the
February number of the International Dental Journal^ and to other
more recent articles, which will repay careful study.
I have seen cocaine used by cataphoresis a sufficient number of
times to convince me that it has a place in dental practice, and I
mean to use this method for obtunding sensitive dentine in extreme
cases. It is, however, too cumbersome to be used as a routine
method. There is usually more or less pain, sometimes a good deal
of nervous apprehension attending its use, and in some cases it fails
to make any appreciable difference in the sensitiveness ot the tooth.
This may be due to faulty manipulation. The dam should always
be in place when this method is applied, as I am not convinced that
cocaine used in this way is less poisonous than when used in the
ordinary manner. Two possible improvements have suggested
themselves to me — one would be to have the obtunding done by an
assistant, and thus save fifteen minutes of your valuable time, for
the loss of time is a serious objection to this process ; and the other
would be the substitution of tropa cocaine.
The suggestion has recently been made that the incisors may be
rendered insensible to the touch of the instrument by placing pellets
of cotton saturated with a lo per cent, solution of cocaine in the
nostrils. I have seen this tried with entire satisfaction, but I
hesitate to endorse the method from the danger of forming the
cocaine habit. Doubtless you know that snuffing cocaine up the
nose is a particularly delightful form of indulging in the cocaine
habit and one that is easily acquired. Singers sometimes acquire the
habit by using the drug to dry up the secretions and get temporary
relief while singing. Neither the morphine nor the alcohol habit
compares with the cocaine habit in the undermining influence on
the mind and body. For this reason I should discourage the use of
cocaine by this method.
Another method of producing local amesthesia with cocaine was
suggested by Dr. Schleich, of Berlin, who recently published a
monograph on the subject. Briefly, it consists of an almost infinite
number of injections of an almost infinitesimal amount of the drug.
The injections are made, not subcutaneously, but intracutaneously,
380 THE DENTAL RECORD.
and the technique is somewhat as follows : — Beginning always in the
healthy skin, and holding the syringe almost parallel with the skin,
the needle is introduced, great care being taken not to push it
through the skin. The fluid will distend the skin and raise a white,
bloodless wheal. This area is instantly anaesthetic. Keeping within
this area, you introduce the needle near its edge and produce
another oedematous white spot. In this way you can gradually
anaesthetize a toot of territory. The anaesthesia lasts about twenty
minutes, and infiltration can be repeated if necessary. In dealing
with inflamed tissue it is always desirable to encroach upon it
gradually from the surrounding healthy tissue. In operations
requiring deep incisions the gradual process should be adopted in
getting at the seat of the disease.
The strongest solution used contained only two-tenths of one per
cent, of cocaine, and the weak solution contained only one-hundredth
of one per cent, of cocaine, with a little salt solution added. Indeed,
it is pretty evident that the anaesthesia comes more from pressure
on the terminal nerve filaments than from the drug itself, since it
can be shown that a two-tenths-per-cent. salt solution injected in the
same way will produce anaesthesia ; not, however, without severe
irritation. Chemists are prepared to furnish tablets made according
to the formula of Schleich, and this is, perhaps, the best form in
which to obtain the drug for this method of administration. How
general this method will become no one can predict, but I know of
the successful removal of a good-sized abdominal tumor, several
operations for varicocele, the opening of a felon, and a lot of minor
operations. The mouth hardly offers the best field for the practice
of this method, but in a general way it is not without interest.
I cannot close this paper without a reference to the wholesale
extraction of teeth by ignorant or unprincipled practitioners, who
advertise the painless extraction of teeth by the use of so-called
obtundents. For several years past we have been receiving from
time to time in our mails advertisements of obtundents which are
to be used by injection. In almost every instance the advertiser
claims that no cocaine is used, and tempting offers of exclusive
territory and dazzling riches to follow the use of this particular
preparation are held out to the unwary. By reference to an article
in the May (1893) number of the Dental Cosmos it will be seen
that nearly all of these preparations contain a large percentage of
THE DENTAL RECORD. 381
cocaine. This article is by Dr. Edward C. Kirk, of Philadelphia,
who had a number of these so-called local anaesthetics chemically
examined in the Philadelphia College of Pharmacy. There were ten
different preparations, all of which had been widely advertised, and
in almost every case the impression had been given, if it had not
been positively stated, that the preparation contained no cocaine.
It was found on analysis that every one of the preparations, with the
exception of Barr's, which was merely an alcoholic solution of
peppermint and cloves, contained cocaine, and many of them in such
large amounts as to be dangerous even in small doses.
Unfortunately, the use of these preparations seems to be
increasing. Of course, no self respecting man could be guilty of
violating the code of ethics of his profession by manufacturing and
advertising such nostrums. It is well understood that the profession
has a right to any discovery or improvement that may be made
by one of its members, and each man in the profession is under
distinct obligation to give to the profession any knowledge that he
may have acquired that will benefit his practitioners.
It seems to me that it is equally a violation of the code to use and
recommend any nostrums that may be put upon the market. In
this particular case there is an additional reason for taking a high
stand, as a disguised danger is more to be dreaded than an open one.
It would be well if we could bring about such legislation as would
make it a criminal offence to deceive the public by flooding the
market with such nostrums, but I am not sanguine about our
power to institute reforms by legislative action. We have to combat
not only the inertia of political bodies, but the opposition of
uneducated and unprincipled practitioners as well. Every peripatetic
tooth-puller eagerly avails himself of these preparations, reckless of
the danger, and while it would be a great gain to humanity to
exterminate this species of dental practitioner, I can see only one
way to accomplish it, and that is by a crusade of education and the
creation of a higher and better public opinion.
It is the duty of every man in the profession to use his influence
in warning the public against these fearful traps laid for the unwary.
Every means in our power should be used to expose the charlatans
who, for a fee, are willing to subject a patient to any risk, and who
are doing irreparable injury by the wholesale extraction of valuable
teeth. We must check this evil if we wish to uphold the dignity of
382 THE DENTAL RECORD.
our profession and preserve our self-respect. How we can handle
this problem best it is difficult to know ; but with high ideals and a
high appreciation of our calling we can carry on an aggressive
warfare that will eventually result in the extermination of nostrum
manufacturers and irresponsible practitioners. — International,
LIQUID SILEX.
By H. H. BuRCHARD.
The solution known by this name, or as soluble glass, chemically
the sodium silicate (NaoSiOg), is quite as effective a medium to
prevent the adhesion of plaster to vulcanite as is tin foil, but certain
precautions are necessary to procure the best results. The material
should be kept in a moderately warm place, and tightly stoppered.
As soon as its viscidity becomes greater than that of a thin syrup,
throw it away and buy a new bottle. Should it lose its perfect
clearness discard it. The writer finds that about one-third of the
four-ounce bottles in which it is sold is useful ; the remainder is
usually so deteriorated as to be worthless. Dilution with hot
water and warming the solution restores its appearance, but for
dental purposes not its virtues. The model, after investment, and
also the teeth and entire investment are freed of adherent wax by
pouring over them a stream of boiling water. The excess of water
is absorbed by means of bibulous paper. As soon as the wet
appearance disappears from the plaster it is ready to receive the
silicate, not before.
A camel's-hair brush, having a fine point and no loose hairs, is
dipped in the solution and the surplus wiped off the brush. The
plaster surfaces, all of them, are painted lightly with the silex,
carefully avoiding contact with the porcelain or platinum pins. By
means of the fine point on the brush the matrix of the rim is painted
between the teeth ; in coating the cap side of the investment, much
care is required to prevent touching the teeth. Small wisps of
bibulous paper are quickly and gently passed over the painted
surfaces until there is but a thin glaze covering every part of the
plaster. The pieces should be set aside for at least fifteen minutes,
to permit thorough hardening of the silex. After vulcanizing the
flasks should not remain unopened over night, for if salt (sodium
chlorid) has been used to hasten the setting of the investment, the
THE DENTAL RECORD. 383
surface of the vulcanized plate will be covered by a hard and
tenacious gloss ; if opened as soon as cold the plaster and silex part
from the vulcanite, without even washing, leaving a smooth, glazed
surface equal to that found under tin foil.
The mechanic may be certain that the lack of good results is due
to either carelessness or faulty silex.
This is an important matter, as unquestionably many or most of
the ills attributed to the wearing of vulcanite plates are due to
roughness upon their palatal surfaces. — Cosmos.
FILLING ROOTS.
By A. E. Matteson.
I WANT a tough guttapercha. Eucalyptol is sufficient to lubricate
the surface of the guttapercha and allow it to pass easily in a fine
root canal, and I venture to say that any canal which can be opened
can be filled with guttapercha. I mean the guttapercha we now use
for base plates — red guttapercha. If the canal is open, is dried and
flooded with either the volatile extract of eucalyptol or oil of cajeput,
it can be filled. My method is to cut it in square strips lengthwise,
the way in which it has been rolled, that would make a square rod,
then, holding it over the lamp or flame, gently twist and draw it.
You can draw it down to the fineness of a hair, and as it is twisted
it forms a cone screw. This can be cut off" in sufficient lengths such
as you will want, one-quarter of an inch, heat the end of the broach
and catch on the end of the guttapercha point and carry it to its
place. The difference between that and soft white guttapercha is,
that the latter will invariably curl up, and this will do it if you are
not rapid. It can be carried up in the cavity and the screw allows
the surplus to flow back, and another cone is then pressed to its
place and the softened partis returned toward the opening. The
reason why I prefer this red guttapercha is that we frequently have
occasion to crown these teeth, and with any tooth which has to be
crowned where the root canal has been filled with either white
guttapercha or with any of the cements it is almost impossible to
tell when you are drilling out the canal whether you are drilling the
tooth structure or the cement. There is no difference in the colour.
With the red guttapercha it is different, for when your shavings
show you are cutting white you are cutting tooth structure instead
of the filling. This is for the purpose of crowning where you wish
384 THE DENTAL RECORD.
to open in the canal for the purpose of inserting a post. I have
experimented with this a number of times in showing my friends
how I fill root canals, and have taken teeth and had my son cleanse
out the canals. They are generally pretty dry. I filled them, and
in taking them up afterwards found some cracks in them which
could not be discovered till after they were filled. They would show
red guttapercha, and any filling material that will fill those cracks
is good enough to fill the roots.
I have experimented with glass tubes made as near the form of
root canals as it is possible to do, have had them inserted in plaster
and filled them in that manner, and then opened them. I believe
any canal that can be opened up can be filled with guttapercha in
this manner.
I will say to those who fill root canals with chloropercha that
there is danger of pumping it back and getting air in the canal, and
in the experimental cases that I have filled in this manner I have
invariably found there were bubbles. — Items of Interest.
DOSAGE EXTRAORDINARY.
When Chunee, the celebrated Indian elephant, fell sick, it was
decided that he was suffering from constipation, and after thirty-
two hours of coaxing, he was induced to swallow his first dose, which
consisted of 24 pounds of salts, 24 pounds of treacle, 6 drachms of
calomel, i^ drachms of tartar emetic, 6 ounces of powdered gamboge,
and a bottle of croton oil. This produced no more appreciable
results than an ordinary bun would have done. Six pounds of beef
marrow with 4 drachms of calomel was then administered, but
absolutely without result ; and Chunee becan:e so violent that it
was decided to destroy him. But all attempts to get him to take
the dose, consisting of 40 drachms of arsenic, with \ drachm of
corrosive sublimate and a lot of strychnine, were unavailing ; and
the aid of expert marksmen and finally of the military had to be
called before he could be disposed of. It took 260 rifle balls to kill
him. And behold ! at the autopsy it was found that Chunee had
been driven mad with a toothache. One of his enormous tusks was
extensively decayed, and the diseased tooth, a specimen of mal aux
dents on a very large scale, is preserved with the skeleton of the
beast at the South Kensington Museum. — The Dental Headlight*
The dental RECORD.
Vol. XVI. SEPTEMBER 1st, 1896. No. 9.
©riginal Ot0mmitnicatxons,
A CASE OF SEPTICEMIA, THE RESULT OF ALVEOLAR
ABCESS.
(^Lately under the care of Dr. Wasliboiirn, at Git.y''s.)
Communicated by L. Strangways Hounsell.
Sydney R., a lad of 13, first complained of toothache on Friday,
March 27th, and his face commenced swelling on the 28th. He
was able to go about as usual, but on the 29th, the swelling
increasing, he came to Guy's Hospital (Dental Out-patients), on
Monday, the 30th. His face appeared much swollen and cedematous
on the left side, which extended to the orbital region. With some
difficulty his mouth was opened sufficiently to observe that the
upper first permanent molar was carious, and that pus was oozing
between the gum and its neck. It was removed without difficulty,
being very loose, and a considerable quantity of pus flowed from the
socket. The patient seemed relieved and was sent home, with
instructions to keep warm and quiet. Shortly after reaching home
he appears to have become delirious, and he was therefore put to
bed. Later in the evening he became unconscious and lost
voluntary control over micturition and defecation. Upon learning
from his father his condition, arrangements were at once made to
admit him as an in-patient in the Clinical W^ard at mid-clay.
From the presence of internal strabismus, he appeared to be
suffering from meningitis, which was subsequently found to be
congenital, but eventually septicaemia was diagnosed. His pulse
registered 156, and his temperature was as high as 104-5°. The
pupils were dilated and muscular twitching of both the sterno
mastoids v, as present, the facial muscles and others of the neck
were also affected, and at times those of the extremities. The face
was swollen and cedematous, on the left side the hard palate also
was affected, and blood and pus were oozing from the socket of the
0 0
386 THE DENTAL RECORD.
extracted molar. A probe passed into the cavity did not appear
to penetrate the antrum, and there was no nasal discharge. The
neighbouring lymphatic glands on the left side were much enlarged.
The patient remained in much the same condition during the
night, but next morning the muscular twitching was less marked,
and at lo p.m. the temperature fell to loo^. From the morning of
the 2nd the patient continued to improve, and in the afternoon an
antral syringe was used to thoroughly wash out the cavity, and it was
then seen that the second upper left molar was loose, and under the
circumstances it was removed, affording a freer drain and precluding
the possibility of the patient swallowing it whilst still semi-conscious.
The tooth was examined, and found to be perfectly polished and
completely denuded of periosteum, being bathed in pus and
exudation from the wounds. Under a treatment of injections of
anti-streptococcus serum the patient made remarkable progress, and
was eventually sent out with nothing worse than a little necrosis of
the alveolar portion of the left superior maxilla.
He continues to attend the dental out-patient department, and
it s«ems probable that the bone will separate as far forward as the
canine. The partially erupted wisdom was also removed ; still it is
probable that the little patient will only have the loss of his teeth
to remind him of his visit to Guy's Hospital.
At the June Meeting of the Odontological Society, during the
discussion which followed a paper on " Some Points in Connection
with the Bacteria of the Mouth," read by Dr. Washbourn, assisted
by Mr. K. W. Goadby, of Guy's Hospital, in reply to remarks by
Dr. Durham on serum, Dr. Washbourn said (referring to the above)
that '' A very interesting case had come under his notice ; a boy
who shortly after the removal of a tooth was taken with severe
symptoms of septicaemia and with cerebral symptoms. He felt
quite sure the boy had commencing meningitis, and that it was
probably a streptococci infection. A httle of the pus from the tooth
was examined, and streptococci were found, but unfortunatel}^ the
virulence was not tested, nor were a series of cultivations made in
order to see whether it was the streptococcus longus, or some of the
streptococci from the mouth, which had accidentally entered the
tubes. The case was treated with serum with most remarkable
results, and very soon after the injections the boy got better and
ultimately completely recovered,"
THE DENTAL RECORD. 387
Previous History. — When eight years of age he suffered from a
sHght concussion — no fits since. Had measles. Family history good.
There therefore appears to be no other explanation of the disease
than as a result of the infection from the carious molar. The chief
point of interest in this case is the rapidity of the course of the
disease, only three days intervening between the commencement of
the swelling and the appearance of symptoms simulating septic
meningitis. The antrum not being affected the poison must have
been absorbed by the lymphatics into the blood stream, the glands
remaining swollen throughout the previous symptoms. It behoves
us therefore to warn our patients of the possibility of fatal or grave
consequences which may arise from continued neglect of an alveolar
abscess, there being little doubt that the little patient's life was only
saved by his prompt admission to the hospital, and the subsequent
successful treatment he underwent.
iP.^tos antr jSnt^s*
The Dental Hospital of London, Leicester Square, has received
a donation of ;^200 from the Baroness de Hirsch towards the amount
required for purchasing a site and building a new hospital.
During the July Examinations the following gentlemen passed
the First Professional Examination for the License in Dental Surgery
of the Royal College of Surgeons, Edinburgh : — Thomas Percy
Wolston Watt, Ceylon ; William Joseph Low^ ; Arthur Capper,
Huyton ; Harry Eugene Field, Birkenhead ; Francis Radley King,
Newcastle ; Andrew Walker Mouat, Leith ; William Black
Alexander, Edinburgh ; George Hills Watson, Edinburgh, and
John Alexander Kennedy.
The following gentlemen having passed the Final Examination
were admitted L.D.S. Edinburgh : — Lloyd Thomas Lavan, Jersey ;
William Jones, Edinburgh ; Charles Linnaus Routledge, Exeter ;
Thomas Roger Dove Walkinshaw, Newcastle ; Bernard Smith,
Huyton ; Theodore Stancombe Rendall, Torquay ; William Edward
Stewart, Dundee ; James Wallace Bell, Edinburgh ; Richard Mason,
Edinburgh ; Alfred William Wellings, Salop ; Alexander vShennan,
Houghton-le-Spring ; and Matthew Rodway Lceming, Salford.
CC3
388 THE DENTAL RECORD.
THE DENTAL RECORD, LONDON : SEP. 1, 1596.
THE BRITISH DENTAL ASSOCIATION MEETING.
Our present issue departs somewhat from its ordinary-
lines. The coincidence of a resum6 of the proceedings of
th-^ recent British Dental Association Meeting and our
educational number account for this. We suppose our
provincial readers will not cavil at our saying that the
meeting of the British Dental Association in London invests
this annual event with great importance. It is not that
there is anything lacking in the hospitality or in the
intellectual power of provincial centres^ but that, London
happening to be the capital of the Enapire, all roads lead
thereto. So it follows that meetings held in London are
sure of a large and representative gathering. Hence, in a
measure, the success which attended this last gathering. It
is difficult to pick out from the doings of such a meeting the
points by which it will be remembered in future years ;
sometimes it is an educational matter, sometimes a political
move, and at others some scientific fact or practical methcd
by which we call to mind such and such a meeting. Perhaps
the attentive, eager groups which surrounded each demon-
strator may suggest that from these much was learnt. The
high order of the scientific papers of the Microscopical
Section shows that the number of workers in this field is
increasing, and that the starting of such a section was a
great idea. But above and beyond everything one bears
away from such a meeting the feeling of the great moral and
social gain which the Association has wrought. Members
meet members, not as rival practitioners, but as friends ;
facts, which but a few decades ago would have been wrapt
about with secrecy, are now freely disclosed and explained.
The gain from such a change, both to the profession and to
the public, is immense. We learn at these meetings to
The dental record. 389
respect our fellow practitioners, who, but too often in the
privacy of private practice we might have known only
through their failures. It is this re' pect in which we learn
to hold each other which is the surest proof that the public
do and will respect us.
BRITISH DENTAL ASSOCIATION.
The Annual Meeting of this Association was held in the
Examination Hall, Victoria Embankment, on Wednesday,
August I2th, 1896.
Mr. W. Bowman MacLeod, retiring President, in the chair.
Mr. MacLeod, in the course of a brief valedictory address, spoke
of the steady advance which had been made since 1878 in the
consolidation of professional interests and the consequent elevation
of the status of the profession. It was, however, not time yet to
relax their efforts in that direction, or cease from taking advantage
of every opportunity which might enable them to perfect their
educational training, to render more perfect and uniform the pass
standards of their licensing bodies, and devise some amendment to
their Act which would restrict or prohibit the practising of dentistry
by untrained persons. The machinery at their command was not
yet sufficiently powerful to reach those desirable ends, nor would it
be so until they could secure, amongst other things, direct repre-
sentation on the Medical Council.
Mr. MacLeod then vacated the chair, which was taken by the
new President, Mr. F. Canton.
The President, after offering a cordial invitation to the
association, observed that there was no teaching University in
London, neither were the medical schools in London endowed with
chairs, nor were there teachers, with a few exceptions, dignified by
the title of professors, and yet he ventured to say that both schools
and teachers were second to none in the influence which they
exerted in the teaching of medical and surgical practice. Whether
the advent of the great boon to the London students of a teaching
University was at hand, or only in the distant future, they might
take it for granted that it would come, and when that time occurred
it would be for the executive of the association to see that the dental
390 THE DENTAL RECORD,
profession received that recognition to which it was entitled. They
must ever keep in view the advancing requirements of dental
practice. Their profession was perhaps a little more difficult to
deal with than some others, as they had a mechanical and surgical
side as well as a more purely scientific one. One of the objects of
the association should be to see that neither one side nor the other
preponderated. To hit the happy medium was not an easy matter.
Practically their curriculum was a five years' one, and he should like
to see it declared as such, and the suggestion he should throw out
was that the third year of the three devoted to dental mechanics
should be devoted to hospital work, with a view to maturing and
utilising the knowledge and skill required in the workroom. In
that way one of those arbitrary and unsatisfactory divisions of their
profession would be bridged over gradually and even unconsciously.
Two very important subjects of their training might, he thought,
be improved on, and those were dental histology and dental materia
medica. The first especially should have a separate and well-
organized department to itself in all their schools and include the
elements of bacteriology. He believed that by having a declared
five years' curriculum instead of four, and by having two exami-
nations for the dental diploma, it would not be putting any extra
strain on the student, but, on the contrary, would give him the
extra time which was required by the average student to enable him
to pass with greater ease. Their Act of Parliament did not prohibit
advertising, which was the great misleader of the public. It had
been suggested that possibly it might be of assistance to the public
if they adopted the system of the Stock Exchange and made it
known " That no member of the British Dental Association is
allowed to advertise." That, however, would entail some alterations
in their bye-laws, but as those changes would be of a utilitarian
rather than of a sentimental character they might repay the
necessary trouble by being profitable. That might enable the
public to make a few more enquiries before consulting a dental
practitioner. There were, of course, many respectable practitioners
who were not members of the association, and it was to be regretted
that such was the case. He could not help feeling strongly that it
was the duty of every professional man to do his utmost to assist in
the elevation and cultivation of the profession to which he
belonged.
THE DENTAL RECORD. 391
Mr. Mummery, in proposing a vote of thanks to the retiring
President, alluded to the excellent way in which that gentleman had
fulfilled the duties of the Chair.
Mr. Bkeward Neale seconded the motion, which was carried by
acclamation.
Mr. Tomes proposed a vote of thanks to Mr. Canton for his
address.
Mr. Smith Turner seconded the motion. The motion was
unanimously adopted.
Mr. MacLeod and the President briefly acknowledged the vote
of thanks.
The Treasurer then read his Annual Report.
Mr. Storey moved, and Mr. Lawrence Read seconded, the
adoption of the Report, which was agreed to.
The Hon. Se: retary (Mr. W, B. Paterson) read his Annual
Report.
Mr. Brunton moved, and Mr. Lee Rymer seconded, the
adoption of the report.
Mr. Blandy referred to the paragraph in the report relating to
dental advertising. He said, that at one of the meetings of the
Representative Board it was proposed that legal opinion should be
taken as to the powers of the General Medical Council to enforce
their decision. It was a peculiar motion, seeing that it was for the
General Medical Council itself to decide on the legality of its own
proceedings. A resolution was passed by a large majority to obtain
legal opinion, and good cases were afterwards produced to go upon
which had been prepared with great care and submitted to the
General Medical Council, At a subsequent meeting of the Board,
however, it went back upon its decision asking for legal opinion,
and refused to present cases. He had himself been put upon the
Board because he had taken up the advertising question from so
early a date as the Birmingham meeting. He had gone on with
the matter ever since, and had succeeded in getting the support of
the whole of the General Medical Council. He had seen Sir Dyce
Duckworth on the subject, who had urged him to bring the matter
forward. He had also interviewed another member of the Council,
who could not understand the refusal of the Representative Board
to take the matter in hand, and recommended him (Mr. Blandy) to
persevere in his action, even if it led to the formation of another
392 THE DENTAL RECORD.
society. He was, however, unwilling to produce a split. The
Association was a splendid one, numbering 930 members. No
doubt they were all anxious to promote the interests of their brother
dentists, but many of them were too cautious, and were willing to
stand still and leave their provincial brethren to be worried by
advertising men. Mr. Oliver, of Cardiff, had taken the bull by the
horns and formed a little Association consisting of 20 or 30 dentists,
who had each guaranteed ;^io. They had thus formed the nucleus
of a National Defence Union. He did not think it was any use to
bring forward another resolution at the Representative Board. He
was not fond of running his head against a wall, and he should not
do it again. He felt no animosity towards any members, but he
thought it was his duty to speak out. If the members generally
refused to act, he, and others who were acting with him, would do
their utmost to bring the question before the General Medical
Council.
Mr. Smith Turner wished to know if the gentlemen in Cardiff
had made any prosecution for advertising, because, if they had not,
Mr. Blandy's claim to their support was a mistaken one.
Mr. QuiNLAN said that in Cardiff they had not interfered with
advertising, but had simply prosecuted non-registered practitioners.
Mr. Oliver said that the Association at Cardiff was not a
separate body from the British Dental Association, or in any way
opposed to it. The body was formed for the purpose of more
effectually carrying out prosecutions under the Dentists Act, and
its members were perfectly loyal. Of the 22 members who had
joined the Society, several had become members of the Association^
and others were asking to be proposed. He believed that if the
Association fulfilled the objects and desires of the members of the
dentists' profession in South Wales they would all join, and he
felt sure that the same thing applied to all the dentists throughout
Great Britain. If the Association neglected the requirements and
felt wants of the great mass of dentists it could not be expected that
they would attach themselves to it. The Association had done
good work, and was, perhaps, right in being cautious, but there was
such a thing as an excess of caution. There was a time for all
things. There was a time to be cautious and a time to prosecute
the war in an energetic manner. The enemy was all around them,
and the Association was by its constitution incapable of grappling
THE DENTAL RECORD. 393
with the thousands of cases cropping up. Local associations were
therefore required in every part of the kingdom to carry on the
work. That was the only way by which the great evil of the
unregistered practitioner could be satisfactorily dealt with. The
result of the combination in South Wales had been that seven
convictions had been already obtained. The fault that he found
with the British Dental Association was that it had funds at its
disposal but did not use them for that purpose. The raison a^etre
of the Association was the prosecution of such men as he had
mentioned, and if it would perform its duty manfully he believed
there would be no association in the kingdom so strong as the
British Dental Association. He w^as quite sure that the requisite "
funds would be forthcoming. It was their duty to protect the public
when -it was swindled, to protect the great body of practitioners,
and also the coming men of the profession, who were looking to
them and asking what they had done to pave the way for the
younger generation. A resolution had been sent up from the
Western Counties Branch recommending the Association to assist
and encourage the formation of local centres thoughout the kingdom,
and he hoped that that resolution would be acted upon.
Mr. West wished to know why the consideration of the question
of advertising had been withdrawn by the Representative Board.
The President said that the resolution that had been reported
to the members had been adopted after a careful discussion. The
matter had been referred to the solicitors, and when it came back to
the Board, it was thought, in consequence of the information
brought before it, that it would be unadvisable at present to bring
the question of advertising before the General Medical Council.
Mr. CoxoN thought that some reasons should be given for the
conclusion arrived at.
Mr. Smith Turner said the members could hardly expect an
explanation of the minutes of the proceedings of the Representative
Board. Many things were there done that it would not be expedient
to publish. If they could not trust their representatives they should
turn them out ; he, for one, was perfectly ready to go.
Mr. Coxon was aware that Representative Boards could not
always state the grounds for their actions, because questions of libel
might arise. Still, he should be glad to know why the matter
under discussion had been shelved.
894 THE DENTAL RECOki3.
Mr. Cunningham thought that the Association ought to know
more of what was going on on the Representative Board, and how
the members voted on the diffeient questions brought before them.
On the present occasion, however, he supported the Secretary's
Report, because he thought it was unfair to ask questions from the
authorities which they could not do justice to, either on the one side
or the other.
The motion for the adoption of the report was put and carried.
The President said he was quite sure that any members of the
Board would be happy, privately, to give any gentleman any
information he might desire.
On the question of the meeting of 1897 —
The President said that a cordial invitation had been received
by the Association from the Irish Branch to hold its next meeting
in Dublin, and it had been recommended that Dr. Theodore Stack
should be the President, the meeting to be held in August, the
precise date to be fixed by the Board later on.
Mr. Corbet said that if the invitation were accepted (which he
proposed) he believed the Association would have a hearty and
hospitable reception.
Mr. Andrews seconded the motion, which was unanimously
adopted.
Dr. Stack thanked the members for electing him as President
for the next year, and promised them a hearty welcome in Dublin.
The President announced that as the result of the ballot for
ten members of the Representative Board the following gentlemen
had been elected : — Messrs. L. Matheson ; S. Bennett ; W. E.
Harding; R. J. Lennox; G. Cunningham; Dr. Corbet; T.
Gaddes ; J. Walker; F. W. Richards and W. Helyar.
The Sixth Report of the Schools Committee on the teeth of
children was then read.
The following resolution, recommended by the Representative
Board, was also read : *' That the British Dental Association regrets
that there is no mention of teeth or dentistry in the recent Report
of the Departmental Committee of the Local Government Board on
Poor Law Schools, although its attention has been called to the
matter by statistics and by the evidence of the Local Government
Board Inspector ; that this Association is strongly of opinion that
the importance of the care of children's teeth, especially those of
THK DENTAL RECORD. 395
the wage earning classes and the poor, should receive immediate
attention by the Boards of Guardians and other authorities ; and
further, that all such school dental appointments should be made
upon similar lines to those regulating medical appointments, and
therefore subject to the inspection of the Local Government
Board."
Mr. Smith Turner moved the adoption of the School Com-
mittee's Report. It showed, he said, that the matter in question
was going on slowly but surely. It was not desirable to do things
by rushes. On the whole, he regarded the report as extremely
encouraging, and hoped that it would be unanimously adopted.
Mr. Redmond seconded the motion.
Mr. Storey said that in the districts of two Boards of Guardians
in his town, honorary dentists had been elected who were both
advertising men, and had undertaken to do the duties without fee
or reward and without any regulations as to the amount of work to
be done. He was sure that that was far from the intention of the
Association or the Committee. Mr. Spokes had shown him a copy
of the book or chart in which particulars were to be kept, and which
had been approved by the Local Government Board Inspector. It
would be placed by the Governor of the Board of Guardians in the
hands of the honorary dentists, who would be required to keep an
exact record of all the operations done. He suggested a similar
course of action in other towns, with a view of preventing such
honorary appointments.
Mr. Oliver thought the question was one of national im-
portance. He wished to know what powers Boards of Guardians
had in regard to the payment of dental practitioners attending their
schools. If they had no such power, machinery should be brought
to bear so that such appointments should become general. As far as
he had had the question of fees brought before him, he thought they
were adequate for the work required to be done. All school children
should have their teeth seen to regularly three times a year, and as
thoroughly cared for as in the case of patients seen in private
practice.
Mr. Maitland said that the Guardians had power to make a
representation on the subject, which might be accepted or refused.
Mr. Headridge thought that the subject should apply only to the
Boards of Guardians, and not to schools generally. There were
396 THE DENTAL RECORD.
large numbers of children under the care of Boards of Guardians
who were entirely without a dentist. They had only the ordinary
surgeon to attend them, and their teeth were pulled out in the most
clumsy iashion.
The motion for the adoption of the report was carried.
Mr. Smith Turner moved the adoption of the resolution follow -
ing the report.
Mr. Dennant seconded the motion, which was unanimously
adopted.
The meeting was then adjourned.
Wednesday^ August 12th.
Afternoon Meeting.
Mr. F. Canton, President, in the Chair.
A Paper was read on " Some Experiments in Bridge Work,"
with lantern illustrations, by Mr. G. Cunningham, MA. Cantab,
L.D.S.Eng., D.M.D.
Mr. Maitland asked the author how his work, with its vari'ous
complications, compared in speed with the older fashioned system.
Mr. Hunt asked to be enlightened on the subject of the experi-
mental results in ordinary average cases. He was not himself partial
to bridge work.
Mr. Matthev^^s was disappointed that the author had not touched
upon the subject of " bridge-plates " as substitutes for " barcorners,"
as mentioned in the printed abstract.
Mr. Wynne Rouw thought the author had sacrificed almost
entirely the aesthetic principle to that of use. Both, he thought,
should be combined. No attempt appeared to have been made to
contour the crown which did not take more time than blocking out
the crown. A judicious admixture of the two might, he thought,
have been adopted in some of the cases mentioned. With regard to
the cantilever system it seemed to mean continuing the crown for
the masticating surface over a space not occupied by teeth. In some
of the models shown there appeared to be no other support for the
continuation of the masticating surface. From his limited ex-
perience he thought that ledges so left formed a very favourable site
for the collection of large masses of food, which could not be
dislodged with ordinary efforts.
THE DENTAL RECORD. 397
Mr. Breward Neale asked whether the author had found in
the cantilever cases that the life or usefulness of the bridge was less
than in a case supported definitely at each end.
Mr. C. O'DuFFY said he had seen scores of bridges with their
abutments on unprotected teeth, and the results, if not fatal, had been
always injurious. He would never insert one without both ends of
the bridge being attached to these crowns. The result he had
noticed had been decay of the abutting teeth or else displacement
by the pressure of masticating.
Mr. J. Dennant presumed that bridge work cases were only
successful when they were specially selected. He should be glad to
know something as to the percentage of failures in the direction say
of periostitis in connection with teeth supportmg the bridges.
Mr. Reinhardt said he had noticed that several of the cases
shown had abutments or supports which werj evidently living teeth.
He had put crowns on living teeth by trimming up their enamel,
and he had inferred that the patient would rather be seventeen years
without the crown than have another one done.
Mr. G. Whittaker did not agree with the author in leaving such
a large space underneath. He did not see any harm in having gold
and porcelain teeth v. ell pushed against the gum in preparing the
crown. He had found that after a few years there was not much
absorption, and in several cases none whatever, and he did not see
the food lodging underneath. The gum became a hard, corny
substance, and undoutedly the mucous membrane was very hard
underneath. That was much more satisfactory than having a hollow
space where food could lodge. He was in favour of small bridges.
A few years ago he would have hesitated to destroy a nerve in say a
central tooth if there were a good set of teeth with one central tooth
perhaps knocked out, but lately he had been in the habit of destroy-
ing the nerve, although it was a perfectly sound central tooth, crowning
it, and adding a tooth to it, and he thought that far preferable to using
a large plate.
Mr. Beadnell Gill would be glad to know if the author had
chosen fortuitous cases in which he brought not a crown but a mere
rest on to a natural and healthy tooth. In tlie case of teeth that
they might do what they liked with, and that could not very well
produce decay, the system might be a good one, but those cases were
very rare, and he feared would become still more so. With regard
398 THE DENTAL RECORD.
to cutting down teeth which still retained their vitality or their pulp,
he agreed that patients generally did not appreciate that proceeding.
If Mr. Cunningham could show any method by which he could
treat the more delicate mouths in which the necessity for applying
bridge work most frequently arose, he should be very glad to hear
it. He doubted if, after some years of experience, even Mr.
Cunningham would recommend the frequent application of bridge
work to the average class of mouth met with in general practice.
Mr. W. R. HuMBY said he should like some further information as
to the irregularities in the manufacture of platinum-iridium. The
author had stated that there was not a definite composition of
iridium and platinum. There was a great need of a pure material,
and the actual composition of gold and platinum ought to be known.
If Dr. Cunningham had an analysis of the platinum he should be
very happy to see it.
Dr. Cunningham, in reply, said that with regard to the question
of speed there could be no doubt that the new work required more
time and a greater exercise of mechanical skill than the ordinary
methods. As to the "experimental results," they related, as stated
in the abstract, to the character of suitable cements, so far he had
not found out any particular cement which he was prepared to
recommend as the best. The phosphate cement varied greatly, and
those of the same makes often produced different results. The real
factor in contour was to be found in coronal contours, which gave
a good masticating surface. With regard to the length of life of
cantilevers, his own life had been too short to come to any conclusion
on the subject. A cantilever need not press on another tooth, and
very often there was a great deal of useful wear where there was no
other place to lean upon. His experience in regard to decay did
not coincide with that of Mr. O'Duffy. He could give many
instances in which, after several years, there was absolutely no decay
when the patient took reasonable care of the appliance. He had had
very little trouble with periostitis. In answer to Mr. Reinhardt, he
might say that many of his patients, after going through their
purgatory, were satisfied with the results. As to food collecting in
the hollow spaces, that was not the case, because they were so hollow
and clear that they were easily cleaned. He was glad to hear
Mr. Whittaker's remarks about resting the appliance on the gum.
He had spoken of the gum underneath being cornified. He
THE DENTAL RECORD. 399
(Mr. Cunningham) knew other places where the mucous membrane
disappe?.red and there was a raw ulcerated place. That was a matter
to be tested by experience. He could not say whether his cases were
"fortuitous," they were the best at his command.
Mr. Sidney Spokes, M.R.C.S., L.D.S.Eng., then read a paper
entitled " Notes on Fracture and Hypoplasia."
The author suggested that the term Hypoplasia should be adopted
for enamel defects instead of the misleading name of Erosion. Dr.
Barton had come to the conclusion that the faulty development of
enamel was mainly caused by errors in feeding during the first years
of life, but the author did not propose to say much as to the etiology
of Hypoplasia ; all were probably agreed that the defect was due to
interference with the child's nutrition, and possibly several factors
existed, any one of which might bring about the disturbance. The
author gave statistics of 1,904 children from a Public School, Poor
Law Schools, and Poor Law Ophthalmic Schools. Hypoplasia was
present in 147 cases, distributed as follows : —
258 College Boys
841 Poor Law Boys
103 Ophthalmic Boys
622 Poor Law Girls
80 Ophthalmic Girls
Must it not be assumed that the college boys were not subjected
in early life to the same extent to the causes which produced
Hypoplasia ? There might be some temptation also from the table
to establish a relationship between eye affections and hypoplastic
teeth, but the circumstances hardly warranted that, and the dis-
crepancy must remain unexplained. In twelve instances the
bicuspids shared in the defect, and although some denied that any
later teeth were affected, Burten, of Wiirzburg, had recorded three
cases where the second molars were affected, and Witzel claimed to
have observed Hypoplasia of the third molars. No one could have
many instances of Hypoplasia without noticing that the regularity
of the tide-mark did not always coincide to the usually accepted
ideas. Although 27 cases were found in which the upper laterals
had escaped, the following were also noted : — Upper canines escaped :
centrals and laterals affected ; molars escaped : molars alone affected.
In the cases tabulated, instances of teeth modified in form (suppression
of cusps) by syphilis, but not ridged or fitted as in ordinary
12
or
4-6^
.. 60
11
7-1%
.. 17
>?
i6-5^
.. 47
n
7-5^
.. II
5J
137^
400 THE DENTAL RECORD.
Hypoplasia, were not included. Six cases were met with where
molar crowns were '* modified," one with the upper centrals so
affected, and two cases of the true Hutchinsonian type. In four
other cases diagonised as subjects of hereditary syphilis the incisors
and molars generally were modified and in one the incisors were peg-
shaped, with the left upper central and right lower lateral incisors
notched. Other cases of enamel defect, not included in the figures,
were those where a single bicuspid had deficient enamel. It had
been suggested that a local rather than a constitutional origin should
be looked for in such cases, and a plausible explanation had been
found in the shocking state in which abscessed temporary molars
were sometimes seen, but curiously enough in none of the 37
instances met with did the records show that the molar which
preceded the bicuspid was abscessed. On the other hand, there were
seven or eight instances in which abscessed temporary molars were
followed by bicuspids with perfectly sound enamel. The distribution
of the faulty bicuspids was 8 in the upper jaw, and 29 in the lower, the
right second bicuspid providing eleven instances, and the left second
oicuspid nine. Out of 250 infants there were 15 cases where
Hypoplasia affected the temporary teeth, whilst among the older
children with permanent incisors and molars, but also with
temporary canines and molars present, there were 10 instances of
hypoplasic temporary teeth. Whatever the cause, it must occur in
iiteroy and the author suggested that the prolonged attacks of vomit-
ing in pregnancy, which sometimes appeared as late as the seventh
month, might so interfere with the nutrition of the mother as to
affect the developing teeth of the foetus.
Mr. Smith Turner said he should have been glad if Mr. Spokes
could have told them what the patients were suffering from in the
Ophthalmic Hospital. Was it only ophthalmia entirely or were
other eye diseases included ? Frequently bicuspids had brown
stains on the pit of the enamel — perhaps only one in a full set of
teeth, but in those cases the dentine was stronger, and always able
to take care of itself.
Dr. Greevers thought that the cases in which the bicuspids
were concerned must be exceptional. In his experience they were
sometimes affected, and he knew of a family in which all the seven
children had hypoplastic teeth, all the bicuspids being Hkewise
affected. One should be careful in pronouncing as to hypoplastia.
THE DENTAL RECORD. 401
His experience had been, in following cases from very early childhood,
that where only one bicuspid was affected it was generally due to
the eruption of the teeth. The temporary molars had suffered from
chronic periostitis, and he had found that they wanted roots, and
either an abscess had been there or some inflammatory condition.
He had sometimes fancied that he had detected a hypoplastic
condition of the temporary teeth, but fie had found on inquiry that
the children, to keep them quiet, had been given to suck a composition
of bread and sugar put into linen bags, and in those cases hypoplasia
was well imitated. The children in England were better off than
those in Holland, for in an orphan asylum which he had there
visited, he had found the large majority of children with hypoplastic
teeth ; and even in the higher classes of society in Amsterdam he
had found a large majority of children whose teeth were in that
condition.
Mr. Hartley said that one cause of the hypoplastic condition
had been held to be the visitation on the child of some disease of
an eruptive character daring the first few years of its life. He had,
however, made inquiries on the subject, but had never been able to
ascertain such to be the case. It had also been considered to be due
to artificial feeding, but he had met with cases of hypoplasia where
the child had been suckled up to the ninth or tenth month. He had
found the children in the better classes, especially girls of an anaemic
character and of a phthysical tendency, to be extremely marked
with a hypoplastic condition.
Mr. Betts said that in his experience the parents of the children
generally acknowledged to a rather severe attack of illness of some
kind. In one marked case under his care it was stated that during
the first six months of life the child could take no milk food at all.
Mr. Spokes, in reply, said he could not state what the children
were in the hospital for. A large proportion were in for contagious
ophthalmia, having been sent from the different parishes in the
metropolitan area. The sound dentine of defective bicuspids was a
thing generally recognised. It was easy to differentiate between a
hypoplastic condition and an ordinary erosion caused by sugar food
and acid secretions ; but, no doubt, indirectly by giving a child
starch at too early an age that condition was set up. There were
now ten thousand cases waiting for investigation if some one could
be found to do the work. A number of cases on board the
D D
402 THE DFNTAL RECORD.
Exmoiith training ship had been investigated by Mr. Paterson,
who had accurately recorded the particular condition of hypoplasia
in every child.
General Meeting, Thursday morning, August I'^th.
Mr. F. Canton in the chair.
A paper was read by Mr. A. J. Woodhouse, entitled —
'^ Reminiscences of 54 Years in the Dental Profession."
He recalled some of his early recollections of fellow dentists, and
said that in his younger days the great proportion of those who
practised had no professional education, and, indeed many, little
education of any kind. Modes of practice were jealously guarded,
each working as a hermit in his cell. In Exeter, where he was in
practice, dentists made most of their own instruments. The first
dental depot was started by Claudius Ash, in a small house in Broad
Street, Golden Square. Before the days of the engine there was
nothing but the file and the enamel chisel for dividing teeth, and
these were freely used. The engine introduced by Morrison caused
some trouble. He had to defend a patent action brought by the
inventor of a sheep shearing and horse clipping machine. Wedging
teeth was quite unknown, and until 1849 the syringe was not used?
the loose fragments being removed with cotton wool and an ex-
cavator. The materials for hard stopping were gold and tin,
precipitated silver and mercury and Sullivan for amalgams. The
adhesive gold stopping was comparatively modern. It was invaluable
in certain cases, but was often used when the old fashioned stopping
would be much more suitable. The great objection to amalgams
made from precipitated silver was that they stained the teeth black,
and were not very hard, but they did not shrink, and often lasted
for years. Conservative dentistry had greatly advanced of late
years, and leeth were now preserved which formerly would have
been ruthlessly removed. The dental pharmacoepia had also
wonderfully developed. Anaesthetics were invented during his
pupilage. They were an inestimable boon to both patient and
operator. When he began practice in London, in 1848, he did all
his mechanical work himself, often working till two in the morning.
Mr. Woodhouse's paper concluded with some friendly advice to
the younger members of the profession.
THE DENTAL RECORD, 403
The President said the members were greatly indebted to
Mr. Woodhouse for his excellent and interesting paper.
Mr. RoBBiNS said that Mr. Woodhouse had had a unique
experience, and few could tell such a tale of hard work and great
success.
Dr. George Brunton also thanked Mr. Woodhouse for his
agreeable and instructive reminiscences.
Mr. C. S. Tomes, M.A., F.R.S., M.R.C.S., L.D.S., then read a
paper entitled "■ Notes on Dentinal Tubes and their Relation to other
Channels and Spaces in Dentine," with Lantern Illustrations.
After some remarks by Mr. J. H. Mummery —
Mr. F. J. Bennett asked how it was that the enamel, the densest
structure in the body, and highly rigid, covered one highly elastic ?
Mr. Tomes's remarks on interglobular, or lacunae, spaces might,
perhaps, find confirmation in febrile conditions, such as scarlatina.
Where interglobular dentine was formed it was possible to regard it,
as Mr. Tomes suggested, as a reversion to an earlier condition.
Mr. Caush thought that the remarks of Mr, Bennett appeared
to him to confirm Mr Tomes's theory. If there was no possibility
of elasticity between the enamel and the pulp every time theie was
the slightest undue pressure it must necessarily be conveyed to the
pulp.
Mr. Tomes, in reply, said that the question of the deadness of
certain portions of the dentine had occurred to him only that
morning. He was looking under the microscope at a specimen of
Mr. Charters White, in which he had filled the tubes of the dentine
of various teeth with stained collodion. It went to show that the
tubes in the transparent zone in caries were permeable to some
extent by collodion. He had suggested that Mr. White should set
to work and see what was the condition as to permeability in the
dentinal tubes of a rodent's tooth, and he had agreed to do so. As
to the secondary dentines with lacunae spaces and various irregulari-
ties in them being the form in which vascular dentine ceased to be
vascular and became tubular dentine, there was possibly something
in the idea. In places where there had been a little difficulty in the
formation ot the regular dentine, a dentine of that kind was formed.
Mr. Caush's explanation as to the rigidity of a whole tooth was, he
thought, a true one. In the room upstairs there might be seen
prisms of enamel from a young elephant's teeth in their natural
l)D 2
404 THE DENTAL RECORD.
condition, and from the same teeth — which had been calcined in a
strong red heat in a muffle furnace — and there was no material
difference between the two. A dead inelastic tissue had to be carried
in continuity with a highly sensitive tissue like the pulp and
periosteum, and they bridged between the inelasticity of the one
and the sensitiveness of the other by a tissue of intermediate
elasticity. Mr. Caush had not mentioned that if the whole tooth
were as inelastic as the enamel, not only would the shock be
conveyed to the pulp, but the whole tooth would probably split
right down to the pulp under a strain which at present it bore quite
well.
