Chapter II: Part 2

Rindfleisch says: "The accumulation of the fluid is not produced by the continuance of the normal secretion, but by an exudation surpassing the normal measure of the serum of the blood with salts, albumen, fibrinogenous substance, and extractives, in the most varying proportions. The exudation cysts have little to do with pathological new formation. Of extravasation cysts," he says, "a parenchymatous bleeding can very well be the point of departure for the formation of a cyst. The hemorrhagic depot can present itself primarily as a cyst, namely, when the blood is poured out between two surfaces in themselves smooth; for example, bone and periosteum, cartilage and perichondrium, and thereafter remains fluid. As a cyst may also be formed when upon the one hand the limitary parenchyma furnishes a connective tissue membrane, upon the other hand, the blood itself is resorbed through a series of metamorphoses up to a small remainder, and is replaced by a clear fluid."

The above-mentioned condition is liable to manifest itself within the body of the jaw, the bone and periosteum, after severe mechanical injuries to the bone, and the rupture of blood-vessels within the parenchyma. There can be little doubt that many of the so-called dentritic cysts of the jaws have their origin primarily from causes brought about by falls, strokes and mechanical violence, causing rupture of blood-vessels. It is quite true, history of cases fully confirms such facts.

Clinical observations leads us to believe, however, that only in cases where the abscess does not open, we find the pathological new formation taking place within the jaws. Pulpitis, and as has been observed, followed by pericementitis and periodontitis, is a prolific cause of the development of the dentritic cystic tumor.

_Treatment._--The removal of all dead teeth involved. Other teeth whose pulps are living may be loose, and to a casual observer appear to be complicated, but a careful examination will reveal the fact that they should not be disturbed but retained in their places; only one tooth may be the offender, being a dead one which has caused the trouble. After the removal of the cause, let it be either one or more dead teeth or fangs of teeth, cyst walls may be punctured with a sharp instrument, and the contents of the sac released, this being done by carrying the instrument through the alveoli, and not through the bony parietes of the jaw. After the contents of the sac is let out, and the sharp spicula of bone trimmed, with engine burs, tincture of iodine full strength may be forced into the cyst sac, by saturating tufts of cotton-wool and allowing them to remain, again repeating the treatment at intervals of a day. If necrosis of bone be present, it is good practice to alternate the iodine treatment with aromatic sulphuric acid. Cases generally yield to this treatment in from six week to three months. I have seen cases not yielding to treatment for nine months. There are other and shorter methods in the treatment which perhaps some would prefer--the cutting down through the body of the tumor, by making a crucial incision and scraping out the contents of the sac, afterwards allowing nature to do the rest--but I do not believe it is the best or safest way. There is surely a much greater loss of structure, which is never restored as in the former method by granulation, after the secreting cells have been destroyed by medicinal applications of iodine and sulphuric acid treatment.--_Medical and Surgical Reporter._

ARTICLE V.

THOROUGHNESS.

BY L. P. DOTTERER, D. D. S.

[Read before the South Carolina Dental Association.]

Though scarcely more than a novice in the vast field of Operative Dentistry, I have gleaned sufficient experience from observation and practice to know that THOROUGHNESS is the surest means of success.

Just as the tillers of the soil sow their seeds, watch their crops, and reap their harvests, so must we do our duty, advise our patients as to the best means of preservation, and would that I could say, reap our harvest. There has been so much written upon this subject that I have nothing _new_ to say, but will touch upon several points, and in giving my idea of thoroughness, as there applied, I may draw out some discussion.

The first step towards the preparation of the mouth for dental operations is the removal of calculus and decayed fangs. Let this be done in a manner that will _insure future cleanliness_, where the proper after attention is given on the part of the patient.

As regards the preparation and filling of cavities, there are so many conflicting conditions, that we must be governed entirely by the case before us; but to be thorough in our preparation, we must so shape the cavity as to have the walls nearly plumb, uniform margin, slightly undercut. In proximal cavities there may be a groove or pit at cervical wall, but do not have it too near the margin, on account of its liability to produce fracture, and consequent failure at that point. On grinding surfaces, cut out all fissures leading into cavity, and be careful to have no angles.