A paper was then read by R. T. Stack, M.D., F.R.S.I., L.D.S.
Eng., entitled — ^
*' Touch Bulbs in Dentine."
In connection with this subject several lantern slides were shown,
and the paper took the form of explanations of the pictures presented.
The author said he thought there was some warrant for assuming
that the definite formations which appeared near the ends of the
dentinal tubules when they had entered the enamel might fairly be
set down to have a connection with the sense of touch. The first
slide showed the processes of odontoblasts, having been pulled out
from the dentinal tubules, and tracing that somewhat further, they
came to the ramification and inter-communications of the dentinal
tubules, and finally, to those definite endings in the enamel which
appeared in a more or less bulbous shape. On reflecting what a
wonderfully delicate sense of touch there was on the surface of the
enamel, it would not be surprising to find a special development of
the nerve endings at the inner side of the enamel, or, as far as
possible, produced into the internal structure of the enamel. There
were between the enamel and the dentine, and between the cementum
and the dentine, and in the substance of the dentine itself in certain
cases of defective development, spaces of a different character, more
irregular in shape, both in the cases of the granular layers under the
cementum and the enamel, and spaces also irregular, but in the
main with an irregularity capable of explanation, in the inter-
globular space of defective development. In young teeth, where
the calcification of the dentine was not complete, there were spaces
very much of the same character as those of the inter-globular spacer.
In the case shown of a young tooth, the space in all probability
THE DENTAL RECORD. 405
would have become entirely obliterated if the tooth had grown. One
or two specimens were shown where a somewhat similar space was
found towards the outer surface of the dentine close to the cementum.
With regard to a later slide, the author thought the definite fusiform
space could be traced into absolute connection with the large cement
corpuscle, and would seem to point to some interchange of nutrient
material between the cementum and the dentine. Further slides
pointed rather to a general force communication between the cement
corpuscles and the dentinal fibrils. With regard to the expansive
bulbs in the under surface of the enamel, there was a great difference
between the smooth outside surface of the enamel — on which no
bacterium should be able to find a footing— and the inner surface,
hollowed out, a very haunt for bacterial invasion. With regard to
the somewhat similarly shaped spaces in the surface of the dentine
close to the cementum communicating freely with the cemental
corpuscles, he would ask was it yet established how far the dentine
of a tooth from which the contents of the pulp chamber had been
removed might be considered to be a dead tooth, or how far nutrition
in the sluggish form required by the dentine might not be carried
on in the collateral plasmic circulation through the cement
corpuscles and the fusiform dilatation in the dentinal tubules.
Mr. Caush said that in staining he had found in many cases that
there had been an absolute intercourse between the tubuli and the
spaces found especially in the newly deposited tissue of dentine. He
had been able to obtain stains passing right through into the enamel,
even in the ground sections.
Mr. Tomes said that Mr. Mummery had a lantern slide of
Dr. Dentry which probably he might show. The specimen showed
a body very much of the form of many familiar nerve end organs,
but it had a big hole in the dentine. It was obtained from the
dentine of a temporary tooth. Mr. Mummery and himself had
been looking at hundreds of dry sections of temporary teeth, and
had never found anything like it. There was a little doubt about
accepting the view that nerve end organs were common, or existed
at all in the principal nerves of the dentine. If they were there he
thought they would have a greater regularity. The occasional
finding of a space which looked like a nerve end organ was not
enough to prove that it contained a nerve end organ unless the
thing had ceased to be functional and was in process of disappearance-
406 THE DENTAL RECORD.
The whole physiology of dentine, and particularly of those outer
layers, was very much unknown, and there were difficulties in the
way of accepting Dr. Stack's or any other views.
Mr. Mummery exhibited Dr. Dentry's specimen.
Mr. F. J. Bennett thought they should pause before attributing
to many of the specimens shown by Dr, Stack a highly nervous
condition.
Dr. Stack, in reply, said he had no " views " on the subject.
He had tried, however, to show that the spaces were of a sufficiently
regular character to warrant the assumption that they contained
developments of the fibre. But when he said that the enamel had
no doubt a delicate sense of touch, he did not mean to convey the
impression that the enamel itself was sensitive. He meant that
with a tolerably thick enamel on the top of the tooth there was a
provision by which it could feel the minutest thing on it, and he
could hardly conceive that that could be the case without some
specially developed nerve on the inner surface. He did not lean to
any particular view as to how the sensation was conducted.
Dr. E. H. Angle (St. Louis, U.S.A.), in the course of his paper
(with Lantern Illustrations) on " Treatment of Certain Irregularities
of the Teeth," described his special spHnts, and illustrated their use
by descriptions of special cases.
Mr. Campbell, in expressing his thanks for Mr. Angle's paper,
said his experience with regard to protruding upper teeth was that
there was a great tendency for the protrusion to return.
Mr. J. Smith Turner regretted that the subject could not be
more fully considered.
Dr. Angle said he had only given a smattering of what might
be said on the subject. If the members would go to St. Louis and
stand by his chair they would be heartily welcomed, and he might
be able to give them some points which would make the subject a
little clearer.
Microscopical Section.
Thursday Afternoon^ August i^th.
Mr. C. S. Tomes, in the chair.
Mr. J. H. Mummery exhibited several slides showing certain
pathological conditions in an elephant's tusk.
Mr. D. E. Caush, L.D.S.I. then read a paper (with Lantern
Illustrations) on " Exostosis."
THE DENTAL RECORD. 407
The Chairman thought the point ot greaetst interest was the
great frequency of alternating actions of absorption and re-
deposition.
Mr. Henry proposed a vote of thanks to Mr. Caush for his
interesting paper. He did not quite follow the author, who, in
showing one of his earlier slides, seemed to imply that external
inflammation ^excited action upon the internal lacunae, causing
enlargement and alteration of structure.
Mr. Hopewell Smith asked Mr. Caush his opinion on the
formation of inostosis, and if the structure was similar to that of
exostosis ?
Mr. Caush said he thought that the reason why they had
inostosis was that exostosis commenced in most cases (except nodular
exostosis) very near the apex of the tooth — where the tissues w^ere,
comparatively speaking, soft — where the granular layer was much
larger and the tissue of a softer character than that nearer to the
neck. The nearer they got to the neck the more dense the tissue,
therefore, when there was a resulting inflammation they had a
general absorption preceding exostosis. So far as he had microsco-
pically examined the structure of inostosis he saw no diff'erence
between it and exostosis. He had found exostosis near the crown,
but never at the root of the teeth.
A paper by Mr. Hopewell Smith on '' Some Dental Lesions
induced by Caries," was withdrawn owing to lack of time in which
to read it.
Mr. F. J. Bennett exhibited a series of skiographs on teeth.
The Chairman suggested that a vote of sympathy should be
passed to their President, Mr. Arthur Underwood, whose absence
had been due to the illness of his wife.
Mr. Henry said he should be happy to propose the motion.
Mr. F. J. Bennett seconded the motion, which was unanimously
adopted.
A vote of thanks was also accorded to readers of papers.
The Chairman said that Mr. Arthur Baker was the President of
the Section for next year, but it would be desirable to elect also a
President for the following year.
Mr. Hopewell Smith proposed Mr. F. J. Bennett as the
President elect for 1898.
408 THE DENTAL RECORD.
Mr. Campbell seconded the motion, which was unanimously
adopted .
On the motion of Mr. Hopewell Smith a vote of thanks was
accorded to Mr. C. S. Tomes for presiding, and the Section adjourned.
Friaay, August \\th.
Mr. F. Canton, President, in the Chair.
A paper on " The Mechanical Factor in the Eruption of Teeth
hitherto Unrecognised," was read by Mr. T. E. Constant, M.R.C.S.,
L.R.C.P., L.D.S.Eng. Briefly stated, Mr. Constant's idea was that
the pressure of the blood on the vessels under the teeth was the cause
of the teeth moving into place.
Mr. C. S. Tomes thought Mr. Constant's idea a very possible one,
and it had certainly been overlooked, but the circumstances under
which it occurred were perhaps a little more complex than might be
supposed from Mr. Constant's presentment of it. Blood pressure
was equally distributed in all directions so long as the tooth was
surrounded by vascular tissue, and an erupting tooth before it got
clear of the gum had blood pressure in front as well as behind. It
was, perhaps, Mr. Constant's idea that in the tissues in advance of the
tooth, in the gum for instance, the blood pressure was kept in hand
by the walls of the vessels, whereas in the tissue which he had often
emphasized as gelatinous, and the tissue which was underneath it,
the blood vessels had possibly less muscular tissue of their own
walls, and so the blood pressure was bottled up in comparatively
rigid tubes and let loose to act on the so-called gelatinous tissue
underneath the tubes. He did not know whether that was Mr.
Constant's idea, but there was something necessary to enable them
to form any idea of a blood pressure under a tooth overcoming a
blood pressure above. As Mr. Constant drew his diagram, it seemed
to suggest that the arrangement was, with a good many exceptions,
like the arrangements of a hydraulic press in which there was one
little tube containing water, the pressure expanding out into a big
chamber, and the same pressure existing over the whole area, so that
the effective force was much greater. But he was not in a position
to discuss the question at a moment's notice.
Mr. Constant, in reply, said that Mr. Tomes's suggestion had
occurred to him as a very strong objection ; but in the jaws that he
had examined he had been struck by the great difference between
tHE Dental record. 409
the surroundings of the tissues overlying the tooth and the tissue
underlying it. He had been speaking of the purely mechanical
aspect of the eruption. He was aware that while the root was going
up there was a physiological process going on, and also another process,
of which little was known, which was removing the superimposed
tissue, so that it was only necessary to have a slight force constantly
acting from below to cause the very slow gradual eruption that took
place. The intermittent pressure given by the blood was highly
favorable to such eruptions. If there was any insuperable objection
to the idea he had brought forward he should be glad to be informed
of it, as he had no wish to perpetuate a fallacy.
Mr. H. Rose threw on the screen photos of a case of extreme
open bite. It was, he said, that'of a girl of 19, all of whose teeth he
extracted in order to give her a masticating surface. Her teeth in
front were nearly three-quarters of an inch apart. The extraction,
under gas and ether, took place on July 9th, and on August 7th he
placed in the girl's mouth a temporary case by which she was
making very good progress, both in regard to mastication and
appearance. The patient would be in attendance, and he thought it
would be acknowledged that the case, though treated from a purely
mechanical aspect, was a fairly successful one.
Concluding Business Meeting.
The President said the next business was the alteration of the
bye-laws in accordance with the resolution passed at the Edinburgh
Meeting. The Representative Board had made the following
recommendations :
Bye-Law XV to read :
"The Representative Board shall consist of the President,
President-Elect and Vice-Presidents of the Association,
and of at least forty Members, including the President and
Vice President of the Board, the Treasurer, the Hon.
Secretary, and the President and Hon. Secretary for the
time being of each Branch of the Association, and of
Members elected by the Branches^ and Members elected by
the Association^''
Bye-Law XVI. to read : —
** After the Members of the Representative Board, elected by
the unincorporated body called by the same name, at a
meeting held on March 3rd, 1879, have held office for two
410 THE DENTAL RECORD.
years, ten members of the Board, selected by the members
of the Board, shall retire annually. The vacancies thus
created shall be filled up by the Members of the Association
by general ballot from such of their number as have been
nominated by not less than six Members of the Association ;
such nominations must be received by the Hon. Secretary
not less than 30 days before the Annual General Meeting.
In addition to its representation by the President and Hon.
Secretary, each branch shall annually elect one Member to
the Representative Board, who shall hold office for one
year."
Bye-Law XVH. to read : —
'' In order to carry out the election of the ten Members of the
Representative Board elected annually by the Association,
the Hon. Secretary shall issue voting papers to the Members
of the Association as soon as possible after the nominations
of candidates for election have been received, returnable
ten clear days before the Annual General Meeting, and
the voting papers so returned shall be examined by the
President of the Representative Board in the presence of
the Treasurer and Honorary Secretary, who shall have
power to ask any other Member or Members of the
Association to assist in counting the votes, or to take the
place of an absentee, the result of the ballot to be announced
at the Annual General Meeting.
" All Members of the Representative Board elected either by
the whole Association or by branches, shall hold office from
and after the termination of the Annual General Meeting
at which their election is announced.
" All retiring representatives shall be eligible for re-election."
Alterations consequent upon the foregoing bye-laws as agreed to : —
Bye-Law XVIIL,|as at present known, will be cancelled, and new
Bye-Law XVI. will take its place. The present Bye-Laws XVI. and
XVII. will become XVIII. and XIX. respectively.
Mr. Blandy moved, and Mr. King seconded, the alterations
proposed be adopted. The motion was carried.
The President said the next matter for consideration was the
resolution sent up from the Western Counties Branch : " That the
Representative Board of the British Dental Association be invited
THE DENTAL RECORD. 411
by this Branch to encourage and assist in the formation of local
centres for the purpose of more effectively carrying out the provisions
of the Dentists Act." At the meeting of the Board there were no
Western Countiesi gentlemen present to explain the resolution, and
the Board was a little undecided as to what it meant. It was
accordingly decided to submit it to the meeting for consideration.
Dr. Hunt apologised for the absence of Western representatives.
He was not prepared to speak on the subject as he did not repre-
sent the branch.
Mr. Rees-Price thought that as no representative was present
the subject had better be dropped altogether.
Mr. WooDiwiss moved that the resolution be referred back to the
Representative Board.
Mr. Husbands seconded the motion.
Mr. Smith Iukner said that Mr. Oliver had gone into the matter
very fully at the opening meeting, and if the members would tax
their memories a little they would have no difficulty in knowing
what the branch meant and what its objects were.
The resolution was adopted.
The President said he was sorry to inform the members that
the Treasurer, Mr. Betts, had resigned, much to their regret, and
that it was necessary to elect a successor.
Mr. Neale moved a hearty vote of thanks to Mr. Betts on his
retirement for his very able management of the financial affairs of
the Association.
Mr. Spokes seconded the motion.
The motion was carried by acclamation.
Mr. Betts acknowledged the vote of thanks.
Mr. Smith Turner proposed that Mr. William Hern be elected
Treasurer.
Mr. Maitland seconded the proposal, which was unanimously
adopted.
The President said the President of the International Dental
Congress in Nancy had kindly sent a telegram of congratulation and
good wishes, and that a suitable reply had been forwarded.
Dr. Geo. Cunningham asked if, in the reply, any expression of
sympathy had been sent at the loss sustained by the National
Society in the death of their first president, M. Paul Dubois, who, it
would be remembered, was at the Brighton meeting.
412 THE DENTAL RECORD.
Mr. CoxoN, in seconding the motion, said he could testify to the
courtesy extended by M. Dubois to all the members who attended
the Congress at Paris.
The motion was then agreed to.
Votes of thanks were then passed to the Committee of Manage-
ment of the Examination Hall ; the President and Members of the
Royal College of Surgeons ; the President and Members of the
Metropolitan Branch of the British Dental Association and other
London Branches ; the Readers of Papers and Demonstrators ; the
Members of the various Executive Committees, and to the Earl of
Ellesmere.
The minutes of the business meetings were read and confirmed.
The proceedings then terminated.
The Demonstrations.
" Impression taking with Guttapercha," by J. H. Badcock,
M.R.C.S., L.R.C.P., L.D.S. Eng.
" The Ronten X Rays as applied to Dentistry, by means of
Photography (and possibly by means of Fluorescent Screen)," by C.
A. Clark, L.D.S.I.
" On Fining Teeth with De Trey's Solila Gold," by J. Charters-
Birch, L.D.S.I.
" The Various Methods oi Attaching the Newland-Pedley
Crown," by E. C. Dimock, L.D.S. Eng.
The root was ground down to a trifle below the gum margin, the
nerve canal reamed out, and the pin fitted in it. The artificial crown
being next selected, it was placed on the pin in the root. Then the
part of the pin beyond the face of the root, not being in a proper
direction, it was bent backwards to the required angle. The crown
was fitted to the root, as one fits a tube tooth to a plate. The pin
and crown were then fixed with phosphate cement. Other methods
of fixing crowns shown in specimens : — Specimens — a. Prepared
roots, showing the straight pins and also the forked pins, for the
bifurcated roots of first bicuspids in position, b. Central root
fitted with a crown and fixed with phosphate cement, c. Bicuspid
crown fitted to root, the crown being fixed to the pin by Lennox's
fusible metal, d. Bicuspid crown fixed to root with phosphate
THE DENTAL RECORD. 413
cement, with an amalgam joint, without any attempt at accurate
fitting of crown (quick method), c. Anterior root fitted with a gold
ferrule cap and pin, to which the crown was attached with sulphur.
"A Small Bridge to carry a Lateral Incisor" ; and also "The
Morrison Crowning System," by W. M. Gabriel, M.R.C.S., L.D.S.
Eng.
" Filling Cervical Cavities with Gold by the help of the Herbst
Needle," by W. R. Humby, L.D.S.Eng.
The rubber dam is adjusted in the usual manner, in the present
case exposing eight of the anterior teeth ; the dam secured by clamps
on the first bicuspid on either side. The rubber is carried up
between the teeth by a thread, the tooth to be stopped is thus in
view, and it only requires the Herbst's needle to be applied — so that
the gum and dam may be held out of the way — that our work on the
cervical portion of tooth may be proceeded with. The needle in use
is one made from a broken bur, the latter being ground to a fine
point on the side of a carborundum wheel by gentle pressure and
rotation ; the latch end is broken off and any roughnesses at fracture
smoothed away. The point is inserted beneath the free edge of the
dam and passed upwards until the needle point has passed by the
seat of caries, and the sound cement is felt to have been reached.
Until now, the direction of the point has been upwards and
backwards ; when the true position is believed to be attained the
direction is changed so that the needle stands out at right angles to
the cement, the position to be retained throughout the operation.
Securing the needle is very simple : one of the fingers of the left
hand is placed on the projected rounded end of the needle, while the
forefinger and thumb of the right grasp the middle, so as to release
the left hand from its hold on the needle ; the left hand thus being
free, it is used to stretch the dam forward and draw it over the end of
needle, the rubber, by its contraction towards the teeth, pulls the
needle into firm contact with the cement. According to Dr. Herbst,
this is the only hold the needle requires, but in consequence of a
tendency to displacement, it is better to have a clip — such as are used
for fastening neckties — passed under the rubber from the upper
surface and made to grip the needle through the rubber. The clip
is thus presented edgeways to the patient's face ; to prevent local
pressure a piece of domed metal is attached to edge of clip by soft
soldering. This addition resting against the lip secures the needle
414 THE DENTAL RECORD.
in position, and leaves both hands free during the greater part of the
operation. If the mallet or disc is used, it is better to give the needle
a little support by gently pressing it, but this precaution is only
occasionally required. The advantages are : the entire absence of
pain ; the very rapid adjustment of dam and needle, averaging two
minutes ; the entire freedom from any obstruction to cavity ; no
laceration of gum and no blood is drawn, the only evidence of any
operation being a small red mark where the side of the needle rested
against the gum margin, and there is no need for any ligature.
Blocks would be required to describe the shape of the cavity,
retaining point drills, etc.
" A Method of Repairing Bridge Work by Soldering within the
Mouth," by H. Baldwin, M.R.C.S., L.D.S.Eng.
" A Method of Treating Absorbed, Undeveloped, or Perforated
Roots by Sponge-grafting," by G. Brunton.
"Electro-guaiacocaine-cataphoresis : its Application to Extraction,
Sensitive Dentine, and Exposed Pulps," by H. B. Ezard, L.D.S.
Edin.
The idea of driving medicaments into tissue electrically is by no
means new. Indeed, it is said to date back to the early fifties. Some
eight years ago I covered a large field of experiments with a view of
discovering a method of electrically injecting cocaine into sensitive
dentine (searching for that Utopia of dental surgery — a reliable
obtundent). I had to suspend my experiments at that time owing
to the fact that I could not procure or manufacture a method of
reducing a current to zero — this being absolutely necessary, as tooth
matter is sensitive to one-eigth of a volt and sometimes less. My
attention was strongly recalled to the matter by a paper by Dr.
W. J. Morton, of New York (Professor of Diseases of the Mind and
Nervous System and of Electro-Therapeutics), which was quoted in
The Electrical Review, o^ July 26th, 1895, on "Bleaching Teeth
with H2 O2 by means of Electro-Cataphoresis," and again by a
paper by him in The Dental Cosmos^ of January, 1896. In this
latter paper I saw that the Electro-Therapeutic Company, of New
York, had devised the very current controller for which I had so
long and vainly sought. After much correspondence and (seemingly)
a curious hesitancy on the part of the company to supply the
instrument, I managed to procure the Wheeler Volt Selector which
I now show you. The milliampere meter is not a necessary part of
THE DENTAL RECORD. 41
the apparatus, and I use it simply to indicate the amount of current
passing and of estimating the amount of leakage. Now, as to
current, I do not favour the street supply, for, as I have already
mentioned, a sensitive tooth will feel the minutest fluctuation. I
prefer a primary or secondary current as being absolutely steady.
Without doubt the most easily managed primary battery for dental
purposes is my modification of the Poggendorf cell (see Proceedings
of British Dental Association, August, 1895), but I find it more simple
to use the " Gardner Plant " with 7 E.P.S.Co.'s. [_ type storage cells
as a governor, keeping the cells fully charged. From this source you
have a constant current of 15 volts (about) always ready for use.
Dr. Morton gives as his formula, an 8 per cent, of cocaine hydrochlor
in guaiacol. I have, however, obtained better results with a 20 per
cent, solution. Guaiacol when electrolised has an abominable and
penetrating odour. I have therefore concocted the following
formulae, either of which is more fragrant. Guaiacol c. cocaine 20 per
cent. — of the above two parts, Otto of Roses one part ; or guaiacol
c. cocaine 20 per cent., two parts of this to one part heliotropine.
These are the positive solutions. The negative or sponge solution is
— solution sodium chlorate 20 per cent. Now as regards the practical
working of the apparatus. Join the wires from the Selector to the
batteries. You have now to find the positive pole. The most
simple method is to moisten a piece of white blotting paper (which
has been saturated with iodide of potassium) and place it across the
terminals, turn the knob until the dial indicates 10, in about one
minute the positive pole will turn the paper a dark brown. To this
screw you attach the application wire, to the other the negative or
sponge wire. The subject of the present demonstration is a lateral
incisor — pulp unexposed and fully alive. 1 propose to anaesthetise
the pulp through the thick layer ot carious dentine, expose
it and remove it. The surrounding parts are first dried, and
then protected by a napkin or dam, and any metallic filling is
varnished with shellac varnish or guttapercha solution. In this
case there will be a good deal of current leakage, as the two centrals
are metal-backed pivots. The sponge electrode is saturated with the
salt solution, and is held tight in the patient's hand. A small
pledget of wool saturated with guaia-cocaine cum rosa is placed in
the cavity, the indicator is placed at zero, and the needle applicator
placed against the pledget. The current is now turned on very
416 THE DENTAL RECORD.
gently, and without a jerk, the patient's lower eyelids being carefully
watched, as they give the immediate indication of the current being
felt. On that indication the current is to be slackened, say one third
of a volt, and left stationary for a minute, and in this way you proceed
until the patient is unconscious of any increase or cessation of
current. The time necessary varies from seven to 47 minutes,
depending largely on the condition of the patient and the initial
current which can be borne without pain. (The pulp took 42
minutes to cataphorise and remove.) I do not recommend you to
try it for extraction, for although the extraction is painless, the
guaiacol has too strong an escharotic action on the mucous mem-
brane. It appears to me that the great utility of this guaia-cocaine
cataphoresis is in such cases as this, viz., for immediate treatment of
exposed putrescent and aching pulps. Suppose a case presents itself
with pulp exposure possessing the distinct phosphatic odour — isolate
it with dam — cataphorise it (this, as a rule, only takes seven minutes)
excavate thoroughly, and cover it with a transparent celluloid cap
(the advantage of these transparent caps is that you can see the
actual exposure) and fill right off. I know it is heresy to publish
such a treatment in defiance of " the books," but I argue that if you
mummify and embalm the pulp, and then seal it up, you cannot
have any more trouble, and such has been my practical experience
with this treatment for six months. I hope many more of our
profession will advance along the same line and give the results of
their experience at the Dublin meeting next year.
" The Chief Essentials for Success in Administering Anaesthetics
for Dental Operations, with Special Reference to the Subject of
Posture," by Fredk. Hewitt, M.A., M.D.Cantab.
" Plaster Impressions of the Mouth in Easy and Difficult Cases,"
by W. A. Hunt, M.R.C.S., L.R.C.P.Lond.
"Nerve Extraction," by E. Preedy, L.D.S.Eng.
Mr. Edward Preedy removed pulps from recently extracted teeth
mounted in various positions in a Fergus' headpiece. The instru-
ments used were Donaldson's Canal Cleansers, and the special points
illustrated by the Demonstrator were : — a. Direct access to the
canals so as to permit of the free rotation of the instrument, b.
The use of the cleanser, cut down to about one inch in length and
thickened with sealing wax to form a handle in order to allow their
IHE DKNTAL RECORD. 417
being rotated in distal cavities and those difficult of access at the
back of the mouth.
" The Biittner Crown in Conjunction with the Downie Furnace, '*
by J. H. Badcock, M.R.C.S., L.R.C.P., L.D.S.Eng.
*' On Continuous-gum and Crown-and-Bridge Furnaces, and 3
New Porcelain Crown," by J. H. Gartrell.
*' Putting a Porcelain Facing on a Live Honeycombed Incisor," by
Peter Headridge, L. D.S.I.
*' Porcelain Crowns, using the Downie Furnace," by William
Hern, M.R.C.S., L.D.S.Eng.
" A Method of Preparing and Inserting Dove-tailed Porcelain
Inlays in Incisor Teeth," by F. R. Howard, L.D.S.Eng.*
" Fitting a Dowel Crown to a Living Front Tooth, Working to a
Model, and using, if practicable, one of Ash's New Crowns," by A.
Jones, L. D.S.I. , and R. P. Lennox.
" Crowning, using the Downie Furnace," by W. J. May, L.D.S,
Eng.
"The R6ntgen Rays," by J. H. Mummery, M.R.C.S., L.D.S.
Eng.
** Filling Teeth with Gold, and Tin and Gold," by H. W. Norman.
Gold and tin contour filling in a bicuspid : the cavity being cut
in form of double wedges, the tin cylinders were placed in a layer
at cervical edges, firmly welded, and the filling finished off in the
usual manner with gold foil. The tin was not trimmed up till
after the cavity was filled.
" Filling Posterior Interstitial Cavity in a Bicuspid with De Trey's
Solila Gold, using a Matrix," by G. Northcroft, L.D.S.Eng.,
D.D.S.Mich.
"Platinum and Porcelain Crowns," by H. Rose, L.D.S.Eng.
'* Crowning Front Teeth Without Pins in the Root-Canal using only
Band, Porcelain Front and Downie Body at Back," by G. O.
Whittaker, L.D.S.Eng.
" Plastic Filling by the Aid of the Ferrule Matrix," by George
Cunningham, M.A.Cantab., L.D.S.Eng., D.M.D.Harv., and E. C.
DiMOCK, L.D.S.Eng.
In the demonstration of plastic contour filling by the aid of this
matrix, it was shown how quickly and easily the latter can be
* The substance of this Demonstration will appear in an article in our next
issue. - Editor.
EE
418 THE DENTAL RECORD
applied, and the largest compound cavity converted into a simple
one. A number of the matrices should be kept ready for use,
arranged in graduated sizes in box or boxes, with about two dozen
partitions. Thus, when fitting one of these matrices, if the first one
is not quite correct in size, try it on the measured mandril, and
select another, smaller or larger, as the case may be, till one be found
to fit. The matrices are made from the Herbst or any German
silver strips of about No. 2 thickness. A sheet of this metal should
be taken and cut up into strips of different lengths and depth ; then,
each of these strips should be bent into a ferrule with an overlapping
joint, and soldered with soft solder over a spirit lamp. From one to
two hundred of these can be made in a day. When the edge
of the cavity to be filled is deep under the gum, the matrix should
be cut freely away at its cervical edge to fit the gum, except that
part of it which corresponds to the cavity ; thus a flange can be left
at any required position. The matrix should be left on the tooth
until the next appointment, when it should be carefully removed
and the filling polished. The matrix may also be used for gold
contour fillings, and also for measurement in crown or bridge work.
Immmediate root filling, taper screw posts, adjustable holder for
pulp canal cleansers, the Kirby amalgam balance and mixer, and the
use of a contour amalgam of known ingredients were included in
this demonstration.
" The Hydraulic Swager," by C. D. Grundy.
*' A Simple Method of making Richmond Crowns," by Vernon
Knowles, L.D.S.Eng.
'* A Series of Preparations showing a Method of Strengthening
Vulcanite Plates," by C. R. Morley, L.D.S.Eng.
" Making a Furnace for Baking Porcelain," by William
RusHTON, L.D.S.Eng.
"Open Bite," by J. F. Colyer, M.R.C.S., L.R.C.P., L.D.S.Eng.
*' The Mechanical Factor in the Eruption of Teeth Hitherto
Unrecognised," by T. E. Constant, M.R.C.S., L.R.C.P., L.D.S.Eng.
Mr. Sidney Spokes, M.R.C.S., L.D.S., exhibited in the Theatre
models showing the results of the immediate regulation of teeth.
THE DENTAL RECORD. 419
STUDENTS SUPPLEMENT.
Registration of Dental Students.
The registration of dental students shall be carried on at the
Medical Council Office, 299, Oxford Street, W., or at the Branch
Offices, I, George Square, Edinburgh, and 35, Dawson Streeti
Dublin.
Every dental student shall be registered in the manner
hereinafter prescribed by the General Medical Council.
No dental student shall be registered until he has passed a
preliroinary examination, as required by the General Medical
Council,* and has produced evidence that he has commenced
dental study.
The commencement of the course of professional study recognised
by any of the qualifying bodies shall not be reckoned as dating
earlier than fifteen days before the date of registration.
Students who commenced their professional education by
apprenticeship to dentists entitled to be registered, or by attendance,
upon professional lectures before July 22nd, 1878 (when dental
education became compulsory), shall not be required to produce
evidence of having passed a preliminary education.
Candidates for a diploma in dental surgery shall produce
certificates of having been engaged during four years in professional
studies, and of having received three years' instruction in mechanical
dentistry from a registered practitioner.
One year's bond fide apprenticeship with a registered dental
practitioner, after being registered as a dental student, may be
counted as one of the four years of professional study.
The three years of instruction in mechanical dentistry, or any
part of them, may be taken by the dental student either before or
after his registration as a student ; but no year of su':h mechanical
* Exception may be made in the case of a student from any Indian, Colonial,
or foreign university or college who shall have passed the matriculation or other
equivalent examination of his university or college, provided such examination
fairly represents a standard of general education equivalent to that required in
this country.
H E 2
420 THE DENTAL RECORD.
instruction shall be counted as one of the four years of professional
study unless taken after registration.
Forms of registration may be obtained at the office of the
General Medical Council. No fee is required for registration as a
student.
Resolutions of the General Medical Council in regard to
THE Registration of Medical and Dental Students.
Preliminary Examination.
1. Subject to such exceptions as the Council may from time to
time allow, every dental student shall, at the commencement of his
studentship, be registered in the manner and under the conditions
prescribed by the Standing Resohth'ons of the Council.
2. No person shall be allowed to be registered as a dental student
unless he shall have previously passed a preliminary Examination in
the subjects of general education as hereinafter provided.
3. It shall be delegated to the educational committee to prepare
and issue, from time to time, a list of examining bodies whose
examinations fulfil the conditions of the medical council as regards
general education.
4. Testimonials of proficiency granted by educational bodies,
according to the subjoined list shall be accepted, the Council
reserving the right to add to or take from the list.
5. A degree in arts of any university of the United Kingdom,
or of the Colonies, or of such other Universities as may be specially
recognised from time to time by the medical council, shall be
considered a sufficient testimonial of proficiency.
List of Preliminary Examinations held in Great Britain which
are Recognised by the General Medical Council for
Registration of both Dental and Medical Students.*
Victoria University. — Entrance Examination in Arts ; Prelimi-
nary Examination.
* With few exceptions the Council will not in future accept any Certificates
of Pass in Preliminary Examination in General Education, unless the whole of
the subjects included in the Preliminary Examination required by the Council
for Registration of Students of Medicine have been passed at the same time ;
but this rule shall not apply to those who, previous to January, 1892, have passed
a part of any Preliminary Examination recognized by the Council.
THE DENTAL RECORD, 421
University of London. — Matriculation Examination,
University of 0;c/br<y. — Responsions ; Moderations; Local
Examination (Junior and Senior).
University of Cambridge. — Previous Examination ; General
Examinations ; Local Examinations, Junior, Senior, and Higher.
University of Dnrham, — Preliminary Examination in Arts, for
Graduation in Medicine and Science ; Examination for Certificates
of Proficiency.
University of Wales. — Matriculation Examination.
Universities of Edinhiirgh^ Glasgow, Aberdeen, and St. Andrews.
— Preliminary Examination for Graduation in Science, or Medicine
and Surgery ; Local Examinations (Junior or Senior Certificate) ;
Examination for Degree in Arts.
University of Dublin. — Public Entrance Examination ; General
Examination, at end of Senior Freshmen year ; Examination for
Degree in Arts.
Royal University of Ireland. — Matriculation Examination.
Oxford and Cambridge Schools' Examination Board. — Lower
Certificate ; Higher Certificate.
Royal College of Preceptors. — Examinations for a First or Second
Class Certificate (ist or 2nd Division) ; Preliminary Examination
for Medical Students.
Royal College of Physicians and Surgeons of Ireland. —
Preliminary Examination.
Intermediate Education Board of Ireland. — Junior, Middle, or
Senior Grade Examination.
Educational Institution of Scotland. — Preliminary Medical
Examination.
Pharmaceutical Society of Great Britain. — Preliminary and
Minor Examinations {pro tanto).
Scotch Educational Department. — Leaving Certificate in each
grade and in Honours.
A list of Examinations recognised by the General Medical
Council, held at Colonial and Foreign Universities and Colleges
may be obtained from the Medical Council.
422
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430 THE DENTAL RECORD.
THE DENTAL HOSPITAL OF LONDON MEDICAL SCHOOL,
Leicester Square.
Dental Hospital.
Consulting Physician. — Sir Richard Quain, Bart, F.R.S.. M.D.,
F.R.C.P., LL.D.
Consulting Surgeon. — Mr. Christopher Heath, F.R.C.S.
Consulting Dental Surgeons. — Mr. T. Arnold Rogers, M.R.C.S.,
L.D.S. ; Mr. J. Smith Turner, M.R.C.S., L.D.S.
Dental Surgeons. —StOTQv Bennett, F.R.C.S., L.R.C.P.. L.D.S. ;
C. E. Truman. M.A.Cantab., M.R.C.S., L.D.S. ; Leonard Matheson,
L.D.S. ; E. Lloyd Williams, L.R.C.P., M.R.C.S., L.D.S., L.S.A. ;
W. B. Paterson, F.R.C.S., L.D.S. ; W. H. Woodruff, L.D.S.
Assistant Dental Surgeons. — A. Clayton Woodhouse, M.R.C.S.,
L.D.S.; J. F. Colyer, L.R.C.P., M.R.C.S., L.D.S; C. F. Rilot,
L.R.C.P., M.R.C.S., L.D S. ; H. Baldwin, M.R.C.S., L.D.S. ;
H. Lloyd IVilliams, M.R.C.S., L.D.S. ; W. H. Dolamore, L.R.C.P.,
M.R.C.S., L.D.S.; Percy Smith, L.R.C.P., M.R.C.S., L.D.S.;
G. Hern, L.R.C.P., M.R.C.S., L.D.S. ; J. G. Turner, L.R.C.P.,
F.R.C.S., L.D.S. ; W. R. Barrett, L.R.C.P., M.R.C.S., L.D.S. ;
Ashley Densham, L.R.C.P., M.R.C.S., L.D.S.
AncBsthetists.—D\xd\Qy W. Buxton, M.D., B.S.Lond., M.R.C.P.
Lond. ; Frederic W. Hewitt, B.A., M.D.Cantab. ; Carter Braine,
F.R.C.S. ; Henry Davis, M.R.C.S., L.S.A.
Assistant Ancesthetists. — George Rowell, F.R.C.S. ; A. S. Bridger,
M.D.Edin. ; R. Turle Bakewell, M.B.Lond., M.R.C.S., L.R.C.P. ;
Harvey Hilliard, L.R.C.P., M.R.C.S.
Demonstrators. — N. G. Bennett, L.D.S. ; H. J. Stevens, L.D.S. ;
D. P. Gabell, L.R.C.P., M.R.C.S., L.D.S. ; W . S. Nowell, M.A.Oxon.,
L.D.S.
Medical Tutor.— W. H. Dolamore, L.R.C.P., M.R.C.S., L.D.S.
Curator of Mechanical Laboratory. — W. E. Fletcher.
Medical School.
Dental Anatomy and Physiology (Human and Comparative) —
Charles S. Tomes, F.R.S., M.A.Oxon., M.R.C.S., L.D.S.Eng. ; on
Wednesdays and Saturdays, at 8 a.m. (Summer).
Dental Surgery and Pathology. — Storer Bennett, F.R.C.S.,
L.R.C.P., L.D.S., on Tuesdays and Fridays, at 8.0 a.m. (Summer).
Mechanical Dentistry.— E. Lloyd Williams, L.R.C.P., L.S.A.,
M.R.C.S., L.D.S.Eng., on Wednesdays, at 5 p.m. (Winter).
THE DENTAL RECORD.
481
/
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d.
5
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5
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8
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Metallurgy in its applicattott to Dental Purposes. — Dr. Forster
Morley, M.A., F.I.C.. F.C.S., on Thursdays, at 5 p.m. (Winter).
Fee for the Special Lectures and Hospital Practice required by
the Curriculum, £^0 in one payment, or 50 guineas when paid in
two yearly instalments.
All fees are payable on day of entry.
FEES FOR SINGLE COURSES.
Dental Anatomy and Physiology, one Course
,, ,, two Courses
Dental Surgery, one Course ...
„ two Courses
Dental Mechanics, one Course
„ ■ two Courses
Metallurgy, one Course
,, two Courses
Qualified Medical Men or Gentlemen holding Foreign Diplomas
to practice in their native country, can receive six months' practical
instruction in the Hospital, fee 20 guineas.
Students who perform Operations for Filling Teeth must provide
their own instruments for the same, the approximate cost of which
For further particulars apply to the Dean, who attends at the
Hospital every Wednesday from 10 a.m. to 12 noon.
Morton Smale, Dean.
NATIONAL DENTAL HOSPITAL AND COLLEGE,
Great Portland Street, W.
Hospital Staff.
Consulting Physicians. — Sir W. H. Broadbent, Bart., M.D.
F.R.C.P. ; Sir B. W. Richardson, M.A., M.D., F.R.S.
Consulting Surgeons. — Sir Spencer Wells, F.R.C.S. ; Christopher
Heath, F.R.C.S.
Consulting Dental Surgeon. — Sir Edward Saunders, F.R.C.S.
Hon. Visiting Physician. — James Maughan, M.D.
Hon Visiting Surgeon. — E. W. Roughton, F.R.C.S., etc.
Dental Surgeons. — Monday, F. Henri Weiss, L.D.S.Eng. ;
Tuesday, Alfred Smith, L.D.S.Eng. ; Wednesday, Marcus Davis,
L.D.S.Eng.; Thursday, T. G. Read, L.D.S.Eng., D.M.D. ; Friday,
W. Rushton, L.D.S.Eng. ; Saturday, C. W. Glassington, M.R.C.S.,
L.D.S.Edin.
432
THE DENTAL RECORD.
Assistant Dental Surgeons. — Monday, Willoughby Weiss,
L.D.S.Eng. ; Tuesday, Edgar Beverley, L.D.S.Eng. ; Wednesday,
Sibley W. Read, L.D.S.Eng. ; Thursday, T- W. Pare, M.D.,
L.D.S.Eng. ; Friday, W. H. Wheatley, L.D.S.Eng. ; Saturday,
H. J. Relph, L.D.S.Eng.
Ancesthetists . — Monday, G. B. Flux, M.D. ; Tuesday, C. H.
Cozens, M.R.C.S., L.R.C.P. ; Wednesday, C. J. Ogle, M.R.C.S.,
L.S.A. ; Thursday, G. Everett Norton, M.R.C.S., L S.A. ; Friday,
James Maughan, M.D. ; Saturday, Harold Low, M.A., M.B.Camb.
Lecturers (Winter Session).
Dental Anatomy and Physiology. — J. W. Pare, M.D.Edin.,
L.D.S.Eng.
Dental Surgery and Pathology. — A. Hopewell Smith, M.R.C.S.,
L.R.C.P., L.D.S.Eng.
Dental Mechanics^ — Harry Rose, L.D.S.Eng.
Dental Metallurgy. ^^ . Lapraik, Ph.D., F.LC, F.C.S.
Operative Dental Surgery. — Geo. Cunningham, M.A.,
L.D.S.Eng., D.M.D.
Dental Materia Medica. — Chas. W. Glassington, M.R.C.S.,
L.D.S.Edin.
Elements of Histology. — Dr. J. Maughan, M.D.
Fees to Single Courses.
One Course. Two Courses.
Dental Anatomy and Physiology ... £2 12 6 £/\ 4 o
Dental Surgery and Pathology
Dental Mechanics
/2 12
2 12
2
3
2
2
I
I
12
12
2
I
I
Dental Metallurgy
*Operative Dental Surgery
*Dental Materia Medica ...
*Elements of Histology ...
*Demonstration on Dental Mechanics
Fee for the two years' Hospital Practice required by the
Curriculum, ^15 15s.
Total Fee for the Special Lectures and Hospital Practice required
by the Curriculum, £^\ los.
An Entrance Exhibition, value £iS^ is open for competition at
the commencement of each Session.
Sydney Spokes, Dean.
* These Lectures are free to Students of the College who have fully entered
for the Special Lectures.
THE DENTAL RECORD. 433
GUY S HOSPITAL DENTAL SCHOOL.
Dental Surgeons. — F. Newland-Pedley, F.R.C.S., L.D.S.
W. A. Maggs, L.R.C.P., M.R.C.S., L.D.S. ; J. H. Badcock, L.R.C.P.
M.R.C.S., L.D.S.
Assistant Dental Siirgeo7is, — J. Mansbridge, L.R.C.P., M.R.C.S.
L.D.S. ; H. L. Pillin, L.D.S. ; G. O. Richards, M.R.C.S., L.D.S.
R. W. Rouw, L.R.C.P., M.R.C.S., L.D.S. ; A. E. Baker, L.R.C.P.
M.R.C.S., L.D.S. ; F. M. Hopson, L.D.S.
Demonstrators of Practical Dentistry. — J. B. Parfitt, L.R.C.P.
M.R.C.S., L.D.S.E. ; W. R. Wood, L.D.S.E. ; E. C. Dimock
L.D.S.E. ; J. L. Payne, L.D.S.E.
Anesthetists.— Y. W. Cock, M.D., M.S. ; J. F. W. Silk, M.D.
H. F. Lancaster, M.D. ; W. J. Scott, M.B., B.S. ; C. J. Ogle
M.R.C.S. ; E. F. Hamilton, M.D.
Lecturers.
Dental Surgery and Pathology. — Mr. Newland-Pedley.
Dental Anatomy and Pathology. — Mr. Maggs.
Dental Mechanics. — Mr. Rouw.
Metallurgy. — C. E. Groves, F.R.S.
Operative Dental Surgery — Mr. Badcock.
Ancesthetics. — Mr. T. Bird.
Dental Microscopy. — Mr. Baker.
Practical Dental Mechanics. — Mr. Pillin.
Dean. — Dr. Shaw.
FEES.
Special Lectures and Demonstrations, and Dental Practice only
£^0., paid on entrance.
Seven guineas is charged for any further period of Dental Practice
not exceeding six months.
Arrangements cannot be made for short periods of instruction.
General Lectures, Demonstrations, and Hospital Practice required
for the L.D.S.Eng., £^o paid on entrance, or 30 guineas at the
beginning of the first year, and 30 guineas at the beginning of the
second year. From these fees a reduction of 12 guineas will be
made to students who produce, on joining the school, recognized
certificates of instruction in Chemistry, Practical Chemistry, and
Materia Medica.
General and Special Lectures and Demonstrations, and to the
Hospital and Dental Practice required for the L.D.S.Eng., may be
F F
434 THE DENTAL RECORD.
obtained by payment of £iio on entrance, or of 60 guineas at the
beginning of the first year, and 50 guineas at the beginning of the
second year. The reduction mentioned above will be made.
The inclusive fee for the M.R.C.S., L.R.C.P., and L.D.S.Eng., is
190 guineas, or if paid by instalments at the commencement of the
first year 60 guineas, second year 60 guineas, third year 40 guineas,
fourth year 40 guineas.
EDINBURGH.
Dental Hospital and School.
Consulting Physician. — Alex. Peddie, M.D.
Consulting Surgeon. — Joseph Bell, M.D., F.R.C.S.Eng.
Fee for the two years' practice required by the Curriculum,
£1^ 15s. Fee for each course of lectures, £2) 5S-
Consulting Dental Surgeon. — John Smith, M.D., F.R.C.S.E.
Dean. — W. Bowman Macleod.
Dental Surgeons. — Messrs. George W. Watson ; J. Stewart
Durward ; James Macintosh ; J. G. Munro ; J. S. Amoore; David
Munro.
Assistant Denial Surgeons. — T. Gregory ; Frederick Page;
H. B. Ezard ; Robert Lindsay ; J. Alex. Young ; Hume Purdie ;
J. Malcolm ; D. Bailie Wilson ; S. Simmons ; R. N. Hannah ;
Fred. J. TurnbuU.
Chlorofor mists. — Drs. J. M. Farquharson ; W. Lundie ; G.
Matheson Cullen ; R. J. Johnston ; Thomas Proudfoot.
Tutorial Dental Surgeon. — Mr. J. Morris Stewart.
Dental School (Lecturers).
Dental Anatomy and Physiology (Human and Comparative). —
Mr. Andrew Wilson.
Dental Surgery and Pathology. — Mr. George W. Watson.
Meehanical Dentistry.— ^^is^x^. W. Bowman Macleod and J.
Graham Munro.
Practical Mechanics. — Mechanician, Mr. James Mein.
Conservative Dentistry. — Mr. J. Graham Munro.
Dental Materia.--SR\\Xi2.m Guy, F.R.C.P. and S.Ed., L.D.S.Ed.
Gold Filling. — Mr. J. Morris Stewart.
Dental Metallurgy. — Mr. John E. Mackenzie.
Dental Histology.— ^y. G. W. Watson.
General fee fcr the Hospital Practice and Special Lectures
required by the Curriculum. — Hospital Practice, £1^ 15s. One
THE DENTAL RECORD. 435
course each of Dental Anatomy, Dental Surgery, and Mechanical
Dentistry and Demonstrations, £0^ 15s. — £2^ los.
Fees to separate Classes. — Dental Anatomy, Dental Surgery,
Mechanical Dentistry, ^3 5s. each.
The hospital practice and lectures qualify for the Dental Diploma
of the Royal College of Surgeons, Edinburgh, and also for that of
the other licensing bodies. Second courses of the lectures, as required
by the Royal College of Surgeons of England, £2 4s.
The Session, 1896-97, opens October ist, 1896, General fee for
the hospital practice and special lectures required, £1^ los.
For further particulars apply to the Dean, 31, Chambers Street,
Edinburgh.
BIRMINGHAM SCHOOL OF DENTISTRY, MASON COLLEGE
(QUEEN'S FACULTY OF MEDICINE).
The teaching of Dentistry has been undertaken by the Mason
College acting in association with the Birmingham Dental Hospital,
and the Birmingham Clinical Board, so that students may fully
qualify themselves for the Dental Diplomas of the Royal Colleges.
Lectures for the Dental Curriculum.
Dental Surgery. — Frank E. Huxley, M.R.C.S., L.D.S.
Dental Anatomy. — J. Humphreys, L.D.S. I.
Dental Mechanics. — F. Hampton GofTe, L.D.S.
Dental Metallurgy.— ?txQ,y F. Frankland, M.D. ; W. G.
McMillan, F.C.S., F.I.C.
Surgical Diseases of the Month. — F. Marsh F.R.C.S.
Medical Diseases of the Month. — Stacey Wilson, M.D., M.R.C.P.
Demonstrators.
Operative Dental Surgery. — W. T. Madin, L.D.S.
Mechanical Dentistry.-— V . R. Howard, L.D.S.
Dental Pathology and Histology. — Dencer Whittles, L.D.S.
General Subjects. — As taught in the Medical Faculty.
College Fees.
A Composition Fee of ;^5o, payable in one sum or in two sums,
viz., ^25 at the beginning of the first year and £2^^ at the
beginning of the second year of studentship, admits to the full
curriculum required for the Dental Diploma {exclnsive of the
necessary Hospital Practice).
Students wishing to take the Diplomas of M.R.C.S., and
L.R.C.P., in addition to their dental qualifications, pay a
Composition Fee oi £^^. This covers all College Fees.
436 THE DENTAL RECORD.
BIRMINGHAM DENTAL HOSPITAL,
71, Newhall Street.
Consulting Physician. — Robert M. Simon, M.D.
Consulting Surgeon. — John St. S. Wilders, M.R.C.S.
Consulting Dentists.— Ad^im^ Parker, L.D.S. ; Charles Sims
L.D.S.
Anc^sthetists.—S. W. Haynes, M.B. ; J. Henry Blakeney, M.R.C.S. ;
Cyril Hutchinson, M.R.C.S. ; Chas. St. Johnston, M.R.C.S., L.R.C.P. ;
T. Sydney Short, M.B. ; W. H. Pooler, M.R.C.S.
Dental Surgeons. — H. Breward Neal, L.D.S. ; Frank E. Huxley,
M.R.C.S., L.D.S. ; J. Humphreys, L.D.S. ; F. W. Richards, L.D.S. ;
A. E. Donagan, B.A., L.D.S. ; Frank H. Goflfe, L.D.S.
Assistant Dental Surgeons. — W. T. Madin, L.D.S. ; P. T.
Naden, L.D.S., L.S.A.Lond ; F. R. Howard, L.D.S. ; J. Mountford,
L.D.S. ; J. E. Parrott, L.D.S.
Demonstrators.— A. T. Hilder, L.D.S. ; W. Malcolm Knott,
L.D.S.
Hospital Fees.
For Dental Hospital Practice and Demonstrations —
Composition Students (2 years) ^12 12 o
Non-Composition Students (2 years) £1^ 14 o
Non-Composition Students (i year) £% 8 o
Non-Composition Students (6 months) £^ 5 o
For General Surgical Hospital Practice, Lectures, and
Demonstrations.
Surgery (2 years) ^10 10 o | Surgery (i winter) £6 6 o
N.B. — Further particulars may be obtained from the Registrar,
at the College, or Mr. J. Humphreys, 149, Edmund Street.
OWEN'S COLLEGE, MANCHESTER.
Dental Department.
Professors and Lecturers. — Anatomy^ Descriptive and
Practical.— FroiQisor Alfred Young, M.B., F.R.C.S. Physiology.—
Brackenbury Professor Wm. Stirling, M.D., D.Sc. Chemistry. —
Professor Harold B. Dixon, M.A., F.R.S. Organic Chemistry.—
Professor W. H. Perkins, Ph.D., F.R.S. Materia Medica and
Therapeutics.— Froitssor D. J. Leech, M.D., F.R.C.P. Medicine.—
Professor J. Dreschfeld, M.D., F.R.C.P. Systematic Surgery.—
Professor T. Jones, M.B., B.S., F.R.C.S. Clinical Surgery.—
Professor Walter Whitehead, F.R.C.S.E., F.R.S.E. Dental
THE dp:ntal record. 437
Surgery. — G. G. Campion, L.D.S. Operative Dentistry. — G. O.
Whittaker, L.D.S. Dental Anatomy and Physiology. — W. A.
Hooton, L.D.S., L.R.C.P., M.R.C.S. Dental Mechanics.— ThomdiS
Tanner, L.D.S. Dental Metallurgy.— C A. Burghardt, Ph.D.
Dental Pathology and Histology Demonstrator. — David Headridge,
L.D.S.
Fees. — ^50, in two sums, at the commencement of first and
second year.
Professor Alfred H. Young, M.B., F.R.C.S., Dean.
THE VICTORIA DENTAL HOSPITAL OF MANCHESTER.
Devonshire Street, All Saints.
Dean. — Mr. George G. Campion.
Consulting Physicians. — Hy. Simpson, M.D. ; D. J. Leech, M.D.
Consulting Surgeons. —Mr. E. Lund ; Mr. F. A. Heath ; Mr. T.
Jones ; Mr. J. Hardie.
Consulting Dental Surgeons. — Mr. H. Campion ; Mr. G. W.
Smith.
Dental Surgeons. — Mr. George G. Campion ; Mr. Edward P.
Collett ; Mr. Leopold Dreschfeld ; Mr. John W. Dunkerley ; Mr.
William Dykes ; Mr. William Headridge ; Mr. W. A. Hooton ;
Mr. Isaac Renshavv ; Mr. William Simms ; Mr. Walter Smithard ;
Mr. Thomas Tanner ; Mr. G. O. Whittaker.
Assistant Dental Surgeons. — Mr. H. T. Dreschfeld ; Mr. D.
Headridge ; Mr. P. A. Linnell ; Mr. F. W. Minshall ; Mr. C. H.
Smale.
Administrators of Ancesthetics. — Mr. Alexander Wilson ; J.
Prince Stallard, M.B.
Patients attended at the Hospital from 8.30 to 10 a.m. daily, and
on Monday, Wednesday, and Friday, from 7 to 8 p.m.
The Hospital is conveniently situated for students, being between
the Royal Infirmary and Owens College, and only about five
minutes' walk from the latter. It contains three separate operating-
rooms, devoted respectively to fillings, extractions, and operations
under anaesthetics, and two Dental Surgeons are in attendance each
time the Hospital is open.
FEES.
The fee for the two years' Dental Hospital Practice required by
the College of Surgeons of England is /12 12s., which must be paid
438 THE DENTAL RECORD.
in advance, or £^ 8s. for the first year and £^ 5s. for the second
year.
Note.— Students are required to provide themselves with the
necessary instruments, for hst of which see the prospectus of the
Victoria Dental Hospital.
LIVERPOOL DENTAL HOSPITAL.
Mount Pleasant.
Consulting Physician. — Thomas Robinson Glynn, M.D.,
M.R.C.P.Lond.
Consulting Surgeon. — Frank T. Paul, F.R.C.S.Eng.
Conmlting Dental Surgeons. — C. Alder, L.D.S. ; H. C. Quinby,
L.D.S. ; W. H. Waite, L.D.S., D.D.S.
Dental Surgeons. — Reg. H. Bates, L.D.S.Eng. ; R. M. Capon,
L.D.S.Glas. ; E. A. Councell, L.D.S.Eng. ; R. Edwards, M.R.C.S.,
L.D.S.Eng. ; W. Maplebeck, L.D.S.L ; Thos.Mansell, L.D.S.Edin. ;
J. Royston, L.D.S.Eng.; Fredk. Rose, L.D.S.Eng. ; E. A. Mansell,
L.D.S.Eng. ; J. P. Roberts, L.D.S.Edin. ; C. A. Barston,
L.D.S.Eng. ; W. J. Pidgeon, L.D.S.Eng.
Demonstrator on Operative Dental Surgery. — W. H. Gilmour,
L.D.S.Eng.
Chloroformist. — J. E. Gemmel, M.B., CM.
House Surgeon. — J. A. Woods, L.D.S.Eng.
The Hospital is conveniently situated within five minutes walk
of the Medical School. There are four separate operating rooms
and a work room, all facing north, and there is an abundant daily
attendance of patients.
Every facility is afforded to Students who are anxious to acquire
proficiency in Dental Surgery, and to prepare themselves for the
L.D.S. of any of the licensing bodies.
The electric light has been introduced (the lamps being supported
on brackets specially manufactured).
Fee for two years' hospital practice, 12 guineas. Perpetual,
15 guineas.
R. Edwards, Dean.
DEVON AND EXETER DENTAL HOSPITAL.
Consulting Surgeons. — Messrs. A. J. Gumming, F.R.C.S.Eng. ;
James Bankart, M.B.Lond., F.R.C.S.Eng.
Consulting Dental Surgeon. — S. Bevan Fox, L.D.S.Eng.
THE DENTAL RECORD. 439
Dental Surgeons. — Messrs. J. T. Browne-Masoii, L.D.S.Eng.
Henry Bigging Mason, L.D.S.Eng. ; T. G. T. Garland, L.D.S.I.
J. M. Ackland, M.R.C.S., L.D.S.Eng. ; T. A. Goard, L.D.S.Eng.
W. H. Goodman, L.D.S.Eng.
Honorary Secretary. — Henry Yeo.
Attendance on the practice of this Hospital is recognised by the
Royal College of Surgeons of England as qualifying for their Dental
Diploma.
Pupils of any member of the staff or other registered Practitioner
(being a Life or Annual Governor) are permitted to attend the
practice of the Hospital, subject to the approval of the Medical sub-
committee, on payment of £i 5s. annually to the funds of the
Institution.
DENTAL HOSPITAL OF IRELAND,
25, Lincoln Place, Dublin.
Consulting Physicians. — F. R. Cruise, M.D. ; John W. Moore, M.D .
Consulting Surgeons. — E. H. Bennett, F.R.C.S.L ; Sir W. Stokes,
F.R.C.S.L
Consulting Dental Surgeons. — R. H. Moore, F.R.C.S.L ; Daniel
Corbett, M.R.C.S.E., L.D.S.Eng. ; W. Booth Pearsall, F.R.C.S.L
Dental Surgeons, — Messrs. Robert Hazelton, F.R.C.S.L ; R.
Theodore Stack, M.D., F.R.C.S.L, D.M.D.Harv., L.D.S. ; P. W. W.
Baker, M.D., F.R.C.S.L, L.D.S. ; Daniel Corbett, jun., A.B.,
F.R.S.S.L ; George Wycliflfe Yates, M.B., Ch.M., L.D.S.L ; G. M. P.
Murray, F.R.S.S.L ; J. S. Thomson, L.D.S.Edin.
Assistant Dental Surgeons. — Shenstone Bishop, L.D.S.L ; Kevin
E. O. Duffy, V. Doyle, G. C. Moore.
Anaesthetists. — Messrs. John G. Cronyn, L.R.C.S.L ; John R.
Graves, L.R.C.S.L; John B. Coleman, M.B.
Pathologist. — William Mallet Purser, M.D.
Registrar. — William A. Shea.
The Lectures on Dental Surgery and Mechanical Dentistry will
be given during the winter, those in Dental Anatomy and Metallurgy
during the summer months.
In addition to the longer courses of Hospital attendance, special
courses, of three months' duration, will be given to Surgeons about
to join the Army and Navy, or to practice in the Colonies or remote
country districts.
Regulations as to Fees and other conditions can be obtained from
the Registrar of the Hospital, or from r Theodore Stack, Dean.
440 THE DENTAL RECORD.
MEDICAL SCHOOLS.
Bartholomew's Hospital, Smithfield, E.G.
Sixty-three guineas ; or 31^ guineas ; first summer, 31^ guineas.
Charing Cross Hospital, W.C.
Fifty-four guineas in one sum ; or 30 guineas on entering ;
30 guineas 12 months later.
King's College, Strand, W.C.
No special arrangements.
London Hospital, Mile End, E.
Composite fee for dental students, ^42.
Middlesex Hospital, Berners Street, W.
Fifty-four guineas ; or 40 guineas on entrance, and 20 guineas
at the beginning of the second winter session.
St. George's Hospital, Hyde Park Corner, S.W.
Exclusive of practical chemistry, ^50 ; or in two instalments :
first year, ;^30 ; second year, £2^.
St. Mary's Hospital, Paddington, W.
^55 I payable in two instalments : — First year, ^30 ; second
year, /2 5.
St. Thomas's Hospital^ Albert Embankment, S.E.
^65 ; or by instalments, ;^''55 for the first year, and £\^ for the
second year.
Westminster Hospital, Broad Sanctuary, S.W.
^50 ; or in two payments of £2'^ los. each at the commence-
ment of each academic year. A scholarship, value £20^ is open to
commencing Dental Students.
University College, Gov^er Street, S.W.
£^0 guineas ; or including Chemistry, Practical Chemistry,
Physics and Materia Medica, 65 guineas.
School of Medicine, Edinburgh.
The fees for the general subjects (including practice at the Royal
Infirmary) required of dental students, according to the curriculum
of the Royal College of Surgeons of Edinburgh, amount to £'}^'^ los.
Illustrations of Mr. Douglas E, Caush's
Article.
MI:'
Fig. 15.
a Cavity produced by absorption.
h Absorption commencing.
Fig. 16.
Semilunar spaces.
New tissue, cemental in character.
The dental RECORD.
Vol. XVI. OCTOBER 1st, 1896. No. 10.
Original €amm\xnitatianz.
EXOSTOSIS.
By Douglas E. Caush.
(Continued from page 342.)
In this third paper we desire for a short time to draw your
attention to certain changes that take place in the dentine in and
around the pulp canals of exostosed teeth.
In the two previous papers we discussed those changes which
took place on the exterior of the dentine, and sought to show how
the new tissue has been built up, layer by layer, in the exostosed
teeth and while these changes have been taking place on the exterior
of the dentine certain other changes may have been going on
affecting the ^interior portion of this tissue, and it is these we now
wish to dwell upon.
Soon after we commenced the microscopic examination of
exostosed teeth our attention was drawn to some sections of teeth
that had variations in the structure of the tissue surrounding the
pulp canal, and, not being able to find any explanation of these
changes published, we have, after continuous examination and a
series of experiments, drawn the following conclusions.
It was whilst examining a section of an upper molar we first saw
that a series of excavations had taken place in that portion of the
dentine forming the walls of the pulp canal, leaving, instead of the
regular outline — " as seen in a healthy tooth " — a margin having a
number of semi-lunar shaped cavities on the inner surface of the
tissue, and on continuing the examination of a number of teeth we
were able to follow up the various changes that took place in this
portion of the dentine,
G G
442 THE DENTAL RECORD.
To better understand these changes we will examine a tooth
having an inflamed pulp, and on making a section of it we shall
probably find the following change has taken place. In the layer of
odontoblast cells that form the connecting link between the pulp
and the dentine — ^at that point of the tissue that had teen affected
by the inflammation — we shall find the individual odontoblast cell
altered in character and appearance ; there is an absence of the
usual processes, especially those which pass into the dentine, and
instead of these we have a cell somewhat oval in shape. It is not
at all unusual to find the cells have increased in number, and in
appearance are like those cells seen in the cemental surface of a
piece of inflamed alveolar dental membrane ; there is an entire
absence of the usual processes, and apparently the connection
between the dentine and the pulp through the odontoblasts has
ceased. This change may be restricted in area, or if the inflamma-
tion of the pulp has been either very acute or become chronic, a
much larger area may be thus aff'ected, or the cells themselves may
become more active, and as a result of the increased supply of
formative material brought by the inflamed condition of the blood
vessels, increase of the cells, by cell division, takes place, and a
certain amount of pressure is thus produced by these cells upon the
dentine.
This change in character of the odontoblasts may, as we have
already said, be extended over a large or small area, according to the
circumstances under which it is brought about. Should it be
permanent it leaves indellible traces behind it ; on the other hand,
if it is only temporary, we think the result of the cutting off" of the
supply of nourishment from the restricted area is to produce those
transparent zones so frequently seen in the microscopic sections of
teeth where there are apparently no tubuH radiating from that
portion of the pulp canal in which these changes have taken place.
This may spread until the whole of the dentine between the pulp
canal and the cementum in this restricted area is apparently
structureless. We believe that this change is brought about by the
softened portion of the ^tubuli of the dentine being solidified, and
thus forming a transparent zone as seen in the perfectly calcified
cementum.
We have experimented on this zone, and found that, though it
was an easy matter to fill the tubuli on either side of this transparent
THE DENTAL RECORD. 443
portion with either air or coloured alcohol, and thus to much more
thoroughly differentiate the tubuli under the microscope, yet we
failed in this transparent portion to obtain any traces of the entrance
of either fluid or air into the tubuli ; thus the whole tract of the
dentine in this zone becomes almost, if not quite, structureless. A
similar condition of the dentine may be produced artificially by
perfectly dehydrating a hard section and filling up the tubuli with a
solution of balsam in chloroform, and on mounting we have a
section similar in character, but artificially produced.
In the mouth we believe these changes are produced by the
alteration of the character of the odontoblasts, in those cases where
the pulp remains to a very large extent healthy excepting at the
point of issue. Should, however, the pulp continue inflamed, we
find the original odontoblastic layer becoming thickened, the
processes having being previously absorbed or retracted into the
cells, and the cells themselves assume a somewhat oval shape, the
thickening being produced by the increase in the number of cells in
this layer, and after a time we have a development of a number of
giant cells in the thickened layer, especially in that portion of the
layer that touches or presses upon the dentine. The action of these
cells upon the dentine is to absorb the latter away, and this
absorption may be very varied in the amount absorbed, and, as a
consequence, the irregularities of the outline very marked ; it may
be restricted to a single point or two points, as in Fig. 15. When
we have a section of a lower molar with two points of absorption,
very restricted, but at the same time fairly deep, or it may spread
laterally, so that the two or three canals in the roots of a molar
tooth may become united into one long irregular canal, or absorption
may proceed from any given point absorbing away the tissue more and
more deeply until a canal is produced partially through the dentine
towards the cementum ; in fact, there appears to be no restriction as
to the amount of absorption that may take place in the dentine.
This absorption is so varied in its outline that almcst every section
shows an alteration in the conformation of the canal, yet after a
time another stage of the change becomes manifest, the character of
the cells formmg the outer layer of the inflamed pulp change, and
instead of osteoclasts continuing to carry on the work of absorption,
the cells appear to alter to those capable of laying down new tissue.
No longer does the work of destruction continue, no longer does
GG 2
444 THE DENTAL RECORD.
the absorption go on, but, instead, there appears a new tissue in the
spaces previously produced by the osteoclasts. This new tissue is
quite distinct in character from the surrounding tissue, so that
instead of its having tubuli produced, as we get in secondary
dentine, there is no appearance of the latter, but the microscopic
character of the tissue resembles cementum with a number of
lacunae, each having canaHculi (Fig. i6), and these are often found
anastomosing with canaliculi of the surrounding lacunse, thus we
have deposited in these excavations a fresh tissue truly cemental in
character.
This tissue may vary very much in quantity, from that of a thin
layer no more than one cell thick to that in which the tissue is so
pronounced that it may be seen without the aid of the microscope
on cutting the roots of the tooth transversely. This thicker layer
of tissue has usually a very large number of lacunae, and in some
cases we have seen a number of small canals in the pulp canal
surrounded by this new tissue. That this tissue is not secondary
dentine may be proved from the fact that the first change that
takes place before the tissue is deposited is that of the alteration of
the character of the odontoblasts in the pulp, then we have the
alteration of the margin of the pulp canal by the absorption of a
portion of the dentine, and, lastly, the tissue deposited in these
semi-lunar spaces there is an absence of any approach to tubuli as
found in dentine proper, whereas in the deposition of secondary
dentine the latter is added to the original dentine without any
absorption^ the tubuli frequently following on in a line with those
already deposited, with an absence, as a rule, of lacunae. In
secondary dentine the tissue is continuously and regularly deposited,
so that the pulp chamber becomes gradually smaller, but in the
case of the new tissue it is not so, the latter is not deposited
regularly and is alway preceded by absorption, and usually contains
lacunae and canaliculi.
That exostosis is not of recent date we have had the opportunity
of confirming, thanks to the kindness of Charles Dawson, Esq.,
F.G.S., F.S.A., he having kindly placed at my disposal, for the
purpose of making a microscopic, examination, two teeth found by
him. He says : " The two molar teeth were discovered in the
chalk debris within the artificially excavated caverns at Hayes
Down, Lavant (situated on the Goodwood estate of His Grace the
THE DENtAL RECORD. 445
Duke of Richmond and Gordon, K.G.). With the teeth were
associated some flint implements of the latter Neolithic type. The
age of the teeth probably is not later than 2000 years, and perhaps
much earlier."
The one was the cooth of a comparatively young patient, we
should imagine, from the fact that the cusps were perfect and showed
little or no attrition, whilst in the case of the other tooth it had
been very much worn down, until the crown was almost absent, the
pulp chamber fully exposed but filled with secondary dentine ;
the roots ^themselves were perfect, but covered with nodular
exostosis. In the case of the first one the roots were covered with
general exostosis, gradually spreading from the apex towards the
crown.
In examining the teeth of domestic animals we have also found
that similar changes take place in the tissues, this is especially so in
the case of the horse, as we have had the opportunity of examining
about 200 of these. We found a very large number of them
exostosed, and changes similar to those already described had taken
place, but especially noticeable was the result of the alveolar abscess,
and the formation of new tissue, as also was the changes that took
place in the pulp canals : both showed these changes more intensified
than the changes found in the teeth of man.
Since the two previous portions of our paper were written we have
extracted three or four temporary superior canines that have also
shown exostosis. In all these cases the teeth have been retained in the
mouth much beyond the usual time, and hence the reason why they
have been exostosed. Another proof, we take it, that the formation
of this new tissue does not take place until after the whole of the
tooth has been erupted and the root calcified.
In conclusion, we would desire to say that it is quite possible that
the changes spoken of in this portion of the paper also may occur in
teeth where there has been no exostosis. Our microscopic examina-
tions of such teeth has been small, and we are therefore unable to
say if this is so, but should any of our readers have found them
in teeth that have not been exostosed, we shall be glad if they would
let us know of it.
446 tHE DENTAL RECORD.
A METHOD OF TREATMENT BY PORCELAIN INLAYING.
By Frederick R. Howard, L.D.S.
It not infrequently occurs that dentists meet with objection
on the part of the patient to having fiUings which are hkely to be
conspicuous inserted in teeth at the front of the mouth, and it is
sometimes necessary against one's better judgment to humour the
patient by resorting to osteos or guttaperchas instead of gold, which,
notwithstanding its good qualities as a sealing iplug, is open to the
objection just named.
Such consideration it was which led me to experiment, or, as one
might say, fad, with porcelain inlays. To begin with, the porcelain
as a filling material has so much to recommend it — imperishability,
non-shrinkage, non-flaking, &c. The weak points of the treatment
were poor anchorage and imperfect adaptation to the walls of the
cavity, and, as the individual who endeavoured to create perpetual
motion said of friction, "this was all I had to overcome." Many
good inlays had been prepared by " Herbst's method " (2".^., moulded
to the cavity) ; but these were only of softish glass of low fusing
point.
In these, too, the anchorage was insufficient, whilst colour
matching with them was very difficult, and their permanency was
for several reasons doubtful. Small porcelain discs, which were
ground into the cavity whilst held on an engine mandril, from
which they were afterwards detached and subsequently fixed in place
with cement, gave a good appearance, fitted fairly accurately, and
were held quite securely ; but this treatment was applicable in so few
cases. The greatest need was a method suitable to the usua]
Fig. I.
interstitial cavity, which I take it is by far the most common in
incisor and canine teeth (Fig. i). Mr. Dall, of Glasgow, on several
occasions demonstrated a method, no doubt well known now, which
was to shape both back and front cavity wall alike, and to a definite
pattern ; then, from a series of porcelain rods of various forms on
section, to select one the contour of which was exactly adaptable to
the case. To this method I am indebted for the suggestion which
THE DENTAL RECORD.
447
enabled me to devise a porcelain inlay, hereafter described. The idea
of fitting the porcelain rod through the cavity as it were seemed to
me too good not to be taken advantage of, for by this method it is
mechanically easier to cut the cavity to any desired shape, and at
the same time secure accuracy of fit.
My own method differs from Mr. Ball's in this respect, that
whereas he shaped the cavities on more or less curved lines, I
obtain three absolutely flat walls arranged to form a slight dovetail.
Reference to the illustrations will partly explain this. Porcelain rods
(Fig. 2) are prepared which are four sided, and tapered ; in dimensions
Fig. 2.
some inch and three quarters long, about a quarter of an inch
broad at one end and rather less than an eighth at the other. The
thickness varies also from the eighth at the thicker end. The
section of this rod then would appear to be an oblong, but this is
not so, for the breadth on one side is slightly less than on the other,
giving a slight dovetail. Three of the surfaces of this rod are
ground true on a flat stone, viz., the two edges and broader side.
From this, except for contouring purposes, the porcelain is not cut,
but the cavity is shaped by means of fissure burs and a special file
Fig. 3. Fig. 4. Fig. 5.
to accommodate the rod along some portion of its length, the rod
in this position pointing its thin end towards and in the mouth.
(See Figs. 3, 4 and 5.)
It is obvious, of course, that greater accuracy of fit is obtainable
between two flat surfaces than two curves, and herein lies the
possibility of absolute adaptability. When the fit is accurate, both
on the lingual and labial aspect, the contouring of the porcelain
commences by the cutting off back and front of the superfluous
448 tkE DENtAL RKCORtJ.
portions of the rod, and is complete when the bulk lof the inlay is
reduced very nearly to the actual contour desired. I have found
Havard cement to be the best medium for fixing the inlay, but a
light colour should be chosen. Once fixed, I defer all trimming for
some hours, to give the cement ample time to set. Final stoning is
done with fine grit wheels and discs. In the earlier cases I have
used small brushes and fine ground pumice for finishing, but to my
disappointment found that the bristles whipped out very small
portions of the cement, which was perceptible under the lens.
It is over three years now since this method was shown at a
branch meeting of the Association, and I am pleased to be able to
say that the actual cases treated then are now in perfect condition.
It would seem to many, no doubt, that there is danger to the lower
border or cutting edge of the tooth in this treatment, that there is
a liability for that part to fracture off". I can only say I have not
experienced an accident of the kind. Of course, it goes without
saying, that one would always choose the cases to be so treated ; nor
do I even suggest that this method is suitable in all cases. In
instances where decay extends deeply in a cervical direction I have
often built up that wall with gold to the level of the gum margin,
afterwards truing it in the same way as the others withthe file.
This latter instrument, by the way, consists of an octogon steel
holder, carrying strips of '' Flexo " files sheared down to an inch in
length and a twelfth to a sixteenth in width.
Fig. 6.
There are four points in favour of this treatment which I think
merit consideration — ist The repair to the tooth treated is almost
invisible. 2nd Nearly all the cavity edge is exposed to the cleaning
action of the lips and tongue. 3rd The inlay is self supporting.
4th By this method geometric exactness is oossible. (See Fig. 6.)
I should like to add that I am considerably indebted to the
Dental Manufacturing Company for the trouble they have taken to
make porcelain rods to my patterns. They are now prepared, I
understand, to supply the profession with the inlay rods and also the
files and file carriers.
tHfe DENTAL RECORD. 449
THE DENTAL RECORD, LONDON : OCT. 1, 1S96.
DIRECT REPRESENTATION OF THE DENTAL
PROFESSION.
Little things show which way the wind blows. Now,
though we are not apt to put too literal a meaning on post
prandial orations, yet, taken with other tokens, they are at
least suggestive. Thus, when at the annual dinner of the
British ^Dental Association, a surgeon of eminence said :
" I trust that you will have a definite representative of your
own on the General Medical Council. I have no doubt that
you will soon attain that object, which I am sure you fully
deserve,^^ we might, perhaps, not have thought more of
the matter, than to acknowledge a kindly and complimentary
wish, were it not that several of the candidates for the
posts of direct representatives on the Medical Council
make, in their election addresses, the support of the
appointment of a direct dental representative a distinct
ground of claim for support. Surely these facts show that
the election of a direct dental representative to the Medical
Council is, at any rate, within the range of practical politics.
How great is the advance which has been made in this
matter is clearly seen if we contrast the state of present feel-
ing with that held but a comparatively few years ago. Thus,
at the same dinner, Mr. Smith Turner said : — '^ At the time
when the question of direct representation was becoming
very acute in the medical profession, the Dentists Act was
just about being introduced into the House of Commons ;
and at a meeting in reference to direct representation I
heard the remark made, ' Why, with all these changes, by-
and-by even the dentists will be requiring a representative
on the Council.^ In this way the dentist was held up as a
^50 tttE DENtAL RECORD.
'bogey man' to frighten reformers and prevent them from
pressing this very needful innovation. '•'
Many practitioners may pass this matter by as one
with which they have no practical concern, but this is not
so. The Medical Council is the body in whom the admini-
stration of the Dental Act is vested. It has control over the
various corporations which grant dental diplomas, and
subject to the supreme control of the Privy Council it is
able to bestow or withdraw this power as it sees fit. Thus
it controls dental education. Now^ though there are other
of its duties to which reference could be made^ yet the
educational question being one that so intimately concerns
each practitioner, be he old or young, it will suffice to
impress on all that the composition of a body, having this
power, is one of vital import. It is, therefore, no idle
request that the profession should have on this Council one
who is familiar with its wants. The medical profession may
be, and are, our very good friends ; those of them who have
seats on the Council may, and do, use their powers after
mature deliberation, but there are many things they cannot
know, and in which it would be to their advantage to have
the active co-operation of a dental colleague. Although we
may with advantage leave the agitation of this question to
our representative bodies, yet each individual member of
the profession may do something to help forward the
movement. It may be hoped that the Medical Council will
voluntarily yield this claim, but if pressure be needed, it
would seem that it must be brought to bear through the
medical profession, and it is in bringing the individual
members of this to appreciate the sweet reasonableness of
our wishes that each member of the dental profession may
be of use.
We understand that the buildings on the site acquired by the
Dental Hospital of London for the new building have been con-
demned and will shortly be pulled down and the site cleared.
tHE DENTAL RECORD. 451
The Plymouth Medical Society has decided that its members
should refuse to administer chloroform to the patients of dentists
who are not on the Dental Register.
Mr. G. H. Bailey, President of the Society of Anaesthetists, will
be glad if those who wish to take part in the Jubilee of Anaesthetics
will communicate with the secretaries of the society.
It is with sincere regret that we learn of the suicide of Mr.
S. A. Parker, of Birmingham. He seems to have been much
depressed by some falling off of his practice, and in an aberration of
mind to have taken an overdose of laudanum. The coroner, an old
personal friend, testified, at the inquest, to the many excellent
qualities of the deceased, and a pathetic letter was read in which he
asked " if possible let me lie by the side of the only one I dearly
loved, my father."
At the Glasgow Sheriff Court, on September 7th, before Sheriff
Fyfe, J. H. Hatfield, residing at 5, Trongate, Glasgow, was charged
at the instance of Samuel M. Carrick, writer, Glasgow, acting on
behalf of the British Dental Association, with having contravened
*'The Dentists Act, 1878," as amended by '* The Medical Act,
1886," inasmuch that not being a legally qualified practitioner, and
not being a person registered under the Dentists Act, he displayed,
at his house, the words " Surgeon Dentist,'* and other words
implying that he was registered under the Act, and a person
specially qualified to practice dentistry. The accused pleaded guilty,
and a fine of £s was imposed.
The Continental match factory of Passaic, New Jersey, U.S.A.,
has issued an order requiring all employes to show a certificate
from a dentist that their teeth are sound, or that they have been
satisfactorily repaired. A very sensible order this, and one all
match factories should adopt, for phosphorous necrosis is, unfortu-
nately not altogether a thing of the past, though other regulations
have undoubtedly lessened its frequency.
452 THE DENtAL RECORD.
Anaesthesia being, if not the discovery certainly among the
chief discoveries of the Victorian era, it is interesting to recall, as
does the Dominion Dental Journal, that Sir James Simpson's
discovery was denounced as impious, and contrary to holy writ.
It was said that its use was " to avoid one part of the primeval curse
on woman." Replying to his theological opponents, Sir James said,
''They forget the 21st verse of Genesis ii. That is the record of
the first surgical operation ever performed, and that text proves that
the Maker of the universe before He took the rib from Adam's side
for the creation of Eve, caused a deep sleep to fall upon Adam."
At a meeting of the Second District Dental Society, held in
Brooklyn, April 8th, 1895, Dr. F. T. Van Woert, says the Cosmos^
presented the following novel method of quickly making a porcelain
crown in an emergency case. A gentleman called at his office a
short while ago, early in the evening, having just broken a central
Logan crown. He was going to a wedding that same evening, and
said that a new crown must be supplied. The dental depots were
closed, and there was no way of obtaining another crown suitable
to the case at such short notice. The pin was easily and quickly
removed from the root, and an impression with modelling compound
was taken, into which quick-setting plaster was poured, A dowel
was selected, the projecting end of which was split for a short
distance and the parts bent over at a right angle. A rubber tooth
was then ground to position on the plaster model. With the tooth
and dowel in place on the model, the bent-over ends of the dowel
extending to just below the pins of the tooth, fusible metal was
melted over the end of the root exposed and against the palatal
surface of the tooth. While still fluid it was pressed with a piece
of chamois skin so as to fill the space between the end of the root
and the shoulder on the tooth above the pins. This was quickly
cooled, removed from the model, trimmed and polished. The fit
was accurate, the metal having gone absolutely to place, so that it
could be finished with perfect edges, and the result was a very strong
and beautiful crown. The whole operation was so quickly performed
that twenty-five minutes after his first appearance at the office the
gentleman departed with the new crown in position. Dr. Van
Woert demonstrated this case at the meeting by making another
crown on the same cast in ten minutes.
THE DENTAL RECORD. 453
At the end of last year a notable woman died, Olga von Oertzen.
For some time she practised dentistry in England, having been to
a dental college at Philadelphia, though we believe she was not
registered here. But she earned her reputation and many medals
as a nurse with the German army during the campaigns against
Denmark, Austria, and the Franco-Prussian war. Her experiences
were many and varied. Once outside Metz she was in charge of
a ward of sixteen patients, mostly cases of typhoid or dysentery,
which was emptied three times in one week. They had no water to
drink and little to eat. One day peas, which after nine to ten hours
boiling were as hard as ever, lying at the bottom of the pot, and
this was the food for the patients. But she came of a fighting
family. Six great uncles won the Iron Cross fighting against
Napoleon, and it is said the family was ennobled in the time of
Barbarossa. The Emperor, fighting on the banks of a river, was
holding the enemy at bay, at great odds. The enemy pressed on
him and a soldier held a boat for him to embark. The man's arm
was cut off, he immediately held the boat with the other, which
shared the same fate. He then held the boat with his teeth ; the
Emperor escaped and in acknowledgment of his bravery ennobled
him ; he gave him the name of von Ertzen, meaning '' made of
metal," and also a ring, which as he had no arms to hold out he
received in his mouth. The crest has ever since been two dissevered
arms over a coronet and the ring in the hands.
There is a story told of Peter the Great in the character of
a dentist which strikes one, writes Mr. James Payn, as very
characteristic of his impulsive and high-handed ways. Peter had
studied dentistry, in common with most other useful arts, and
plumed himself on his dexterity in drawing a tooth, though one
finds no record of his giving himself the trouble to fill one.
Observing one of his valets de chainbre to be in bad spirits, he asked
what was the matter — an unexpected trait in Peter — and was told
that it was the spectacle of his wife suffering from tooth ache that
so distressed him. " Why doesn't she have it out ? " inquired the
Czar, beginning to feel the professional instinct. " I can't persuade
her, sire ; she always pretends not to suffer when we wish to give
her ease, but renews her lamentations — which distress me to hear —
when the dentist is dismissed." Let me see her," said the Czar ;
454 THE DENTAL RECORD.
'' I'll cure her/' He was introduced to her apartment, and in spite
of her protestations of there being nothing the matter, examined
her mouth. Having satisfied himself as to which was the peccant
molar, the Czar said to her husband — " Hold her head and arms,
and she shall be cured in an instant." l^'hen, in spite of her cries,
he extracted her tooth with great address, and without an anaesthetic.
Hearing a few days afterwards that the whole affair was a trick of
the valet's to torture his wife, with whom he had quarrelled, the
Czar beat him within an inch of his life — not so much, it was
shrewdly suspected, on account of the deception practised upon him,
as because it had caused him to make an incorrect diagnosis.
ABSTRACT OF AN INAUGURAL ADDRESS
Delivered Q7i October ist, 1896, at St. Alary s Hospital^ Faddmgton^
By Morton Smale,
Surgeon in charge of the Dental Department.
After some preliminary remarks, Mr. Smale said: — The
repeated invitations of the press that we should address the public
on such occasions, opens up a very wide field to the speaker. It
may be presumed that anything we have to say to the public is not
likely to be of a complimentary character, but that it will take the
form of warning or complaint, and I may add, that on the latter
ground we may find unlimited supply of materials. In deference,
then, to the invitation of the press, I shall venture to make a few
remarks on the subject of so-called patent medicines, and if the
public care to listen, I do not think they are likely to hear anything
very complimentary, either to themselves or the patent nostrums
(excuse the grammar), the sale of which they so extensively
promote.
In using the term patent medicine, I do not refer to preparations
which are made for the use of the medical profession, the manipu-
lation of which require special processes which may be patented by
letters patent ; the use of these is a matter w hich lies alone with the
profession, and the fact of their being patented reveals to the public
and the profession all the knowledge that is required for their
application with safety and benefit to the patient. These, however,
constitute but a small portion of the preparations that are offered
to the public requiring the Government Stamp. The popular
THE DENTAL RECORD. 455
notion of a patent medicine embraces all such preparations as have
a Government Stamp affixed thereto, but nearly all of them are
merely proprietary medicines. The following is the true description
of these precious articles of commerce. A preparation, to be liable
to Stamp Duty, must be one which is to "be used or applied
internally or externally as a medicine or medicament for the
prevention, cure, or relief of a disorder or complaint incident to or
in any wise affecting the human body." Then it must also be
brought under one of the following six clauses which constitute
liability to duty, (i) " The seller must have a claim to have an
occult secret or art for making or preparing " ; (2) " An exclusive
right or title to making or preparing"; (3) '* It must have been
patented " ; (4) *' It must be or must have been recommended to
the public as a nostrum or proprietary medicine " ; (5) " As a
specific" or (6) "As beneficial for the prevention, cure, or relief of
any disease."
Any one of these conditions alone entails liability to Stamp
Duty. It will be evident, therefore, that although a patent medicine
must have a stamp the patent is not a necessary condition.
The condition is, that it must be or must have been recommended
to the public as a proprietary medicine, or as a specific, or as having
a secret — it may be an occult one — attached to its preparation. One
of the peculiarities to be observed here is that it has to be recom-
mended to the public, but by whom it is to be so recommended
the conditions are dumb. The person or persons who recommend —
to this I call particular attention — may be entirely ignorant, not
only of the specifics or cures which they prescribe in a wholesale
manner, and of the nature, or source, or course, or sequelae of the
diseases which are to be prevented or cured, but are also utterly
ignorant of the complex human tenement which carries the disease.
Whatever else their knowledge may be, whether it be limited to the
laws of profit and loss and a good balance sheet, or to the glorious
mendacity and effrontery of quack advertisements, or whether it
includes in its grasp all that has been taught of anatomy and
physiology and all that has ever been or can be known of medicine
and surgery and the action of drugs, we may rest assured they can
never know the circumstances surrounding the sufferer, or anything
of the mental or physical conditions accompanying the disease for
which the specific or cure is sold.
456 THE DENTAL RECORD.
Thus, gentlemen, while the members of the medical profession
may not possess in secret anything which would in any way benefit
suffering humanity, and while the unqualified assistant may not
(rightly, I think) act but under the strictest surveillance, the
humbug may distribute his wares broadcast, fortified by all the glory
of a Government Stamp. I say fortified, advisedly, for we all know
the spurious value which is attached— not only by the so called
ignorant classes, but by many who might be expected to know
better — to the revenue label.
Mr. Alpe, of the Inland Revenue Department, in his book on
the *," Medicine Stamp Duty," says : — *' Another objection urged
against the duty was that ignorant persons regarded the Government
Stamp as a guarantee of purity. The stamp is still held out by the
makers of medicine who have paid for the privilege of having their
stamps printed from an appropriated plate, as a guarantee that the
medicine which it covers is genuine, in the sense that it is really
made by them. In this respect the stamp answers the purpose of a
trade mark of a superior kind ; for whereas the counterfeiting of a
trade mark is only a misdemeanour, and the owner of the trade
mark would probably be put to considerable expense to punish the
counterfeiter, the counterfeiting of a Revenue Stamp is felony, and
the prosecution would be conducted for the protection of the
Revenue at the cost of the Crown. This is a sufficient reason for
the caution still occasionally given to the purchaser, to see that the
name of J. Smith is printed upon the stamp, ' without which none
is genuine and to imitate which is felony.' Such intimations may
have impressed a great many persons with an idea that a medicine
so carefully protected must necessarily possess unusually beneficial
properties, and to remove the possibility of such an apprehension,
every stamp issued since 1885 bears its own statement in legible
letters that this stamp * involves no Government guarantee.' " I
think you will all agree with me in arriving at the conclusion that
the ordinary members of the public are quite unable to appreciate
the value of these two statements, which must necessarily appear to
them to be of a contradictory character.
When we turn from the maker or distributor to the consumer,
the position is even more deplorable, and were it not tor its serious
aspect, might be termed ridiculous. Every advanced medical
student and every medical practitioner knows the difficulties
THE DENTAL RECORD. 457
attending diagnosis and prognosis. It may be too much to ask any but
the specially trained to appreciate the importance of the latter in
indicating treatment ; but to the most ignorant, or, what is perhaps
worse, the most prejudiced mind, the desirability of a correct
diagnosis for successful treatment must be obvious. Yet, gentle-
men, this very first essential principle in the intelligent treatment
of disease, beset as it is with difficulties to the most experienced,
every user of a proprietary medicine assumes and discharges towards
himself, and not only to himself, but with the assurance of ignorance,
frequently towards others.
As to the unimaginative rustic —
A primrose by the river brim
A yellow primrose is to him (and nothing more),
so to the amateur patent medicine prescriber. A cough to him is
a cough and nothing more. How much more it is or how much
more it may become enters not into his calculations. Yet in the
face of this the medical profession is frequently reproached for its
powerlessness to check certain diseases which may have been, and
indeed often are, fostered by the blind faith of the sufferer in some
Government-stamped nostrum or '* cure all " with an enticing
name.
'' The man who is his own lawyer has a fool for his client," says
the proverb ; may this not also be applied to the man who is his
own doctor, although the evidence in the one case may not, to
the unititiated, be so obvious as in the other ? That they are fools
is clear from a perusal of the testimonials in advertisements, which
are by experience found to carry conviction and to secure fresh
dupes to the vaunted specific.
The common talk amongst the public about new diseases, which,
to the medical man are but old enemies, intensified in some instances
by the changed condition of modern life, seems to point a moral.
May not the enormous increase in the indiscriminate consumption
of proprietary drugs, recommended only by interested and
unscrupulous concoctors, have some influence in the matter ; or
again, may not the serious and increasing calls made upon the
resources of abdominal surgery and the numerous intestinal
troubles requiring medical treatment, be in some measure due to
the prevailing fashion of saline drenching so continually resorted to
by self-constituted doctors for the sake of the immediate and
H H
458 THE DENTAL RECORD.
transitory relief which they afford. Or it may be so reducing the
tone of the various organs and tissues of the body, that they readily
yield themselves victims to the attack of any disease germ that may
find its way into the system.
Education may be divided into two sections, one general and the
other special ; the former beginning at the earliest stage of mental
development, first cultivates the power of acquiring and retaining
knowledge, then of classifying and utilising it, and then of imparting
it to others. A good general education should prevent, and at all
events will retard, the inevitable narrowing influence of the special
one. It is through a special education that the vast majority of
people are more or less fitted to take an active part in life, and for
earning their daily bread. This special training must necessarily
be in one direction, and just as its objects are kept in view, and the
power which it gives is discreetly applied, so, other things being
equal, will be the success of its application. If a man apply his
special knowledge in a direction opposite to that for which it is
adapted, he is most certain to come to failure, very likely to do
harm. If he allow a cultivated intellect, or an active imagination
innocent of technical knowledge, to carry him into the region of
exact science, or to handle subjects which science seeks to control,
the results ^are very likely to be unsatisfactory. I make these
remarks in view of a recent article in one of the morning news-
papers where it was stated that the advance of education enabled
people generally to treat for themselves many of the minor
complaints for which at one time the doctor would have been called
in. Now, gentlemen, I know that the advance in medical and
surgical knowledge has rendered necessary the addition of one 3^ear
to the period of study required of the medical student. I also
know that the demands made upon individul acquirements in other
Vv'alks of life, both professional and commercial, have been felt as a
terrible burden both by the student and by those who have to pay
for them. But how all this can have qualified people to treat minor
medical complaints is beyond comprehension. The medical student
has to study one year longer to meet the exigencies of his calling ;
it is therefore evident that the advance of education has not
simplified or lessened his diflBculties. It may be and is no doubt
the case, that these extra demands are made in other professions and
that under the stress of competition they are extended to commercial
THE DENTAL RECORD. 459
pursuits, but let me ask if the additional year requisitioned from
the time of the medical student, qualifies him in any way for being
his own lawyer, or architect, or even his own Doctor f
Going back to the influence of advanced general education, if it
has, as it ought to have done, stimulated the intelligence in a
healthy manner, it will have enabled the individual to recognise and
appreciate the difficulties of the professional man and make him
wary of attempting to interfere in matters of the import of which
he can only have a glimmering perception.
Moreover, if by stimulating the intelligence is meant stimulating
the imagination, I would suggest that the stimulating of this faculty
is more likely to promote minor troubles than to impart the power
of treating them successfully. But, gentlemen, false economy may
be an outcome of advanced education, for education and sound
judgment are not synonymous terms. False economy, I fear, is the
real advanced education which prompts people to treat minor
complaints for themselves for which the doctor would at one time
have been called in.
In a few sentences Mr. Smale contrasted the difference between
the use of drugs administered by trained men and taken indis-
criminately. Continuing, he said : — Well, gentlemen, this is not
a very cheerful indictment to bring against the British public and
against the Governments which countenance such a state of things ;
for the public it may be urged that money may be saved, and that
convenience is met by the sale of such preparations, and for the
Government that it enjoys a substantial addition to the exchequer
from the Stamp Duty.