The margin, after all, is the most important point; for just here failure begins, especially at the cervical wall, and care should be taken to thoroughly remove all softened structure, and aim to reach a solid foundation. These margins should be carefully trimmed and burnished, and thus our cavity is ready for the filling.

We often hear practitioners decry the rubber-dam, and boast of their skillful use of the napkin; but, gentlemen, many are the failures consequent! For in deep proximal cavities, the dam is invaluable in keeping guard against oozing moisture from the gums, which, without this precaution, will flow upon the filling without our knowledge. The dam adjusted, we proceed to form a mass of non-cohesive gold, and where the walls are strong enough, we can continue with this material throughout. But where cohesive gold is necessary, we should cover our borders, as far as possible, with soft foil; for this is more adaptable to the walls. Another advantage to be found in non-cohesive gold, is its pliability, ease of starting, and rapidity in finishing. We should thoroughly condense from beginning to end, whatever may be the kind of foil used.

Filing and finishing is too often hurried through, leaving a surplus of material at the cervical wall, or lapping the edges--another sure cause of failure; and every care should be directed to finish in such way that an instrument passing over the line of demarkation cannot detect it. After filing, we would use pumice, either on a strip of orange-wood, or by some other convenient means, and then polish. The same general rule holds good in amalgam work, and the main cause of failure in these cases is that lack of thoroughness in finishing.

In grinding surface cavities, where the enamel leading thereto is funnel-shaped, we often introduce too much amalgam, extending it beyond the margins of the cavity, and finishing to a fine edge. This material, when hard and bit upon, will fracture perpendicularly around the margins, giving the finishing a bulged appearance, and exposing a V-shaped crack, which will invite decay. Consequently, we should remove all surplus material, and finish at the very margin of the cavity. When gold is used, this precaution is not so necessary, as the edges of a gold filling will not fracture. Since we do not have to mallet amalgam, it is natural to suppose we don't require firm margins, but this is a mistake; and as much, or even more care should be exercised in the preparation of a cavity for amalgam than gold, as tooth-structure seems to waste away more rapidly from the former.

Let our motto be, "Whatever is worth doing at all is worth doing well." If applying arsenic or a disinfectant, cover it with gutta-percha, for the patient may be delayed a few days longer than we anticipate; and what is worse than removing a foul piece of cotton, and finding the tooth in a poorer condition than we left it? If we introduce a temporary stopping on account of exposure or frailty, let it be done thoroughly; and after relating its importance to the patient, caution her to return at a certain time for its removal and permanent filling.

We must be teachers at our chairs, if we wish the public to appreciate us, and we should instruct patients in the proper care of their teeth by an intelligent and thorough use of the brush, pick, etc.

Such is the importance of thoroughness in dental operations. This paper does not half express it, but for fear of trespassing too much on your valuable time, I commend these ideas to your criticism.--_Southern Dental Journal._

ARTICLE VI.

WHAT FILLINGS SHOULD WE USE?

DR. W. G. A. BONWILL, PHILADELPHIA.

When I look back at my commencement and reflect that my early practice was founded on what the older men in authority had published and taught, and how I feared to do other than they demanded, I shudder at the many teeth I extracted I now know might have been saved, with even the amalgam of that day. And I tremble at the advice _now_ given by the authorities that _gold_ only should be used as a permanent filling. Young men knew no better, but the older do. God forgive them, I cannot. While I do not belong to the disciples of the new departure, _so far as their theory is concerned_, I stand side by side with any person _who can save teeth by plastic materials_, where gold cannot be used. Better do this than persist with gold indiscriminately, and lose teeth, rather than stoop to conquer with _any article_ that is _not gold_. The public are demoralized on the subject of _gold_. "Are you not going to fill my teeth with gold?" says nearly every new customer; "Dr. ---- would not think of using anything else." A city operator must have more than the usual quota of courage to stand before the societies and state "he has been using _amalgam_ more freely of late." For the first eight years of my practice I would not touch it, because Doctors Elisha Townsend and J. D. White passed their anathemas on everything but gold and tin. I worked myself nearly to death with tin to find it preserves from caries but not from attrition. Since 1862, I have been feeling my way, and while I think I have reared many beautiful and substantial monuments of gold, and have perfected machinery with which to do it, yet I consume more amalgam than ever before.