In reply it may be urged that public convenience, which is
greatly a matter of habit, might be met in other ways, and that
although the tax of two hundred and fifty thousand pounds,
which the patent drug consumers lay upon themselves, may help
the revenue, it says but little for the economical instincts of that
portion of the public — we keep reason on their part out of the
question.
In the year 1880, the Medicine Stamp Duty yielded Xi35)366 ;
ten years later, in 1890, its yield reached ;^2 17,264. So that in the
present year of " educational enlightment " which gives " power over
minor diseases, " we may take it that the returns are over a quarter
of a million from the Medicine Stamp Duty alone. The rates of
H H2
460 THE DENTAL RECORD.
duty vary from i Jd. in a packet not exceeding is. in value, to 20s.
on a package over 50s. in value, and the vendors of dutiable medicines
have to pay 5s. yearly for a licence.
If we take the duty at 10 per cent, all round, a very low estimate,
we shall find that the amount of money spent on stamped medicines
bought and used by the public — in the majority of cases for they
know not what — amounts to something like ;^2, 500,000 per annum.
Much has been said about the Drink Bill of the country, but in the
consumption of excisable liquors the consumer generally knows what
he is paying for and is able to form some opinion as to its merits. I
would urge my hearers, nevertheless, to be very moderate in the use
of them.
This enormous sum is annually spent by the intelligent British
public, which imagines it is doing a smart thing when it listens to
and is guided by the quack as against the medical man ; but then the
quack, with his plausible platitudes, pretends to bring the mysteries
of scientific medicine to the level of the uninstructed (speaking pro-
fessionally), while persuading his victims that he is raising their
knowledge to the level of that possessed by those who have devoted
their lives to the study and alleviation of disease, and who have
patiently worshipped at the shrines of nature and of science ; he
panders to the worst traits in man's character — his self conceit, his
superstition and his blind faith in those who claim to be able to
perform miracles. Much of the so-called success of the quack is no
doubt due to the natural impatience of suffering, especially when
accompanied by credulity and incapacity. The doctor who cannot
in a few weeks or months cure the malady which has been for years
gaining its ascendancy, and which may have been materially helped
on by the ubiquitous patent medicine perseveringly applied to
symptoms, under the assumption that treating symptoms and treating
disease are the same thing, is called an impotent pretender and
dismissed. Perhaps if the doctor were in many such cases less
reticent, and were to tell the patients a few plain truths, it might be
better for both parties ; but the British public, which provides
customers for the patent medicine man, also provides juries for the
Law Courts, and so can prescribe penalties as easily as it recommends
quack medicines. I fear that the same public can yet spend its
millions on quack medicines and yet begrudge the 'doctor his fair
remuneration, and goes out of its way by organising clubs, societies,
tHE DENTAL RECORt). 461
associations, and working through Co-operative Stores and such-hke
arrangements, to buy his skill as cheaply as possible, are not much
to be trusted in the consideration of medical ethics, and so the
medical man finds his safety in silence ; for even when he tries to
explain some of the subtleties underlying disease?, his explanation is
misunderstood, misquoted, and strange and fantastic stories repeated
as to what he has said.
To help us realise how enormous is the traffic in patent medicines,
I am able to assure you that the largest customer of the Post Office
is an Insurance Company, and the next largest the proprietors of a
patent medicine. If by any chance there should happen to be any
relationship between those who take so-called patent medicines and
this Insurance Company, it might be a good thing for the surviving
relatives of the patent medicine imbiber.
It may be that the public are like the Irishman quoted in
Le Fanu's '• Seventy Years of Irish Life," who said he never called
in a doctor because he wished to die a natural death. We may feel
content that the man who possessed wit enough to say that had
wisdom enough not to take patent medicines.
Having so far tried to comply with the requirements of the
press, and pointed out as strongly as possible a matter that may be
called a grave and serious scandal, it seems incumbent upon me to
suggest some remedies for the state of things I have laid bare.
This, perhaps, is neither the time nor the place to do so, never-
theless, I would urge that the Government Stamp should be
abolished, and the present seems to be an opportune moment for
abolishing it, when the revenue of the country is so largely
augmented by the recently established " Death Duties " ; and
although this would not at once either reduce the number of
proprietary medicines, or abolish the disgraceful and discreditable
advertisements that disfigure our lovely country and infest every
periodical that reaches our hand, I am convinced that very shortly
it would do so, so sure am I that it is the Government Stamp that
attracts and enhances the value of so-called medicine in the eyes of
the public.
One other suggestion is that drugs should only be supplied to
the public by pharmaceutical chemists, and that no combination of
them should be compounded or sold by anybody but a qualified
chemist, and then only with a doctor's prescription.
462 THE DENTAL RECOR^.
If some practical philanthropist, let us say, Sir John Lubbock,
could be convinced of the harm that is yearly being done by these
nostrums, he could frame and introduce a Bill into the House
of Commons that would confer a benefit upon his countrymen by
restricting very largely, if not abolishing altogether, the opportunities
which the laity now possess for self medical treatment.
Mr. Smale concluded his address by offering some sound advice
to the students.
DEMONSTRATIONS AT THE BRITISH DENTAL
ASSOCIATION MEETING.*
Mr. William Hern's demonstration with the Downie Furnace
consisted of the following items : —
1st. How to lengthen a tooth by soldering a small piece of
platinum to the lower pin and bending them under the tooth to
support the Downie body, fusing the body and coating with pink
gum.
2nd. How to shorten a tooth by painting a concentre piece of
pink gum and fusing.
3rd. A single front collar crown backed up with Downie body.
4th. A Logan bicuspid crown with collar and filled in with
Ash's body and pink gum.
5th. A molar collar crown having cusps of a vulcanite or osteo
tooth fitted to the bite supported and filled in with Downie body.
6th. A bridge carrying two front teeth backed with Downie
body.
Messrs, Jones and Lennox's demonstration showed how they
deal with a living cuspid or incisor, the crown of which is past
filling.
They sawed off the crown and at once removed the pulp by
means of a Donaldson bristle dipped in carbolic acid, an operation
which proves in practice by no means so painful as one is apt to
imagine, the patient in the case demonstrated not flinching at all.
The apex of the root having been sealed and the face brought
to a convex form, with its anterior edge rather beyond the gum
margin, a plaster model was obtained from an impression taken by
* The following descriptions did not reach us in time for publication in our
last issue.
tHE DENTAL RECORD. 463
Mr. Lennox's method, and to this an Ash's tube crown was fitted.
A post was prepared, bent to suit the crown (with a properly made
crown this would not be necessary), and soldered to the tube.
Finally the crown was fixed to the root by means of a shred of floss
silk and thick gum mastic, a little base-plate guttapercha being
placed below the crown.
'*Buttner-Downie Crowns," by Mr. J. H. Badcock, M.R.C.S
L.R.C.P., L.D.S.
The root canal of a right upper central having been previously
prepared, the demonstrator proceeded to ream it to the required size.
The root was then cut down flat to the level of the gum and
trephined, Biittner's instruments No. 5, being used throughout.
The root (in this case) happened to be unusually small. Special
stress was laid on the importance of selecting a trephine of such a
size that, when sunk to the requisite depth, no part of its circum-
ference should project beyond the cementum. By paying attention
to this point the operation was rendered practically bloodless, and
pain reduced to the minimum.
As the section of the root was somewhat triangular, small pieces
of enamel and dentine remained beyond the ring made by the
trephine. These were split ofi" with a fine chisel inserted into the
groove and slightly rotated. Owing to the tapering of the root
towards the apex, the resulting edge was almost inappreciable.
A Biittner's impression cap was then placed on the root and an
impression taken with a small piece of Stent's composition, into
which the patient was allowed to bite. On removal from the mouth,
the cap, which remained behind, was replaced in the stent, and the
brass cylinder inserted ready for casting in plaster. For the
construction of the crown, a platinum Biittner cap was used, the
pin of which projected through the coronal surface about three-
sixteenths of an inch. The crown was completed according to the
Downie method, z>., an Ash's pin tooth was fitted to the cap, over-
lapping the band entirely, so that no platinum was visible from the
front. The tooth was retained in position by bending its pins round
the post, and its back was built up with Ash's porcelain body, and
fused in Ash's bridge furnace. The result was a porcelain crown,
perfect in appearance in front and behind, translucent and
strong.
464 THE DENTAL RECOREl.
In order to save the time that would have been spent in ^fitting
the tooth, another had been already prepared for the other central
in the same mouth, and this was fixed with Poulson's Liquid
Phosphat-Plombe Cement.
The method of using the Downie and Ash's furnaces and bodies
was shown — the operator giving preference to Ash's — as, in his
opinion, this body is more adherent to the porcelain, and can be cut
and polished with greater impunity. It is made in the chief shades
of Ash's teeth.
Mr. Badcock claimed for the crown that it was very strong, of
good appearance and easily made, with the infliction of much less
pain, and the expenditure of much less time than any other form of
cap crown. Moreover, if, with advancing years, the gum should
recede, no metal would become visible. It fits entirely beneath the
free edge of the gum, and presents no edge that can possibly cause
irritation, the margin of the gum keeping its normal pink colour
after years of wear.
" Guttapercha Impressions," by Mr. J. H. Badcock, M.R.C.S.
The material used was the best pure guttapercha, easily obtained
of any indiarubber merchants at about seven shillings per pound.
It is of a dark brown colour, and the best quality is translucent in
thin sheets. Owing to its elasticity, even deep undercuts are
accurately reproduced, and " dragging " with consequent distortion
of the neighbouring gum is obviated.
Sufficient guttapercha for the required impression is immersed
in boiling water, and the tray filled as usual ; any tendency to
stickiness being overcome by wetting the fingers. A special tray is
often advisable, though not a necessity, but it should not fit too
closely. A little vaseline is smeared on the patient's lips, or they
are thoroughly moistened. The fitted tray is then removed from
the basin of boiling water to another of cold water, and partially
immersed for a few seconds to cool the metal. The cold water
should not be allowed to touch the surface of the guttapercha until
immediately before it is transferred to the patient's mouth, when it
is firmly pressed home and held in position for four minutes.
The resiliency of the material which is so valuable in preventing
distortion of the impression while being removed from the mouth,
and preserving undercuts, is the very quality which it is necessary
to overcome when inserting it, for otherwise, there will be a
triE DENTAL RfeCOkt). 465
tendency to effacement of the impression, and a model will result
with short teeth, a fault difficult to detect until the plate is tried in
the mouth, i.e.^ the guttapercha must be used very hot, that its
particles may the more readily take up their new position and
retain it until all tendency to rebound has disappeared. Neither
should it be cooled during this time, as cooling would tend to
produce stress and subsequent warping.
On removal from the mouth, the impression should be placed in
cold water and kept there until ready to be cast.
When removed from the tray the guttapercha should be cleaned,
pressed into wafers of convenient size between two pieces of plate
glass and kept under water or glycerine. After some time it
becomes sticky and loses much of its elasticity. It should then be
discarded in favour of new.
As it does not become hard in the mouth, guttapercha is
especially useful for cases when long loose teeth are standing, though
its softness necessitates care in withdrawal.
The demonstrator showed a number of models taken with gutta-
percha, which were generally considered by members to be much
better than could be obtained with any other material except
plaster.
He also took and cast several impressions of the mouth of a
patient with long loose teeth.
On Thursday, August 13th, Mr. Baldwin demonstrated his
" Method of Repairing Bridge-work by Soldering within the Mouth."
The case was that of a bridge extending from the second molar to
the first bicuspid, and had the porcelain face of the first molar
broken off; this Mr. Baldwin replaced by another porcelain face,
which he attached with " pearl " solder by means of a small
soldering iron.
On the following day, Friday, August 14th, he repeated the
demonstration on another case ; this one being a Richmond crown
on an upper canine root which had the porcelain face broken off,
and which he repaired by the same process.
Mr. G. O. Whittaker's demonstration consisted of *' Preparing
and Fixing two Crowns on to the Roots of two Central Incisors,"
using a gold band, with porcelain front and Downie body at the
back, but without a pin up the root canal.
466 tHfe bEi^TAL RECOfefi.
The success of the method depends on the special shaping of the
root and contouring of the band.
The Downie body at the back produces a much stronger and
more translucent tooth than with gold at the back.
In preparing the root, the labial wall was ground down to the
level of the gum, the enamel being chipped away beneath the gum
with enamel chipper and fine fissure burr, the lingual wall was left
intact, and as long as possible, taking into consideration the articula-
tion of the lower teeth. The mesial and distal walls were sloped
with a diamond disc. The band (previously fitted to a plaster of
Paris model) was finely fitted to the root in the mouth.
In fitting the band it was tucked under the lingual edge, and
tipped forward over the labial, then driven beneath the gum with a
strong foot plugger, the sides of the band (pressed upon the sloping
mesial and distal edges) widened in diameter, thereby reduced the
labio-lingual diameter. Thus the higher the band was pressed
beneath the gum the tighter it fitted.
The tooth was now fitted and waxed into position, removed with
the band, sunk in sand and plaster, and a platinum diaphram soldered
across, the pins were attached to this with pure gold, then filled up
with Downie body, and cemented to the root. The gold used was
specially prepared platinized gold, and would stand the heat of the
fusing of the Downie body.
^batrarts attir ^dtttion^.
COCAINE AND COCAINEISM.
In the Revue de Therapeiitiqtie Medico Chiriirgicale of March
15, 1896, Sallard contributes a paper with this title, in which, after
a brief historical resume of the influence of this drug upon various
portions of the body, he proceeds to discuss the causes and symptoms
of acute and chronic cocaine poisoning.
After stating that these untoward symptoms arise from subcu-
taneous and submucous injection, and from the use of large
quantities upon the mucous membranes, particularly the urethra,
he reminds us that Reclus, after a careful study, has concluded that
tHE DENTAL RECORD. 467
on an average three grains of cocaine is the safe limit for anaesthetic
purposes. He also quotes an experience of Abadie's, in which, after
the injection of two-thirds of a grain of cocaine into an eyelid
before an operation upon ectropion, the patient, aged 71 years, was
seized with coma, which lasted for five hours, death ultimately
occurring.
He also quotes an experience of Hugenschmidt, a celebrated
dentist of Paris, who had a case of syncope lasting half-an-hour as
the result of injecting 10 drops of distilled w^ater into the gum, thus
illustrating the fact that injections under mucous membranes are
capable of producing symptoms independently of the presence of
cocaine. We believe this patient had already suffered from an
attack of acute cocaine poisoning as the result of an injection. No
case of death, however, has resulted after the absorption of a small
amount of cocaine. There is one case, however, of a death from
the injection into the urethra of a solution containing eight grains
of this drug. The symptoms of acute poisoning under these
circumstances are variable ; sometimes they are simply those of a
brief and fleeting vertigo ; in other instances there is great excitation
of the nervous system and a tingling in the extremities, with flush-
ing of the skin followed by pallor ; in other instances there are
gesticulations and the patient passes into a condition of active
talkative delirium. The latter symptoms are seen most frequently
in women. In other instances the symptoms are those of marked
depression. The vertigo produces nausea or sensations similar to
those of sea sickness. There is marked feebleness, and the patients
are in a condition of semi-stupor. There may also be palpitation
of the heart and some vomiting. There is marked pallor of the
face, dilatation of the pupils, coldness of the extremities, and profuse
sweating. Should convulsive symptoms come on, the intoxication
is of course exceedingly profound and the prognosis grave. Con-
vulsions are at first tonic, then clonic in character, sometimes
resembling those of ordinary eclampsia. There is marked dyspnoea,
probably due to tetanic contractions of the respiratory muscles,
and cyanosis is present from similar reasons, the cause of death
being failure of respiration. The duration of these untoward
symptoms produced by poisoning by cocaine is usually from one to
two hours, although, of course, they may last for a longer period of
time. Marked insomnia is very apt to follow these symptoms.
468 tHE DENTAL RECORO.
Sallard points out that Gauthier has stated that the administra-
tion of nitroglycerin will greatly diminish any danger connected
with the use of cocaine, and that Gliick has claimed that by the
use of phenate of cocaine these symptoms can also be avoided.
Goesel has also proclaimed the advantages of tropacocaine as
less likely to produce depression of the heart and other untoward
symptoms.
Magitot, after stating that only very minute quantities should be
used for producing local anaesthesia under the skin or mucous
membrane, adds that cocaine injections should never be used in
neuropathic patients or in those suffering from cardiac disease or
chronic affections of the respiratory passages. Great care should
also be taken that it is not introduced into the veins. The
patient who receives cocaine injections should always be placed in
the horizontal position, save in those instances where in operations
upon the mouth or head a semi-reclining or erect position is indis-
pensable. Again, the greatest care should be used that the
hydrochlorate of cocaine is absolutely pure and not mixed with
other alkaloids which may possess a toxic influence. It is also well
to inject gradually rather than all at once. Magitot believes that
cocaine possesses over chloroform and ether incontestable advantages.
Should symptoms of acute intoxication by cocaine develop in
any case, the treatment is to place the patient fiat on his back and
use slappings of the face and chest with hot and cold towels,
ammonia ' by inhalation, and, if necessary, nitrite of amyl, and
hypodermic injections of ether and caffeine.
Chouppe has recommended that from one-third to one-half a
grain of morphine be given hypodermically.
In regard to chronic intoxication by cocaine, or what has been
called cocaino-mania, Sallard tells us that this habit is constantly
increasing in France. The symptoms consist of loss of appetite,
cardiac palpitation, headache and vertigo, finally followed by
hallucinations or delusions. The following treatment is to be
instituted :
In the first place, abstinence from cocaine is to be insisted upon
under proper control of attendants or in a hospital. The method
of decreasing the cocaine need not be instantaneous, but it should
be tapered off rapidly. Hydrotherapeutic measures designed to
increase nutrition should be resorted to, and iron, quinine and
THE DENTAL RECORD. 469
arsenic, with heart tonics, such as caffeine and sparteine, should be
employed. Chloral, trional or sulphonal may be employed to
overcome insomnia, and the whole effort of the physican should
be directed by means of appropriate exercise and a regular method
of life 10 improving the patient's general nutrition. — Dental Review,
THE ADYENT OF DENTAL SCIENCE IN THE UNITED
STATES.
By William H. Trueman, D.D.L., Philadelphia, Pa.
The first advent of dentistry in our midst seems to have been at
Boston. In 1636, the Plymouth Company, an association organized
for the purpose of colonizing that section of country, sent out from
London to Boston a company of physician?, an apothecary, and
three barber surgeons. Now, it is not true that the barbers were
the only dentists of that period. There were at that time many
medically educated men who confined their practice to disorders of
the teeth and gums, and who attained therein much skill and
expertness. They brought into line irregular teeth, treated diseased
conditions of the teeth and gums, cleaned and filled teeth, extracted
and replaced with artificial substitutes those which had ceased to be
useful. These were called then, as those who do such work are now
called, dentists ; they were professedly dentists ; collectively they
were known and honoured as members of the dental profession.
When and where these terms originated is lost in the dim, misty
past. It is true, then as now, that in isolated communities, com-
munities so small that they are unable to support a dentist, there is
usually found some one, blacksmith or schoolmaster, with more
courage or ability than his neighbours, who is able and willing to
relieve sufferers of an aching tooth, or to suggest remedies for the
ills to which the teeth are subject. That does not, however, make
them dentists. Such are no more entitled to be considered members
or representatives of the dental profession than is a mere vendor of
quack medicine, or an amateur midwife, or a natural bone-setter, to
be considered a member of the medical profession.
The barber surgeon seems to have been used as a somewhat
similar makeshift ; more closely allied, however, to the medical than
to the dental profession. When, in course of time, as little by little
470 THE DENTAL RECORD.
his multi-vocation became specialised, dentistry proper had no part.
This is clearly shown by the history of the barber surgeon's
association in England." The Company of Barber Surgeons was
first incorporated by Edward IV., in 1461. In 151 1, an Act of
Parliament was passed prohibiting any one practising surgery
without first having passed an examination as to qualification. In
1540 the title of the organization was changed and became " The
Company of Barbers and Surgeons," the barbers being at the same
time restricted in surgical practice to drawing teeth. Five years
later, the preamble to an Act of Parliament still further separating
these former close companions recites that the trade or practice of a
barber is foreign to, and independent of, the practice of surgery. In
1745, the barbers and surgeons separated, each forming an association
of their own ; the surgeons organizing as " The Commonality of
the Art and Science of Surgery," a title frequently shortened to
"The Surgeons' Company." This in 1800 gave place to the
" Royal College of Surgeons of London." It is probable that the
barber surgeon drifted into dental practice from his position as a
public valet, a beautifier of the person. From hair-dressing to teeth-
cleaning is but a step. The gentleman of leisure of the olden time
would have his morning shave, the brushing up and fresh powdering
of his wig, and his teeth polished at the same time and in the same
shop. Of this we have evidence from an advertisement in a New
York paper published about 1766, which reads : ^'' James Daniel^
Wigniaker and Hairdresser^ also Operator upon the Teethy\ The
more progressive of these public valets advanced still further into
dental lines when circumstances encouraged them so to do, especially
as beautifiers of the person and purveyors to personal comfort,
adding tooth-drawing and replacing of lost teeth. All this was,
however, outside of his legitimate calling, and only acceptable to
the community when nothing better was obtainable.
Of the three barber surgeons sent to Boston I have so far been
unable to find any professional record. The name of one only,
William Dinely, is known.! He seems to have been unfortunate.
Shortly after his arrival he got into trouble by embracing Anne
* Memorial History of Boston, Justin Windsor, 1881, vol. i, page 502.
f Annals and Occurrences of New York City and State, John F. Watson,
1846, page 281.
J Memorial History of Boston, Justin Windsor, 188 1. vol. i., page 502,
THE DENTAL RECORD. 471
Hutchinson's peculiar religious notions. In 1639, a Roxbury man
suffering from toothache sent for him to come and draw the tooth.
He started on this mission of mercy accompanied by a maid who
brought the message. They were overtaken by a violent storm,
lost their way, and were found some days after frozen and dead.
His misfortunes have preserved his name to posterity. Madam
Dinely shortly after gave birth to a son, who was named, with
homely pathos, Fathergone Dinely.
The next reputed dentist of whom I find record is Isaac
Greenwood, Jr., also of Boston.* The family came from Norwich,
England. Nathaniel Greenwood arrived in Boston about 1650, and
engaged in business as a ship carpenter. He died in 1685, leaving
two sons, Samuel and Isaac. Isaac became the first professor of
mathematics cf Harvard College, and was the father of Isaac, Jr.,
whose name is first brought to notice in a newspaper account of the
Boston massacre of March 5th, 1770 ; he is there described as an
ivory turner, a business " naturally embracing that of dentist," so
says the chronicler. Dr. ChapHn A. Harris refers to him in his
Dictionary of Dental Science as " the first practical dentist in
Boston. "t So careful and painstaking a writer, who had the
advantage of mingling with many who had personal knowledge of
those early times, we may safely assume knew whereof he wrote.
Of Isaac Greenwood's five sons, three became dentists ; two, John
and his younger brother, William Pitt, will ever be remembered for
their good work as pioneer dentists in the United States.
The story of John Greenwood,! as written by himself toward
the latter part of his life, although little more than a mere sketch,
probably unfinished owing to his sudden death from apoplexy in
1 81 5, is particularly interesting. Born in Boston in 1760, he
attended school until his thirteenth year, when he was apprenticed
to his uncle, a cabinet-maker of Portland, Maine. Two years later
the battle of Lexington brought the strained relations between
England and those of her American colonies now embraced within
the United States to a crisis. A peculiar train of circumstances led
young Greenwood to enlist in the American army rapidly gathering
* Memorial Biographies of the New England Historical and Genealogical
Society, Boston, 1880, page 268.
t Harris's Dictionary of Dental Science (1849). John Greenwood, page 333,
I Americufi Journal of Dental Science, vol. i., 1839, pages 73, 97, 113.
472 ^ THE DENTAL RECORD,
near Boston, and shortly after, at Bunker Hill, he received his first
baptism of fire. With his company he assisted to cover the retreat
of that patriot band whose defeat brought no disgrace to the
vanquished and gave no comfort to the victors. Later he took
part in that first and most disastrous campaign in Canada, and
ended his army career, his term of enlistment having expired,
immediately after taking part in Washington's masterly surprise
of the Hessians at Trenton. He enlisted as a fifer, a position which
exempted him from many hardships and dangers ; but of this he
took no advantage, but manfully and courageously did his full duty
as a soldier. After a few weeks' rest at his father's home at Boston,
he entered the naval service as a privateersman, and in various
capacities served therein until the close of the war. We now find
him in New York city, almost penniless. Refused assistance by his
brother, Clark Greenwood, who was then in that city in practice as
a dentist, through the favour of a friend he began business in a
small way as a nautical and mathematical instrument maker, with
most promising success. A mere chance turned his attention to
dentistry, and developing therein exceptional skill, he soon acquired
a large and lucrative practice.
John Greenwood, when he performed his first dental operation
if the extraction of a tooth may be so termed, was a skilful mechanic.
So satisfactorily was this extraction done, that the patient, a
physician of repute, asserted that he had never had a tooth removed
so carefully or with so little pain, and declared that he would there-
after recommend to him any of his friends or patients requiring a
like service. In a little while, so promising seemed this new
vocation, that he sold out his business and resolved to devote his
whole time and attention to dentistry, determined to make himself
a master in his calling. Passing beyond the usual limits of dentistry,
tooth-drawing, tooth-replacing, and tooth-filling, he boldly entered
the domain of oral surgery, and acquired fame in successfully
treating, by novel surgical procedure, diseases of the maxillary
sinus.
He was a type of the men who have made illustrious and
honoured the dental profession in the United States. His education
was meagre, his opportunities for acquiring professional knowledge
limited ; he made, however, the most of both, and with unflagging
zeal and untiring industry this carver of ivory and worker in bras^
THE DENTAL RECORD. 473
reached a well-merited and recognized position in the front rank of
his profession.
His younger brother, William Pitt Greenwood* was also an
ivory turner. After spending a short time in New York assisting
his brother, he located in Salem, Massachusetts, as a dentist, in 1790.
A few years later he removed to Boston, continuing in dental
practice until incapacitated by age. He died at Boston, May loth,
1 85 1, on the eighty-fifth anniversary of his birth. He early
acquired a reputation as a skilful carver of bone dentures ; practiced
while the fad lasted, replantation ; and during his long professional
career enjoyed and maintained an excellent reputation and practice.
He received in November, 1840, the honorary degree of D.D S. from
the Baltimore College of Dental Surgery. He was present at a
meeting of the American Society of Dental Surgeons at Boston,
July 19th, 1842, when he gave to the society an interesting account
of the profession as he knew it some fifty years before. It was said of
him then, " that although approaching 80 years of age, his step is still
elastic, and his mind possessed of the vigour and freshness of youth. "t
Another Boston lad, a few years younger than John Greenwood,
while perhaps not so well known (for it was not his fortune to have
been dentist to his Excellency, the first President of the United
States), will ever occupy an honorable position in the annals of
dentistry in America. Of his early life but little is known. He,
too, had joined the patriot band, and we first find record of Major
Josiah Flagg, a youth of but eighteen years, as being in the army
while the French and Americans were in winter quarters, side by
side, near Providence, R.I., 1781-82. He served until the close of
the war, and then, shortly after, began practice as a dentist in
Boston. During the war of 181 2 his martial spirit was again
aroused ; he entered the naval service, was soon taken prisoner and
carried to England, where he was paroled. His enforced stay in
a foreign land was made less irksome by the kind attentions he
received, in recognition of his well-merited reputation, from the
learned surgeons of London. While his thoughts were of home
and the profession be loved, under the most pleasant auspices he
made the most of the opportunity to increase his medical knowledge,
and in social intercourse with many distinguished medical teachers
* Memorial Biographies of the New England Historical and Genealogical
Society, Boston, 1880, page 268.
t American Journal of Dental Science, vol. iii., September, 1842, pages 69, 74, 77.
I I
4:74 THE DENTAL RECORD.
of London, attending their lectures, assisting in their practical work,
and in the study of their methods of teaching, he gathered much
that he fondly hoped to make useful to his brethren at home. The
war over, he was soon again in Boston, anxious that they should
share with him the good he had learned ; but shattered health
frustrated his plans. Seeking rest and health, he went to Charleston,
S.C., and died there, September 30th, 181 6, aged fifty-three.* He
was the first of a family whose " brainy " men have made their
mark in various pursuits. In dentistry they have developed a
faculty of early getting to the front and staying there. As teachers
and as investigators they have proved earnest, progressive,
aggressive, and uncompromising.
Let us now consider for a few moments an event which I think
has had an important bearing upon dental history in the United
States. It was a sad and anxious winter, that of 1777 and 1778, for
the leaders of the American Revolution. The outlook of their
attempt to establish a government of the people by the people, and
for the people, was gloomy in the extreme. When the fate of the
new nation hung as on a balance, it was reserved for a citizen of
Philadelphia — our representative in Paris — to transform impending
disaster into a grand success, and in so doing transplant to these
shores, from the land where it had received its then highest
development, the science of dental surgery. Dr. Franklin's world-
wide reputation as a scientist secured for him a warm and enthusiastic
reception in Paris, for Paris was then and is now what Francis the
First's ambition had made her. Notwithstanding that she has
been torn by internal strife, sacked by foreign foes, deluged with
blood, and baptized by fire time and again, she still remains the
metropolis of the scientific world.
While other monarchs of his time were busy with conquest, the
gratification of personal vanity, or less laudable pursuits, Francis
the First of France was ambitious to make the capital of his domain
a literary and scientific centre. Under his wise rule, all that
promised usefulness in letters or in science received at Paris a warm
welcome and the fullest encouragement. The spirit he there
implanted and so zealously fostered has grown, and borne in the
years that have passed abundant fruit. In Paris modern surgery was
born, and at its birth the dental surgery we now know received its
first educational impulse. It was, indeed, an auspicious time for a
* Dental News Letter, vol. vii., July, 1854, page 212.
THE DENTAL RECORD. 475
great mind to do the world a signal service when Ambrose Par6
arrived at Paris, about 1525, to begin his wonderful career by an
apprenticeship to a barber surgeon. At that time the occupation
of barber and surgeon, and a little dentistry, was usually combined
in one. He early evidenced a disposition to master the more
important features of his art, and while still a young man his
marked ability as a surgeon attracted the attention of Captain-
General Rene de Monte Jean, commander of the French forces
during the campaign in Piedmont in 1537, and he received from
him a commission as Master Barber Surgeon. In this position he
found opportunity and encouragement to introduce those reforms
in surgical practice that have earned for him the well-merited title
of the Father of Modern Surgery ; and, let me here add, he may
as justly be styled the Foster-Father of Modern Dental Surgery.
Compared with the dentistry of the present, the dentistry of his
day, although crude, was far more advanced than was the general
surgery of 1537 compared with that of 1895. He proposed to treat
wounds with supporting bandages, control hemorrhage by ligatures,
and assist nature with soothing applications in the place of the time-
honoured actual cautery and boiling oil. Contemptuously throwing
aside his whole array of searing tools, he presented his brazier and
oil pots to his cook for use as porringers, and entered upon his work
armed only with bandages and a few simple emollients. This
radical departure from the accepted creed of the times aroused a
violent storm of indignation among his professional compeers ; but
the results he obtained made his services in demand by the wounded
and the suffering. Where he had charge, the restfulness and quiet
was in marked contrast to the stench of burning human flesh and
the cries of anguish — time-honoured accompaniments of the then
accepted orthodox surgical methods, especially in army practice.
To be waived aside, to see this unpretentious youngster, scarcely
out of his apprenticeship, and his unheard of methods preferred to
theirs, was humiliation enough to those who clung with all the
ardour of ethical fanaticism to time-honoured customs ; but to see
patients who would, after enduring hours of untold anguish under
their strictly professional procedures, have been the subjects of a
pretentious funeral, by this new departure, after a few weeks' of
recuperative rest, fully restored to health and vigour, was
exasperating in the extreme ; and they were minded to make things
" hot " for Ambrose Pare,
I I 2
476 THE DENTAL RECORD.
Returning to Paris, he at once, paying no heed to the ravings of
his detractors, fully supported and receiving every encouragement
from the court, vigorously set to work to reform surgical educational
methods and practice. He insisted that surgeons should receive a
medical training, be thoroughly instructed in anatomy by dissections,
and well versed in all that pertains to the art, and he organized
schools for instruction. He wrote a number of works in French
upon surgery and surgical practice, touching also upon the practical
part of dentistry. He lived to see his work appreciated, his methods
generally adopted, and the science he loved placed fairly upon a
scientific basis, and died lin 1590, honoured and respected by all.
The work so well begun went steadily on, and towards the close of
the seventeenth century the surgeon and the dentist had so far
separated from and advanced beyond their former companion, the
tonsorial artist, that they began to claim an equal standing with the
profession of medicine, and after a vigorous struggle they gained
their point. During this contest the dentist and the surgeon fought
for their rights side by side, and at its conclusion, in France, the
physician, surgeon, and dentist became professional brothers. There
and then, possibly for the first time since the dark ages, dentistry
assumed the place she has since held — ever recognized and un-
challenged— a science amongst sciences. About the year 1700,
persons destined for the profession of dentist were compelled, in
France, to undergo a regular examination, the same as surgeons
and physicians. From this time on, dentistry assumed, in France,
an importance it had nowhere else on the globe. The dental
profession attracted to its membership gentlemen medically educated,
of broad culture and marked ability, and of the highest scientific
attainments. Its progress was rapid. Dental writers and investi-
gators increased in numbers, while their work acquired greater
scientific value. We find articles upon dental science and practice
freely published in the medical and scientific periodicals. In a
word, the dental profession there stood shoulder to shoulder with
the liberally learned professions of the day, and received with them
equal recognition and appreciation. French dentistry occupied
then a similar position to that assigned in later years to so-called
*' American Dentistry," a term it would be well for the dignity of
our profession could we effectually efface from the record, with all
the bombastic nonsense associated with it.
Dr. Franklin's mission to France proved a brilliant success.
THE DENTAL RECORD. 477
With all the adroitness of a born statesman, taking full advantage
of the political surroundings, he secured from France that material
and moral aid the struggling colonies so badly needed, and in a few
years a new nation was born. Now, let us see how closely and yet
strangely Dr. Franklin's success as a diplomat is connected with the
history of dentistry in the United States.
With the land forces sent to our assistance by France was a
young officer, Joseph Le Maire,* a dentist of Paris, who, following
the example of many of his countrymen, abandoned for the time
being his business and tendered his services to the cause of liberty.
With the French fleet arrived James Gardette, a naval surgeon on
his first cruise, a man whom we dentists of Philadelphia will ever
hold in grateful remembrance. He did much to make dentistry in
Philadelphia what it is. James Gardette was educated for the
medical profession. When he resolved to enter the navy, as part of
his profession as a naval surgeon he received instructions in dentistry
from M. L. Roy de la Faudiniere, a distinguished dentist of Paris,
and provided himself with dental text-books and instruments.
This was required of naval surgeons in the French service in 1777.
We have no reason to think that he contemplated the practice of
dentistry when he left France other than as part of his work as a
naval surgeon. He soon acquired a distaste for the sea, and resigned
his position. During the w^inter of 1781-82, the war then being
virtually over, the French and American armies were in winter
quarters side by side near Providence, R.I. In that camp, relieved
of the tension associated with active service t and expecting soon to
resume civil life, we find, in intimate friendship, Joseph Le Maire,
James Gardette, and Josiah Flagg. Le Maire had, now and again,
to the great comfort and satisfaction of his companions, performed
dental operations for their relief, and now many of the officers and
others took advantage of the opportunity to secure his services.
Josiah Flagg had been greatly interested in Le Maire's work, and
proved an apt and zealous student. Gardette also embraced the
opportunity of adding to his dental knowledge already gained. So
you see it needs but little stretch of the imagination to locate the
first school of dental instruction in the United States, and the first
* Sometimes by old writers spelled " Lemayeur." Towards the close of the
last century, the French Academy simplified the spelling of many French words,
dropping silent letters, &c. Le Maire changed the spelling ol his name to
conform to this.
t American jfouyaal 0/ Dental Science, vol. i, New Series, April. 1851, page 375,
478 THE DENTAL RECORD.
dental meeting for mutual improvement, around this Revolutionary
camp fire. We may safely say that scientific dental surgery in the
United States owes much of that which has given it its well-merited
reputation to the good work there done in 1781-82.
Not only did those connected with the army have opportunity
to observe and receive the benefits of skilled dental services, but
the presence of the array in its then inactive condition attracted
from all parts of the country many of our best citizens. When the
army disbanded, the merit and advantages of dental attention were
made known far and wide, as they could have been so quickly by
no other means. This created a demand, the return of peace and
prosperity furnished the means, and we soon find dental prac-
titioners in all parts of the land. Towards the close of the last
century our profession in the United States was well established
and fully appreciated.
I am not unmindful of the good and skilful men, native-born or
from abroad, who by their example or their labour have done much
to extend our professional knowledge, when I present to you these
men as the Fathers of Scientific Dental Surgery in the United
States, and so close this story of the advent of dental science in our
midst. — Cosmos.
DENTISTRY IN THE ORIENT.
By Richard Henry Kimball, D.D.S., Chicago, 111.
During my sojourn in the " East " I was naturally desirous
to obtain all the information I could concerning the progress of
the Chinese in that field of science in which I was particularly
interested, but I was unable, from lack of time, to extend my research
much beyond the limits of foreign residence. Careful observation
whenever opportunity presented, and inquiry of those resident
among them, failed to reveal even the most primitive attempt at
preservation of the natural teeth. I, therefore, believe that I am
fully within the bounds of truth when I say that beyond certain
remedies for relieving toothache, extracting, and an occasional crude
attempt to supply an artificial tooth, or a few teeth, there is no
knowledge whatever of dentistry among the hundreds of millions of
Chinese.
In the treaty ports with the daily contact with foreigners there
has naturally grown up in the minds of many of them, some
knowledge of the medical and dental methods of the western world,
The dental record. 479
and from the medical missionary. Many even of those Hving in the
far interior have come to appreciate the value and importance of
foreign medical and surgical skill.
None of them are so ignorant of dental matters, however, that
they cannot appreciate, in some degree at least, the distress and
inconvenience of an aching tooth, and employ some agency for relief,
it may be spiritual, medical or mechanical. It is the quite generally
accepted idea with them that pain in the tooth is caused by the
presence of a " worm, " which has taken up its abode inside of it.
They are encouraged in this belief by the class of men who go
about the city streets extracting teeth. These find it to their
pecuniary advantage to cater to his notion, and, to prove the truth
of their assertion, it is their frequent habit after extracting a tooth
where the imprisoned " worm " has been making things particularly
lively, to break the tooth and exhibit the " worm " to the astonished
victim and interested onlookers. I wish I could bring before you a
picture of an aspirant for dental honors as I first saw him at a little
village a few miles out from Hong Kong. He was squatting by the
roadside, in front of the shops on the main street, proclaiming in
loud tones his skill as a "worm "and tooth extractor. (This I
learned from a Pigeon English speaking native.) His outfit consisted
of a wooden tray some two feet long, fifteen inches wide and perhaps
three inches deep, elevated upon a stool. At either end of the tray
an upright was fastened, and between these several wires extended
upon which were strung hundreds of teeth. In the tray were
perhaps enough more teeth to fill a peck measure, beside a number
of bottles and paper packages.
I enlisted the aid of the friendly interpreter to find out about the
bottles and ascertain what appliance he was using for extracting,
there being no instrument whatever in sight.
■ He was shyness itself, but after much palaver he produced from
that part of his clothing made famous by Bret Harte a rather large
pair of ancient, much worn, and abominably dirty pliers, of foreign
manufacture. These, after some hesitation, he permitted me to take
for examination, and I was conscious as I held them in my hand of
a profound feeling of respect for the simple tool, the product of
some humble European artisan, probably long dead, who in making
it had toiled to a better purpose than he had ever dreamed.
In all probability either you or I would have discarded the
implement as not retaining enough of its original usefulness
480 THE DENTAL RECORD.
to be of service in tack pulling, and, but for all the horribly
abundant septic possibilities present, would have doubted that
this was the instrument used, and according to his statement, the
only one.
No amount of questioning elicited the least information regarding
the other articles in his tray (the bottles and packages), a shake of
the head being the only response to my repeated inquiries. Common
report tells of a mysterious powder some of these men use in
extracting teeth, a small amount of which is placed on the gum
around the tooth to be extracted, when after waiting several minutes
the tooth can be removed with the fingers.
After much difficulty and several years of waiting I finally
succeeded in obtaining, through a Chinese acquaintance, what was
said to be a specimen of this powder, and its analysis shows it to be
composed of potassium nitrate, sodium sulphide and what seems to
be red sealing wax. That only the fingers are used in removing the
tooth is true, the powder being employed simply to mystify, which it
succeeds in doing thoroughly, deceiving many foreigners as well as
Chinese, for I have frequently been assured by the former that the
powder did the work. A wonderful degree of strength is developed
in the fingers by long years of practice in pulling wooden pegs from
boards. In Japan the boys are put to this exercise when quite
young, and as a result pegs are easily withdrawn by them that we
would find it difficult to remove with forceps.
As an object lesson in Chinese dentistry I coveted this outfit, and
offered the man what was a large sum for it ; but he refused
to sell.
Then it was proposed to pay him his own price, including a good
pair of forceps, but to no purpose ; he could not be induced to part
with anything. It may not be amiss to speak, in passing, of the
peculiar trait of the Chinese illustrated in this incident. It is
characteristic of them no matter how much they may wish to dispose
of any article, how desperately they may be in need of the money its
sale will bring, they invariably refuse to sell when openly approached
with an offer to buy.
They have their customary way of conducting such matters, and
with them custom outweighs in importance every other consideration,
almost to that of life itself.
The preliminaries to a sale must be conducted with great
discretion, for an axiom of much importance in China is, " The
THE DENTAL RECORD. 481
country villager is born perverse ; the more you wish to buy the
more he is determined not to sell. "
Suspicion is a national characteristic ; jnot as applied to one's
neighbour solely, but each man suspects himself, or recognises his
own weaknesses, and in all trades except in shops and open market,
where prices are fixed, the employment of an intermediary is
necessary. I cannot dwell longer on this trait than to quote the
Chinese adage, '' If there are no clouds in the sky there will be no
rain on the earth ; if there is no one to stand between, business will
not be done. "
For years I have been trying to get possession of the outfit of one
of these Nomadic individuals, even enlisting the assistance of
residents of interior cities, where I felt that the prejudicial conditions
might not be so great, but thus far without success. What I
have stated is, so far as I have been able to ascertain, the sum
total of the Chinaman's own unaided efforts on behalf of the natural
teeth.
They make an indifferent attempt at supplying the places of lost
teeth, the artificial being made of ivory or bone, shaped with a file
and attached to the remaining teeth with a brass wire. The effect
in mouth is often hideous beyond description. Where a single tooth
is lost, an artificial substitute is shaped to fit the vacancy and forced
to place, no retaining wire being used. When the space has enlarged
until that piece is no longer retained, another and wider piece is
made that will fit tight. This wedging operation is repeated until
the retaining teeth assume such an angle that it becomes necessary
to wire the piece in place. I have with me some specimens of this
class of work, and appliances with which they were made.
The file with its teeth cut only one way, is a very fair tool you
will observe, rather course for such work, but it is marvellous how
much they accomplish with just such instruments. It is of native
construction and its temper is poor.
The drill is made from an umbrella rib, while the wire is doubt-
less of foreign manufacture.
In some of the larger coast cities are to be found a few Chinese
practicing dentistry. " AUe same foleign dentist," they would tell
you. Their knowledge of things dental is purely empirical, and has
been derived from association with foreign dentists : either as assistant,
or an attendant, whose duties were to receive visitors and keep the
office in order.
48^ THE DENTAL RECORD.
During his tenure of office he had probably permitted his
sponge-Hke procHvities to operate with some freedom, and so had
"absorbed" enough of the worn, or nearly worn out belongings of
his master, to fit him out very fairly when he decided to set up for
himself.
Two of these men I know to be possessed of a considerable degree
of skill ; one practicing in Hong Kong, was for several years Doctor
Roger's assistant, and when I first went there in 1886 was patronised
by a number of leading foreigners in preference to the only European
dentist there at the time. The other, who is now practicing in
Shanghai, was assistant to Doctor H. H. Winn for 15 or more years
before I joined him, and continued with us until the time of Doctor
Winn's death in 1890, thus enjoying a pupilage of fully 20 years.
Both of these men have fully equipped modern dental offices,
furnished in one case with a Wilkerson high low base chair and
fountain spittoon, and in the other with an S.S. White pedal lever
chair. Each has a full equipment of White's instruments. All of
these Chinese practitioners are patronised quite largely by a class of
foreigners whose means will not admit of their going to a foreign
dentist, such as a merchant and naval seamen, soldiers (in Hong Kong)
and many others. They are also doing a good work in educating
their own people to some knowledge of dental matters, as many of
the better class of Chinese go to them for both operative and prosthetic
work. As each one of these native " tooth doctors, " as they are
called, has a small army of relatives and family connections who, like
parasites, attach themselves to him, their value as educators is
greatly increased, and I predict that it will not be many years
before the foreign dentist in China will have Chinese graduates from
American dental colleges to compete with. — Dental Review.
SURGERY OF THE NERVES.
Trifacial Neuralgia, — The justifiability of the necessarily severe
operations undertaken for the relief of this extremely painful
affection is gradually being recognised, and the number of patients
subjected to the modern operative procedures is undoubtedly on the
increase. There are, however, some who hesitate to admit the value
of surgical interference in these cases, among them Dr. Gilles de la
Tourette,* who contributes a paper on the subject from the medical
point of view.
* Med. Week, July 17, 1896.
THE DENTAL RECORD. 483
In discussing the diagnosis of the condition, he says that the
sensory root of the fifth nerve alone is concerned, and he lays
particular stress on the "painful spots" where the branches emerge
on the face, viz., the supra-orbital, palpebral (at the outer angle of
the eye), nasal (at the inner angle), and the ocular points, all
associated with the opthalmic division of the fifth. Those associated
with the second or superior maxillary division are the infra-orbital,
malar, dental, and palatine : and with the third, or inferior maxillary
division, the tempero-maxillary, inferior dental, lingual (along the
side of the tongue), and rcental points. In addition to these points
of excessive hyperaethesia, the whole side of the head, in some cases,
is sensitive and tender. In less severe cases only one or two
branches may be involved. There are two distinct varieties of
trifacial neuralgia, (i) A benign and ephemeral variety, in which
the pain is continuous throughout the whole course of the disease,
with exacerbations of a shooting character. Ic is often attributable to
external irritation, such as cold, and may follow on influenza or other
infective diseases. (2) In true tic douloureaux, on the other hand,
the symptoms are always paroxysmal, reaching their acme at once,
and subsiding with equal suddenness. In the intervals between the
attacks there is complete freedom from pain. The pain is intense
while it lasts, and the attacks come on with varying frequency, ten,
twenty, or a hundred times a day, but are always of short duration.
An attack might be excited by such physiological acts as talking,
swallowing, coughing, sneezing, &c., all of which the patient
tries to avoid as far as possible. Pressure over the tender spots
to some extent relieves the pain, and this being resorted to
very frequently may result in producing facial marks, or even
deformities.
Vaso-motor and trophic changes often accompany the disease,
such as injunction of the eyes, oedema of the lids, nasal discharge,
excessive salivary secretion, or herpatic eruptions. The essential
feature of this variety is its persistence ; the older the patient grows
the shorter the intervals of freedom from pain become, and the more
severe are the attacks.
The etiology of the condition is very obscure. In a few cases
the nerve is pressed upon by tumours, syphilitic growths, meningitic
patches, or fragments of broken bone, but in the great majority of
cases no such definite cause is forthcoming, and the nerve disturbance
has to be attributed to such constitutional conditions as gout,
484 THE DENTAL RECORD.
rheumatism, diabetes, and so on. Undoubtedly some cases show
evidence of being hereditary.
Krause has found pronounced histological changes in the
Gasserian ganglion, but none in the peripheral branches of the fifth
nerve. Fowler thinks that the sclerotic changes in the vessels may
be the essential pathological lesion.
Differential Diagnosis. — Ty^iQ^S. tic douloreaux has to be
diagnosed from — (i) The benign form of facial neuralgia ; (2)
Migraine ; and (3) Hysterical paroxysms in the form of facial
neuralgia. These are of long duration, with comparatively long
intervals between attacks. The paroxysms come on only two or
three times a week, at fixed intervals, last for some hours at a time,
and often end with a convulsive seizure and weeping. There is
almost always an aura, such as the globus hystericus, noises in the
ears, or ephemeral hallucinations. The importance of recognising
this clinical form lies in the fact that surgical treatment would be
particularly inappropriate. At the same time it is to be borne in
mind that trifacial neuralgia and hysteria may co-exist, as in a case
quoted by Tourette.
Medical Treatment. — The benign variety is always influenced
favourably by analgesics — antipyrin, phenacetin, hydrobromate, or
valerianate of quinine ; whereas true tic defies all such drugs. The
writer pins his faith to the treatment advocated by Trousseau and
employed by Charcot, namely, the administration of extract of
opium in large and progressively increasing doses. He illustrates it
by the treatment of a given case. Pills accurately measured and
prepared with a view to ready and complete absorption, were ordered,
each containing two centigrammes of the extract of opium. On
the first day the patient took three pills at regular intervals, and one
additional pill was given each day. When a dose of eight pills had
been reached the ^attacks had decreased by half, and the patient
could eat and speak without bringing on a paroxysm. After twelve
pills a day the pain had disappeared. For five days this dose was
given, and then the pills were reduced at the rate of one every other
day, and in twenty-five days the treatment was discontinued. A
fortnight later (date of reporting) patient was free from pain and
gaining weight.
Unfortunately, this relief can only be looked upon as tem-
porary, and on a further attack supervening the pain is less well
borne.
THE DENTAL RECORD. 485
This is the case for medicinal treatment by one of its great
supporters, and on such data operative measures are disapproved if
not actually condemned as unnecessary. — The Hospital.
PYORRHCEA ALYEOLARIS.
Dr. Younger said that he considers pyorrhoea to be a disease of
the pericementum and not of the gums or other tissues. What is
wanted is to create an irritation that will excite granulation.
That is best accomplished with lactic acid which will prove
successful in 24 out of 25 cases. If this treatment fails it will be
because all deposits have not been removed, or because the pockets
have not been first cleansed of blood, serum, &c. The lactic acid is
best kept in a little test-tube which can be held over the alcohol
flame until liquefied and warmed. If not warm it will cause too
much pain. One application, once for all^ will be all that will be
required if the deposits have been thoroughly removed and the
pockets properly cleansed. He said : " You may laugh, but try it."
Before applying the lactic acid the surrounding tissues should be
protected by coating with glycerine and covered with cotton ; then
flood the pocket. The lining membrane will be exfoliated, contrac-
tion follows and the gum soon clings closely to the root again. Then
wait a week. If the point of the syringe can be introduced it is
proof that the deposits have not been thoroughly removed, or that
the application was not sufficiently thorough to cause perfect exfolia-
tion of the lining membrane, and the treatment must be repeated.
When union is not prompt in cases of implantation the applica-
tion of lactic acid in the socket will secure perfect union, which,
Dr. Younger said, upholds him in his theory of persistent vitality, as
there could not otherwise be such perfect reattachment. He said :
" By my method take one tooth at a time and give one, two, three
or four hours, if necessary, to the removal of deposits. The next
day take another tooth in the same way. If there are three contiguous
teeth to be treated, clean the central tooth and the adjacent sides of
each of the adjoining teeth. The next day finish the outer sides but
do not disturb the central parts. The treatment is very simple but
it must he thorough^ and be very particular not to do any washing
out after applying the lactic acid. Flood the pockets and leave it
there. As a subsequent wash chlorate of potash, as strong as can be
borne, will be found very soothing." — American Dental Association.
486 THE PENTAL RECORD,
" Notes on the Treatment and Filling of Teeth." By
W. Cass Grayston, L.D.S. Published by the Dental Manu-
facturing Co., London.
Many of our readers will be glad to hear that the above notes,
which have already appeared in the Dental Record, have been
published in book form. It is always pleasant and useful to peruse
the notes of a busy practitioner, and it would be well if others were
to follow his example, and thus enable younger men to quickly gain,
in some measure, the knowledge of their seniors. Mr. Grayston has
arranged his work under many headings. He commences with some
useful notes on " The Relief of Pain, " but he seems almost too
cautious in certain cases ; for instance, he says: "If the tooth is
carious, decay should be sufficiently removed to admit a temporary
filling, " recommending carbolic acid and tannin as a first dressing ;
but if this fails to relieve pain, we are then told to try either carbolic,
or oil of cloves ; should this be found useless, he suggests the
application of the rubber dam, the dehydration of the cavity,
followed by the application of chloroform and other drugs ; if still
unsuccessful, then expose and kill the pulp. We fancy most of us
would resort to "making an exposure" at the second sitting. His
remarks on periostitis are useful, as also are those on localising the
faulty tooth in referred dental pain. In speaking of rhizodontrophy
the author omits to mention its use in the filling of pulpless
temporary teeth ; but rightly considers the operation only suitable
for temporory relief, or in an emergency : he amusingly remarks,
" It is rather awkward for the rhizodontrophist when the drill pops
into a living instead of, as was expected, a dead pulp" ;yes, decidedly
awkward, and yet we think all must have experienced the occasional
great difficulty in diagnosing a dead from a living pulp. He gives
us very little information on the method of scaling teeth ; but his
notes on pyorrhoea are good and interesting, although we are rather
surprised that he makes no special mention of copper sulphate. The
author's notes on the filling of teeth are good, although somewhat
elementary ; his suggestions on the best methods of inserting various
kinds of gold are interesting and instructive, and the text is rendered
more valuable by several diagrams. He thinks, like most others,
that gold is the best filling material, provided, as he wisely remarks,
THE DENTAL RECORD. 487
that one is dealing with a good patient, healthy mouth, and teeth of
fairly sound structure. For all that, he has a good word to say for
other materials, especially guttapercha in smallish interstitial cavities
not extending to the biting surface. He quotes as one of the
advantages of amalgams, their "ease and rapidity of introduction, "
but we think that one reason why some operators have a poor
opinion of amalgams is that they do not take sufficient time
and care in their insertion ; he does not mention the value of
thoroughly polishing amalgams at a subsequent sitting. In speaking
of tin foil in conjunction with gold, he says :" I consider its only
reliable value lies in being a valuable starter for gold, and an excellent
low conducting lining under gold" : but he appears to have little
faith in its presence at the cervical edge, for he remarks : " In using
tin to start gold fillings it is always inadvisable to allow it to extend
to the margins" ; on this latter point much difference of opinion
seems to exist. Further on we come to his notes on exposed pulps,
with reference to which he correctly remarks : " It is as a rule pre-
ferable to waste no time and run no risks of future annoyance, but at
once to apply the minute quantity of arsenic necessary to destroy
the pulp" : but qualifies this statement by recording the numerous
occasions on which he has found nerves that refused to die under an
arsenic dressing, and even suggests the advisability of " capping "
such, and leaving them to die a natural death. His notes on the
treatment of dead and putrid pulps are well worth reading, and
he concludes- by quoting some interesting observations of Dr. Harlan
on the value of essential oils. We do not like the expressions
"pulpitis" and *' soreness of the teeth." Mr. Grayston, in his
introduction, writes : " It is hoped that here and there may be found
a hint that will be of service to younger practitioners" ; we think
that all who read his notes will be able to glean some useful
knowledge, and find that their perusal will stimulate thoughts on
many a half- forgotten detail.
Extraction of the Teeth. By J. F. Colyer, L.R.C.P., M.R.C.S.,
L.D.S. Claudius Ash & Sons, London.
Much useful information may be elicited by the perusal of this
little and unpretentious volume, with its 90 and odd pages. Taken
through and through, the book may be regarded as a fair present-
ment— in epitome — of the popular ideas, as they prevail, to-day on
488 THE DENTAL RECORD.
the subject of which it treats. Of the five chapters into which the
work is divided, Chapter II., dealing with '* the Extraction of
Individual Teeth," pleases us the most. We are not in agreement
though with the author when he states — speaking of the extraction
of the upper incisor — that " a firm inward movement should be
made." We have not yet seen fit to depart from the time-honoured
custom of adopting the rotatory method for the removal of the
teeth in question, and we are glad to find that in a later paragraph
the writer, though dissenting from, recognises this practice.
The advice given to the *' method of holding an elevator ....
for the removal of the teeth on the right side of the mandible," does
not, in a commendatory sense, appeal to us. We aver that in each
case, whether operating on the right or the left side, the position of
the finger — a highly important matter — should remain unchanged,
i.e.y should lie along the flat side of the blade.
Chapter III., devoted to the consideration of '' The Extraction
of Misplaced Teeth," is embellished with many woodcuts which, in
the main, are an excellent supplement to the descriptive matter of
the text ; we take exception though to Fig. 37, where, if the
illustration be true, a more rational means of treatment than that
suggested might, in our judgment, well be employed.
Within the limits of the remaining chapters, " The Use of
Anaesthetics and Complications and Sequelae," many points of
distinct interest are to be found congregated.
Philologically considered, the book leaves something to be
desired. What are we to make of such a sentence as *' Another
indication for extraction is in cases of teeth setting up ulcers " ?
We have no wish, however, to be thought captious in our criticism,
and such small faults as we have pointed out in no way militate
against the usefulness of a work whose perusal must be fraught with
advantage to the reader, be he student or practitioner.
We are informed that the work on " Dental Materia Medica,"
by Mr. Glassington, will be published about the end of this month.
Errata. — Mr. Ezard writes to point out that he, and not
Mr. Stewart, is the Lecturer on " Gold Filling " in the Edinburgh
Dental School, as given on page 434 of our last issue.
On page 415, "sodium chlorate" should read '' sodium chloride."
On page 399, " Barton " should read *' Berten."
The dental RECORD.
Vol. XVI. NOVEMBER 2nd, 1896. No. 11.
©rigxnal Cnmmunirattona.
ON REPAIRING BRIDGES AND CROWNS BY A PROCESS
OF SOLDERING IN THE MOUTH.
By H. Baldwin, M.R.C S., L.D.S.
The question of repairing bridges and crowns, which have had
their porcelain facings broken, is one which has called forth a good
deal of ingenuit}', but can hardly be said in any of the usual methods
to have found a satisfactory solution. For some years I have
treated all the cases which have presented themselves to me
by the process of soldering on the new faces with soft solder
in the mouth. I have now repaired over thirty cases of
bridges and crowns in this way with satisfaction to myself.
The first experiments in this direction were conducted with
various kinds of blowpipes, and were all utter failures ; but as
soon as I got to work with a small clockmaker's soldering " iron," I
found the operation easy enough. The soldering " iron " is a small
copper " bit," attached at right angles to an iron stem, and fixed to
a wooden handle. The copper "bit" as sold in the trade requires
a little filing down to reduce its width at ihc point, and also requires
bending to an angle of about 45°, to avoid contact with the lip. The
bending is effected by fixing one end of the "bit" in a vice and
striking the other with a heavy hammer. The iron stem, too, of the
clockmaker's tool requires shortening, for greater handiness in use.
The kind of solder used varies somewhat with the work in hand.
In easy bridge cases a fine quality of ordinary soft solder is the best,
in more difficult cases, such as Richmond crowns, a lower melting
solder is necessary, and this is to be met with in the trade under the
name of " pearl " solder, which contains, in addition to tin and lead,
bismuth and mercury, and one variety of which softens in boiling
water. A medium grade is the one I generally use, as an increase
in readiness to melt implies a decrease in strength. The process
K K
490 THE DENTAL RECORD.
consists in soldering a "backed " tooth to the pre-existing "back" in
the mouth. It would be naturally supposed that the extra back
would cause a very undue projection of the tooth, but this is hardly
ever so, because in the majority of cases the teeth have been broken
by the bite, and it is necessary to place their successors further out
in order to insure their safety ; and, again, it is possible always to
choose a rather thin tooth and to " back " it with a rather thin
backing. It is important to remember that the closer the surfaces
of metal come together the stronger will be the union, and therefore
it is absolutely necessary to get the two backs well into apposition
over their entire surfaces. Those operators who wish to adopt this
\ \A A PtfKCfLAIV FACf
SOLDER. .^"^JreA I 1^'^
THE CORRECT WAY.
method, and are not expert in soft-soldering, are advised to practice
it out of the mouth, so that no hitch may occur during the opera-
tion, as it is the rapidity of the soldering which prevents the heat
from reaching the patient in any important degree.
The method of procedure is as follows : — A rather thin porcelain
flat tooth is selected and backed with No. 7 gold. The pins are cut
short and rivetted down into countersunk holes, and then still
further attached to the back by melting gold solder over them.
The back is then filed down perfectly flat and smooth. The old back
remaining in the mouth is also trimmed smooth, all prominences
caused by the old pins, &c., being burred down. The new tooth
is let down till it takes its proper position in the mouth. The new
back is '' faced " with an excess of " pearl " solder, by means of the
soldering iron, which has itself been previously faced with the same
solder. A piece of blotting paper is inserted under the bridge (if
bridge it be) and allowed to project each way, to protect the gum
THE DENTAL RECORD. 491
and palate from radient heat from the " iron.'' A roll of bibulous
paper is placed in the labial sulcus and a napkin applied in the usual
way.
The old back in the mouth is then faced with the same solder by
means of the soldering " iron." Hydrochloric acid and zinc is
used as a flux. The new tooth is then placed in position, held there
by the finger, a small piece of bibulous paperintervening, and the solder
is melted by touching the '* iron" to the tips of the two backs where
the solder comes to the edges. The '' iron " must carry a bead of molten
solder in its end. The union is known to be complete when the
new tooth is felt to suddenly sink down into its exact position under
the pressure of the finger. After each application of heat in the
mouth, the work is immediately cooled off with a cold wet swab of
\
\
.. S<7L0fiRlN& (ROM
THE INCORRECT WAY,
cotton wool. Several other details to observe are the following : —
If the new tooth is to be next to a contiguous live tooth, see that
both the backs, old and new, are just free of it, and place a single
thickness of blotting paper between. See that the new back does
not extend so far as to touch the gum. Let the back of the new
tooth be as large as possible and its lateral edges not bevelled. See
that in facing the backs with pearl solder, the solder be carried well
over the cutting edges. See that the " iron " is as hot as possible,
always provided it be not over-heated and the facing of solder spoiled
thereby. Test the heat of the " iron " by seeing that it will instantly
K K 2
492 THE DENTAL RECORD.
melt bits of solder when pressed upon them. The iron must be
very hot, so as to do the work quickly, and quickness is the soul of
the process. When attaching the tooth do not attempt to conduct
the heat through the old back, but apply the ''iron " to the cutting
edges of the backs, so that it comes into contact with the solder pre-
viously put upon them. This is the most important detail of all,
as no amount of heat will do the work properly through the old back.
The diagrams show the correct and the incorrect way of applying
the soldering " iron."
The melting of the solder between the backs seems to be induced
by actual contact of that solder with the molten solder constituting
the facing of the " iron." The molten condition is evidently passed
on from molecule to molecule, each molecule when falling into the
molten state knocking down the one next to it in a way which seems
to be analogous to the way in which a row of nine pins may be made to
knock each other down, or a row of dominoes set up on end. This
explains why the molten solder constituting the facing of the "iron"
must be placed against the solder already in the "backs." Mere
heat will not suffice.
In this way a complete melting of the solder between the backs
is effected, no matter how long the tooth. The length of time
required to effect this is about two to four seconds, varying with the
size of the tooth.
If the tooth after being soldered on is found to be in an incorrect
position, it must be melted off again by again applying the " iron "
to the tip of the new back, touching the solder^ and pulling it
forward with the " iron." The reason for putting an excess of
solder on the new back when facing it, is, that when it melts it
allows the tooth to sink under the pressure of the finger, and so tells
when the melting is properly done, and it also ensures there being
plenty to fill up all the spaces. The excess is attracted away by the
"iron." I have done some cases with teeth backed with dental
alloy, but am not sure that the solder attaches quite so well to this
as to gold, but when using gold I find it does not do to use a gold of
less thickness than No. 7, as the solder in that case has a bad effect
on the gold.' In wear, the soft solder does not disintegrate nor suffer
in any way, nor does it give rise to an unpleasant taste, but the bite
must always be made quite free of the new tooth and of its
"back,"
THE DENTAL RECORD. 493
SOME POINTS OF INTEREST IN DENTAL HISTOLOGY—
THE ENAMEL ORGAN.*
By Professor Paul, F.R.C.S.
Mr. President and Gentlemen, — Having yielded to a request
from our hon. secretary that J would furnish a paper for the first
meeting of the Society this session, I have looked through the work
of the past year in the hope of finding something that may interest
you, and hav^e put together some notes relating to the structure
and development of the enamel organ. I cannot offer these notes
as finished work, but rather as an incentive to discussion, and as a
stimulus to further investigation.
The points to be dealt with are, of course, all concerned with the
development of the dental tissues, a subject full of interest and full
of opportunities.
The first recognisable stage in the process by which teeth are
evolved in the higher animals is, I need scarcely remind any one here,
the growth of a band of cells derived from the surface epithelium,
which penetrates the embryonic connective tissues of the foetal jaw
to a considerable depth, and is now known as the tooth band.
From this primitive tooth band an epithelial bud, called the enamel
organ, is produced at the site of each future milk tooth. The
enamel organ is the formative organ. It calls the tooth into
existance, and probably determines its shape and size, even although,
as in several animals, it forms no part of the tooth finally produced.
A tooth band, theoretically, is constructed to originate a constant
succession of teeth by the continuous budding of enamel organs from
its lower margin. This happens in many of the lower vertebrata,
but in mammalia the band becomes exhausted after the production
of a second set of germs. In rare instances a third successional
germ buds form a part of the tooth band which has already
originated two others. Such a germ may remain abortive, or may
continue to develop, and become either a supernumerary tooth or
an odontome. The former condition, the budding of a third enamel
organ which undergoes no further development, is perhaps not so
very uncommon, and is a point which should be settled as regards
the human subject by examining a series of embryos during the
* A Paper read before the Liverpool District Odontological Society, October
2oth, 1896.
494 THE DENTAL RECORD.
later months of intra-uterine life. I have some sections at that
period which certainly seem to show this third budding Irom the
tooth band, but not sufficient to indicate its frequency.
The enamel organ as first produced is a solid bud of epithelial
cells, but the latter, as the bud grows, are rapidly differentiated into
the four characteristic layers of the enamel organ. The outermost
or peripheral layer of cells are elongated. They are continuous with,
and correspond to the important cubical layer of cells constantly
found at the base of a stratified epithelium, and they fully retain
their character of importance in the enamel organ. Over the deep
half of the bud these cells constitute the internal enamel epithelium,
from which the enamel fibres are developed ; whilst those which
cover the superficial half become the external enamel epithelium,
the chief function of which seems to be the separation from the
blood of those constituents of enamel which are elaborated by the
internal epithelium. I think we should keep in mind this early
association between the two layers of the enamel organ and their
common derivation from the active cubical layer of the surface
epithelium, because the value of the external layer is likely to be
lost sight of, though, as I have frequently noticed in the germs of the
sheep, ox and other animals, the character of its growth and the
high vascularity of the papillary connective tissue associated with it
suggest that it has useful work to do. The other two layers of the
enamel organ are the enamel jelly, and the stratum intermedium.
I believe there is a general agreement that the stellate cells are
not functional, and that they merely fill a space which may be
readily occupied by the growing enamel. As regards the cells of the
stratum intermedium, the generally, but not universally accepted
view that they recruit the internal epithelium as the surface to be
covered grows larger, seems to me to be correct.
To return to the internal epithelium itself, we are still in want
of exact information as to the process by which it is changed into
enamel. The question as to whether the fibres are the result of
secretion or conversion is not yet definitely settled ; but to my mind
it is of much less importance to decide this point than it is to
recognise that enamel is certainly the outcome of some change in
the cells themselves, and not a change which is effected by the cells
upon an intercellular matrix. Herein lies the essential distinction
between enamel and dentine. Dentine, like all connective tissues,
THE DENTAL RErORD. 495
has a matrix ; enamel, like all epithelial tissues, has none. No doubt
between the cells there is a certain amount of intercellular substance,
which serves to cement them together, but this is in no way
comparable to a connective tissue ground substance. In the end
this cement becomes calcified, but only imperfectly, as is shown by
the readiness with which acids act upon it and cause the fibres to
fall apart. The recognition of this important fact in the construction
of enamel opens the way to understand some of its peculiarities. One
of these is the occurrence of the well-known cavities on the dentinal
aspect of the enamel with which dentinal fibrils frequently com-
municate. The cavities ha\-e been variously stated to be within or
between the fibres. The former is an irrational theor}^ and is not
likely to find much acceptance ; indeed, all tubes or spaces occuring
in an epithelial structure must almost of necessity be placed between
and not within the cells. We can best understand these enamel
tubules, as they are met with in mammalian teeth, by examining
microscopically germs in an early stage of development and after
very careful fixation On the first appearance of the layer of
odontoblasts these cells are seen to be separated from the ameloblasts
by a narrow band of transparent tissue, due to a change in the outer
border of the pulp matrix. The transparent condition of the pulp
matrix is evidently owing to the action of the odontoblasts, and is,
indeed, merely the first stage in the formation of dentine matrix into
which it will shortly be fully transformed. This first band of dentine
matrix lying between the odontoblasts and the ameloblasts is not so
sharply defined and cut off from adjacent tissues as superficial exami-
nation might lead one to imagine. Mummery has shown — and I
fully endorse his views — that it sends processes between the odonto-
blasts which communicate with the fibrillar matrix of the pulp.
The presence of these processes is unquestionable, as they may be
readily seen in certain stages of development in properly prepared
sections. Now not only are there the processes described by
Mummery, but the dentine matrix is not even sharply cut off from
the line of ameloblasts. You may see in some sections that it sends
arms or processes up between the enamel cells as it does down
between the odontoblasts, keeping them apart, and leaving
between them when they calcify elongated spaces filled with dentine
matrix. That processes of dentine matrix thrust up between the
enamel prisms should never calcify is certainly nothing surprising
496 THE DENTAL RECORD.
when one remembers that the first layer of dentine usually only
calcifies imperfectly, being characteristically the site of the
interglobular spaces of Tomes.
If we accept this as a reasonable explanation of those spaces in
enamel which are met with in close contact with the dentine, and
admit the general principle that all spaces or tubes in enamel are
between and not within the prisms, then the structure of genuine
tubular enamel seems less difficult to understand. It is clear that
any imperfect approximation of enamel cells must leave spaces
between th3 prisms which can only be filled with an indefinite
intercellular substance, or possibly by further prolongations of
dentine matrix, and in neither case is it likely that such interprismatic
matter would become calcified, because on the one hand it is too
far removed from the influence of the odontoblasts, and on the
other because the calcifying energy of the ameloblasts is almost
entirely expended upon their own internal petrifaction. I would
therefore suggest that tubular enamel is an enamel in which there is
an excessive amount of intercellular substance only imperfectly calci-
fied, and much as it looks like tubular dentine, it is reallv formed on
an exactly opposite plan. The one is a negative and the other a
positive picture. In dentine the cells occupy the tubes, and the
intercellular substance becomes the solid calcified matter ; in enamel
the tubes are represented by the intercellular substance, whilst the
cells become the solid calcified matter.
Tubular enamel is regarded as one of the rarer dental tissues,
but — at any rate in fish — I am under the impression that it is
sufficiently common, and is rather the rule than the exception.
Take, for instance, the whole series of the elasmobranch fishes. In
the development of their teeth an enamel organ plays a very
prominent part. The whole surface of the tooth germ is covered
with long and evidently functional ameloblasts, and when it is
necessary to decalcify there is a; space between the ameloblasts and
the dentine matrix which could hardly have been occupied by
anything but formed enamel. A study of the development of such
teeth would lead one to assume that enamel would be well repre-
sented in the fully formed structure, yet they are described as follows
by Tomes : — *' A central body of osteo dentine, the outer portion of
which has dentinal tubes so fine, regular, and closely packed as to
merit the name of hard unvascular dentine, and over this again a
THE DENTAL RECORD. 497
thin varnish of enamel. (?) " Let me call your attention to a few
sections of shark and ray teeth. In all you will notice that the
main body of dentine is covered over with a further layer, which is
distinctly differentiated from that beneath it by a line of demar-
cation. This latter, though partly obliterated in older teeth,
becomes, in some immature specimens, a line of separation, allowing
the cap of so-called hard dentine to come away from the rest. The
cap is thickest at the apex of the tooth, and shades away at the base.
It has, in fact, the shape and general appearance of a cap of enamel.
Moreover, the external *'thin varnish of enamel " is part and parcel
of it, there being not the slightest indication of any line of demar-
cation such as should be more or less visible between enamel and
dentine. Hence I am inclined to regard the whole of this outer
layer of calcified tissue as enamel, but of the tubular variety : and if
tubular enamel is constant in the elasmobranch fishes it is tolerably
certain to be not uncommon in other classes.
A further point of interes^: in connection with the enamel organ
is the question of its vascularity. This point has been raised by
Professors Howes and Poulson, and is one which ought to admit of a
definite settlement. I am glad to know that Mr. Woods is preparing
to investigate the subject. Up to the present I have never yet seen a
vessel in the enamel organ, though I frequently examine this structure
in various animals, and therefore hold to the commonly accepted
view, that it, like other epithelial structures, is non-vascular. Con-
cerning this question I have rather occupied myself in trying to
ascertain how two such observers, if they are mistaken, could have
come to hold such an opinion. It seems to me that a mistake might
rather easily arise, for there is often a stellate-celled connective tissue
just outside the enamel organ, which is almost indistinguishable from
the enamel jelly, except for its vascularity. Over the apex of a tooth
the internal and external epithelium soon come together, so that one
frequently sees a tooth germ in which the apex is embedded in a
stellate-celled connective tissue, whilst the sides are surrounded with
enamel jelly. Under such circumstances the two tissues might
readily be assumed to be two parts of the same structure, and the
vessels of the former could hardly pass without observation. The
similarity is rendered more complete by the line of condensed tissue
of the sac appearing in section not unlike an external enamel
epithelium undergoing atrophy. An examination of some of my
498 THE DENTAL RECORD.
sections will show that in small animals a careful discrimination
must be exercised to distinguish between the two structures, though
in the wide expanse of enamel jelly visible in the large germs of
sheep and oxen no such mistake can be made, and it may be
positively asserted that in these animals the enamel organ is
non-vascular.
Finally, in connection with the enamel organ, having made
further observations in regard to Nasmyth's membrane, I shouldilike
to add a few remarks to what I said on a former occasion. Originally
I experienced some difficulty in isolating and staining the structure.
This is now readily accomplished in the following manner. A fresh
unworn tooth is taken immediately after extraction and placed in a
phloroglucin decalcifying solution for a few minutes. As soon as the
membrane begins to separate the tooth is removed and well washed
in several changes of water. It is then stained in Ehrlich's acid
haematoxylin, again washed, and placed in an aqueous solution of
eosine. Finally the membrane is stripped from the tooth and
mounted in Farrant. By this process a permanent preparation of
Nasmyth's membrane may be made within a quarter of an hour after
the extraction of a suitable tooth, and one in which the nuclei of the
epithelial cells are often brilliantly stained. Under the microscope
the membrane is seen to consist of two layers, the outermost being
composed of large flattened epithelial cells, beneath which is a thin
translucent pellicle usually marked with hexagonal impressions
derived from the ends of the enamel prisms. Hence I think there
can be no doubt that Nasmyth's membrane is a remnant of the
enamel organ, and not, as advocated by Tomes, a thin layer of
cementum. On a former occasion I gave my reasons for not
accepting the observations offered by Tomes in support of his view
as proof that that view was correct. It is not necessary to repeat
them ; the specimens may be left to speak for themselves.
The points of interest in connection with the enamel organ are
by no means exhausted, but what time is left at my disposal this
evening I would rather occupy in demonstrating than in talking,
and I hope that those who are at all interested will not be satisfied
with having seen the lantern slides, though they are mostly
micro-photographs, but will critically examine the specimens
themselves.
THE DENTAL RECORD. 499
FERMENTATION AND ORAL ANTISEPTICS*
By J. C. Douglas.
Mr. President and Gentlemen, — In a work recently published
on the subject of " The Present Evolution of Man," the writer
argues that " there is an evolution which has escaped the notice of
biologists, but which threatens by survival of the fittest, and
elimination of the unfittest, to advance at accelerated speed in the
near future." This evolution is one mainly against disease, more
especially against zymotic disease, and exists wherever men are
crowded together and can take disease from one another, or are
under other unfavourable circumstances. When, as we see every
year, more and more people pour into our already crowded cities, and
and the system of life changes, the arguments adduced appeal
with some force. When one remembers that, under normal
conditions of ordinary country air, it is estimated that at least
14,000 to 15,000 microbes enter our bodies every hour we breathe —
and that a certain number of these are disease producing — whilst
the majority are capable of causing grave disturbance of the system,
more especially when they find lodgment in degenerate tissue, it
seems wonderful that we retain even an average state of good
health. Metschnikoff has recently shown us, however, that these
death producing bacteria have many enemies in the body, notably
the phagocytes, which little cells act as the police and scavengers
of our system, dealing out death to the death dealing microbe,
and so tend to keep an equilibrium in our vitality.
He also points out that the tonsils, which for a long time have
been believed to be functionless, play the part of phagocytes.
Other writers assert that " the complex salivary liquid resulting
from the mixture of the salivae secreted by the three different glands
can have a special chemical quality capable of destroying the noxious
action of the pathogenic or disease producing bacteria," and M. Vallude
in a paper on " Tuberculosis," lays special emphasis on this point. He
also says : " In any case it is probable that tuberculous microbes are
directly attacked and destroyed by the micro-organisms of every
kind which swarm in the saliva."
Acquired immunity against any disease by the accumulation of
inborn traits, this writer says, determines the ultimate success of a
race in the struggle for life.
* A Paper read before the Students' Society, Dental Hospital of London.
500 THE DENTAL RECORD.
Immunity against disease is at present a vague, much discussed,
and scarcely defined term. Many investigators have many opinions.
Without going into a discussion on this subject, I would suggest as
prominent examples of immunity to a considerable extent the
Israelites, who thousands of years ago had, as part of their religion,
the most magnificent set of hygienic laws laid down, that have ever
been known. By close observance of these this people can, in
many cases, pass unscathed, and when attacked live through fevers
and other ailments to which Gentiles frequently succumb.
Observations in connection with our special subject of dental
surgery, which have only extended over a period of two years, can
scarcely give much ground for argument, but one must notice
how small is the proportion of Jews coming to this hospital for
treatment, and amongst the very few (mostly children) of that race,
whom it has been my duty to treat, the apparent quality and
strength of their teeth has been remarkable.
From the Address of Sir Joseph Lister, delivered before the
British Association four weeks ago, we see what advances have been
made in the science of surgery since the advent of antiseptic treat-
ment, and it would, therefore, seem a natural deduction that a
leading work of the medical profession in all its branches would be,
by dictation, not only to patients, but to the general public, of
such a system of antiseptics (m its broadest sense, ?>., as to diet,
hygiene, method of life, &c.), as would at any rate tend to give
greater immunity against the more virulent classes of microbes once
they have entered the body.
In our own branch, as one of the smaller and more specialized of
the medical profession, we would seem to have given into our hands
many opportunities of assisting the other branches in the matter of
antiseptics so far as preventative measures can.
The respiratory organs (the mouth and nose) are the normal
openings by which it has been shown that microbes enter the body.
How then can we as specialists so treat these, as to assist, to
however small aii extent, in causing a certain immunity from disease ?
The various structures found in the mouth, from the hardest in
the human body to the softest, suggest a variety of treatment, and
as we see, from the investigations of our leading bacteriologists,
that pathogenic micro-organisms may under certain conditions be
nourished in these hard tissues, as well as in the soft, we are the
THE DENTAL RECORD. 501
more impressed with the necessity of serious and careful attention
to both, at all times, but more especially however in cases of
lesions.
From the numerous experiments and careful clinical observations
during recent years of such men as Messrs. Milles and Underwood,
Professor Miller and others, we know that caries of the teeth begins
by dissolution of the enamel caused by the action of acids, but
principally lactic, which is produced by the fermentation of carbo-
hydrates (in the form of starchy and sugary foods) which have been
left in contact with the teeth for some time.
After the enamel has been washed away the dentine is attacked
by the micro-organisms, and a sort of peptonising, or, may I call it,
putrefactive fermentation set up. Next to be attacked is the pulp,
here we get the various stages of inflammation, resulting eventually
in its death and decomposition. Fermentation in one or other of its
forms would therefore seem to be the chief and only cause of decay
in teeth.
So far back as 200 years ago that eminent philosopher Robert
Boyle, in an essay on '^ The Pathological part of Physik " wrote as
follows : — " He that thoroughly understands the nature of ferments
and fermentation shall probably be much better able than he that
ignores them to give a fair account of divers phenomena of several
diseases (as well fevers as others) which, perhaps, will be never
properly understood without an insight into the doctrine of
fermentations."
What a prophet he was ! To-day our great investigators are,
through the proper understanding of fermentations, finding the
actual causes of many of the diseases which have been mysteries for
centuries.
Knowing the causes, we must surely hope, with the assistance of
our chemists, to find preventatives, and, let us also hope, cures for
many of the maladies and ills from which we suffer.
On this account I therefore think it worth while to take a
passing glance of fermentation.
According to the greatest investigator of modern times on this
subject, M. Pasteur, fermentation is ''life without air."
In the brewing of beer we have a notable example of fermentation.
A brewer after grinding his malt has it mashed in hot water and
boiled with hops until all the soluble portions have been extracted,
02 THE DENTAL RECORD.
this being known as wort. This liquor, which is sweet, is drawn off
and cooled as rapidly as possible by running it over tubes containing
iced water, after which it is mixed with yeast, after having been run
into vessels or vats with only one aperture open to the air. Soon
after the addition of the yeast a brownish froth appears through the
aperture, and grows larger and larger until it falls over the sides of
the vessel. This is new yeast, and shows that fermentation is active ;
but from what does it originate? On examination with the
microscope we find a minute unicellular fungus or plant which
multiplies by gemmation or budding, that is, it gradually contracts
about the middle, until the two parts divide, each with a similar
power of dividing again, and so on. So early as 1680 Leeuwenhoek
found yeast to be a mass of floating globules, but he had no idea
they were alive. This was proved in 1835 by Cagnard de la Tour
and Schwann. Then Pasteur, in 1862, next investigated the origin
of these organisms, and by his careful investigations into the
subject of fermentation of wine and its ailments, he saved to
his country hundreds of thousands of pounds. Still, a few years
later, his investigations into the fermentation of beer has given us a
complete enlightenment as to the action of the yeast ferment, the
torula or saccharomyces cervisiae.
At the same time we find beer may be fermented without yeast,
and the brewer, in order to prevent such fermentation, has added
hops to his beer, the essential oil of which is an antiseptic to other
ferments.
If beer is left in contact with air it will sooner or later ferment,
but most probably'not with what is known as the alcoholic fermenta-
tion. The maladies of beer are wholly due to the admixture of
these outside ferments. Pasteur set himself the task of finding the
causes and reasons of this, and he has taught us how to separate
the commingled ferments of the air, and to study their individual
action.
From numerous experiments he found that if yeast be sown in
a fermentable liquid which is supplied with plenty of pure air it
will flourish, and produce quantities of carbonic acid gas. The
oxygen, in this case, it gets from the surrounding atmosphere.
Examination of the liquid hardly showed a trace of alcohol ; the
yeast flourished and increased, but almost ceased to act as a ferment.
When, however, the fermentable liquid was placed in a vessel
THE DENTAL RECORD. 503
with only a small aperture and the yeast sown therein, true
fermentation was begun and the liquid fermented ; why, simply
because the amount of oxygen which the yeast required for its
existence it could not get in sufficient quantity through the small
opening in the cask, so it wrenched it from the surrounding
substances containing oxygen in a state of combination. It
decomposed the sugar of the worts in which it grew, breathed
carbonic acid gas and the liquid product of the decomposition was
alcohol. The act of fermentation is therefore the result of the
effort of the plant to maintain its respiration by means of combined
oxygen when its supply of free oxygen is cut off.
The fermentation of wine is similar to that of beer. Pasteur
showed that when the grape was ripe the bloom, or must, which is
seen on the skin was principally composed of the itorula, so that
when the juice was squeezed into a vat the ferment usually
accompanied it. So also with other fruits. To prove this, by a
beautiful experiment he showed that if the juice be carefully
extracted, so that none of the bloom accompanied it, it might be
left in contact with pure air for an indefinite time and no
fermentation would take place.
When one speaks of pure air, one means air free from dust
particles. If you on a sunshiny day go into a darkened room where
only a small ray of light may find its way, through say a hole in the
shutter, you will see myriads of particles of dust dancing in the
line of sunshine. Well, take any sterilized but fermentable liquid
such as milk, unfermented wine, or juice of beef, let it stand
in the room for a time, and in a day or two you will find it
fermenting.
If you, however, had a small well-built box which could be closed
to all draughts, paint the walls with some sticky substance such as
glycerine, so that the particles of dust would adhere to them — then
when the box is closed and all the air clear within, pour through a
pipette or some other conductor your fermentable liquid into a flask
which you have left inside, you would find your liquid keep clear
for weeks and months, and no fermentation would take place. From
this experiment of the late Professor Tyndall (whose lecture on
fermentation is well worth perusal, and from which I have quoted
largely), we learn that there is no such thing as spontaneous
generation.
504 THE DENTAL RECORD.
Regarding his experiments with milk, he found if it were
exposed to air, an organism named '' Vibrio " would shortly be
found in it, and he showed that these organisms and other analogous
though apparently motionless ones decompose the milk and render
it sour and putrid. They are the lactic acid and putrid ferments,
as the yeast plant is the ferment of sugar. If they and their germs
are kept out of milk, it will remain sweet. But he found that milk
might become putrid without becoming sour. Microscopical
examination revealed a number of shorter organisms, sometimes
associated with the " Vibrios," sometimes alone. These showed a
wonderful alacrity of motion, but so long as they were kept out of
the milk, it remained quite sweet.
Lister, in some later experiments, demonstrated the fact that
newly collected blood neither coagulates nor putrifies, if care be
taken while collecting it to exclude the presence of these micro-
organisms contained in ordinary air.
Putrefaction, or, as it is often called, putrefactive fermentation,
is a more complicated process, which also varies according to the
amount of oxygen present. It is usually a double process, the first
stage of which is brought about by the bacteria which require
abundant oxygen (known as aerobic), and the second stage by those
which flourish when Oxygen is absent (or anaerobic). If oxygen is
present it is not usual to have foul smelling gases — but, if absent,
or only very limited in quantity, true putrefaction takes place, and
various foul smelling gases, together with various substances
(collectively known as ptomaines), which are mostly of a highly
poisonous nature are produced. The final result of the processes
set up is that the complex organic substances are decomposed into
simple or elementary substances. This power possessed by bacteria
is of the utmost importance in the economy of nature. When an
animal or plant dies all the complex organic matter of which it is
composed must be broken up into simple salts before they can be
made use of by plants. This breaking up is chiefly performed
by animals, but it is also largely brought about by the agency
of bacteria. We thus see that they are most useful agents
and auxilliaries to animals in keeping our earth clear of dead
matter.
Being satisfied that fermentation in its various forms is caused by
the products of the struggle for existence of bacteria, let us consider
THE DENTAL RECORD. 605
for a very few moments the different varieties of bacteria, but more
especially those found in the mouth.
Bacteria, germs or micro-organisms, are exceedingly minute,
unicellular, spherical, or thread-like plants, which multiply by fission
or by spore formation, and consist of protoplasm enclosed by a cell
wall. Outside this cell wall is a gelatinous sheath which develops
in different degrees in different bacteria.
According to their shapes they are known as micrococci — small
round or oval like bodies. Bacilli — or small rod shaped bodies.
Spirilli — or thread-like bodies ; besides others of varying forms such
as the Blastomycetes, the yeast plant ; the Hypopmycetes or moulds
as the Leptothrix. Some of these are motile whilst others have no
power of movement. Some require oxygen for life ; to others a
free supply of oxygen means death, whilst, again, there is a class
between those which can live in an atmosphere of oxygen but
prefers to be without it.
Another class, known as parasitic bacteria, mostly of the bacilli
or spirilla shapes, are the proved disease producers or pathogenic
bacteria. Amongst them we find tubercle bacillus and the bacilli of
erysipelas, anthrax, &c.
Of all the various classes it would seem from experiments
performed on animals that in some form they are essential to life.
Animals, when placed in closed cases, breathing only filtered air, and
eating only sterilized food, lived most unhappilv for varying short
periods, some a few hours, some a few days. Therefore, all we can
do is to do our best to either destroy the pathogenic members, or in
some way nullify the noxious action of their products.
In order to live and thrive, bacteria require several favourable
Conditions, and, as we shall now see, the mouth forms about the
best ground they can find. They require : —
1st. Asufficientsupply of moisture. In the mouth they have saliva.
2nd. A certain temperature— this again is found in the mouth,
and is very constant.
3rd. An alkaline or nutrient medium— such we have in saliva.
4th. Various nutrient media — such as the carbohydrate and
albuminous food stuffs left between the teeth.
5th. Darkness.
6th. A certain amount of air.
I need not further enter into the various classes of bacteria.
L L
506 THE DENTAL RECORD.
Suffice it to say, Professor Miller, and Messieurs. Galippe and Vignal
have found six varieties, which evidently take an active part in
dental decay, and of these, four were constantly present, the other
two occasionally. Five of these were bacilli, and one a micrococcus.
Of pathogenic micro-organisms Miller found four classes fairly
constant in the mouth, and in his work on " Micro-organisms of the
Mouth " he mentions a large number of diseases, some resulting in
death, evidently caused by the accumulation of bacteria in wounds
of the mucous membrane, in decayed teeth, in tartar^ and in cases
of infection of intact soft tissue of the mouth.
Fermentation of carbo-hydrates produces an acid reaction, whilst
fermentation of albumens produces an alkaline reaction, and the
fermentation of both together is acid. At the same time we find
that the products of bacteria are poisonous to themselves when these
products amount to more than a certain strength. The yeast plant is
killed by the alcohol it produces when this amounts to 20 per cent.
Lactic acid, the product of the fermentation of carbo-hydrates,
seldom, however, is in strength of over one per cent, in the mouth,
and is therefore sufficient to dissolve the enamel of the teeth, but
scarcely sufficient to kill the producing bacteria.
The vitality of many bacteria has been proved to be great,
whilst others are more easily killed. Owing to the sheath covering
their cell wall some forms withstand prolonged boiling, whilst
others withstand exposure to sulphuric acid for lengthened periods ;
but in all, the spores are most resisting, and we find in many cases,
though we know the micro-organism is dead and may have been so
for a very long time, if placed in favourable ground, its spores,
which have been lying dormant, will quickly revive, and soon
develop into fully grown bacteria.
This brings us to a consideration of antiseptics.
For many generations antiseptics have been used both in this
and other countries, though as far as we can learn without a
knowledge of their peculiar action. To give two examples, we find
in the works of Theocritus a reference to the use of sulphur, which
is at the present time the official antiseptic of this country. In a
translation by Fawkes, he says : —
" Next with pure sulphur purge the house and bring
The purest water from the freshest spring,
This mixed with salt, and with green olive crowned.
Will cleanse the late contaminated ground."
I
rHK DENTAL RKCORD. 507
Again, referring to the hygienic utiHty of essences and perfumes,
Dr. Cornelius Fox, in a work on Ozone says : — " They demonstrate
that the disciples of Empedocles were not in error when they
planted aromatic and balsamic herbs as preventatives of pestilence."
In another part of the same work he alludes to the fact, recorded by
Herodian, that '* in a plague which devastated Italy in the Second
century, strangers crowding into Rome were directed by the
physicians to retreat to Laurentum," now San Lorenzo, *' that by a
cooler atmosphere and by the odour of laurel they might escape the
danger of infection."
In our own country the ancient custom amongst physicians of
furnishing the handles of their canes with vinaigrettes, the fumes of
which might protect them from the noxious exhalations of their
patients, and the old practice of strewing aromatic herbs, such as
rue, before filthy prisoners in the dock of a criminal court, so that
the olfactory nerves of those round about them should not be
offended, as well as that of providing the chaplain with a bouquet
when accompanying a criminal to Tyburn, lose their apparent
absurdity when one considers the reasons ; also when considered
under the light of recent investigations.
Considering the various structures in the mouth, also the
extremely poisonous nature of many of our antiseptics, it will be
apparent that a careful selection is necessary, more especially in
those cases where the patient is to use them at home.
The general surgeon uses strong antiseptics, such as carbolic
and mercury. First, because they have such affinity for the
epidermis, and in the case of carbolic acid acts as cleansers of fatty
matters. Secondly, because they are cheap. Neither of those
reasons need specially restrict us to their use. We have not skin to
deal with, and the quantities we use are so small that cost need only
be a secondary consideration. I would place scrupulous cleanliness
as the leading antiseptic for treatment of the mouth in health and
disease. To obtain that, the use of the toothbrush night and
morning is absolutely essential, also the use of the quill or wooden
toothpick after meals is, if anything, rather more necessary than
those dainty finger bowls presented to us after dinner.
Miller also recommends the cleansing of the teeth inttrstitially
by passing between them a strand of silk thread which has been
dipped in an antiseptic. Of toothbrushts, the pattern which I find
I. L 2
508 THE DENTAL RECORD.
most satisfactory is one known as the Wessel, children's size, and of
medium hardness. The majority of toothbrushes are much too
large to do their work effectually, especially round the molars.
After brushing with a tooth powder, the mouth ought to be
washed, and the fauces gargled with an antiseptic and tonic mouth
wash, and I am not sure that one ought not to wash the nostrils as
thoroughly as the mouth. Personal experience would lead me to
say yes to that, but I should like to have opinion on the point.
Of the many tooth powders and washes sold to the public one
can say but little. Numbers of them are extremely bad for both
teeth and gums. As a rule, amongst our more respectable chemists,
the powders which they make themselves, at any rate, do not
contain any deleterious matters. However, I think we ought to be
prepared to prescribe our own powders and washes to suit the cases
we treat.