A gold filling _properly_ impacted, with cavity judiciously prepared, and the walls shaped as to forbid future decay, _will save_, irrespective of the frailty of their bony structure? But as thousands of teeth _cannot be so prepared_, both of strong and of frail organizations, and the circumstances _cannot_ be controlled, we should resort to something that will enable us the more surely to meet the issue.

To enumerate the many cases of peculiar character that forbid the use of gold, would be too great a task. Physical impossibilities lie in the way of every undertaking; and it is for the successful engineer, who is well acquainted with his material, and their relative strength and _adaptability_ for his purposes, to so use each, that his design will be consummated, and which shall not by future wear, prove a failure. There is a fitness in every material that experience has proven to be specially adapted for a given work, and when this general law is recognized and we become first-class engineers, we shall the better see where we can adapt our materials to the work to be done, and we can be the more certain of success, for it is founded on the logic of mechanics and physical law.

Where is the dentist that first lays out his design and orders materials best adapted for specific portions of it?

As well say everything should be made only of iron, or steel, or wood, as that every tooth should be filled with gold; or, as _equally ridiculous_, that the amalgam or some one of the plastic fillings should be the only material used.

It is not _necessary_ to found a _creed or departure_ on a law of _incompatibility_ to tooth substance. We need not look so far into the unknown and unknowable. We poor, short-sighted creatures must have the tangible; not a hypothesis on a _supposed theory_. Any one with half an eye can see just where the incompatibility is; not between gold and dentos, but between dentos and untutored and unskilled brain and hands to _carry out the law of adaptibility_--the correlation of forces involved.

One skilled in the use of the mallet, with the rubber-dam and a substantial starting point, with walls ever so frail, can perfectly impact and complete the work in gold filling, _provided the surroundings are there_. But allow _one little vacuum_ between the tooth substance and the filling, and a _capillary tube_ will be formed to suck up _fermentable material_; and the _acid generated_ will act on the tooth whether it be filled with gold, amalgam, oxyphosphate, or gutta-percha. A thousand capillary tubes making porosity in the gold or the amalgam, will not do it; but if there is one, however small, between dentos and filling, destruction is sure.--_Transactions of the Odontological Society of Pennsylvania._

ARTICLE VII.

SOME METHODS OF SEPARATING TEETH WITH WEDGES.

BY DR. DWIGHT M. CLAPP, OF BOSTON.

[Read at the joint meeting of the Massachusetts and Connecticut Valley
Dental Societies, held at Worcester, Mass., June, 1885.]