To be of use, a tooth powder ought to have as a base some
material like prepared chalk, which to a certain extent neutralizes
acid secretions, is softer than enamel, and therefore polishes without
scratching it. A soap should be added to clean away fatty or greasy
matter, then tonics for the gums and antiseptics to act in the small
spaces inaccessible to the brush are necessary. Finally, flavouring
and colouring matters are added.
Professor Miller puts more faith in the energetic use of the brush,
silk and toothpick, with a simple powder, such as prepared chalk, and
followed by a mouth wash than in a special powder. However,
I fancy both have their good points and corresponding usefulness.
Of mouth washes, an antiseptic and tonic are the principal
essentials, but as these are often rather unpleasant to taste, and
sometimes to smell, they are usually combined with a colouring and
a sweet or aromatic substance.
One thing has to be kept in mind ; it is no use prescribing the
best antiseptic tooth powder or mouth wash if it tastes at all bad —
patients won't use them. It is therefore a good plan to try your
prescriptions yourself first.
I would here draw your attention to a base for a powder which
has been recently introduced. It is named " Dimatos," and is got
from the crushed remains of a bivalve algae, the Diatomaceae. It
does not absorb, and so destroy the power of essential oils and other
antiseptics nearly so much as prepared chalk or magnesium.
THE DENTAL RECORD. 509
In the case of foetidily of the breath and the numerous
troubles of which it is the symptom, there are many which we can
treat, others of which belong to the domain of the physician and
surgeon.
Badly fitting, and even well fitting dentures, badly fitting pivots
and crowns (especially those fixed to roots which have been abscessed)
collections of tartar, carelessly inserted fillings and carious cavities
are some of them.
Those who wear artificial plates should, for their own comfort,
and that of those with whom they come in contact, be instructed
to remove the denture at night, carefully brush it with an antiseptic
and leave it in water till the morning.
Taking first what is sometimes spoken of as the "chief or king
of antiseptics," perchloride of mercury, we find it about the most
widely used in general surgery. According to almost all authorities
it takea the highest rank as a germicide and antiseptic.
The strengths in which it is used v^ary from i — 500 to i — SjOOO.
Professor Miller, of Berlin, places it absolutely first in his list. He
says I — 500,000 will arrest the action of, whilst i — 100,000 destroys
the bacteria in the mouth, and recommends it as a mouth wash in
strength of i — 5,000. Many authorities assert that it blackens the
teeth even in weak solutions, and as it is very poisonous, and acts as
an irritant to the skin in strength of 1 — i»5oo to i — 2,000, it does
not seem to be a proper application for a mouth wash. Used as a
dressing for foul root canals, after they have been cleaned, and before
filling, it is most useful.
Unfortunately, however, it coagulates albumens, and in doing so
loses its antiseptic properties, so that the roots would require to be
well cleansed with bristle, drill and heat before using it.
Not long ago Drs. Lubbert and Schneider found that a solution
composed of
Perchloride of Mercury ... ... 2 parts
Sodium Chloride
Distilled Water
Glycerine
Rectified Spirit ...
did not coagulate albumens, and retained the antiseptic qualities of
the perchloride.
Another preparation, introduced by Mr. C. T. Kingzett,contam
100
600
100
200
510 THE DENTAL RECORD.
5 per cent, of mercuric perchloride and 5 per cent, of peroxide of
hydrogen. These are so combined that they do not coagulate
albumens, and the antiseptic property is not impaired.
For safety in the surgery it is better that poisonous preparations
should contain some colouring matter, such as indigo blue, to
distinguish them from other drugs. Another preparation, mentioned
by Dr. S. Rideal in his very complete work on Disinfectants, is
potassio mercuric iodide. This is said to have double the germi-
cidal powers of perchloride of mercury, and to be much less
poisonous. In the experiments tried, i — 4,000 of this was found to
have equal antiseptic properties to i — 2,000 of the perchloride. It
is insoluble in water, and composed of one grain of mercuric iodide
to one grain of iodide of potassium. The mercuric salt is soluble
in an excess of iodide of potassium, and remains of a bright scarlet
colour. I should think one of these might be tried in the treatment
of foul roots.
The next antiseptic in general use is carbolic acid. It was first
introduced in the early seventies by the father of modern Antiseptic
Surgery, Sir Joseph Lister. It is, perhaps, the most widely used
antiseptic we have got.
Sir Joseph Lister and Sir William MacCormac place it as the
most useful antiseptic we have — when in solutions of i — 20 or
I — 40 — principally, I think, because of its affinity for the epidermis,
and because it mingles with fatty matters, whereas mercuric
perchloride does not.
Recent investigations have shown us that though an antiseptic
(or germ disturber), it is not a disinfectant (or germ destroyer).
Professor Miller places it ninth on his list. Koch, whilst placing
it seventh on his list when in water solution, found that in an oil or
alcoholic solution it had no effect at all.
Dr. Bond says carbolic arrests the growth of fungi, but does not
destroy them.
Sternberg and Gartner and Flagge place carbolic on a higher
basis than Miller, Koch, Klein or Bond.
Its exact mode of action is uncertain. It coagulates albumens,
and thus loses much of its antiseptic power ; in strengths of i — 20
it irritates the skin, and it is a poison.
As an obtundent, when excavating carious cavities, especially in
combination with cocaine, it is excellent, but to have full effect the
THE DENTAL RECORD. 511
cavity must first be dried with hot air. You must frequently have
noticed when cutting out a cavity some extremely sensitive spots
between the enamel and dentine. At this position, according to
Mr. Stack, of Dublin, is a layer of nerve endings. One, therefore,
wonders that the progress of caries does not cause pain when the
enamel has been dissolved. An explanation I would suggest would
be that as the ptomaines produced by bacteria have been shown
to have actions like the alkaloids, aconite, curare, &c., and as these,
we know, paralyse the nerves of touch and sensation, so they might
possibly act in the same way on those in the teeth. If this is so, it
might also, to a certain extent, account for the extreme sensi-
tiveness so often found in erosion cavities, where there has been no
caries.
Being escharotic as well as antiseptic we find carbolic extremely
useful for cleaning painful and suppurating cavities in the gums and
alveolus after extraction. In solutions of i — 20 and i — 40 it is an
excellent wash for syringing old sinuses to abcesses once or twice, as
its irritant qualities are useful in such.
For disinfecting instruments, it is I believe along with boiling
water the most effective cleanser, besides which it has no ill effects
on steel.
It is much used in tooth powders, but I am disinclined to believe
in its good qualities in these, because, to be of any use, it ought to be
of a strength of not less than 5 per cent, (free), and that strength
would have a markedly bad effect on the gum, and mucous
membrane of the mouth.
When carbolic remains suspended as globules in water, it may be
judged impure — and only acts as an escharotic.
A mixture of carbolic and sulphuric acid of equal parts, known as
asceptolyOr sozolic acid, is spoken of as being a good antiseptic, which
does not coagulate albumens, is not escharotic, is soluble in water,
glycerine and alcohol, but, mixed with the two latter, is inactive
Copper sulphate is the French oflficial disinfectant ; Rideal ranks it
next to mercury ; Dougall says it is the best of the metallic salts ;
whilst Miguel and Bucholtz both place it very high in their lists,
pockets Kingzett says it is the best of the sulphates. This is useful for
packing of gum round teeth affected by pyorrhoea alveolaris, because
it dissolves so slowly, but its extremely unpleasant taste is much
against its use. It discolours the teeth and coagulates albumens.
512 THE DENTAL RECORD.
Salycilic Acid. — Miller found a solution of i — lOO killed bacteria
of the mouth in a quarter of a minute. Sternberg places it high
amongst his list of disinfectants. It is said, however, to have a bad
effect on enamel, even in weak solution ; it is irritating to the skin,
but non-poisonous. lodiiie is one of the best antiseptics, but is very
irritating to the skin and discolours. Miller found i — 6,000 destroyed
mouth bacteria. Rideal says it has about three times the power of
carbolic. It is very destructive to steel instruments.
Iodoform — has lately come much into use in dental surgery for
the disinfection of root canals. Its action is not thoroughly under-
stood, but it would seem that, being so volatile, it in some way
becomes chemically combined with putrefying matter, releasing
iodine and acting in this way. Clinically, it seems to act well,
sweetening foul and smelling sores — and as a soothing agent.
Experimentally, however, Hehn and Rosvinj, Reidlin, Bouillat, and
many others found it had practically no antiseptic action. The
greatest objection to its more general use is the unpleasant smell and
taste. Therefore a root canal with a dressing of iodoform ought to
be well sealed, or the patient is likely to complain of the constant
presence in the mouth of the unpleasant taste of this drug.
/o^o/, another iodine preparation, has not the unpleasant smell of
iodoform, is non -irritating, and is not poisonous, and is said to be a
useful temporary dressing for root canals.
Arntol and sozoidol^ are spoken well of for the same uses as
iodoform and iodol.
Of the zinc compounds, the chloride is deliquescent, caustic and
strongly antiseptic. Sir J. Lister and Watson Cheyne use it in 8 per
cent, solution for dressings. Miguel places it third in his list of anti-
septics. Richardson, Hamilton, Pettenkoffer and Calvert also put a
high value on it as an antiseptic — whilst Mac Cormac says: "Where
wounds have been open to septic influence zinc chloride is about the
best antiseptic we can employ, " and recommends it specially for
disinfection of sinuses or wounds in the .mouth.
It enters into the composition of some osteos, but these ought
only to be used either where there is a considerable thickness of
healthy dentine between the pulp and the cavity or where there is
no pulp.
It is occasionally used as a mouth wash in weak solutions.
Benzoic acid is placed by vSternberg as the highest among the
THE DENTAL RECORD. 513
organic acids — as an antiseptic. Miller also speaks highly of it. It is
stimulant and expectorant, therefore, in solutions of say i — loo or
I — 200 should be useful in mouth washes. Of boric acid a great deal
has been made, but from the various experiments I have studied its
power seems to be comparatively small. Still, for a cheap and
effective mouth wash — a mixture of equal parts of chlorate of potash,
and boric acid — half a drachm to the ounce of water I have found
very efficacious, and decidedly pleasanter in every way than permanga-
nate of potassium.
In permanganate of potassinm we find an effective antiseptic
solution suitable for mouth washes and gargles in cases of suppura-
tion and foetid breath. It is a powerful oxidiser. By many it is
said to be a better deodorizer than actual disinfectant, but clinically
we find it satisfactory. Koch says it ought to be used in five per
cent, solutious. The objections to its use are that it corrodes and
stains so readily. It is very astringent, and the taste is not pleasant.
Of the Naphthol series, Dr. Edington says : Hydronaphthol is more
efficient as a disinfectant and germicide even than mercury, and
much more than carbolic acid. It is also recorded as being a
powerful antiseptic for treating foul roots, abscesses and ulcers.
Creosote is used by many practitioners. It is a most powerful
disinfectant. According to Buccholtz and Werncke i — i,ooo kills
bacteria. On the other hand it coagulates albumen, and is
poisonous. All these antiseptics I have mentioned, excepting
iodoform and napthol, act by coming in actual contact with the
micro-organisms. There are of course many others, such as Izal
(which is scarcely poisonous, does not coagulate albumens, and in
strengths of i — 200 is said to be more powerful than carbolic. It is
non volatile). Guatacol^ resorcin salol^ chlorinated soda^ sulphur
in some of its many forms — especially aromatic sulphuric acid —
aluminium acetate^ and others.
Added to these we have a number, which, by virtue of the
gases they give off, are very effective, as by this volatile action
they can more thoroughly in a cavity attack every part. Of
such the first and leader is peroxide of hydrogeii. This is made
in three strengths of 10 and 12 volumes, and of 20 volumes*
z>., that when the lo volume strength is decomposed i c.c.
yields lo c.c. of free oxygen. With this antiseptic we approach
more nearly to nature's hygiene than by any other. The lo volume
514 THE DENTAL RECORD.
strength is best suited for dental purposes, as the 20 volume strength
creates too much disturbance when introduced into a cavity, and
causes great pain, swelling, and bleaching of the surrounding tissue.
As a sterilizer of root canals and abscess sacs, I believe it is
unsurpassed. Unfortunately, it easily decomposes, and as it should
be perfectly fresh when used, it is better to get it in small quantities
and in coloured bottles, which should be well corked. A more
stable compound is ozonic ether ^ but I think, with ordinary care, the
peroxide is quite satisfactory.
This brings us to the essential oils and terpenes, of which
there are such a number that I shall only treat of a few.
Mr. Kingzett, who has made exhaustive enquiries into the values
and strengths of these as antiseptics, has given us many writings
upon the same, to which I would refer you. He found that many
of these absorbed large quantities of oxygen, and when afterwards
brought in contact with decomposing matter gave it out again, and
so nullified and destroyed the septic influences arising from such.
We find such action most noticeable in the case of the eucalyptus
tree. Districts which were at one time hot beds of malaria and
other fevers have quite changed since the planting and growth of
this tree. Now we find the oils possess such properties in an
increased scale, and because of their volatile nature they are
specially valuable to us in our work. For tooth powders and
mouth washes, they are mostly pleasant to taste, aromatic and
effective as antiseptics. Of these I would specially mention thymol^
oil of wintergreen^ oil of peppermint^ and eucalyptus.
Thymol dissolves slowly and if after a foul root canal has been
cleaned with peroxide of hydrogen and the bristle it is partly filled
with thymol, it will keep sweet for a very long time. Eucalyptus
oil with iodoform has much the same effect. Combinations of these
we find in Listerine^ which contains borobenzoic acid, thymol,
eucalyptus, baptisia, gaultheria, and peppermint ; also in Sanitas^
which contains thymol, eucalyptus, and oil of turpentine.
I now wish to mention, in connection with the use of oxygen —
nature's own antiseptic — a home which has been opened in London
for the treatment of abcesses and ulcers by nothing more than rest,
cleanliness, and oxygen. The founder. Dr. Stoker, was, I believe, an
army "surgeon, and noticed during the Zulu War how those wounded
in battle were removed as soon as possible to the highest hills or
THE DENTAL RECORD. 415
mountains, and how quickly in such positions the wounds healed.
Further study led him to devise some means of treating patients in
London with oxygen. I have visited this home, and 1 think my
friend our chief secretary will bear me out when I say the results we
saw were surprising. I have been so much impressed with this that
I should very much like to see a Committee of our Surgeons try the
treatment on one of those prolonged and tedious antral cases, which
are so often well nigh incurable. Apparently new but really very
old methods are starting up round us every day, and I believe in
our profession we are like many others — only at the beginning. My
argument would therefore tend more in favour of the use of
oxygenating antiseptics, in the majority of cases, as by such means
we would more nearly approach nature's methods, which surely are
the best.
Some Dental Preparations.
These are mostly from the prescriptions of French practitioners
and are recommended, not because of their being in any way better
antiseptics than many British, but because they are as a rule more
palatable.
Antiseptic Tooth Powders. (M. David's).
I. R Pulv.
Cretae preparata ...
...
45 grains
n
Mag. Carb.
• • •
45 11
))
Acidi Boraci
...
25 11
>?
Pot. Chlor.
...
60 „
11
Guaiac
60 „
Ess.
Mentha, pip. (i in 50)
6 mins.
or „
Rosae
...
3 r
From this is suggested : —
2. R Pulv
. Dimatos ...
...
5ij.
n
Cretae precip
3ij.
V
Acidi Boraci
...
3 ss.
>)
Pot. Chlor.
• ••
3ss.
11
Guaiac
• ••
grs. Ix.
Ol.
Sanitas
••i
ni X.
11
Rosae (geranium)...
nt X.
516 THE DENTAL RECORD.
(M. David).
3. ft Pulv. Cretae precip 3 35
„ Pummice ... ... ... „ ij
„ Iridis „ 6J
„ Pot. Chlor „ i|
„ Acidi Boraci ... ... „ if
Vanilline grs. 75
Sod. Fluosilicate 3 6^
Salol grs. 75
Ess. Rosae ' nt 75
Cochineal q.s.
A tooth powder suggested : —
4. ft Pulv. Cretae precip 5 ij.
„ Dimatos I iv.
„ Saponis Hisp 3 iij-
„ Pot. Chlor 3 ij.
01. Eucalypti m x.
Ess. Mentha, pip. (i in 50) ... nt x.
Otto Rosae rn mvj.
Liquid Preparations. (Eau de M. Botot).
ft Star Anise 3 2
Cannelle Bark 3 i
Cloves grs. 15
Pyrethrum Root i? 60
Cochineal ... ... ... „ 70
Cream of Tartar n 80
Gum Myrrh ... ... „ 30
Ess. Peppermint (i in 50) ... ni 60
Alcohol 3 70
TiNCT. Arnica (Aromatic). M. Bouchut).
ft Arnica Floreto 3 iJ
Canelle ^
Cloves V grs. 150
Ginger j
Aniseed ... ... ... ... 3 3i
Alcohol 335
THE DENTAL RECORD. 517
BoRASEPTiNE. (M. Rosey). To Hnse mouth after extractions.
R Acidi Boraci 5 ij
Glycerini ... ... ... ... 5 3^
Aquae dest... ... ... .. 3 35
Ess. Mentha, pip. or Rosae ... 9 s.»ti
Mix with equal parts in warm water.
For THOSE Wearing Artificial Plates. (M. Loewe).
R Alcohol (decressou du para) ... 5 i|
Tinct. Krameria ... ... ... mi5o
Thymol ... ... ... ... grs. 7
Ess. Oil of Thyme tti 7
For Stomatitis, Ulceration, &c. (M. Melangez).
Pot. Chlor.
grs. 150
Aqua. dest.
3 8
Mel. Rosae
grs. 150
Acidi Hydrochlor.
m 30
Mouth Wash. (M. Galippe).
Acidi Benzoici ...
grs. 45
„ Thymigi ...
li
Tinct. Eucalypt. ...
nuso
Aquae, dest.
5 35
Jl^pnrta
of ^atutits.
LIVERPOOL DISTRICT ODONTOLOGICAL SOCIETY.
The first Ordinary Meeting of this Session for the above Society
was held in the Medical Institution, on Tuesday evening,
October 20th.
There were 23 members and two visitors present ; and the
President, Dr. Waite, was in the chair. After some preliminary
remarks by the President, who drew attention to the papers, &c.,
that had been promised for this Session, he called upon the Hon.
Secretary to read the minutes of the last meeting.
Mr. TindaU L.D.S.Eng., was proposed for membership.
Mr. Haden (Southport) showed a very good specimen of a three-
rooted upper first bicuspid.
Mr. Bates spoke to the value of base plate guttapercha as a
filling material, he had found it more durable than any of the
518 THE DENTAL KECOKD.
manufactured forms of guttapercha. The question of guttapercha
as a filling material was discussed by Messrs. Haden, Woods, Waite,
Royston and Matthews.
Mr. Phillips proposed a very hearty vote of thanks to Dr Waite
for the exceedingly enjoyable reception that he gave to the members
of the Society in April last at the Adelphi Hotel, and for his able
speech on that occasion. This was carried by acclamation, and,
Dr. Waite having suitably replied, he then called upon Professor
Paul for his paper, entitled " Some Points of Interest in Dental
Histology. The Enamel Organ." (See page 493).
After a discussion, in which Messrs. Royston, Councell, Matthews,
and Woods took part. Professor Paul was thanked for his valuable
paper, and the meeting was adjourned.
DENTAL STUDENTS' SOCIETY, DENTAL HOSPITAL OF LONDON.
The first General Meeting of the Winter Session was held on
Monday, October 12th, the President, Mr. F.J. Colyer, in the chair.
The Curator and Librarian, Mr. Douglas, said that he much
regretted to announce that he had received, as yet, no answer to the
appeals for books that were recently sent out. He thought,
however, that this might partly be accounted for by the presence of the
summer holidays, and hoped that there would be a more generous
response to the next appeal.
There were no casual communications.
The President then called upon Mr. Douglas for his paper on
"Fermentations and Oral Antiseptics." (See page 499.)
In the discussion which followed —
Mr. Heath said he was very grateful to Mr. Douglas for all that
he had learnt that evening, though he could not possibly hope to
carry away all the facts with him. He did not quite understand
Mr. Douglas when he said sulphur was the national antiseptic, and
added that he should regard anyone who carried out Mr. Douglas's
rules for cleansing the mouth after every meal with an admiration
not unmixed with awe.
Dr. Austin thanked Mr. Douglas for his excellent paper, and
drew a distinction between asepsis and antiseptics. He remarked
that one could go even further back into history than Mr. Douglas
had gone, instancing the case of Ulysses who used sulphur after the
departure uf Penelope's suitt>rs.
THE DENTAL RECORD. 519
Mr. NowELL spoke in praise of the Oxygen Hospital mentioned by
Mr. Douglas, citing a case which he had seen there, where an ulcer
two inches in diameter had completely healed within 48 hours.
Mr. Gabell insisted on the fact that in dentistry cleanliness
came before antiseptics. He could see very little use m antiseptics
in the mouth, for one had not there to deal with a pure cultivation,
but with organisms covered with thick mucous, mixed with all kinds
of debris^ and inaccessible to position.
In reply, Mr. Douglas said he much regretted that owing to
the lateness of the hour they had had no criticism from the President
or the Surgeons present, as he believed these discussions were chiefly
valuable to students, because of the summing up of those who had
been in practice for S3me time, and could therefore the better
judge the good points cf both sides. He was pleased to note the
distinction drawn by Dr. Austin between Asepsis and Antiseptics.
Regarding Mr. Nowell's remarks on the Oxygen Home, one point
he would add, which he believed was new as regard bacteriology
and wounds. In treatment with oxygen it was found that when a
wound was healing the two chromogenic micro-organisms streptococci
pyogene aureus and citreus were always present, and grew to large
size, and the necessity for I heir presence was proved by the fact that,
where a wound was foul, and slow in healing, an inoculation of a
pure cultivation of one of these had an almost immediate beneficial
effect en the wound. The other chromogenic pyogenic micro-
organisms did not have the same effect. To Mr. Gabell he would
reply that he would use the words clean and antiseptic as having the
same meaning; but specially noted the necessity for mechanical as
well as chemical cleansing, for the reasons that Mr. Gabell gave,
viz., a mixed culture and heav^ily covered organism, and would
specially draw attention to Professor Miller's comparative table of
times taken to kill mixed cultivations, found in the mouth^^with
various chemicals. He finally wished to thank the gentlemen
present for their attention to his paper, and his critics for so gently
dealing with it.
The President then proposed a vote of thanks to Mr. Douglas
and those gentlemen who had taken part in the discussion, and
announced that the next General Meeting of the Society would take
place on Monday, November i6th, at 7 o'clock p.m.
The proceedings then terminated.
520 THE DENTAL RECORD.
THE DENTAL RECORD, LONDON : NOV. 2, 1S96.
It is claimed, and doubtless with truth, that the lot of
man is fairly equal, that that which he lacks is ever
compensated by that which he has. The practitioner of
dentistry is no exception to this rule, and if we dwell for a
time on his disadvantages it should be taken in no sense
that we are oblivious to the other side of the picture, nor
that we regard his condition to be at variance with this
general equilibrium. Perhaps the chief disadvantage in
the practice of dentistry, or rather the chief difficulty with
which we have to contend, is the wearying nature of the
work ; the intense application to each case, which is needed
to ensure the highest result, the constant repetition of the
same kind of thing, and the unvarying nature of the
strain. It is obvious that it is given but to few to ignore
this weariness and to allow no trace of this to mark
work with signs of imperfection. If dentistry has made
great progress in the last half century, it has also become
a harder task master, demanding, not only greater skill,
but closer attention; a higher strain, a more complete
neglect of self. But because of all this, and because if not
to-day, then to-morrow, this will result in lowering the
standard of the ideal, it behoves all to avail themselves of
the different mechanical aids which the genius uf others
has provided. Among the chief of these we should place
the use of an operating stool, so that, at any rate, the longer
operations may be done sitting down. There is no novelty
in this, but it is a practice which is but too rarely followed,
and which, though it may pre^^ent some inconveniences at
the first trial, is reall}^ quite as suitable for work as the
standing position. Nor need we dwell upon the fact that long
standing by the chair is apt to lead to permanently diseased
condition of the veins of the lower extremities, which, to
say the least of it, renders the practice of denti'^try yet more
trying. To follow this practice to the full extent, we must.
THE DENTAL RECORD. 521
of course, use a chair having the full range of movement
and have instruments within reaching distance. It is even,
we suppose, possible, that the old-fashioned, cumbersome,
rigid chair of a previous date, still lingers on beneath its dirty
velvet. Is it necessary to assure its owner that he would be
consulting his own comfort by consigning his old friend to
the quiet seclusion of the lumber room. Students we would
advise to learn from the first to operate sitting down, though,
indeed, they are often handicapped by the very imp?rfect
arrangements under which they work. It is, of course,
difficult to arrange that each student shall have some similar
arrangement for his instruments, &c., as is usual in private
practice, but it is a consummation devoutly to be wished.
Imperfect light, whether natural or artificial, is another
cause of needless strain, which, in the long run, must tell
disadvantageously. With regard to the former, windows
facing north-west always seem to us to be the best. The
additional period of daylight in the evening which these
give, is, in the usual arrangement of working hours,
a great gain. Of artificial light, electricity doubtless
possesses great advantages, but care is needed in using it
that both the eyes of the operator and of the patient should
be shielded from its direct rays. This is more especially the
case when using the more powerful lamps while stopping
teeth ; indeed, it always seems to us that the light required
for extracting is distinct in kind to that needed for other
work. For, whereas the latter requires to be powerful and
concentrated, the former requires a more diffuse illumina-
tion, issuing, if possible, from different points, so that
shadows may be minimised. Many other illustrations of
labour saving methods could be mentioned, and although in
some cases they may not agree with the preformed ideas, yet
in trying them, and, when satisfactory, in permanently
adopting them, the practitioner is not merely making a
concession to modern ideas, but by so much as they save
his labour, by so much they increase his capacity for doing
work of hiifh merit.
M M
522 THE DKNTAL RECORD.
In connection with the new Dental Bill of New South Wales, we
learn that the authorities of the Sydney Hospital are making provi-
sion for the practical training of students in chemistry ; and the
Senate of the University of Sydney has referred to the Faculty of
Medicine for report a proposal to establish a School of Dentistry in
connection with the Medical School. The scheme provides for a full
curriculum and a diploma in dental surgery.
In a recent issue we noticed that a match factory in the neigh-
bourhood of New York had decided that the employees should have
their teeth examined and present a certificate on the condition of
these; this has not been taken at all kindly, or wisely, by the factory
girls, some hundred of whom refused to obey these directions and
have now come out on strike. Ignorance is, it is true, no excuse,
but at any rate it offers an explanation. The more one may
sympathise with the aspirations of the working class, the more we
must lament such ill-advised action. It is quite on a par with the
reception often accorded to improvements in machinery intended to
save life and lessen accident. One cannot help feeling that there is
something wrong in the educational methods in the elementary
schools that children should grow up so oblivious to that which is for
their own real good.
On October 22nd a lively scene occurred at the meeting of the
Burnley Board of Guardians, on Lady O'Hagan proposing the
appointment of dentists to attend children in cottage homes,
Mr. Barton objecting to the expense : •' They should remember they
were only workhouse children.'' — Mr. Whittaker, interrupting: "They
are not workhouse children — the word stinks." — Mr. Barlow, continu-
ing, said that few ratepayers sent their children to dentists. — Lady
O'Hagan retorted : " Then they ought to." — Mr. Whittaker said
Mr. Barlow was evidently a man who wanted eye for eye, tooth for
tooth — to visit the sins of parents on children. The resolution was
referred to a committee.
What a farce that some Members of these Boards should be called
Guardians of the Poor !
THE DENTAL RECORD. 523
" L'Odontologie " quotes a case of a supernumerary tooth in the
nose, met with by Dr. Seifert in a patient whose dentition was
complete and well formed. It was situated on the floor of the right
nasal fossa, two centimetres from the anterior margin, and was
encrusted in calcarious salts and covered over by granulation tissue.
THE DENTISTS BILL, NSW.
The Dentists Bill, according to the last report, has passed the
Upper House of the N. S. Wales Legislature. It contains nineteen
sections — that is to say, it is less than half the size of the British Act,
which contains forty sections.
Provision is made for the establishment of a Dental Board, a
Registrar, the qualifications necessary for registration, the penalties
inflicted upon unregistered persons using the terms that imply
registration, also upon persons who commit frauds on the Act.
Section 15 states, amongst other things, that the Board may make,
alter, and repeal regulations for carrying the Act into full effect, and
for prescribing what certificates, &c., will be recognised by the Board,
and for holding examinations and prescribing the subjects and fees
therefor. It is provided that the regulations of the Board be
approved by the Governor, and that they be laid before both Houses
of Parliament.
The first Dental Board will be a nominee body of eight members,
two of whom must be registered medical practitioners, four of whom
must be dentists who are qualified for registration under the Act,
and two of whom must be persons not medical practitioners or dentists.
One of the eight is to be appointed President. This Board will
continue in office for three years only. At the expiration of the three
years the registered dentists will elect a Board according to regula-
tions approved by the Governor. The elected Board will choose one
of its number as President. At least five of the elected Board shall
be dentists, and three shall be legally qualified medical practitioners.
The Bill, if passed into law, will come into force on January ist,
1897, after which time no person other than a medical practitioner
shall be entitled to take or use the name of d<jniist, or any name, etc.,
implying that he is registered under the Act without being liable
(as in Great Britain) to a penalty not exceeding twenty pounds.
M M 2
524 THE DENTAL RECORD.
The portions, therefore, of the Bill that deal with the qualifications
necessary for registration become important. The requirements for
registration are almost identical with those of the British Act. In
Section ii of the Bill they are stated as follows : — Any person who (a)
is registered in the United Kingdom in accordance with the laws for
the time being in force therein as a dentist or a medical practitioner ;
or (3) is entitled as hereinafter mentioned to be registered under this
Act as a dentist ; or (c) has for a period of six months before the
commencement of this Act been do7td fide engaged in New South
Wales in the practice of dentistry, either separately or in conjunction
with the practice of medicine, surgery, or pharmacy, and who has
made application for registration to the Board within one year from
the commencement of this Act ; or {d) has attained the age of
twenty-one years, and has been engaged during a period of not less
than four years in the acquirement of professional knowlege in
dentistry, and has passed an examination before the Board according
to the prescribed regulations ; or {e) has attained the age of twenty-
one years, and shall have been a pupil or apprentice of a registered
dentist for a period of two years, and shall have been such pupil or
apprentice for a period of six months before the commencement of
this Act ; or (/) has obtained a diploma or degree in dentistr}' from
a university in Australia shall be entitled to be registered as a dentist
under this Act. And in Section 12 : — ^Any person who has practiced
dentistry for not less than twelve months elsewhere than in New
South Wales, and who holds some recognised certificate as herinafcer
defined, and who proves to the satisfaction of the Board that he is of
good character, shall be entitled upon the payment of the prescribed
registration fees and without examination to be registered as a
dentist under this Act. The term "recognised certificate" means
a certificate, diploma, membership, degree, license, letters, testimonial,
or other title, status, or document granted by some university, college
or other public institution in a British possession or foreign country,
and which is recognised by the Board as entitling the holder thereof
to practice dentistry in such possession or country, and as furnishing
suflficient guarantee of the possession of the requisite knowledge and
skill for the efficient practice iof dentistry. — Australasian Medical
Gazette
THE DENTAL RECORD. 525
NEW COLLEGE BUILDINGS OP THE ROYAL COLLEGE OF
DENTAL SURGEONS, ONTARIO.
This splendid new building was opened on October ist, by His
Honour Lieut. -Gov. Kirkpatrick.
Dr. R. J. Husband, President of the College, occupied the Chair,
and opened the procjedings with a brief address of welcome.
The Rev. Principal Caven then delivered a short opening
prayer.
Dr. J. B. WiLLMOT, Dean of the College, gave a review of
dentistry in Ontario. He detailed the growth of dentistry in the
province. He thought that dentistry was an individual science,
apart from medicine, to which it owed little, and believed it should
continue to develop as an individual science.
Dr. H. T. Wood, the oldest member of the board, and chairman
of the Building Committee, resuming, believed this was the proudest
day of his life. He had laboured for years to attain the object
which it was his pleasure to now behold. He had been connected
with the movement since 1868, and had always held as his goal the
erection of such a building as the directors now had for dental
education.
Dr. Husband then vacated the chair, and Dr. Wood presided for
the remainder of the meeting.
Hon G. W. Ross, the Minister of Education, congratulated the
directors and the faculty of the college on the good taste shown in
the erection of such a building for dental education. The directors
had shown great judgment and enterprise, and it was a marvel to
him how ihey were in a sufficiently strong financial position to
undertake such a task. It was a mystery how they secured the
money. He was glad to hear of the upward evolution of dentistry.
He was pleased also to know that it required such a high educational
standing before a scholar could enter the college. Such should
always be. He was glad for the honour of the profession that this
standard had been founded. It was as high, if not higher, than that
required for any other profession in the world. Dentistry was now
in line as a leading profession in Canada, and it embraced all the
science and skill of the other medical professions. The Dental
College was the youngest of those affiliated with the Toronto
University, but by no means the least. The State University had
520 THE DENTAL RECORD.
done well to admit the Royal Dental College, and it was the duty
for every State Uuiversity to open its doors and encourage such
fondhngs in education. A great responsibility rested upon the
graduates of the dental school, he said, in conclusion. They should
give of the best of their ability to the country which gives of its
best to them, so that no stigma should rest upon the standing or
character of any graduate of the Royal College of Dental
Surgeons.
Prof. Thomas Fillebrown, of the Dental Department of
Harvard University, desired to express the high esteem in which
the members of the profession in Ontario are held by their brethren
in the States. He offered the cordial greeting of the dental
profession of the United States to the dental profession of Ontario.
He would not make any apology in opening his remarks. Men
differed, and he would deal with his theme as it appeared to him.
A question had arisen : — " Is dentisty a speciality of medicine, or
is it not ? " He believed it was. Dentistry was one of the first
specialties of medicine. Early in the Christian era it had its
foundation. The professor then dealt with the gradual development
of dentistry. It had a noble past, an honourable present, and there
was awaiting it a glorious future. To make it practical for medical
schools to include dentistry in their courses of study some changes
must be made in the present plan of the study of specialties. When
medical education is organized upon the plan proposed, and each
student shall be required to be informed in ail the principles of
medicine, and shall have opportunities to perfect himself practically
in some one specialty, then will dentistry assume its proper place.
It will be found that it will take quite as much practice and clinical
observation for an ophthalmologist or a laryngologist to acquire
practical ability as for a stomatologist, and the seemingly well-
grounded objection to making dentistry a part of medical instruction
on account of its essentially practical nature will disappear. When
this principle is fully recognised and teaching is arranged to conform
to it, all difficulties as to the medical education of dentists will
vanish. The large increase of dental students and the extraordinary
growth of the Harvard Medical School have again brought to the
front this question of the proper education of dentists in Harvard
University, and a marked difference of opinion is found to exist
there as here. Shall our medical schools educate dentists as medical
THE DENTAL RECORD. 527
men and graduate them as such ? Professional men say yes. Well
informed public opinion says yes. A large number of the dental
profession have declared themselves in favour of it, and every friend
of higher education and skill admits its desirability. Thus all the
signs of the times point to the medical standing of dentistry.
Medical schools should claim it as not only their duty, but their
right and privilege, to include dentistry in their instruction.
They should reclaim dentistry from the custody of partial culture,
as medicine, n.^t many years ago, reclaimed surgery from the
ignorant practice of the barber and blacksmith." Professor
Fillebrown, concluding, wished " Long life to the Royal College of
Dental Surgeons, and the University and Government which has
fostered it. And amid our rejoicings let us not fail to remember
that greater Government the mother of us all, on whose domain
the ' sun of Heaven never sets,' and also to render homage and
honour to her who, for the longest period in the history of England,
has been the ideal ruler of this great nation, one in whom the
world so much admires the queenliness of the woman, and the
womanliness of the Queen. God save the Queen."
His Honour Lieut. -Governor Kirkpatrick then rose to declare
the college formally opened. After the very entertaining speeches
he would say very little, but desired to add his praises to those who
had spoken previously, complimenting the directors on the erection
of the building. Dentistry was one of the great professions of the
age, and he was glad to see its development in Ontario. He wished
to tender his thanks to Professor Fillebrown for his warm words of
praise on behalf of her Most Gracious Majesty the Queen. Like
Mr. Ross, he hoped that those students who would go out from the
institution in the future would look to the honour of the college, and
do what they could to elevate their own profession. His Honour
then declared the building formally opened.
The building occupies a frontage of 50 feet by a depth of 106
feet, and consists of a high basement and three storeys. The style
is Renaissance, and the materials used are Credit Valley brown stone
for the basement, Portage Entry red sandstone for the ground
storey, and the same stone and red pressed brick for the remaining
two storeys. At the west end is the main entrance with a flight of
stone steps with handsome balustrades, and a hood over the doorway
formed by a boldly projecting dentil cornice, supported by richly
528 THE DENTAL RECORD.
carved corbels. At the east end is an archway leading to the
students' entrance, and closed by a pair of ornamental wrought-iron
gates.
The basement contains the laboratories for metal work. They
have granolithic floors, and are fitted with furnaces for melting
metals, and moulding and casting tables. Here are also the boiler-
room, the students' coat-room and lavatory, and the janitor's
apartments.
On the ground floor at the front are the board-room and reading-
room, in the rear the large lecture-room, seating 200, with the
necessary appliance-rooms, and in the middle of the building is the
general laboratory. The students' staircase is centrally situated on
the east side, extends from bottom to top of the building, and is
reached from the street by the archway referred to. The general
staircase is close to the main entrance and communicates with the
rooms to which patients will have access. The first floor is mostly
taken up by the operating-room and the upper part of the lecture-
room. The windows in the operating-room are so arranged that
there is one opposite each operating chair. The extracting-room
opens off the operating-room, and the clerk's room has communica-
tion both with the operating-room and the students' staircase.
The second storey contains laboratories for histology, technique,
and chemistry, and the small lecture-room. Each of the laboratories
has been fitted up with the most modern appliances for the
particular department of study for which it is to be used, those i.i
the chemical laboratory being the most elaborate, the tables being
fitted with slate tops, and a sink to each two students, with hot and
cold water. Each student is also provided with a cupboard and a
drawer for his own use, and a special gas tap. Gas is also led to all
the work tables where it is required, and washbasins and sinks are
provided for each laboratory, and toilet-rooms for the use of the
professors on each floor. The blackboards throughout are of un-
polished plate glass. The heating is by low pressure steam, and
there is a complete system of ventilation, fresh warm air being
suppled by indirect steam radiators, and the foul air extracted by a
large fan worked by an electric motor.
A room capable of accommodating about 50 bicycles has been
provided under the staging of the large lecture-room.
THE DENTAL RECORD. 529
^batrarta anb ^dtctions.
FORMALIN AS A PRESERYATIYE.
By H. A. L. Ryfkogel, M.D., San Francisco, Cal.
Curator of the Museum t Medical Department, University of California, and Assistant
Demonstrator of Anatomy, Medical Department, University of California.
To find an ideal preserving fluid has long been the aim of those
taking an interest in the care of specimens of organic life.
Such a preservative must not alter the preparation in any way ;
it should cause no shrinkage nor hardening, the colour of the object
ought not to change, the microscopic as well as the macroscropic
appearance must be preserved, the fluid should be non-inflammable
and obtainable at but little cost. As yet no combination has fulfilled
all these indications, nor is it likely that any ever will : for preserving
fluids are usually such by virtue of one of these very objections, if
such it really be, namely the hardening of albuminous material.
Ot necessity all preserving fluids must have antiseptic qualities,
and many such, as alcohol and glycerine, are hygroscopic as well^
This last quality is of course not an advantage, owing to the great
shrinkage that occurs on the withdrawal of any water from animal
tissues.
It is by the presence of these qualities that we must judge the
value of the diff'erent media in use. Thus, solutions of boric acid,
4 per cent., or carbolic acid, i to 2 per cent., are sin;ply antiseptic.
Any object placed in these will indeed not suff'er putrefactive changes,
but after a time will become macerated and practically worthless.
Glycerine is hygroscopic and slightly antiseptic. It alters by shrink-
age, and is too costly fur ordinary use. Alcohol is hygroscopic,
antiseptic, and coagulates albumin. It therefore both hardens and
shrinks the specimens. It also alters by dissolving out many ot the
organic pigments. Finally, solutions of formic aldehyde are
antiseptic. They harden albumin, but cause no shrinkage, and
aff"ect animal pigment but slightly.
Of course, all fluid preservatives alter the appearance of tissues
to a certain degree by the withdrawal of blood.
The specimens we show you have been kept in formic aldehyde
solution, or formalin, which appears to overcome many of the
objections mentioned above.
630 THE DENTAL RECORD.
Formic aldehyde, a gaseous body, discovered in 1863 by Hoffmann
while passing methyl alcohol and air over hot platinum, is one of a
peculiar series of chemical compounds which differ only in the
amount of oxygen they contain. The first of these is methane, or
marsh gas, of which the chemical formula is CH4. The second is
melhyl alcohol, with a formula of CH4O, and the third, methylenglycol,
is represented by the formula CH4O2. If we now extract from this last
one molecule of water, we have the formula of formic aldehyde, CHjO.
Formic aldehyde is a gas, colourless, and possessing a very pungent
odour. When inhaled it is very irritating, quickly setting up a
coryza or bronchitis. Its point of saturation in water is 40 per cent,
and it is this saturated solution that is sold under the name of
formalin by Schering. We probably have here a solution of methy-
Lnglycol, for, as shown above, formic aldehyde plus one molecule
of water gives us methylenglycol, thus : CH20 + H20 = CH402.
On account of its antiseptic properties, discovered by Blum, it
has been used in many diseased conditions dependent on pathogenic
germs, but it is of its uses as a preservative and fixing agent that we
now wish to speak. These, as mentioned above, depend on its
antiseptic powers and ability to harden protoplasm.
Solutions of I per cent, strength, i.e.^ one volume of formalin to
40 of water preserve gross specimens of tissue indefinitely, and so
thoroughly that microscopic sections may be prepared therefrom at
any time. Solutions of this strength will not, however, fix the cells
so as to show fine intercellular structure. Still it is the architecture
of the tissue, as it were, that most interests the pathologist, and this
will be perfectly shown.
Solutions of even less strength may be used, but with less
gatisfactory results as regards preservation of color and minute detail.
When the object to be preserved has many delicate colors that must
be shown, a stronger solution, e.g.^ 4 per cent, to 8 per cent., had
better be employed. Bodies of insects and reptiles, fruit and flowers
should thus be preserved.
You have all noticed that the slime or mucous that covers the
bodies of certain fishes, reptiles, &c., and some pathologic specimens
become converted into white stringy masses when the animal or
tissue is placed in alcohol. This does not occur with formalin in
solutions stronger than one in forty (i per cent.) ; so that any slime
or mucus that covers specimens placed therein remains transparent.
THE DENTAL RECORD. 531
Formalin gives beautiful results in the preservation of the
central nervous system, showing very distinctly the white and grey
matter. For this purpose, however, it has two objections. First,
it causes a certain amount of swelling ; second, the gray matter
becomes very brittle, so that small pieces are broken off in handling.
These may both be remedied by making up the i per cent, solution
of formalin in 50 pet cent, alcohol, thus : —
R Formalin i part.
Alcohol,
Water aa 50 parts.
This at first glance may appear expensive, but it is not so, for
a single emersion will suffice, owing to the great rapidity of pene-
tration of the formalin. Of course, if alcohol alone were used it
would have to be changed one or more times to obtain a good result.
If a strong solution of formalin be injected into the digestive
tube and carolid artery of a small animal, the specimen may be left
hanging in the open air for many months without undergoing change.
Blanchard has preserved leeches in the fluid and found no
alteration in the delicate coloration of the animals after a year.
Egg albumen placed in formalin, 4 per cent., solidifies and
becomes slightly opalescent. If it is now boiled it will not change in
appearance.
Formalin has also been of great use to teachers of bacteriology
demonstrating cultures in gelatin. For, if the vapour of formalin
be introduced into a test tube in which a culture is growing, it
immediately arrests the growth of bacteria. Moreover, the gelatin
which has been liquefied by the bacteria is again solidified without
alteration of appearance. Thus a culture may be kept in any stage
of growth desired.
As a fixing agent in solutions of 2 per cent, to 5 per cent, it far
surpasses alcohol, and almost equals the more costly fixing agents,
such as osmic acid, &c., killing as it does the cells before any change
can take place in the finest intracellular structure. For example, it
has been used instead of osmic acid in Ramon y Cajal's method for
nervous tissues with better results.
Durig has used 4 per cent, formalin as a mordant instead of
aniline-oil water.
Cullen, of Johns Hopkins, has devised a method for making
frozen sections permanent by means of formalin. He places the
532 THE DENTAL RECORD.
section in formalin, 4 per cent., three to five minutes ; alcohol 50 per
cent., three minutes ; alcohol absolute, five minutes. Cullen finds
sections prepared in this manner in twenty minutes after an opera-
tion as definite for diagnostic purposes as those prepared by the
ordinary methods, which take several days.
To recapitulate, the advantages of formalin over alcohol are as
follows : —
1. Alcohol, by withdrawing the water from a specimen, causes
great shrinkage. Formalin, acting only by changing the proto-
plasm, causes very little shrinkage.
2. Alcohol dissolves out most organic pigments and so greatly
alters the appearance of objects. Formalin does not do this to any
extent
3. The price of alcohol is nearly $3 a gallon ; that of i per cent,
formalin solution about 30 cents.
4. Alcohol is very inflammable. Formalin being a watery
solution of a gas, is not so.
5. Alcohol, by changing mucous or slime to white strings, spoils
the appearance of objects covered by this material. Formalin, by
leaving mucous and slime transparent, is free from this objection.
The objection to formalin is the irritating quality of its vapour
when inhaled. This is, however, not troublesome in the solutions
ordinarily employed.
The specimens shown well illustrated the advantages of for-
malin. Two were specimens of pneumonic lung, one in alcohol,
the other in formalin. From the external surface of the one in
alcohol, the delicate mottling and striping had almost vanished. On
the contrary the specimens in formalin — in this case i per cent. — was
almost unaltered.
In another jar was a uterus trom a case dead of pupura hem-
orrhagica. This was placed in a 4 per cent, formalin solution, in
order thoroughly to harden the blood clot in the interior of the
uterus. After four weeks the uterus was carefully cut across and
the specimen was ready. Upon examination it was seen that the
blood clot formed a perfect cast of the cavity. Neither the uterus
nor the clot had shrunken to any appreciable degree.
Colloid material in the Graafian follicles remains clear and has
not decreased in volume ; one of them is filled with a clot which,
like that in the uterus, completely fills the cavity.
THE DENTAL RECORD. 533
Had this specimen been prepared in alcohol everything would
have been shrunken and distorted. The clot would not have formed
such a perfect cast of the uterine canal and the contents of the
Graafian follicles woud have appeared as opaque balls or strings
filling a small part of their interior. — Medical Record.
PROSECUTIONS UNDER THE DENTISTS ACT.
At the Nottingham Summons Court, on September 28th, before
Mr. E. W. Enfield and Alderman Eraser, Edward Jessop Hadley,
described as a dentist's assistant, of Market Street, was summoned
under the Dentists Act, 1878, he not being registered. Mr.
Johnstone prosecuted on behalf of the Nottingham and Notts
Dental Association, and Mr. Arthur Wright (Leicester) defended.
Mr. Johrsione said the prosecution in this case had been
instituted under Section 3 of the Dentists Act, 1878, as amended
by the Medical Act, 1886. There had been several prosecutions
under this Act in various parts of the country ; one of them was at
Newport Police Court, on May 2'2nd.
Mr. Wright objected to this statement on the ground that it
afforded proof ot a malicious prosecution.
Mr. Johnstone (continuing) said prosecutions had already been
heard under this Act, and convictions had been obtained where
even it was admitted that the defendant had, in course of conver-
sation, stated that he was not registered. The evidence he should
put before the Bench that day would show the person who was now
there as the defendant, had distinctly stated that he was a fully
qualified man and a dentist. Those were the words used in the
section of the Act, where a person was liable to a penalty of ;^20,
and if that case was proved he should ask the Bench to inflict the
full penalty, because other cases had been heard where managers in
the service of Messrs. Goodman and Company had been convicted,
and it seemed that previous convictions were no warning to them.
He thought there would be some question as to the identity of the
defendant.
Frank Johnson said he went to the oremises occupied by Messrs.
Goodman and Company, in Market Street, and asked for Mr.
Goodman. He saw Dr. Loveday, who told him that Mr. Goodman
was "hot in. Witness asked Dr. Loveday if he was a qualified
dentist, and he replied that he was not, but that there was a
534 THE DENTAL RECORD.
qualified dentist on the premises. He then saw the detendant, who
said his name was " Mr. Hadley," and that he was a registered and
qualified dentist. Witness told him he wanted his teeth seen to
and defendant thereupon examined his mouth. On the following
Monday he again went to the premises and asked Dr. Loveday if he
could see Mr. Hadley, and the doctor replied that Mr. Hadley had
left some time. He asked the doctor what his name was, and he
replied that, if he particularly wished to know, his name was Jones.
Mr. H. Blandy, L.D.S., stated that on September i8th he
telegraphed to " Edward Jessop Hadley, 163, Cheltenham Road,
Bristol." He produced the reply which he receivod thereto.
Mr. Wright objected to the evidence.
Mr. Johnstone said he knew the service had not been regularly
effected, and he had not anticipated proceeding further than applying
for a warrant. He had not expected to find the defendant present.
Therefore, he should have to ask for an adjournment of the case, so
as to enable him to commuicate with the person whose name and
address were on the telegram.
Mr. Wright strongly opposed an adjournment. Mr. Hadley
was a properly qualified dentist ; his name appeared in the Register
for the current year.
The Bench decided that the telegram was not admissible.
Mr. Blandy, cross-examined by Mr. Wright, said the proceedings
had been instituted in consequence of a resolution adopted by the
Nottingham and Notts Dental Association.
For the defence Mr. Wright called Henry William Meadment,
florist, of 26, Burton Road, Gotham, Bristol, who stated that the
defendant Edward Jessop Hadley was related to him by marriage,
and he had known him about ten years. He had been residing in
Bristol until recently, and practising in that city as a dentist, at
Bristol Bridge, Old Market Street, and Cheltenham Road.
Cross-examined by Mr. Johnstone — Mr. Hadley ceased to carry
on business in Cheltenham Road about two months since.
Mr. Loveday, L.S.A., of 51, Burton Street, Nottingham, stated
that he managed a practice for Messrs. Goodman and Company in
Market Street, Nottingham. He had been in their service about
three years. It was the custom of Messrs. Goodman to employ only
qualified men. He had known defendant about two months.
Defendant was a qualified man, and his name appeared in the
THE DKNTAL RECORD. 636
Register. Witness recollected the witness Johnson and another
man calling on him. They asked him the name of the man who
attended on Johnson the previous Friday, and witness did not tell
them. They then asked where Mr. Hadley was, and he replied that
he had left a long while. He did not intend them to infer that
Hadley had left some weeks or months previously. The Bench
dismissed the case. Upon the question of costs they intimated that
they would give their decision on the following Wednesday.
Before Sheriflf Cowan, in the Sheriff Court, on September 25th,
Louis H. Fenton, 27, George Street, Paisley, was charged with
having contravened the Dentists Act, 1878, particularly Sections 3
and 4, in so far as he, not being a legally qualified practiuon^r^ and
not being a person registered under the said Act, unlawfully did, on
or about September ist, and still continues to publicly advertise
that he was a dentist, thus implying that he was registered under
the Dentists Act, and that he was a person specially qualified to
practise dentistry.
The Sheriff held it proved that he had caused to be issued certain
advertisements as charged, but dismissed the case on a technical
point raised by respondent's agent, viz., that there was no proof put
forward that he was not a registered dentist.
The agent for the prosecution said that as at a former stage the
point in question had been admitted, he had not put forward the
Register of qualified dentists as evidence.
The Sheriff, however, held that it could not be taken as granted,
aiid therefore dismissed the case on the point.
DEATH FROM CHLOROFORM.
Mr. J. J. Thorney (Coroner of Hull), held an inquest respecting
the death of Maria Elizabeth Crowther, who died while under the
influence of chloroform administered for a dental operation.
Mr. George William Crowiher, 14, Sharp Street, husband of
deceased, gave evidencj of identification. Her age was 25 years.
Her teeth were so bad that she could not eat, and it was determined
to have them removed. Witness arranged with Mr. Hart, dentist,
to take them out, and fit in a ne\y set, and with Mr. Wyllie
surgeon, to attend at Mr. Hart's.
536 THE DENTAL RECORD.
Mr. Wyllie said he attended the deceased in her confinement
about eleven months ago. He had not noticed any weakness of the
heart. He attended at deceased's house at three o'clock with
Mr. Hart for the purpose of administering chloroform, preliminary
to Mr. Hart extracting her teeth. Mrs. Crowther seemed in the best
of health. Deceased went readily under its influence, and became
fully influenced in about five minutes. Mr. Hart then commenced
to extract the teeth, and there appeared to be no difficulty in the
extraction. Witness, because he found consciousness of pain return-
ing, renewed the dose perhaps three times, using about a quarter of
an ounce. Everything seemed to go on right. On one occasion
Mr. Hart removed the gag to examine the mouth, and he saw that
six teeth were remaining. He closely examined the patient then,
and she was going on all right. Her breathing was good. The
operation was finished about twenty or twenty-five minutes from
the commencement. The patient was on a couch in the kitchen.
When Mr. Hart removed his hand from the mouth witness saw that
the breathing had stopped, and the lips lost their colour. He then
began artificial respiration, and continued that for about two hours.
She gave two slight moans when he began, but showed no signs of
life afterwards. He sent for Mr. Aikman some time after. He was
not quite sure she was dead. He kept on hoping. He heard the
heart beating at the end of two hours from commencing artificial
respiration. The chloroform had paralysed the lungs and caused
asphyxia. He had administered chloroform more than i,ooo times
without any mishap. The dentist's operations no doubt interfered
with the breathing.
Mr. Aikman, surgeon, said he saw deceased about five o'clock on
Tuesday night. It was difficult to say if she was alive. Mr. Wyllie
was still carrying on artificial respiration. Various methods were
tried to restore consciousness. Witne s had made a post-mortem
examination of the body, which was well nourished and free from
disease. The heart was perfectly sound. Death was due to asphyxia,
caused by chloroform. He thought the operation would interfere
with breathing, apart from the chloroform.
The jury returned a verdict " That deceased died from asphyxia,
caused by the use of chloroform, administered to her for the
purpose of extracting her teeth."
The dental RECORD.
Vol. XVI. DECEMBER 1st, 1896. No. 12.
Original Cfommunirattona.
PAIN*
By R. Edwards, M.R.C.S., L.D.S.
Whether we are prepared to accept the plain, simple biblical
narrative of disobedience as a sufficient explanation for the doom
" that man should live by the sweat of his face," or whether we
prefer to account for it by a somewhat more modern scientific
theory ; the fact nevertheless remains, and is co-existent with the
world's history.
The hardships and vicissitudes attendant on a precarious
existence have at all times rendered him liable to injury and disease,
and it requires but a slight exercise of our imagination to picture to
ourselves a period in man's existence, when nature's powers and
promptings were the sole curative means at his command.
Fortunately for the human race, the Supreme Director of all
things, in His wisdom and benevolence, implanted in man not only
the power to sustain himself under the hardships of labour, but
also a recuperative power from the accidents and mischances of his
precarious existence.
To quote Mr. Hilton,t "The prime agent employed by nature in
the restoration of a disease or injured part is pain. Pain is man's
first prompter of the morbid condition ; pain admonishes him when
he strays from that condition most essential to his recovery ; and
pain enables him to employ so beneficially, and to regulate so
accurately, means for his relief and comfort."
This faculty of providing for the well-being and preservation of
the body is the property of the nervous system. This system of
nerve cells and fibres forms a most complete chain of communication
* A paper read before the Liverpool District Odontological Society,
f Lecturer on " Rest and Pain '
N N
538 THE DENTAL RECORD.
between all the organs of the body, and thus serves to associate the
functions of the different parts, causing them to act in harmony for
Ihe common good of the organism.
So intimate is this relationship, or, as it is commonly termed,
sympathy, that no one part can be disordered in its functions, without
affecting the rest.
Under normal conditions, and if restricted to a limited degree,
this inherent conservative power is a constant source of gratification
and pleasure to us. The reception of good news, for example, will
excite in the cerebrum a train of results, which produce in the mind
a highly agreeable and pleasing sensation. The sincere and hearty
shake of a friend's hand sends its thrill of joy to the brain, which
serves to deepen the mutual respect and admiration. The act of
taking in food stimulates the nerves of taste and deglutition, and the
impulse thus conveyed to those centres eliminates a pleasurable
impression. But if the food is taken in excess, or not of the right
kind, sooner or later the function of these nerves and those of
digestion becomes perverted, an unwonted stimulus is conveyed to
them, sensation is unduly exalted and transformed into pain.
Pain then may be defined as exalted sensation, or, as some prefer
it, altered sensation ; and the agent which causes it is called
a stimulus or irritation, and which may be either emotional,
mechanical, chemical, or therm.al.
Generally speaking, the severity of the pain varies proportionately
with the extent and quality of the stimulus, though light contact
may, under certain conditions of the general health, produce more
intense impressions than severe handling, as is well exemplified in
persons suffering from that morbid complex disease, Hysteria.
But there are other important considerations which serve to
accentuate or modify the exhibition of pain. In many instances
heredity plays an important part. Many persons from their birth
are possessed of such a highly strung nervous temperament, that the
least emotional or physical irritation is productive of severe and
potent impressions, affecting more or less the whole constitution.
Yet, notwithstanding such an error of function, the effect can be
measurably counteracted by an effort of the will at resistance.
The close relationship of the mind with the material organism,
and the predominating influence of this occult power over so many
functions of the body, many sensibly modify the exhibition of any
I
THE DENTAL RECORD. 539
disturbance ; and the continued exercise of this power becomes in
course of time so greatly developed as to control to an appreciable
extent the function of sensation.
This is probably the explanation why some persons bear pain so
much better than others.
In our daily practice, however, we must frequently have observed
that the same persons at different intervals, manifest pain with
different degrees of appreciation ; and it is to the general condition
of the health that we must look for an explanation for these
variations. Many constitutional disorders, some of which may be
regarded as slight ailments, have the effect of increasing the
conductivity of the nerve fibres.
A theory has been advanced that an impulse is conveyed to the
seat of consciousness by a series of vibrations ; consequently the
irritation, in whatever form applied, is productive of pain in
proportion to the facility of the afferent fibres to take on undulatory
action. Any derangement capable of producing deleterious effects
upon the nerve fibres would also act upon the ganglionic centres,
and the probability is, that the changed condition of the latter is also
a potent factor in the perversion. General debility, anaemia,
pregnancy, and blood poisoning, especially by alcohol, and the metallic
poisons often reduce the nervous system to such a tremulous and
agitated condition that the slightest external stimulus is transformed
into acute pain. Also such diseases as malaria, gout, and rheu-
matism, by the presence in the blood of the specific poisons from
which they spring, and the exhausting effects of these diseases on
the system generally are productive of severe nerve lesions. It is
very important that we should bear these facts in mind, so that we
may be on the alert to detect any undue agitation or mental suffering
in those who seek our aid, and employ those palliative means at our
command as circumstances suggest.
In extreme cases Dr. Marshall recommends the administration of
some sedative, such as croton chloral, morphia, or bromide of
potassium 20 minutes or half an hour before operating. Our
efforts should be further directed to gain the patient's confidence,
with the assurance that our utmost skill and care will be exercised
in the treatment. All our knowledge, tact, and judgment should
be exercised to approximately judge how much fatigue and nervous
strain a delicate child or sensitive woman can, with safety, endure.
N N 2
540 THE DENTAL RECORD.
To subject a person to undergo a prolonged or painful operation
when the mental and physical capacities are below par, will often
produce extreme nervous exhaustion ; and the re-action which
follows may prostrate the patient for several days, rendering the
period one of great distress and discouragement.
Pain is usually regarded as a symptom and not a disease, per se^
and when referred by the seat of consciousness to the exact locality
of its cause, it becomes an infallible aid in diagnosis.
We are, however, only too familiar with the fact, that the
irritation of a nerve may, and constantly does, manifest itself by pain
in one or more remote or distant places, and as it were to render
confusion worse confounded, the true seat of lesion may be
altogether free from this symptom.
Not unfrequently the pain declares itself in a perfectly sound
organ, which,- through carelessness or ignorance, may be readily
sacrificed at the expense of the real offender.
Owing to the constant irritation to which its terminal branches
are exposed, the fifth or trifacial is more prone to be the seat of
referred or neuralgic pains than any other nerve in the body. It is
the nerve of all others which concerns us mostly as dentists, and its
varied functions, numerous communications, and wide distribution
should be the objects of our special study. Any diseases affecting
the regions supplied by this nerve may give rise to neuralgic pains.
Amongst the dental causes may be mentioned, sensitive dentine,
putrescent pulp and irritating gases in the root canals, alveolar
periostitis, inflammation of the lining membrane of the antrum, but,
as far as my experience goes, chronic inflammation of the pulp is by
far the most common source of irritation. So constantly are these
pains associated with this latter disease that I always make it a rule
to ascertain their presence or absence, and the information I receive
becomes a valuable guide in my further investigation. The patient's
statement is as often as not unreliable and misleading, and when
this is complicated by the presence of unhealthy roots, pulpless
teeth, or teeth with large fillings in them m the region complained
of, it is no easy matter to identify any particular one with the
disorder. Under these circumstances, when there is a history of
diffused pains, and if in addition the paroxysms are prevalent
at night after retiring to rest, we may rest assured that in ninety-five
per cent, of cases which present themselves to us the irritation is
THE DENTAL RECORD. 541
due to a living nerve and not to a dead one ; and we should not rest
content in our examination until we have thoroughly satisfied
ourselv^es on this point.
The next most frequent dental cause of referred or neuralgic
pain is undeveloped or impacted wisdoms or supernumerary teeth.
Usually dental neuralgia is confined to the branches of the fifth
nerve, but when arising from the retarded eruption of teeth,
especially lower wisdoms, the pain is often more diffused, extending
down the neck, shoulder and arm of the affected side. Nor does
the evil effects of misplaced wisdoms even terminate here.
Numerous well authenticated cases are on record in which wide
neurotic disturbances have been distinctly traced to the reflex
irritation of these misplaced organs.
Mr. Hutchinson, in a paper read bsfore the Southern Counties
Branch, emphatically asserts that important functional derangements
of the whole nervous system, resulting in syncope, partial and
complete, epilepsy and hystero-epilepsy, can be traced to the reflex
irritation arising from some interference with the eruption of
the wisdom teeth.
It is not often that the dentist is consulted in these more extensive
nervous disturbances, unless the medical attendant has recognised
some possible source of irritation in the mouth. Nevertheless cases
of the kind may come under our notice more frequently than we
suspect, and the substantial relief which might follow our interference
should be an incentive to us to pay special attention to the condition
of the wisdoms between the ages of eighteen and twenty-five.
The causes of reflex pain first enumerated are spoken of as
peripheral neuralgia ; the source of the irritation may be situated
at any point in the course of a nerve trunk or its branch, or at the
nerve centres (central neuralgia). I shall conclude with a brief
reference to that intractably painful condition idiopathic neuralgia.
So far comparatively little is known of the pathology of this
affection ; and whether neuralgia pure and simple is of itself a true
disease, or whether it is merely a symptom of some obscure lesion
hidden from our view, is, I think, still a much disputed question.
Many investigators have from time to time observed marked
degenerative changes, more especially in the spinal cord and
posterior roots of the spinal nerves, and in resected nerve fibres
which were the seat of inveterate neuralgic pains; and, in the absence
542 THE DENTAL RECORD.
of any other known cause, these changes have been supposed to be
the source of irritation. It has been pointed out that this disordered
nutrition of the nerve tissue itself may be secondary to some
peripheral or central lesion, and bearing in mind the trophic
influence of long continued neuralgia upon the organs which the
affected nerve supplies, it must be admitted that this explanation is
a very plausible one.
Trousseau says " Whether neuralgia be due to chlorosis or to a
carious tooth it is still a symptom : in the first case of chlorotic
cachexia, in the second of a carious tooth." *' There is a great deal
of difference between these two forms of neuralgia as regards their
obscurity and curability, but not as regards pain."
The sudden onset of the pain, its intermittent character and
complete cessation in the intervals of the paroxysms, its constant
association with many well-known local and systemic disorders, the
rapidity with which a cure can often be effected, and the fact that
in so many instances the most careful microscopical examination
fails to reveal any changes in the nerve tissue itself, would lead us to
the conviction that in the large majority of cases we must regard
these referred neuralgic pains as the symptom of some local
disease or functional derangement. Hence we should approach
them in a sanguine manner, and carefully exclude every possible
cause of dental irritation before regarding them as beyond the scope
of our specialty.
ADAPTIVE MODIFICATION OF TEETH.*
By W. B. Barnard, M.R.C.S., L.D.S.
Mr. President and Gentlemen, — On looking at the list of
Papers read before this Society during the present year, I find the
subject matter of nearly all has a direct and practical bearing, useful
in the extreme, on our everyday work.
The subject of my Paper this evening, " Adaptive Modification
of Teeth," may perhaps at the first glance seem to have but little of
practical importance to us, yet I venture to think that an occasional
review of some of those influences at work in the formation and
modification of teeth, cannot but help us to account for and form a
true estimate of some of the conditions we are liable to meet with
♦ A Paper read before the Students' Society, Dental Hospital of London.
THE DENTAL RErORD. 643
more especially, perhaps, in connection with regulation cases, where
we find modifications in the conformation of the jaws, increased and
diminished number of malformations and malpositions of the teeth.
In the limited time before me, I feel an almost insurmountable
difficulty in compressing into a short space anything like a com-
prehensive survey of the subject. The examples of the extent to
which adaptive modification has taken place in the specialization
of teeth are so very numerous, and the secondary results accruing
from it so very extensive, and at the same time the causes of each
so very involved, that it is extremely difficult, if not impossible, to
confine the consideration of adaptive modification within a narrow
limitation, while a separate description and discussion of the causes
of individual cases would keep you sitting here all night.
I can only hope, therefore, by very broadly mentioning some of
the distinctive influences at work in that very complex force termed
'' Evolution," and by quoting a few of the more marked and
characteristic cases of adaptive modification, to recall its operations
to you, and in a measure illustrate how changes result from its
influence.
I have said from its influence, speaking as though it was per se
a distinctive, all-sufficient agent, but its existence in turn is so
dependent upon, and so intimately connected with the effective
working of other forces of evolution, and upon the ever varying and
changeful conditions under which evolution takes place, that,
regarding it in this light, it must be considered as a complex or
collective influence.
These influences, forces, or agents, as they are variously styled,
with which we are all now so generally familiar, have been in a
measure separately defined or formulated for us, and are presented
to us as more or less scientific axioms in such expressions as
'* Natural Selection," "Adaptive Modification," "Correlation of
Growth," and others, which will readily occur to you.
Adaptive modification may be defined then as a scientific axiom
which represents a certain force in the process of evolution, which
force in its operations tends to eliminate or do away with any part
or parts of an organization, which in the struggle for existence are
not directly useful, and to further develop any part or parts which
are found serviceable ; in other words, it effects " the suppression of
things not needed and the increased development of those most used."
544 THE DENTAL RECORD.
When we come to examine any dentition or individual tooth,
although we may say of it that it has attained to the condition in
which we find it by adaptive modification, it is as well to bear in
mind the varioui progressive steps by which it originated, as we
shall better understand the part played by adaptive modification in
its formation, and indeed we must regard it as the resulting issue of
all these agencies of evolution which we now recognise, and
probably of others which have not yet been finally determined. So
when we speak of adaptive modification of teeth, although we refer
more especially to that phase of evolution which is concerned in
their adaptation and modification into the various forms suitable to
the environment and requirements of their possessors, yet on
account of its very intimate association with the other influences of
evolution, such as " Correlation of Growth," and its dependence as
it were on the antecedent operations of some other of these
influences, we must, as I have already said, broadly keep in view
the general course of events in their gradual formation.
By thus recognising the various influences, their active co-
operation one with another and the ever repeating sequence of
events, we are in a position to understand how a simple dermal
covering becomes modified through successive generations, pro-
ducing dermal papillae, spines, scales, or teeth, as the situation may
determine, and it is by exactly the self-same process as that by
which they originated, and which so differentiated them as to make
them appear at the first glance totally distinct from other structures
with which they had a common origin, that they now assume such
adaptive modifications in structure form, number and position, in
the various classes of organized beings, and such adaptive modifica-
tions even in the same individual as to merit for themselves separate
descriptions.
In tracing out as far as we can the course of events in the record
of adaptive modification, it would appear that gradually, step by
step, the teeth of the various organizations became specialized,
one in this manner, one in that, diverging more and more widely
in their particular characteristics, until at last each organization in
its way was exactly suited to its conditions of life ; and just so long
as the conditions of life remained stable so long did the special
characteristics of each dentition and of each individual tooth remain
constant ; but inasmuch as the conditions of life at no time remain
THE DENTAL RECORD. 545
for any very lengthened period exactly the same, but are constantly
varying in a major or minor degree, so greater or less degrees of
adaptive modification take place, in the one case aflfecting whole
dentitions by a series of changes, in the other altering and
remodelling individual teeth.
Thus we find a complete dentition, carefully built up, specialized
and perfected to meet certain conditions, and in turn, under changed
conditions, just as carefully, as it were, disintegrated and removed,
until perhaps nothing more than a trace remains to show its former
presence, and this applies in like manner to specialized individual
teeth, so that we have to consider adaptive modifications of whole
dentitions, and it is by the consideration of these that we are
materially helped to divide up organized forms into definite and
distinct orders and adaptive modifications in minor degrees, in the
various orders and distinctive features of the several individuals in
each, while we find many adaptive modifications which serve to
link together the various orders.
With each successive modification, it will be readily seen that
there must often be, as the result of, and that the full benefit of such
modification should accrue, a corresponding modification of the
immediate surroundings, hence it is that we find adaptive modifica-
tions of the various tissues which support, carry, or which are
brought into immediate connection with the teeth, and again in the
manner and arrangement of their development.
Another consideration to which I have already alluded is the
very great influence of outside conditions, that is environment and
general requirements of life, which, in turn, by determining the
manner and extent of use to which the teeth are put, exercises a
most important bearing on their further modification.
Thus in the first instance, regarding the function of the teeth
as agents in digestion, the various subsidiary uses to which we find
the teeth put, for any purpose, all tends to adaptively modify them
in certain directions, and it is easily conceivable how certain teeth
may, in process of time, by means of successive adaptive modifications,
come to serve primarily for these particular functions. I have said
that we find adaptive modifications in structure, form, number and
position, and for the sake of preserving some sort of method, I shall
briefly recall to you illustrations of each, although as a matter of
fact they are to a great extent inseparable, the one influencing and
546. THE DENTAL RECORD.
determining the other. Under " position " we can also review
some of the secondary modifications which occur in the surrounding
structures, and some more general considerations connected with
adaptive modification.
Structure. — The investigations into the development and structure
of the various dental tissues, enamel, dentine and cementum, has
demonstrated the adaptive modification of these tissues individually
and of the manner and arrangement of their depositions. Although
we now class these tissues into distinctive varieties, such as " hard
dentine," ''vaso dentine," " plicidentine," etc., yet we know that
each is but a modification from a common origin, and is the
outcome of some special requirement in the structural arrangement
of the tooth. The folding up and wrinkling of ordinary dentine
into " plicidentine " illustrates this, and we see further examples in
the same pulp forming two or more varieties of dentine, as in many
fishes, where we have a hard fine-tubed dentine merging lower
down in the structure to a tubeless " vaso dentine," while in the
** sheep's head fish " (Sargus) and in the "manatee," we have, as it
were, teeth caught in the very act of adaptive modification, for not
only do we find the transition from a hard fine-tubed dentine to a
softer variety, but we have a vaso dentine in which the vascular
canals are in process of suppression. Similar illustrations may be
seen in the various forms and patterns of arrangement of the
enamel fibres, from the simple straight fibres of the before mentioned
'* manatee," to the most complicated and intricate pattern of some
of the rodents ; while, again, some enamel is penetrated by tubes, as
in most " marsupials," some few of the rodents and insectivora,
and in many fishes ; further, the enamel may be entirely absent as
is seen in the " edentata."
In the cementum also we find adaptive modifications in quantity
and position, in some cases being absent or 'scarcely present, in
others forming an essential feature in the bulk of the whole tooth ;
sometimes forming a partial and sometimes a complete investment.
As a very general rule we find a more or less thick coating of the
hardest material placed on the outside to receive the brunt of the
wear, and this at the first glance would appear at once the simplest
and most efficacious arrangement, but the ever varying conditions
of life have necessitated, in many cases, an adaptive modification of
this arrangement. With many grinding and crushing teeth their
THE DENTAL RECORD. 547
efficacy depends upon their keeping a roughened surface, and this
has been attained by the disposition of the tooth structures, plates
of enamel and dentine being, as it were, vertically embedded in
cementum, the difference in the rate of wear of these materials
continually keeping up a roughened area ; whereas, had there simply
been a thick enamel coating, this, in process of time, would
inevitably have worn smooth and rendered the tooth useless.
Again, where a sharp cutting chisel edge is necessary, this same
adaptive modification in the disposition has taken place, the harder
tissues being placed only on the front surfaces, the posterior surface
being thus unprotected and formed only of comparatively soft
material wears away much faster, leaving the front standing as a
sharp cutting edge. Another structural adaptive modification is in
some instances produced by the formative pulp calcifying into an
osteo-dentine.
Many other examples might be quoted showing an almost endless
adaptive modification in structure, brought about by the many
variations in quantity and deposition of the various dental tissues.
Form, — The adaptive modifications in form are, generally
speaking, more obvious than those of structure, and it is to the
form that perhaps more significance is attached when reviewing
adaptive modification. Yet, as is easily understood, the form is in a
measure due to the structure.
It is now generally accepted, that at an early period in evolution,
teeth were all more or less alike in form, orfhomodont, and that all
the heterodont or diverse forms have been produced by adaptive
modifications from a simple pattern of tooth, sorriewhat similar to
certain teeth still found among some of the reptiles and fishes.
Although the varying degrees of development into highly specialized
forms is so extreme that in many instances it is only by analogy
that we can recognise the individual teeth, yet the general course of
adaptive modification, at any rate among the higher orders, has
been sufficiently similar in its results as to bring about a tolerably
uniform resemblance between the various teeth of different animals,
enabling us to classify them into incisors, canines, premolars and
molars, and it is by the comparison of these individual teeth, one
with another in the different species of an order and of the various
orders, that we can more nicely trace out the graduations in the
steps of adaptive modification. i^b \laii; .
548 THE DENTAL RECORD.
Thus the comparison of the premolars and molars of the various
species of carnivorous animals affords an illustration of their
varying development into cutting blade-like instruments, showing
the graduation in adaptive modification suiting the animal to its
special habits of life.
Among the " ^^luridea," the most carnivorous in habits, the
premolars and molars all tend more or less to a blade-like form, and
the sectorial or carnassial teeth proper are especially well marked
both in form and size, while in the " Arctoidae,'' proceeding down
the various sub-families, " Mustelidoe," " Procyonidce," we find a
gradual diminution in this blade-like form, till among the " Ursidae "
this characteristic has almost disappeared. In many instances so
characteristic has the adaptive modification in form become, that it
is comparatively easy to tell, very approximately, the habits and
nature of food of any animal, inversely, as it were, from his dentition.
And, again, especially in the case of the canine tooth, the differen-
tiation in form has become so marked that in those cases where
another tooth has been adaptively modified to fulfil the function
necessitating this particular shape, it has become a matter of
difficulty to determine which is the true canine. The general
characteristics of the canine are too familiar to need mention, but
as illustrating the degrees of differentiation into a highly specialized
weapon, we may recall the "pig" family. Under domestication, the
pig has a comparatively small, harmless looking canine — although
relatively to the other teeth much larger and modified — to serve as a
digging weapon. In his progenitors, the wild boar, living under
vastly different conditions of life, these teeth are much more
developed, the curved and pointed tusks becoming formidable
weapons, not only of use for digging, but furnishing the animal
with offensive and defensive weapons in his struggle for existence ;
thus by comparison we see evidence in the domesticated pig of a
reduction in size and general strength of the canine, i.e,^ the
suppression of things not needed. Turn the domesticated pig out
to run wild again, and in a comparatively short period under the
stimulus of constant use in his changed surroundings, the canine in
succeeding generations once again becomes the tusk of the wild boar
by the increased development of things most used. In the " wart-
hog," with his huge and formidable tusks, and in '' sus babirussa,"
with his immensely elongated and curved tusks, we have evidence
THE DENTAL RECORD. 649
again of the further adaptive modification which takes place under
still more different conditions of life. Similar instances of change
in form, due to different conditions and habits of life, may be found
among the other teeth, as the premolars and molars of the horse,
from the brachyodont type of tooth found in its earlier ancestors, to
the hypsodont type of the present time ; while the manner of
disposition of the tooth structure results in the worn surfaces of the
teeth presenting a series of diagrammatic patterns which literally
record the various changes which have taken place. There are
many other marked instances of adaptive modification in form to
meet special requirements, as the poison fang of the viperine
order, the forceps-like incisors of many insectivora, the huge
development of the incisor tusks of " Proboscidea," the canines of
the narwhal, &c., while among the lower orders we have many both
curious and remarkable examples, as for instance, that very eccentric
modification found in the teeth of the " Mesoplodon Layardii.''
Number. — When we come to examine the adaptive modification
in number, we find that out of an apparent confusion, each species
and mdividual comes to be suited with a definite, well-proportioned
and serviceable number of teeth.
It would almost seem as if during the period of evolution, teeth had
been differentiated in innumerable quantities, in endless succession,
and in almost every conceivable situation, as it were, by way of experi-
ment, and subsequently the process modified according as to whether,
so to speak, the experimental teeth were found serviceable or not.
In this or that case the innumerable quantities have been reduced to
a definite and certain number, and the endless succession to a limited
succession at certain periods of life, or to the persistent growth of
one or more teeth. In many of the lower orders, as reptiles and
fishes, we still see this almost endless succession taking place, while
the specialization of individual teeth and the consequent secondary
modification in the surrounding structures in some measure accounts
for the limitation in number and succession, as is to some extent
shown in the general relation between the succession of teeth and
the retaining of a simple homodont dentition or the development to
a heterodont dentition. As a general rule the homodont having but
one functional set, while the heterodont develops a successional set.
We frequently find those teeth nearest to a highly specialized
one much dwarfed in development, and this gives us some sort of
550 THE DENTAL RECORD.
clue as to the adaptive modification in number ; for it is quite
conceiveable that the bulk of the nutrition as supplied to the
developing germs, would to a large extent be absorbed in the
development of the specialized tooth, while those in its more
immediate vicinity would suffer from a deficiency, and in consequence
remain more or less undeveloped. We can easily understand that
if this occurred to any great extent they would finally perish, partly
from this immediate cause, and partly because their development
would never be suflRciently great to bring them into useful existence,
and as useless appendages they would naturally tend to entire
extinction by this very suppression of things not useful in the
struggle for existence.
The gradual suppression of teeth, as it were, keeping pace with
the specialization of the poison fang in the various dentitions, from
the non-poisonous up to the most venomous snakes, shows this
adaptive modification in number remarkably well. Apparently in
other cases the reduction is effected in a similar manner, but by the
specialization of parts, other than the teeth, as the baleen plates
of the whale, while the total disappearance of teeth in birds may be
accounted for by the adaptive modification of the surrounding
structures into a bill or beak.
The adaptive modification of two of the upper incisors in
elephants into highly specialized weapons, together with the develop-
ment of the trunk, which in many ways fulfils the function of
incisor teeth, would account for the suppression of the other front
teeth.
The intimate connection between " Adaptive Modification " and
*' Correlation of Growth" is exemplified in some of the ruminants in
which the dentition is adaptively modified in number, to the extent
of the loss of the upper canines, or to only a partial development of
this tooth in those animals possessed of horns ; in these instances
the horns functionally taking the place of the teeth.
The examination of almost any dentition, either of an order of
species or an individual of a species, will show evidence of adaptive
modification in the number of its teeth, while in some few instances
among the heterodonts, we have examples of adaptive modification
in the functional use of deciduous teeth with the permanent
(hedgehog, etc.) as though the differentiation into two dentitions
were still incomplete.
THE DENTAL RECORD. 561
Position. — In reviewing the course of adaptive modification of
teeth, we might well start by speaking of the position they occupied,
because in the first instance it was greatly due to the position in
which the elementary tissues came to be situated that their
differentiation into teeth took place : and again the specialization of
any particular tooth is perhaps primarily accounted for by its
occupying a favourable position suitable to that specialization. But
the adaptive modification in position being relatively determined by
the amount of secondary adaptive modification occurring as the
result of specialization in structure, form and number, it is perhaps
best considered after these have been reviewed, while in connection
with it we may consider those further adaptive modifications
occasioned for the effective development, eruption and protection
of these specializations.
We can understand that once specialization has started in any
one tooth, the constancy of its development in that particular
situation in successive generations becomes an essential feature
both in the perpetuation of this characteristic and in its further
modification. Thus " the certainty," if I may so express it, with
which we find, at least among the higher orders, cutting, slicing, or
piercing teeth in the front of the mouth, crushing and grinding at
the back, always being developed and occupying more or less the
same relative position is in a measure the outcome of adaptive
modification. The position primilarly determining adaptive modifi-
cation and the resulting specialization in turn, ensuring by functional
activity a recurring constancy of position. The position then
having come to be more or less fixed, any further adaptive modifi-
cation would in many cases' necessitate further modifications in the
bony surroundings, and these in turn, while not interfering with the
essential position, may effect a relative change in the general
position. The increased area for implantation and for growth from
a persistent pulp, examples of which are numerous, illustrates this ;
thuF, the implanted portion of a persistent tooth will come to occupy
practically the whole length of the jaws, extending possibly beneath
the implanted portions of other teeth. Although many of these
adaptive modifications in the surrounding structures are spoken of as
secondary to that of the teeth, they can scarcely be considered so in all
cases, as they take place concurrently with the modification of the teeth
themselves, and form an essential feature in the general adaptation.
552 THE DENTAL RECORD.
Thus the differentiation of the various manners of tooth attach-
ment may be considered due to adaptive modification, and at any
rate in the case of the hinged teeth is obviously the important
adaptation.
Again, inasmuch as each speciaHzation of either dentition or
individual tooth is directed to the survival of the particular organi-
zation, special adaptive modifications occur for the due protection
of each characteristic, and for their due succession and proper
eruption when required. Downward projections of the lower jaw
occurred in some animals to protect the long upper canines, which,
when the mouth was closed, would otherwise have projected below
the lower jaw. Protection to the poison fang of viperine snakes is
afforded by a highly specialized adaptive modification of the skull
and jaw bones, resulting in a mechanical arrangement whereby the
fang is laid flat along the roof of the mouth when not in use, while
a specialized mode of development takes place ensuring the almost
immediate replacement of a poison fang should it be injured or lost.
The curvature so frequently seen in teeth of persistent growth is a
further illustration of adaptive modification for protective purposes,
the curvature relieving the pulp tissues from direct pressure and
concussions, which otherwise might set up inflammatory conditions
terminating in its destruction.
There are many other secondary modifications occurring in
connection with the adaptation of the teeth, as the alterations in
the general conformation of the skull bones, developments of special
bony areas for increased muscular attachment, and modifications
in the manner of the jaw articulation all of which, though
interesting, would take too long to go into on this occasion.
Perhaps, as illustrating the capacity for, and the certainty with
which adaptive modification takes place, the instance of those cases
were certain species have been isolated and cut off from all inter-
communication with each other, as the " Aye- Aye " of Madagascar,
the ''Wombat" of Australia, and the rodents of the rest of the
world should be mentioned.
Although these species are totally distinct, yet the resulting
outcome of adaptive modification of their dentitions has been
practically the same. So much so indeed that a casual observer
would be led to suppose them, if not quite of the same species, yet
very nearly akin. In these instances, as there was, so to speak, a
THE DENTAL RECORD. 553
different starting point in each case, it would serve to show that it
is not the particular elements available that determine the result,
but rather the conditions and habits of life under which each is
developed, so that should these conditions at all correspond, the
resulting dentitions would in a large measure approximate, and the
existing differences be relatively slight and solely due to the ntegral
differences of the elementary tissues. The same fact is apparent in
the comparison of the hinged teeth of the ''pike" with those of
other fishes, where we find that although the structural peculiarities
of each is distinct, yet the same ultimate result is obtained by
adaptive modification.
Of more especial interest to us is the study of man's dentition,
and we find that in common with the rest of all organized beings,
it has reached its present condition through a long series of adaptive
modifications. It is only by investigating, reviewing and tabulating
the series of steps which have taken place in the origin of the
various species that we are enabled to realize and appreciate its true
character.
The study of the development of the human jaw, of the tooth
germs, the structural peculiarities of the teeth, their form and
number, still afford us some broad hints as to their adaptive
modification from and through lower forms, and although in the
retrogressive study of the teeth of man, back to the earlier and less
specialized dentitions, there comes a period beyond which we cannot
with certainty proceed, the chain of evidence being far from
complete, yet we can by analogically filling in the gaps estimate
fairly accurately the types in form and number from which they
have been adaptively modified.
We can still trace in the gradual transition from one tooth to
another, central to lateral, lateral to canine, and so on, the relation-
ship of one tooth to another, and possibly a suggestion of the
relationship to an antecedent homodont form, though in the earliest
and most primitive mammalian forms known the dentition had
already assumed a heterodont condition. By investigation we have
formulated the typical number of teeth for the mammalian
group as 44, and we see from this that a modification in number
has taken place to the extent of the suppression of 1 2 teeth out of
the 44.
We find in the comparison of the dentitions of anthropoid apes,
o o
554 THK DENTAL RECORD.
early man, and savage races with those of civilized beings, direct
evidence of adaptive modification taking place as it were within
historical measurement.
Although in number, in structure and deposition of tooth
tissue they are practically identical, and the periods of eruption
nearly similar, there is a very appreciable difference in their general
characteristics.
In the dentition of the anthropoid apes we find a very much
greater increase in the general strength and size both of the
individual teeth and of jaw development generally. The third
molar especially, instead of being the same size as the other molars,
as is the case in early man, or even smaller as is generally the case,
at the present time is larger in both the gorilla and orang-outang.
The canines are largely developed, more especially in the males, and
a diastema exists for the reception of the point of the lower one,
while there is a difference in the period of eruption, due to its great
development in the males being chiefly a sexual characteristic, and
hence only erupting when sexual maturity is reached ; while it is
tolerably certain that man's earlier progenitors had a very similar
development of the canine tooth, and we still see occasionally cases
of reversion in which the canine projects above the level of the
other teeth and a trace of a diastema is present.
Apart from racial distinctions, the teeth of early man and savage
nations are, perhaps, denser and harder in structure ; the individual
teeth slightly larger, and the general cusp area consequently greater
and the implantation more extensive ; the third molar especially being
a larger and more typical tooth than is generally found among civilized
races, while the general jaw development is proportionately greater.
Early man was, and savages are, less liable to irregularities and
morbid conditions of the teeth generally, and this would indicate
to a great extent perfect functional use, that is an exact adaptive
modification to their condition of life. Savages in various parts of
Africa and in the Malay Archipelago file the incisors into points
like those of a saw, or pierce them with holes into which they
insert studs, revealing at least by these acts a less sensitive state of
the tooth structure than perhaps the majority of us are accustomed
to meet with.
The consideration of these facts would point to a lesser suscepti-
bility in the tooth structure to those conditions which, in a civilized
THE DENTAL RECORD. 555
being, would rapidly tend to the destruction of the teeth, and thus
indirectly show that some sort of modification has taken place
among civilized communities. The investigations into the deviations
of the cusp patterns of the molar teeth of man point to a modifica-
tion in the number and size of development of the cusps, while the
third molar is slowly but surely tending towards a rudimentary
development which, if continued, must end in its total disappearance.
The frequency with which we find at the present day jaws
developed on a much smaller scale than the teeth which they have
to accommodate, probably points to the conclusion of a further
reduction in number eventually taking place, while some of the
irregularities which we encounter, as suppression or complete
absence of certain teeth, deviations from the normal type, more
especially in the direction of a reduction in size, fusion of cusps and
roots, etc., might be regarded as an evidence of a modification now
in progress.
The susceptibility of the teeth at the present time to caries and
other morbid conditions in structure, although perhaps primarily
accountable to other causes, may indicate a tendency to a softer and
less lasting condition of tooth structure. We have realized that
adaptive modification is occasioned by the changing conditions of
life, and when we review the immense changes that have occurred
in the habits and general surroundings of man, and the very rapid
progress towards further changes, we cannot wonder at, and, indeed,
must expect to see modifications taking place in his dentition.
I have already referred to the correlationship between the
development of one and another part as affecting the course of
adaptive modification. These have been shown to exist between
"hair and teeth," " horns and teeth," '' muscular development and jaw
development," and again between the jaws and the development of
the extremities (hands and feet).
When we consider these in connection with man's circumstances
of life, and think of the many existing conditions which materially
affect the development of the hair, the hands and feet, and muscular
development generally, may we not expect to find his dentition in a
somewhat unstable condition ?
We are perhaps inclined, when reviewing adaptive modification,
to call to mind those teeth which have been developed to an unusual
degree, to serve some special function, as especially illustrative of
002
bbQ THE DENTAL RECORD.
the subject, almost forgetting that the partial or complete suppres-
sion of individual teeth or dentitions, general changes in structure,
eruption and development, however slight, are quite as important ;
while again we are inclined to regard a particular dentition as more
perfect than that of a subsequent generation of the same species, and
to view with regret the degenerate days of dentition that have
befallen the descendants of a once more perfect race. In some such
a manner I have heard our present dentition spoken of, but it is
reassuring to remember that these apparent degenerations may be
regarded as the outward and visible sign of the inward and spiritual
grace of adaptive modification, which tends to the betterment of
all things to meet the requirements of existence.
What the ultimate outcome of the modification of our present
dentition will be is perhaps an interesting but scarcely practical
subject for speculation, but if the present tendency to suppression
in size and number of teeth continues, two points are apparent :
I. — That at some future period our dental formula will have to be
re-written ; and II. (not strictly scientific) that the number of dentists
available for the treatment of man's teeth, or may be " tooth," will
be amply suflficient.
In conclusion, I feel I ought perhaps to apologize for the broad
and general manner in which I have spoken of my subject. In a
measure I may have infringed, and attributed to adaptive modification
what in many instances is due to other influences of evolution ; but,
as I have tried to show at the commencement, the whole question
of adaptive modification is so involved and in the cycle of events
the various influences, as it were, in turn become cause and effect,
that it seems almost impossible to altogether attribute to an
individual agency any one special course. Thus I have spoken
very generally, first, because I found I couldn't help it ; and,
secondly, because it leaves a large field for criticism and discussion.
THE ODONTOLOGICAL SOCIETY OF GREAT BRITAIN.
The Ordinary Monthly Meetings were resumed on the 2nd
ultimo, ihe President (Mr. Robert Woodhouse) in the chair.
The minutes of the previous meeting (which was also the
Annual General Meeting), held on June ist, were read and confirmed.
THK DENTAL RECORD. 657
Mr. Lucien E. Browne, L.D.S.I., Marsh House, Tottenham,
Middlesex, was proposed for membership, and Mr. Robert Stephen
Fairbank, M.R.C.S.Eng., L.D.S., i8, George Street, Hanover
Square, W., was balloted for and duly elected a member of the
Society.
The Librarian (Mr. W. A. Maggs), reported in addition to the
usual periodicals and journals, the following books had been
received : — Two copies, Nos. 12 and 13, '' North American Fauna,"
United States Department of Agriculture ; two copies " La
Photomicrographie," by J. Choquet ; the Calendar of the Royal
College of Surgeons, England, 1896 ; and the "Transactions of the
American Dental Association, 1896."
The Curator (Mr. Storer Bennett) had no report to make.
The President then delivered his Inaugural Address. He
remarked, by way of preface, that his call to office was a surprise
which made him feel like Cincinnatus called from the plough to
guide aflfairs of State, except, that unlike him, he found his
predecessor had so judiciously conducted the work of the Society
that there were no tangled skeins standing over from last Session to
be dealt with. The 40th Anniversary of the Society, which would
be celebrated during the current year, was likely to be an important
one in their history, for in the present Session they must face the
momentous question of their future domicile, now that the hospital
was about to be rebuilt on an adjoining site. The accommodation
required was much greater now than formerly, owing to the expansion
of the Museum and Library as well as the increase of membership ;
but while he would like to see the Society a greater power even than
it had been as regards its great ethical and scientific aims, yet it
ought to be so situated that its social growth could also be enhanced.
Whether they might hope to continue their alliance with the
Dental Hospital in more commodious quarters, or whether they
might possibly locate themselves in some more central position, was
a question which remained open, and he was fortunate in being
supported by an able Council who could well be entrusted with so
important a matter. Since the previous meeting of their Society in
June, the medical profession had to mourn the loss of several of its
leading members. Where [so many had fallen it was difficult to
specialize, but the passing away of two such men as Sir John
Erichson and Sir George Humphrey from amongst the leading
558 THE DENTAL RECORD.
surgeons of the day created a blank which time alone could fill .