Among the many disagreeable and annoying, not to say painful, things that patients have to suffer at the hands of dentists, nothing, perhaps, is received with greater dread and disgust than the announcement that the teeth must be "wedged" before filling. Some, a small minority among us, I think, always fill without previous separation. In regard to the necessity for it, I will enter no argument here, but only say that personally I am a firm believer in wide spaces between the teeth at their necks, and labor to the best of my ability to obtain this result. It is most likely that many of you are using the same means that I am to get the desired room for filling, but by presenting and discussing the subject, it is possible we may obtain some help in doing what I fear the most of us find, at times, difficult and perplexing. For a long time rubber was about the only thing used for separating. It has some good qualities and many bad ones. It probably causes more pain and annoyance to the patient than any other wedge. Its liability to slide into contact with the gum, causing great pain and soreness, and even suppuration, has caused me to entirely abandon its use, I am willing to admit that it may be used successfully sometimes. The best rubber to use, if it must be used at all, is that of which the most inelastic tubing is made, or the erasers sold by stationers, cut into suitable shape. Wedges of wood are well adapted to cases where the sides of teeth to be wedged are nearly parallel, or where there is less space at the gum than at the points of the teeth. The wedge should be about as wide as the length of the crown, that is, it should extend from the cutting edge to the gum, nearly. It should be so shaped and trimmed as to not irritate the tongue or cheek. One advantage of the wooden wedge is that it is more cleanly than tape, cotton, or silk. This same class of teeth, those with nearly parallel sides, can be separated as successfully, and I think with less pain, with tape. Linen tape of various widths and well waxed is the best. It should be folded so as to be of proper width and thickness, and then drawn into place. A sharp knife is preferable to scissors for cutting off the ends. The tape should be thoroughly waxed, which assists materially in getting it between the teeth, and renders it more cleanly when left in the mouth for several days. In teeth with cavities so situated that cotton can be crowded in with sufficient force, this is one of the best wedges that can be used, as regards both effectiveness and comfort. It is necessary to so place the cotton that the force of expansion will be exerted against adjoining teeth and not expanded within the cavity. By once changing the cotton, space enough can generally be obtained. It is difficult to adjust and keep wedges in place between teeth having more or less space at the gum, and touching only at a small point near the cutting ends. It is in these cases that ligatures of various kinds serve an admirable purpose. Take for instance, the superior central incisors. These usually have but a small point of contact, with considerable space between them at the gum, and it is very difficult to put in a wedge of rubber, wood, or tape, that will not slip up against the gum, or come out altogether. If a ligature is used, the knots can be so tied that the string will clasp the point of contact in such a manner as to hold it quite firmly in place. There are many ways of making the knots; one is to pass the silk once between the teeth, then tie a surgeon's knot; but, before drawing it up, pass one of the ends again between the teeth, and then draw the knot so it will wedge from the gum towards the cutting ends; draw it closely, then finish by tying so that the last knot will be at the labial, or palatal side of the teeth. Another way is to make a series of knots like a chain stitch in crochet work, thus enlarging the silk for a suitable length; draw this between the teeth and tie as before, omitting the first knot that is drawn between the teeth. Another, and a very good way of enlarging the ligature, is, after well waxing it, to roll a little cotton around the silk as you would around a broach for wiping out a root canal, and draw this between the teeth and tie the same as when the silk is knotted. Still another method, easy of application and very effective in almost all cases where there is a cavity in one or both of the teeth, is to secure a pellet of cotton with the ligature. The silk is placed between the teeth in some of the before-mentioned ways; a pellet of cotton is forced into the cavity, projecting against the adjoining tooth, then the silk is tied firmly around the cotton. The swelling of the cotton and silk will make all the space necessary between any of the front teeth with but one application. The bulging of the cotton into the cavity or cavities, caused by tying the silk around it will hold it securely in place. This makes by far the most satisfactory wedge I have ever used, and, so far as I am aware, is original with me. It is sometimes well to open the cavity slightly with an excavator or chisel before wedging, so that the cotton will be more readily retained. For bicuspids and molars more than one application may be needed if much space is required. Quick wedging is sometimes possible, and when it can be done readily is usually desirable. Teeth that move easily may be separated sufficiently for operations by placing a wedge at the point of contact, and another near the gum, applying force gently with the hand, or light blows with a mallet, first on one, and then on the other, until wedged enough. Then remove the wedge that interferes most with the operation, leaving the other in place. Another way that often works well with children and with teeth that move readily, is to insert a large piece of rubber and let it remain from fifteen to twenty minutes, when the rubber will have opened a considerable space. A wooden wedge will keep the teeth from springing together while the work is being done. The appliances designed by Drs. Perry, Bogue and others, for making rapid separations, I have not used, but hear favorable reports in regard to them. Having spoken of rapid and semi-rapid separations, it is left only to speak of a method which works very slowly. It applies, as a rule, to the biscuspids and molars only. In many cases where there are large cavities between these teeth, and often, when it is desirable that they should be filled with what I think is very properly called a "treatment filling," it is well to fill the entire space between the teeth with gutta-percha. In the course of a few months the process of mastication will force the gutta-percha toward the gum, and on removing what has not worn away the teeth will be found well separated, the cervical margins well in view, and the cavities in good condition for a metal filling.--_Archives of Dentistry._

ARTICLE VIII.

COCAINE.

WALTER W. ALLPORT, M. D., D. D. S., OF CHICAGO, ILL.

The introduction of cocaine as a local anæsthetic, and the more general use of peroxide of hydrogen (H_{2}O_{2}) in the treatment of dental and oral diseases, are the principal advance made in the medical department of this practice during the year for which this report is made.

The two forms of cocaine which have been most generally used in surgery are the hydrochlorate and the oleate.

In operations in the mouth, involving the mucous membranes, together with the immediately subjacent tissues, these preparations have proven so efficient there is little question of its value as a local anæsthetic in such cases. But its action on deeper structures, such as involve the roots of teeth, is so uncertain as to render its practicable benefits questionable in the operation of extraction. In the surgical treatment of pockets caused by pyorrhea alveolaris, the anæsthetic effect of this agent is often so great as to render this sometimes very painful operation comparatively painless, and its employment in such cases should rarely be dispensed with. In the treatment of hypersensitive dentine, as well as in the removal of tooth-pulps, its action as an anæsthetic has, under some circumstances, seemed to be all that could be desired. But in far the greater number of cases it has proved of little practical value. More recently, however, a new form of cocaine, known as the citrate, has been introduced in Germany by Merck, and is now being manufactured by McKesson & Robbins, of New York. In a series of experiments, conducted by Dr. John S. Marshall, of Chicago, it has been shown that for operations on sub-mucous tissues, or in the extraction of teeth, it seems to possess no special advantages over the preparations previously named. But when applied to dentine or the pulp, its action--though not always positive--seems to be more reliable, especially on the dentine, and gives promise of better results. Under favorable conditions it produces anæsthesia of the parts in from five to ten minutes, and the duration of the effect is of sufficient length to afford time for the preparation of the cavity. This effect has, in some cases been prolonged for more than an hour. The pulp has been extirpated without pain after the drug has been applied in from three to twelve minutes.

If the citrate of cocaine be kept in solution for more than three or four days it decomposes and loses its active properties. As introduced by Mr. Merck for dental purposes, it is made into pills by incorporating it with gum tragacanth dissolved in glycerine, each pill containing 1/8 grain of the citrate. In this form it keeps well. A pill is applied to the sensitive cavity and covered with a cotton pledget, moistened in tepid water. It should be allowed to remain from five to twelve minutes, when--if at all--the desired result is produced. In twenty per cent. of the cases where this remedy has been employed it has proven unsuccessful, but it is hoped that this percentage will be reduced by a better knowledge of the drug and the improved methods of its preparation and use.

With this in view, and at the suggestion of Dr. Marshall, McKesson & Robbins are now manufacturing granules containing one-sixteenth of a grain of the citrate of cocaine, without glycerine or any other saccharine excipient, so that the obtundent may act more promptly than it can in the presence of sugar.--_Address at American Medical Association._

Editorial, Etc.

UNIVERSITY OF MARYLAND, DENTAL DEPARTMENT.--The fourth Annual session of this institution opened with a much larger number of matriculates than ever before in its history, and the number is so rapidly increasing that the present class of seniors and juniors bids fair to be larger than any preceding one.

The reputation of this school has never been sullied by the graduation of students for fees irrespective of professional ability, and the consequence of such a course as has been steadily pursued since its organization, has been to give a professional standing to its diploma which that of no other dental school excels. The present class consists of representatives from all parts of this country, and also Germany, France, South America, Canada, and even Turkey. Many states of this country are largely represented, such as New York, Georgia, Virginia, Pennsylvania, South Carolina and Maryland especially, and also the New England states, while nearly every other state is represented.

Students who have passed a session at other dental schools have entered on a second session at the University of Maryland, Dental Department, to complete their course of study and receive its diploma, and not one of the hundreds of students who have attended a course in this institution, has ever gone elsewhere to graduate. In matriculating the present class, the resolutions adopted by the National Board of State Dental Examiners have been strictly adhered to, and many applicants of this country and Europe have been refused admission who desired to make their attendance obligatory on graduation after ONE session's attendance.

The Infirmary and Laboratory practice is not excelled in size if equalled by that of any other dental school, and the records will show hundreds of gold fillings credited to the individual practice of students for both the regular winter and summer sessions. No other school can offer greater facilities for practical instruction, nor present more complete equipment as to building and appliances than this Dental Department. Dental practitioners are cordially invited to visit the University and inspect the specimen work of its graduating classes deposited in the museum. Large and valuable contributions from all parts of this country and also from Europe are almost daily being received for the Museum, which will compare favorably with that of any other dental school for valuable pathological specimens, which are also utilized for illustrating the lectures of each course.

* * * * *

CORRESPONDENCE.--The following letter was received from a prominent dental practitioner of Georgia for publication:

AUGUSTA, Sept. 30th, 1885.