Sir John Erichson showed his interest in their branch of surgery
in many ways, and was for several years Chairman of the Managing
Committee of the Dental Hospital of London. In passing in
review the immense advance made in .dental surgery since the
commencement of the Victorian era, it must be conceded that it
was in the United States that a systematic training was first
organised, and diplomas in dental surgery first granted ; but while
America was a few years in advance of us in this respect, on the
other hand, the English educational system was on a much more
satisfactory basis. Our examination in arts was a safeguard to the
entrance to the profession, and the examination for the minimum
qualification, newly authorised by the College of Surgeons, enabled
them to look forward to the future with hope and confidence. In
the past there were men of good position and scientific attainments,
or the Odontological Society could not have come into existence,
but it was no disparagement to them to say that they could be
equalled to-day, and behind them was a strong and ever increasing
body of well educated and skilful practitioners — it was, after all, to
the rank and file of an army that its real efficiency was due. Not
only in Great Britain but throughout her colonies and dependencies,
and notably just now in New South Wales, were minds astir in the
question of dental reform. These newer communities had the great
advantage in dental, as in other reforms, of profiting by the
experience and mistakes made by the older country. Although the
practitioners of to-day had such enormous advantages over their
predecessors in every form of appliance and treatment, nevertheless
they had to deal with deteriorating structures, and it was to
efficiently grapple with this condition that all their energies and
resources were called into play. He had, however, been much struck
by the fact that they could often regard caries as a transitory
condition, and even the virulent of phagedaenic form — which in
young mouths well nigh drove them to despair — to a great extent
ceased after puberty, when, if judicious treatment had been adopted,
the strengthening forces of nature came to aid the dental surgeon
in his apparently hopeless task. What the Copernican system of
astronomy was to the old Ptolemaic, the science of bacteriology had
been to the older theories in shedding light on much that was
previously dark and inexplicable; it had revolutionized general
THE DENTAL RECORD. 559
surgical treatment, and their branch of the healing art felt the full
force of the wave ; antisepsis and prophylactic treatment, based on
its investigation, had aided them materially, and fortunately this
knowledge was not limited to professional circles — the general
public was becoming more and more alive to the importance of
having the guidance of the dental surgeon from the first dentition.
When parents realized that neglect of their children's teeth up to
fourteen or fifteen years of age too often meant ruin as to their
future comfort, health and appearance, much would be gained. It
would be remembered that the present year was the jubilee of the
introduction of anaesthetics, and it might justly be said that,
collectively, anaesthetics represent the greatest boon that modern
discovery had conferred on mankind. In connection with this
subject he could not but express the hope that ere long legislature
that so rightly protected dumb animals from needless suffering, would
make the production of narcosis in human beings, save in qualified
hands, a penal offence. ■ He regretted that as much could not be
said for local as for general anaesthetics, in these there was still a
great deal to be desired, although great things were often promised.
Cataphoresis was now raising hopes, but any method requiring a
length of time for its adaptation tended to increase the nerve
tension of the patient, and so discounted its value. Speaking of
the Rontgen rays, the President said it had occurred to him that
possibly it might influence their decision when hesitating as to the
removal of retained temporary teeth, with the hope of permanent
successors taking their place, as well as in other ways. The charge
of monotony and narrowness had sometimes been levelled against
their work, but the validity of such a charge entirely depended upon
the spirit in which that work was done. There was ample scope
for the accurate observer to note facts and form deductions as to the
laws of health, heredity and disease as applied to their vocation.
The busy man was often at a disadvantage in this respect, for, unless
endowed with a retentive memory and power of marshalling facts,
he often missed much that a more leisurely employed colleague
might gather from his experiences. It was to societies like their
own that the codification of incidents in practice was greatly due,
and so a mass of experience was being accumulated for the guidance
and benefit of a future generation. Of late years they had seen a
rapid multiplication of medical societies of all kinds, the ever
560 THE DENTAL KECORD.
widening field of knowledge accounted for this, and specialists like
themselves gained much by the close interchange of ideas thus
afforded. A society ought to be the means of confessing failure as
well as of recording success ; as had been well expressed in a recent
medical journal : " It is certain that in the long run we hesitate to
believe in the man who always believes in himself, and he who
begins by publishing nothing but his success may end by having
nothing to publish."
In looking back through the transactions of their Society, it was
noticeable how the discussions had broadened out, and that many
more took part in them than formerly ; nothing could be more
gratifying to the author of a paper, or more generally helpful, than
evoking a good discussion. Amid professional progress there was a
great deal around to deplore, but time, that impartial eliminator,
would banish much of this, the blatant quack and mendacious
charlatan would vanish midst protective laws and the enlightenment
of a better education. The roma quadrata they saw to-day would
give place to a roma imperialis of the future ; then would be seen
the full fruition of a movement fraught with immense benefit to
mankind, in which their Society had done much, but as yet had
reaped only the first fruits. The President was glad to say the
Secretaries had the promise of some excellent papers during the
coming session, and he might remind the Society how much pleasure
and profit was derived from casual communications ; he therefore
asked them to keep this list as full as possible. In conclusion he
thanked them again for the great and undeserved honour they had
bestowed upon him, and could assure them that no effort of his
would be wanting to justify their trust and to sustain the best
traditions of the Odontological Society.
Mr. William Hern related the particulars of a case of an-
chylosis of the temporary mandibular joint in a rather diminutive
lad, aged twelve, first seen about four or five years ago. The
lower jaw was small, undeveloped, and practically fixed to the
upper, and the one could not be separated from the other for more
than an eighth of an inch. The upper jaw was fairly developed
and had marked protrusion of the incisor teeth. There was no
history of injury to the face or jaw. After mechanical treatment
for about six months, feeling that little could be expected of it,
Mr, Hern, when the boy's dentition was completed in May last,
THE DENTAL RECORD. 561
consulted his colleague Mr. Bland Sutton, who advised the removal
of both condyles of the mandible. The boy came into the Middlesex
Hospital in August last, and Mr. Sutton commenced the treatment
by removing the right condyle, with the result that after the
operation the boy could open the mouth to the extent of over an
inch ; he had since been able to masticate with all kinds of food.
There was one very curious thing in connection with the case, viz.,
the marvellous development of the platysma muscle.
Mr. Bland Sutton said cases of undeveloped mandible had
interested him for a good many years, and bearing in mind the
tradition of surgery, he had never felt disposed to perform any
operation for them ; but when he wrote the article on diseases of the
jaw for Mr. Treves's " Surgery,'* he made up his mind that if ever
another case came before him he would at once operate and
deliberately take out both condyles. Mr. Hern asked him to see the
boy, and he came to the conclusion that the left half of the jaw was
undeveloped, although the right half was fully developed ; the jaw
was so firmly ankylosed that by no manner of means could the
patient get his mouth open, and he used to stuff his food in with
his fingers, much like a schoolboy would fill a popgun. The parents
were quite willing to have the operation carried out, and he started
with the intention of removing both condyles. He made an incision
down to the jaw where the condyle should be, and to his astonish-
ment came on a solid pier of bone, as thick as his thumb. Neither
the condyle nor the place where the joint should be could be
distinguished, but there was a thin narrow chink out of which
fibrous tissue projected. He detached the solid pier of bone, and
then cut a piece out half an inch broad completely across it. The
facts of the case might be fairly well stated by saying that the
ascending ramus of the jaw on the right side was practically
represented by a solid pier of bone, half an inch square, firmly
ankylosed to the temporal bone. Having cut that piece of bone
right through, taking care not to damage the nerve or artery, the
patient's jaw was forced open with a powerful pair of forceps, and to
his (Mr. Sutton's) astonishment the whole jaw began to move, arid
he discovered that there was a perfectly good condyle on the
opposite side. For a few days there was a little trouble with the
wound, a good deal of oozing coming from the under surface of the
bone, but after four or five days the patient was perfectly happy.
562 THE DENTAL RECORD.
The etiology of the condition was one which had exercised him a
good deal, and he thought the most reasonable cause for a lateral
ankylosis of that sort might be possibly explained by an injury to
the tempero-mandibular articulation with the point of forceps during
delivery. An injury at the time of birth might go on very slowly,
and ultimately induce in young children an ankylosis such as had
been described.
Mr. Alfred Woodhouse mentioned a similar case in a lady
who was a little over fifty when she first consulted him. When
about four years old she had measles, and inflammation occurred in
the articulation ; whether from pain or some other cause she ceased
to open her mouth. She was sent to a gentleman of high repute in
those days, but without much benefit, for in the result the jaw
became absolutely ankylosed. She had since lived by pushing food
through a space produced on the right side by taking out the
canines in both the upper and lower jaws. Her lower, which had
not developed much, was altogether receding, the muscles of the
neck were also but feebly developed.
Mr. Cornelius Robbins described the further history of a case
of retarded eruption of the permanent teeth, brought before the
Society some six years ago. The patient was a young lady aged
about twenty. It was one of those cases where no explanation could
be given. The first model showed the jaw undeveloped from the
right upper central to the second bicuspid on the left side, due to
the alveolus remainining in statu quo owing to the nonappearance
of the permanent central, lateral, canine, and first bicuspid. Origi-
nally there was a history of constant irritation in front of the second
bicuspid, which for want of support was leaning forward. There
was occasionally a small discharge at this spot, and on probing
Mr. Robbins could distinctly feel the polished cusp of one tooth, but
could not be sure of a second. Finding there was no possibility of
the tooth erupting in a position to be of use he removed the
offender under an anaesthetic, and found the leaning tooth was the
missing first bicuspid, and immediately below was the misplaced
canine. A small vulcanite plate was made and had been worn ever
since. Within the last few months he had been consulted again,
and, strange to say, the missing central and lateral appeared in
exactly the same spot from which the first two teeth w6re removed.
The second model showed the last two teeUi in situ. At the present
THE DENTAL RECORD. 5C3
time the missing right canine was ready to make its appearance.
Mr. Robbins also showed a photograph of a piece of glass in situ
taken by the X rays, which had been tolerated in the cheek of his
patient for over thirty years. The first attempt to photograph was
made on a piece of sensitized film, somewhat too large. They had
been covered with black paper and rubber-dam. Only a portion of
the large piece of glass showed, but a small portion of another
fragment was demonstrated of which they were ignorant. In the
next attempt they placed a portion of film on the tongue side of the
mandible, and increased the exposure, with the result that the tooth,
alveolus, and a portion of vulcanized plate showed fairly well, but
the glass was a failure. Ultimately they cut a smaller piece of film,
placed it as before, inside the cheek, and during the exposure pulled
the cheek upward, with the excellent result shown in the picture.
Mr. T. Charters White read a communication on " A
Method of Infiltrating Dental Osseos Tissues." His object was to
explain the utility of his process and the method of its manipulation.
First, as to its utility : experience showed that mounting sections of
teeth or bone in Canada balsam resulted in the obliteration of
cavernous and tubulous structures in the finished specimen, owing
to the balsam being absorbed by the dentinal tubuli or the lacunae
of bone. He had overcome this difficulty for many years by
mounting such tissues after thorough saturation in water and drying
their surfaces ; it naturally followed that the internal structures
being filled with water, the balsam could not run in ; but it occurred
to him later that if he filled the spaces with some coloured medium
it would give more decided evidence of the existence of cavities, if
such existed, than could be furnished by the water method. After
a variety of experiments he finally adopted the following process :
in the first place he ground the sections moderately thin to about
./g of an inch, and dehydrated by immersion first in absolute alcohol,
then for the same time in ether. When thoroughly saturated he
transferred it to a dry thin solution of celloidin, about three grains
of celloidin to half an ounce of equal parts of absolute alcohol and
ether. In making this mixture coloured red it is necessary to add
fuschine to the alcohol first, as the dye will not readily mix with the
completed solution. In his earlier experiment she had considerable
difficulty in getting the coloured celloidin solution to run into ill
tlie delicate cavernous structures. This would be obvialed '.he air
564 THE DENTAL RECORD.
contained in these structures was first replaced by ether : the solution
would then follow the ether readily. When the tissue has remained
in this solution for a day or two, if deemed sufficiently impregnated
with it, it might be removed and placed on paper to evaporate.
Paper was better than glass, because the preparations would stick to
the latter, and would become broken in the endeavour to remove
them. If, on the other hand, they should stick to the paper, they
could be readily soaked off in water. Another advantage of this
method of infiltration was that the sections were rendered less brittle
by their saturation with celloidin, and could be ground to the
desired tenuity without much fear of fracture, whilst cavities,
normal or abnornal, showed up a brilliant red, without their
obliteration by balsam running in ; sometimes the balsam became
stained by the red ; but this did not militate against the efficiency of
the process. Specimens indicating the above method were shown
under microscopes.
Mr. F. J. Bennett said Mr. White's ingenious suggestion as to
colouring with celloidin was one which was new, and which
appeared to be full of promise. He should like to ask Mr. White
whose celloidin he used, as it was a substance very difficult to get,
and especially to get it of good quality. When staining larger
cavities, especially cavities occupied by blood vessels, for example
of the cementum and the larger lacunae, they should be on their
guard to remember that celloidin shrank, and therefore if they saw
an apparently new structure under the microscope, it should be
remembered that it was due to the celloidin having contracted in
drying. There was no better study for beginners than to take the
stones of fruit in the spring of the year, say peach stones, and make
sections of them as they developed. It was well known that stones
of fruit at all stages of development were extremely good structures
for illustrating the formation of lacunae of bone. The fruit stone
started as a typical cell, and ultimately it became indistinguishable
to amateurs from bone lacunae.
Mr. Charters White said the celloidin he used was Scherin's.
The usual vote of thanks concluded the proceedings, and the
next Meeting was announced for the 7th December, when a paper
by Mr. J. F. Colyer will be read, entitled " Open Bites."
THE DENTAL RECORD. 565
LIVERPOOL DISTRICT ODONTOLOGICAL SOCIETY.
The Second Ordinary Meeting for this Session of the above
Society was held in the Medical Institution, on Tuesday evening,
November 17th.
Dr. Waite, the President, was in the chair, and there was a
good attendance of members present.
The Hon. Secretary read the minutes of the last meeting.
Mr. Tindal, L.D.S.Sng., was elected a member of the Society.
Mr. Rose presented two casual communications. First — An
impacted upper central, very faulty in the enamel, and root only
half developed ; removed from a cyst by Dr. Newbolt from a boy,
aged 11^. Second — Model taken from a young lady, aged 23 ; the
lateral incisor suppressed, and in its place the canine, and the
temporary canine, ?« sitii^ quite firm and strong.
Mr. CouNCELL showed a very useful bite frame, of his own
pattern, made out of perforated zinc ; also the root of an upper
bicuspid that had undergone a certain amount of absorption, the
tooth had been replanted for the patient some years previous to
removal.
Mr. Parsons handed round a model showing great deformity
through wearing a suction disc.
Mr. Bates brought forward a case of perforation of the apex of
a root in preparing for a pivot. A discussion took place among the
members as to the relative merits of sponge-grafting or guttapercha
in such a case.
Mr. Nixon showed a very interesting model of dilaceration in
the lower central incisors, their crowns were lying almost horizontal
with the cutting edge presented to the lip. There was a history of
the patient having run the blade of a pair of scissors into her gum
when she was about three or four years old.
Mr. DiCKiN (Southport) brought forward the following case . —
Some time ago a lady patient, who has several pivot teeth, had the
misfortune, while away from home, to break the face off .the upper
right lateral crown. The dentist whom she consulted put in a
Balkwill tube and split pin to the new crown. Shortly after her
return home the patient came to see Mr. Dickin about an abscess
which had formed at the root. By removing the crown (which was
an easy matter, thanks to the split pin) he was enabled to dress the
root and pass fluids through the fistulous openings on the gum, and
566 thh: dental record.
effect an apparent cure. But when from home again, a swelUng
came under the right eye, which could not be reduced by cold
water applications, and the root being free from any tenderness,
the patient had the impression that the swelling could not arise
from anything dental ; she being anxious to keep the root if possible.
So, without telling him, she consulted her medical attendant, who
thought there must be some eye affection, and advised opening the
swelling, expecting to find diseased bone, though he found none.
Then, the patient having drawn his attention to the removable crown,
she came again to see Mr. Dickin, who decided that the root must
come out. After its removal a piece (about one-eighth of an inch) of
a broken nerve extractor was discovered protruding through the
apex, the root was dilacerated, and showing a perforation at the bend,
which must have been caused by drilling out the pin of the first
crown, and pieparing for the second. The openings at the side of
the root accounted for the way Mr. Dickin was able to dress the
root. Fortunately the surgical operation had been skilfully done and
now there is only the slightest mark on the face, and all the other
symptoms have long since disappeared.
The President then called upon Mr. R. Edwards for his paper,
entitled " Pain." (See page 537).
After a very hearty discussion, in which most of the members
present took part, Mr. Edwards was thanked for his contribution, and
the meeting was adjourned.
Mr. Dall, of Glasgow, has promised to give a Lantern Demon-
stration on his Methods of Inlays for the next meeting, to be held
January 15th, 1897.
DENTAL STUDENTS' SOCIETY, DENTAL HOSPITAL OF LONDON.
An Ordinary General Meeting of the Society was held on
Monday, November 1 6th, the President (Mr. J. F. Colyer) in thechair.
Some very excellent microscopic slides exhibiting, the structure
of the tooth pulp were shown by Messrs. W. J. May and Miller.
On Casual Communications being called for —
Mr. Heath brought forward the case of a man who came to
this hospital last week with ulceration extending round the gum
hne in both the upper and lower jaws. His breath was foetid and
foul. Both his wife and his child suffered in the same way.
Mr. Turner had diagnosed the case as one of ulcerative stomatitis.
I
THE DENTAL RECORD. 567
Mr. Wallis showed and presented to the Society the model of
the upper jaw of a patient. Two supernumerary teeth, simulating
bicuspids, were present, and were situated external and anterior to
the second molar tooth at either side.
Mr. Gabell brought forward a motion to alter Rule 23, and so
change the time of meetings to seven instead of eight.
An amendment was proposed by Mr. Heath and seconded by
Dr. Miller, that the time should be half-past seven.
This amendment was put to ihe meeting as a resolution and
carried by more than two-thirds of those present.
Mr. Gabell also proposed to alter Rule 33, whereby any member
holding Dental, Surgical or Medical Diplomas was not qualified to
compete for the Students' Society prize. He suggested that the
words " Surgical and Medical " should be struck out.
Mr. Manning proposed as an amendment that any man who
entered for his full course at the hospital should be allowed to
compete, provided he did not hold a registerable dental qualification.
Mr. H. Lloyd Williams seconded this amendment.
The amendment was put -to the Society as a resolution, and
carried by the necessary majority.
The President then called upon Mr. Barnard for his paper on
" Adaptive Modification of Teeth." (See page 542).
In the discussion which followed —
Mr. Gabell thanked Mr. Barnard for his excellent paper, and
said that Mr Barnard seemed to say that there were opposing
evolutions.
Mr. May said that someone had suggested that the reason that
the female sus-barbirussa had not got long canines was because it
always walked behind and with its snout between the hind legs of
the male.
Mr. Morris asked if any trace of a diastema had been found in
the jaws of men ?
Mr. Barnard briefly replied.
The President then proposed a vote of thanks to those gentle-
men who had taken part in the evening's proceedings, and announced
that Mr. Padgett was unable to read his paper on December 14th,
and that a Clinical Evening would be held on Monday, November
30th, at 7.30 o'clock.
The proceedings then terminated.
568 THE DENTAL RECORD.
THE DENTAL'RECORD, LONDON : DEC 1, 1596.
THE RECENT EXAMINATION.
The recent examination at the College of Surgeons of
England has been disastrous to many candidates. The
official list is not yet published; but the percentage of
passes is not, we understand, so high as at some recent
examinations. We have already pointed out in a
previous issue that the ratio of failures to successes is
lower for the L. D. S. Examination than for any other
that this College conducts, and it may well be, with a
much increased standard, that we must not expect this
low percentage to be maintained. At the same time it
must not be forgotten that those schools, which send up all
their men for this examination, cannot expect to have so
high a percentage of passes as those, which only send up
their best men, the others reaching their qualifications
through some wider portal. Not that we would belittle the
success of any school, say of Liverpool, which with seven
passed out of nine candidates took the lead, we fancy, at
this recent examination. This was the more creditable
seeing that the men were wholly taught at this school, a
fact of which the teachers may be proud. But this does not
affect the argument we have mentioned, for this must be
taken into account when comparisons (which, as usual, are
odious) should be made between schools engaged in friendly
rivalry. With regard to the character of the examination
itself, we may, in passing, note a want of precision in the
wording of, at any rate, one of the dental questions, thus
turning a test into a riddle ; and it may well be doubted
whether, in an examination whose rationale is to ensure the
training of practical dentists, a question on trituberculism is
of any practical good. It is interesting, believed by some,
disbelieved by many, and at best a theory, which may
possibly appear ridiculous to our children. Surely there
are enough facts in Dental Anatomy of which to question
THE DENTAL RECORD. . 569
without wandering into the realms of speculation. In the
xica voce the questions in General Anatomy seem to have
been unusually wide of the head and neck. We can believe
that such questions may be but slightly taken into account
in awarding marks. Two reasons may be assigned for their
being put. First to give a fictitious value to the standard of
the examination ; secondly, to act as a warning that in
future the questions will be wider in character. Taking the
second as the probable explanation, it raises a point of
considerable importance to intending candidates. The
curriculum enforces the attendance on a course of lectures
on General Anatomy, and it is obvious that if this course
is attended intelligently simple questions should present no
difficulty. But it must be remembered that anatomy is, to a
large extent, a question of memory, and the memory, like a
lawyer, needs constant ''refreshers^'; hence, if these questions
are to be expected, the final work of preparation becomes
much more arduous. This brings back the question
whether, if such be the case, the recent changes in the
curriculum and examinations for the dental diploma have
been judiciously made. We have already expressed the
opinion that in one direction they have not. We urged that
Anatomy, both General and Dental, should have been
separated from the final examinations, which, under the new
scheme, as of old, touches on many things, but allows the
mastery of none. It must not be forgotten that the charges
were made at the instance and under the advice of this same
body of examiners, and if they now purposely enlarge the
scope of the subjects, they may, perhaps, be acting within
the letter of the stated curriculum ; but they increase the
r objections to this same curriculum, which in their wisdom
they have not seen fit to mend in this direction. One other
rumour reached our ears as an explanation of the questions
now under discussion : it was that the men had not been as
regular in attendance on general lectures as they should
have been. Hence the rod of chastisement. We mention
this to express disbelief of it, for it is no part of the
p p
670 THE DENTAL RECORD.
examiner's duty to go behind the scenes of the work of
preparation. Nor can we believe that those who sign the
certificates would do so were they not assured that their
action was right. To sign the certificate of a man as having
done work which he has not, is, to say nothing of the moral
obliquity of the action, so unkind a deed that we cannot
well believe it happens. It would be unkind because it
allows a man to meet an engagement to which he is not
equal, and because others, seeing delinquencies are winked
at, will fail to work when otherwise they might.
The following gentlemen having passed the necessary examination
of the Royal College of Surgeons in Ireland, have been granted the
License in Dental Surgery of the College : — A. G. Hudson
(Leominster) ; S. R. Lane (London) ; J. Leventon (Dublin) ;
R. Sievers (London) ; W. G. T. Story (Dublin). The following
gentleman passed the Primary Dental Examination : — F. H. G.
Pakenham (Dublin).
The following is the list of Officers of the Birmingham Dental
Students' Society for 1896-97 : — Presidetit — Mr. J. Dencer Whittles ;
President- Elect— Mx . A. T. Hilder ; Ex-President— Ur. Percy T.
Naden ; Treasurer — Mr. A. W. Shedden, 5, Belvidere Road,
Walsall ; Secretary — Mr. H. Percy Joscelyne, " The Bank,"
Redditch ; Committee— Mr. C. C. Wood, Mr. E. E. Turner, Mr. C.
H. Howkins. An interesting list of Papers has been promised.
The following are the dates of Meetings : — (1896) November 26th ;
December 17th. (1897) January 28th; February nth and 25th;
March 2^th.
We understand that Lord Kinnaird has accepted the position of
Trustee to the Dental Hospital of London, Leicester Square, and
seeing that Mr. F. A. Bevan is another Trustee, we may well hope
that the appeal now being issued for funds for the new Hospital,
will meet with public approval.
Federation is the order of the day, and many thinkers in the
States are urging the need of a national dental organization. There are
THE DENTAL RECORD. 571
at present many societies, some confined to certain States and others
embracing larger districts ; of the latter we may instance the
Southern Dental Association, in the Gulf region ; the American
Dental Association, in the Atlantic region, and the Pacific Coast
The effort to fuse so many interests will prove a hard
nut, but Ave'*TH^ our cousins success in their efforts to crack it.
The resignation of the Treasurer of Guy's, Mr. Lushington,
and the appointment of his successor, Mr. Cosmo Bonsor, will, it
seems, be accompanied by changes in the system of management.
Hitherto the Treasurer has resided at the hospital, and has been, we
believe, a more or less autocratic official. Coincident with the
formation of the new Sustentation Fund, the public will be given
some direct control over the affairs of this hospital, and the Treasurer
will cease to be a resident therein.
The death of Sir B. W. Richardson is a matter for universal
regret. The details of his distinguished life have been so freely
published and commented on in the daily papers that it is needless
for us to repeat them here, but it is well to recall the fact that Sir
B. W. Richardson was a frequent contributor to the Odontological
Society's papers, and that years ago he held official position in the
now defunct College of Dentists. He was, indeed, one of its
examiners. We share the loss which is felt by the general public,
but we also lose one of those figures who served to connect us with
the period of Reform now a generation since. We are pleased to
note that the President of the Odontological Society attended the
memorial service in his official capacity.
NATIONAL DENTAL HOSPITAL.
The Annual Dinner of the Past and Present Students of the
School of the National Dental Hospital took place on the 27th ult.,
at the Holborn Restaurant. Mr. Frederick Treves presided, ana
was supported by Mr. Tomes, Alderman Rymer, Professor Bradford,
Professor Herbert Spencer, Mr. S. J. Hutchinson, Mr. Frederick
Canton, and a numerous company.
The Chairman, in proposing the toast of the evening, " The
National Dental Hospital and College,'' said it was impossible on
p }' 2
572 THE DENTAL RECORD,
any occasion similar to the present to avoid the speculation why, in
all civilized countries, anything that had to be celebrated was
celebrated by eating, whether it was the opening of an hospital or
the closing of a bogus company ; and even beyond the confines of
civilization the custom not unfrequently prevailed, for the coming
of a new missionary was made the occasion of a dinner, which also
signalised his departure. But if the custom of public dinners were
indefensible, speaking generally, it must be admitted that no body
of men had a better excuse for dining together than dentists,
for they met to use their teeth. Although circumstances had
prevented his accepting the invitation of their Dean, Mr. Sidney
Spokes, to visit the hospital a few days ago, he was not so
ignorant of the work it was doing as might be supposed ; he
knew of its admirable position and of the good work it accomplished,
and he had a keen notion of the work done by the school. Some
institutions had a great desire to be big ; he took it that the ambi-
tion to be large was not a very lofty ambition. The National
Dental Hospital did not want to be big, but it did want to be good.
Referring to the quite remarkable progress which had been made
by dentistry and dentists within comparatively the last few years,
he thought it would be allowed that surgeons, who were themselves
engaged in the practice of a handicraft, were well qualified to judge
of that progress, and he did not believe that the dental profession
was so well appreciated by any body of men as the London surgeons.
He would like to be able to bring home to dentists how much
general surgeons owed to them ; it was extraordinary how many
maladies were due to the want of a good set of teeth. He could
give them many instances, but he would only mention one : a lady
with a glandular swelHng spent quite a gigantic sum of money in
her endeavour to get cured : she tried a variety of remedies, and
visited a number of watering places and Spas without any benefit,
and finally she went to a dentist who put her teeth in order and the
swelling of the glands disappeared. He felt that a very great good
would accrue to patients if dental surgeons and general surgeons
were more closely in touch with each other. He often heard people
talk about cheap dentistry ; he had the impression there was no
such thing as cheap dentistry — cheap dentistry was not dentistry.
He did not think that dental surgeons, as compared with general
surgeons, were overpaid. It was surprising that patients who would
THE DENTAL RECORD. 573
cheerfully give five-and-twenty guineas, or more, tor an instrument,
professed amazement at a like sum for a set of teeth. The dentist,
he believed, did literally more for his remuneration than did any
other surgeon. He could not help thinking that the progress of the
art and science of dentistry had raised the expectations of the
public ; what^'people expected from teeth now goodness only knew •
they expected them to be absolutely indistinguishable from the real
thing, they must enable the most senile old dotard to speak well,
and digest well. It was said that there is a place far away in the
future where there will be ^'weeping and nashing of teeth," it was
impossible to say to what extent it depended on the dentist of to-day
to realize the fulfilment of the prophesy. He could not help being
reminded of the story of the lady visiting in the village, rebuking
an edentulous old woman on her evil courses, and warning her, if
she did not mend her ways, she would certainly go to a place where
there would be weeping and nashing of teeth, whereupon, the old
dame, showing her toothless gums, said, " let them nash as has 'em.''
Referring, in conclusion, to the alterations recently made in the
regulations for the L.D.S. examinations by the Council of the ivoyal
College of Surgeons, the Chairman gave the health of the Natio al
Dental Hospital and College coupled with the name of the Dean,
Mr. Sidney Spokes.
Mr. Sidney Spokes, in reply, said he w^ould confine himself to
the points touched upon by the chairman, However gratifying it
might be to know the dental handicraft was appreciated by the
consulting surgeon, there was still a great deal to be wished for from
the ordinary general practitioner ; to take only one instance, the
general practitioners throughout the country were often called upon
to administer nitrous oxide gas for dentists, and until they learned
to distinguish between the legal and the illegal dentist the state of
things could not be regarded as satisfactory ; then the chairman had
alluded to the growing appreciation by the dentist of general
pathology and medical knowledge, that he thought was a thing
which was being more and more appreciated year by year. In the
past the student had merely to be signed up as having attended the
lectures on those subjects ; but in the future, under the new regula-
tions, he would have to go through the test of being examined in
them also. The Chairman had led his audience to anticipate that
he (the Dean) would say a great deal about the National Dental
574 THE DENTAL RECORD.
Hospital, but he did not propose to do so, he would only say that
it was going on as well as might be expected. With regard
to the accommodation, they had good elbow room, good
hght, good warming, and so on. He did not think they need
wish to be a very large school. They had room for about 50
students, and until some half-dozen had qualified at the recent
examinations they had about 40 students. There was one point in
connection with the number of students in relation to the hospital
as a charity, and that was the difficulty of getting through the
immense amount of work of adequately providing for the patients ;
they wanted 50 students in order to cope with this difficulty, and
when that time arrived they would have reached their millennium.
He would say that the authorities had determined to do all in their
power to keep out the patients who had no business to be there — he
meant those who could pay, and ought to pay, for the services of the
private practitioner. With respect to the present day student, he
came to them precisely in the same way as the student of the general
medical schools ; he had to face the same preliminary arts examina-
tion, nd was drawn from the same class of society. As the Dean,
he . as perfectly satisfied with the gentlemen who were entering the
sct.ool. In referring to the changes in the staff, the Dean alluded to
the untimely death of Dr. Lapraik, and the great loss the consulting
staff had sustained in the death of Sir Benjamin Ward Richardson.
He again 1 thanked the chairman for the kind way in which he had
proposed the toast, and those assembled for the reception they had
accorded it ; if anything was needed to spur the student on in his
work, the response afforded to the toast would be the means of
doing so.
Alderman Rymer proposed " The Past and Present Students."
When he saw a number of gentlemen before him, some of them
practising their honorable calling to success, and others aspiring to
do so, and when he saw them presided over by one of the most
eminent surgeons of the day, he could not help contrasting the
profession of to-day with that of 40 years ago. In lightly touching
upon the Reform period, he spoke of the late Sir Benjamin Ward
Richardson as one of the most prominent and active supporters in the
movement. It was a great and generous heart that had ceased to
beat. He had known him intimately for 40 years. Sir Benjamin
Ward Richardson had great abilities, was a hard worker, and had a
THE DENTAL RECORD. 3tS
wonderful memory ; this combination of qualities enabled him to
acquire an immense amount of knowledge, which it was his greatest
pleasure to impart to others and tell them how best to apply it. He
concluded by wishing the students God Speed and every possible
success in the future, coupling with the toast the name of
Mr. Frederick Rose (of Liverpool), and Mr. Browne-Thomas who
responded.
Mr. E. W. RouGHTON proposed the " Visitors," and Mr. Tomes
responded.
Mr. George Cunningham gave the health of the " Chairman,"
who, in a happy and humorous reply, spoke strongly of the need
of direct representation on the Medical Council, and warmly
advocated it as the right of the dental profession. He regarded it as
an anomalous state of things that the profession should be
practically controlled by the Council and yet have no voice at its
Board.
Songs w^ere contributed by Mr. Alfred Smith, Mr. Rushton, and
Mr. Browne-Thomas ; a violin solo by Mr. E. W. Roughton j and
recitations by Mr. Genet and Mr. C. W. Glassington.
GENERAL MEDICAL COUNCIL.
The Winter Session of the General Council of Medical
Education and Registration was opened, in the offices of the Council,
Oxford Street, London, on Tuesday, November 24th, when Sir
Richard Quain presided, and there was a full attendance of
members. The President, as usual, opened the Session with an
address, in which, among other things, he announced that reports of
the visitation by Mr. Charles Tomes of the examinations of the four
bodies granting a license in dentistry would be submitted in the
course of the Session. The Council, he [said, was greatly indebted
to Mr. Tomes for the great pains he had taken in the preparation of
the reports, and for the ability therein displayed. One could not help
feeling, he added, that each of the licensing or qualifying authorities
might derive useful information from a perusal of the reports. The
President also announced that a report on the whole subject
would be presented by the Dental Education and Examination
Committee.
576 the dental record.
Charge Against a Dental Practitioner.
At the meeting of the Council on Thursday, November 26th,
further consideration was given to the case of Clement Henry
Sanders, who, during the Summer Session of the Council, was
charged " that being a duly registered dental practitioner, you act
as cover of and by lending your name and assistance, enable an
unqualified and unregistered person named Miiller to carry on a
dental practice and to practise dentistry and dental surgery in all
respects as if he were a duly qualified dental practitioner." When
the charge was investigated in June the Council found it proved,
but adjourned the further consideration of it until the present
session.
Mr. Sanders appeared before the Council represented by
Mr. Johnston Watson, while Mr. R. W. Turner appeared for the
British Dental Association.
Mr. Farrer, solicitor to the Council, explained that Mr. Sanders
had been employing an unqualified person at his practice in Exeter,
while he himself was carrying on practice at Aldershot, and that
when the matter came before the Council last June they gave him
time to appoint a qualified man to conduct the practice at Exeter,
and Mr. Sanders was present to say whether he had complied with
the direction of the Council.
Mr. Sanders, interrogated by Mr. Farrer, said he had employed
a duly qualified dental practitioner named Bolpe for the Exeter
practice, and Miiller, the unqualified person mentioned in the
complaint, was now employed only as a mechanic. He was quite
prepared to give an undertaking not to employ an unqualified person
in the future.
Mr. Turner said that the British Dental Association quite
recognised that this was the first case of the kind brought forward,
but they wished it clearly understood that there was to be, what he
would describe as no humbugging, about the terms operating and
acting as a mechanic. If this were clearly understood then the
Association would have nothing more to say.
Several members of the Council then addressed questions to
Mr. Sanders, and, in reply to these, the latter said he did not wish,
nor did he intend, to employ any unqualified person for operating
purposes, while in the matter of administering anaesthetics he
employed a qualified medical man.
THE DENTAL RECORD. 677
The Council sat in private for some time considering the matter,
and when the pubhc was re-admitted, the President announced that
the Council had come to the conclusion not to adjudge Mr. Sanders
guilty of '' infamous conduct in a professional respect," but they
wished to caution him that in future he should be extremely careful
and should not employ an unqualified assistant.
Mr. Sanders thanked the Council, and said he had already given
this undertaking. \
Abstracts anb ^tltctxon!&.
PART OF THE SECOND LECTURE ON THE STUDY OF
ANATOMY AND ITS APPLICATION TO THE PRACTICE
OF MEDICINE AND SURGERY.
Delivered at Guy's Hospital, by W. Arbuthnot Lane, M. S.,
F.R.C.S.
The body of the same labourer illustrates in a wonderful manner
a function which the organism possesses. I refer to its capacity to
form a perfectly new mechanical arrangement, or to produce a
modification in an already existing one where it is obviously of great
advantage to it to possess it. The sweated shoemaker, as he sits
daily for twelve — and probably a larger number of hours — sewing,
holds his head in a sloping position, so that it is tilted obliquely to
one side. It would obviously be of the greatest service to him, in
that it would relieve him very considerably of muscular strain in
fixing his skull during the abrupt and powerful movements he is
B
Fig I represents the anterior aspect of the atlas, showing the prolongation
upwards of the anterior arch from the margin of the odontoid facets which
develop in consequence of habitual and excessive pressure — b ; also the large
quadrilateral mass of bone projecting from the upper part of the lateral mass
referred to in the text — a.
678 THE DENTAL RECORD.
constantly performing, if he had projecting up from the upper surface
of the lateral mass of the atlas, on the side to which his skull is
tilted, a pillar of bone which articulated with the jugular process of
the occipital bone, and formed with it a secure joint through which
much of the superjacent weight is transmitted. This is exactly what
takes place, and these diagrams illustrate the condition of the atlas
and of the occipital bone. (Figs, i and 2.)
B
Fig. 2 shows the foramen magnum and condyles of the occipital bone.
B indicates the groove which received the sharp free edge of the articular facet on
the atlas, a, a transverse ligament which lay behind this upward prolongation,
and c the facet on the under surface of the jugular process which articulated with
the column on the lateral mass of the atlas.
This represents a new formation quite independent of any pre-
existing joint, and therefore serves my purpose in demonstrating this
function very clearly to you. Yet, though this exists independently
of any joint, if you examine the various changes that take place in
the several joints in the labourer and in the subject whose
mechanics have been altered by disease of bone or joints, or by
fracture of a bone or bones, you will find the same law in evidence
everywhere.
We take advantage of this law very largely in lurgery. Occasion-
ally the temporo-maxillary articulation becomes ankylosed in
consequence of some septic infection, either from its becoming
involved in some adjacent inflammatory process or because of its
infection through the circulation as part of a pyaemic process. In
such cases the articular and interarticular cartilages are destroyed,
and the condyle of the jaw becomes united by bone to, and is
practically continuous with, the temporal bone. The jaws are fixed
on one another in the position in which they are normally closed, so
THE DENTAL RECORD.
579
that the molars and bicuspids come into accurate apposition, while
the incisors of the lower jaw project into the roof of the mouth
considerably behind those of the upper jaw. The patient is there-
fore only able to swallow food of a fluid consistence. If ankylosis
takes place early in life the portion of the jaw represented by the
condyle and neck becomes very broad and thick, and also shorter
than its fellow. The jaw not performing its normal function does
not develop in the same proportion as the rest of the bones of the
face, so that the chin loses altogether its normal prominence. The
lower incisor teeth, missing the habitual pressure exerted by the
upper incisors in biting the food, become abnormally long, and
project into the mucous membrane of the iroof of the mouth, so
interfering still further with the introduction of food. This difficulty
is even more exaggerated by the over-growth of the upper incisors
from the same causes.
The treatment of such a condition consists in cutting down upon
the temporal bone and upon that portion of the jaw which is
Fig. 3-
continuous with it, and in cutting away a piece of bone from the
junction sufficiently large to enable the mouth to be opened.
Within a few days of the operation the child is encouraged to bite
and chew, and by the mutual friction of the bones upon one another
they alter in form, become covered by articular cartilage, and a
580
THE DENTAL RECORD.
synovial membrane is developed. In this manner a perfectly new
joint is evolved, and it performs the function of the normal temporo-
maxillary articulation more or less perfectly. Perhaps I will interest
you more in the manner in which such a joint is formed if I
illustrate it by the report of a case, its treatment, and the result
obtained.
E. H., aged 13, was admitted under my care into Guy's Hospital
in September, 1893. When 18 months old she was stung on the
left upper eyelid. Much inflammation of adjacent parts followed,
with free suppuration, some of the skin of the Hd with the subjacent
orbicularis muscle coming away in the slough. Shortly after this it
was noticed that the child could not open her mouth, and much
difficulty was experienced in feeding her. On admission the face
was much deformed by the fact of the lower jaw being very ill-
developed. It was immovable on the upper jaw, and the incisor
Fig. 4.
THE DENTAL RECORD. 581
teeth of the lower jaw were very long, and projected into the roof
of the mouth, pressing on the mucous membrane. (Fig. 3
represents her condition at this time).
Chloroform was administered on September 19th, when it
was found necessary to open the trachea at once, as the tongue
fell back and occluded the upper aperture of the larynx. After
considerable difficulty the upper part of the ramus of the jaw and
the portion of the temporal bone continuous with it were removed.
There was no indication of the presence of the original joint. Owing
to the angle of the ill-developed jaw coming into contact with the
front of the spine, it was impossible to obtain a greater interval than
I inch between the teeth. This afterwards increased to an inch.
Associated with the more perfect development of the new joint, the
lower jaw increased in size so that the present condition, as shown
in Fig 4, though still very deforming, is not nearly as striking as it
was originally. Here you have developed during a fraction of the
lifetime of the individual a perfectly new mechanical arrangement
having all the structure and functions of a moveable joint, the only
foreign factors which determined its development being movement
and pressure of bony surfaces on one another, the organism itself
providing the necessary structures under their influence.
I will now show you how a bone will vary in form in a normal
subject when its functions change at different periods of life, and
the lower jaw again affords as good an illustration as any. This
bone in the infant performs no function other than that of moving
forwards and backwards upon the temporal bone during the process
of sucking. If you examine the temporo-maxillary joint of the
infant you find it possesses afibro-cartilage and two synovial cavities,
the condition differing from that of the adult in that the head of the
bone is less developed and is flatter on its upper surface, the
eminentia articularis is less prominent, and the fibro-cartilage does
not present the same variations in thickness. These are just such
differences as you would .expect to find between the joint of the
infant which is arthrodial or gliding and that of the vigorous adult
which is ginglymoid or hinged in character.
The jaw of the adult is very large and strong, and the angle has
quite lost the obtuseness of the infant and approaches a right angle
in size. This is the result of traction exerted upon this part of the
bone by the very powerful masseter muscles in forcibly approxi-
532 THE DENTAL RECORD.
mating the teeth in biting, this movement being absent in the
edentulous infant, while the general density and strength of the
bone is consequent upon and varies directly with the amount of
pressure it sustains in mastication.
The head of the bone is large and convex from before backwards,
the eminentia articularis is very prominent, and the fibro-cartilage
is dense and strong, and varies in thickness, so that when the jaws
are separated, it forms a suction socket for the head on the eminentia
articularis, while in the lateral gliding movement of chewing it
forms a smooth elastic surface on which the head of the bone moves.
It also serves another very important function during chewing or
scrunching of hard food, in that it acts as a buffer, breaking the
abruptness of force transmitted suddenly through the jaws. You
observe that the condyles of the jaw bear a very important relation-
ship to the brain, any constant succession of jars upon which might
result in damage to this very sensitive organ. The pugilist is
thoroughly cognisant of this fact, and finds that he can most
eff"ectually knock out his opponent by striking him under the jaw.
The amount of force required to do this is comparatively small as
compared with the strength of blows usually delivered, but the
whole of the force is transmitted through the condyles of the jaw
to the skull and brain within a very limited area.
Let us pass on to the examination of the jaw of the edentulous
subject. The angle again becomes obtuse since the factor which
diminished its size, namely, the severe and habitual strain exerted
by the masseter muscles has ceased to exist. The alveolar process
has disappeared since the mechanical conditions that determined its
development and continued existence, namely, the presence of the
teeth, no longer exert influence upon it. What are the functions
performed by the edentulous lower jaw ? They consist in gripping
the material between the gums and in breaking it up as much as
possible in this manner. Every one of you must have seen such
a subject eating, and must be familiar with the great freedom of
movements of the lower jaw upon the upper in a horizontal plane.
The anaesthetist is fully aware of this. The jaw of the vigorous
adult as a lever of the third order differs altogether mechanically
from that in infancy and edentulous old age.
This movement results in a complete alteration in the anatomy
of the temporo-maxillary articulation as it exists in the vigorous
THE DKNTAL RECORD. 688
adult. The head of the bone becomes flattened on its upper surface,
the fibro-cartilage is first perforated and then removed, and the
eminentia articularis is flattened. If the nutrition of the old subject
becomes very much impaired, the head of the bone and the flattened
glenoid cavity become deprived of articular cartilage and then the
opposing surfaces of bone, by their mutual friction, are gradually
rubbed down and altered still further in form apparently by a process
of decalcification and fibrillation.
Each condition of joint is perfectly normal to the subject at a
certain period of life. What variations exist result simply and
solely from changes in the physiology or function of the part. You
can readily understand that, if such a considerable change takes
place in the normal subject during a portion of a lifetime in
obedience to mechanical factors only, enforced alteration in diet
will readily produce such differences as exist in thejaws and dentition
of animals which are closely allied, as, for instance, man and the
higher apes. In other words this helps to substantiate the truth
of the view I would place before you, and which I hope to strengthen
by subsequent evidence, namely, that the sole factor in evolution is
a mechanical one. — British Medical Jouriial^ to whom we are
indebted for the use of the blocks.
FOREIGN BODY— PLUM SEED— IN THE (ESOPHAGUS:
PERFORATION INTO PLEURAL CAYITY.
C. W. Richardson {Nat. Med. Rev.^ i8q6^ vi., i7) reported the
following case :
The child was four years old. Eight days before the patient was
brought under observation it was said to have swallowed a plum seed.
The child was well nourished and active for its age. The mother
states that while feeding her child with preserved plums she observed
that there was considerable difficulty and then inability to swallow
the food.
On succeeding days the inability to take food was followed by
rapid emaciation, great restlessness and indications of febrile reaction.
The desire to take food and drink was constant, and all efforts on
the part of the little one were in vain. Food was immediately
ejected and liquids returned through the nasal passages.
584 THE DENTAL RECORD.
It was emaciated, showing marked evidence of a septic condition.
The examination of nose, pharynx and larynx gave negative result
with regard to the possible location of a foreign body. It was
interesting to note the little one's effort to aid in every way in these
examinations. The inspection of the pharynx and larynx was ren-
dered somewhat difficult on account of the great amount of pus that
was constantly welling up, apparently from the oesophagus. When
the child was given water to drink it was interesting to note that it
was immediately regurgitated through the nostrils ; the child continu-
ing to drink with the stream of pus and water returning into the
glass from which it was drinking. The column of water evidently
passed onward to the seat of obstruction and then returned up the
pharynx and through the nasal chambers. It now became evident
that the seat of obstruction was high up in the oesophagus. At the
first attempt to pass a small sound, after passing about three inches
below the cricoid cartilage, the sound was firmly arrested. The
breath had the sweet alcoholic odor of sepsis.
The next day the sounds were passed without difficulty and
without meeting any obstruction ; nevertheless the obstruction to
food and drink was as great as ever. On account of the possible
location of the foreign body, of the inability at this second examination
to locate it, and from the desperate condition of the child, it was
decided that endooesophageal or external operations were not to be
considered. The child died early Tuesday morning.
Postmortem. — Rigor mortis was moderate and the body emaciated.
The thorax was opened in the usual manner. Left side of thorax
was first exposed. Left pleura, lung, pericardium and heart were
normal. Right pleura discoloured and filled with pus. Right lung
collapsed. On exposing oesophagus it was found to be intact
throughout its whole course. It was then divided at the diaphragm
and dissected away. On raising the tissue up, when between about
the third and fourth dorsal vertebrae, the seed dropped into the right
thoracic cavity. It was not possible afterwards to locate exactly
which of two rents in the oesophagus the foreign body came through.
It is quite evident that the irritation of the seed set up an inflamma-
tion of the oesophageal wall which terminated in the formation of an
abscess which ruptured into the pleural cavity. — Pediatrics.
ii
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