EDITOR "AM. JOURNAL OF DENTAL SCIENCE":

DEAR SIR: According to my knowledge of the proceedings of the
organizations known as the "National Board of Dental Examiners," and
the "National Association of Dental Faculties," it was determined that
no dental school would be regarded as reputable that did not after
June, 1885, require TWO FULL SESSIONS OF FIVE MONTHS EACH IN SEPARATE
YEARS FOR GRADUATION. The only exceptions made being those who after
graduation in medicine had passed one year in the study and practice
of clinical dentistry, and also those who had attended a previous
session at a reputable dental school. I believe that the American
Dental Association also adopted the same rule. Am I not correct?
I therefore ask how it is that the dental school of Vanderbilt
University is permitted to offer graduation at the close of but one
session, to a student of this city who has passed one session only,
and that very irregularly, at the Georgia Medical College? I also ask
how the same school can offer similar inducements to another
student from Edgefield, South Carolina, as I understand it has done,
and yet be declared reputable? Was it for the purpose of permitting
such violations of the rules adopted by the different organizations
referred to, that the "National Association of Dental Faculties"
allowed the dental school of Vanderbilt University to abstain from
becoming a member of that Association for the present year, and
accorded to its Dean the privileges of the floor at its late meeting
in Chicago? I cannot see why some schools should be compelled to
conform to a rule that others may violate with impunity, and I think
that the State Boards of Dental Examiners of both my own state and
South Carolina should investigate the matter and act accordingly.

Respectfully, &c.,

"JUSTICE."

We can only reply to the above letter by stating that several students who as we had learned from their preceptors, intended to matriculate in the Dental Department of the University of Maryland, on discovering that they would be required to attend two sessions in the institution, had, we are informed, been induced to go to Vanderbilt by the promise of graduation on one session's attendance.

EDITOR OF "AM. JOURNAL OF DENTAL SCIENCE."

Bibliographical.

_A Series of Questions Pertaining to the Curriculum of the Dental
Student._--Embracing Dental Histology, Dental Pathology, Dental
Surgery, Dental Prosthesis, Dental Metallurgy, Dental Materia Medica
and Therapeutics, Anatomy, Physiology and Chemistry. By Ferdinand J.
S. Gorgas, A. M., M. D., D. D. S., University of Maryland. Publishers:
W. K. Boyle & Son, Cor. Baltimore and St. Paul Streets, Baltimore, Md.
1885. Price, $1.50.

This work comprises leading questions on all the branches belonging to the course of study pursued by the dental student, and its object is to facilitate the study of dental science and its collateral sciences.

Some years ago the author published a small work embracing in an abridged form, questions on Dental Science, and the favor with which it was received by the students of his class, was such as to rapidly exhaust the limited edition, and induce him to prepare, when opportunity offered, a more complete series of questions embracing the entire curriculum of the dental student, and even that of the medical student so far as related to Anatomy, Physiology and Chemistry.

The present work, therefore, is the result of such an intention, and is presented with the hope that it may accomplish the object for which it has been prepared.

* * * * *

_Practical and Analytical Chemistry._--Being a Complete Course in
Chemical Analysis. By Henry Trimble, Ph. G., Professor of Analytical
Chemistry in the Philadelphia College of Pharmacy. Illustrated.
Publishers: P. Blackiston, Son & Co., Philadelphia. 1885. Price,
$1.50.

The object of this excellent work is to place before the student of pharmacy and medicine a compact course of analytical chemistry.

The distinguished author believing that the study of Qualitative Analysis should be preceded by some practical experience such as relates to the preparation of the important gases and a few of the salts, devotes Part First to the consideration of Hydrogen, Chlorine, Hydrochloric Acid, Oxygen, Nitrogen, Ammonia, Nitric Acid, Carbon Dioxide and the preparation of such salts as Potassium Chloride, Potassium and Sodium Tartrate, Ammonium Nitrate and Oxalate, Calcium Phosphate, Magnesium Sulphate, Carbonate and Oxide, Aluminium Hydrate, Ferrous Sulphate, Ferric Sulphate and Hydrate, Copper Sulphate and Lead Acetate. Part Second is devoted to Qualitative Analysis, and Part Third to Quantitative Analysis, together with a description of apparatus, and the processes of filtration, evaporation, crystallization, ignition, etc. The work extends over nearly one hundred pages, and is a valuable text-book for the student.

* * * * *

_Chemical Problems._--By Dr. Karl Stammer. Translated from the second
German edition, with explanations and answers, by W. S. Hoskinson, A.
M., of Wittenberg College, Ohio. Publishers: P. Blackiston, Son & Co.,
Philadelphia. 1885. Price, 75 cents.

The text is in the form of questions to which answers are given at the end of the volume, which comprises one hundred and nine pages. Part First relates to the recognized elements, and Part Second to approximate ratios, temperature, atmospheric pressure and mixed problems, making a compact and useful text-book for the study of chemical problems.

* * * * *

_Quiz Questions._--Course on Dental Pathological and Therapeutics,
Philadelphia Dental College. Prof. J. Foster Flagg, D. D. S.
Answered by William C. Foulks, D. D. S. Third edition, Revised and
Enlarged. Publishers: The S. S. White Dental Manufacturing Company,
Philadelphia, New York, Boston and Chicago.

This excellent series of questions and answers on Dental Pathology and Therapeutics is again offered to the dental profession as a work of reference in daily office practice, and is the only book that contains in a condensed and practical form the facts and principles of these subjects, as enunciated by Professor Flagg. Commencing with General Principles, these questions and answers relate to Deciduous Teeth, Pathological Dentition, Lancing, Permanent Teeth, Dental Caries, Sensitive Dentine, Galvanic Action, Pulp Protectors, Obtunding Applications, Pulp Capping, Pathological Conditions of Pulp, Dental Exostosis, Malformed Teeth, Periodontitis and Alveolar Abscess, the whole constituting a work of great value to all engaged in the practice of dentistry. The work is interleaved with blank pages for notes, etc., and gotten up in a neat and excellent style. We take great pleasure in commending this treatise as a valuable adjunct to the regular text-books of the profession.

Monthly Summary.

PEROXIDE OF HYDROGEN.--_Dr. W. W. Allport, Chicago._--The peroxide of hydrogen (H2 O2), though not a new remedy, has only within the last few years gained much prominence in the treatment of surgical diseases. One of its uses in dental and oral surgery is in blind or deep-seated abscesses, such as arise from roots of diseased teeth. As the tendency of pus is always downward, when these cases occur in the lower jaw it is not infrequent that the abscess, if left to itself, and sometimes even after the tooth is extracted, will point through the external tissues at the lower margin of the jaw, and occasionally downward between the muscles of the neck, and open at various points, even as low down as the clavicle. The usual treatment is to extract the tooth and evacuate the pus through the alveolus, but it often happens that the formation of pus and the continuance of suppuration is not checked, and the abscess points, or is opened through the external tissue of the face or neck, leaving, when healed, a disfiguring scar.

By injecting peroxide of hydrogen into such abscesses before they point through the external tissues, this serious disfigurement can usually be averted, and the suppurative process is materially shortened. It is also a valuable aid for the evacuation of the purulent contents of the antrum of Highmore, in catarrhal and suppurative inflammations, and especially where the sinuses are divided into two or more pockets by bony septi. These cases are often protracted by the inability of the surgeon to perfectly evacuate them. But with this preparation it becomes a simple matter after access has been gained to the cavity by the extraction of a tooth or the perforation of its external wall in the proper place at the juncture of the cheek with the alveolar border. A free opening must always be made for the escape of the contents, in order to avoid pressure from the rapid evolution of gas. Two or three applications of a dram each is usually sufficient to completely empty the sac.

It is used with the most gratifying results in the treatment of pyorrhea alveolaris, and is an invaluable agent in treating pulpless teeth, as by its action all decomposed matter from the pulp chamber and dentinal tubuli is readily ejected, thereby removing the most frequent cause of discoloring of this class of teeth, of inflammation of the peridontal membrane, as well as alveolar abscesses.

The efficacy of peroxide of hydrogen depends on the case with which it is decomposed into oxygen and water. Pus is one of the many substances which causes this decomposition. Hydrogen peroxide acts first chemically and then mechanically. When the decomposition takes place the oxygen is set free and escapes from a liquid to a gaseous form; this expansion of the gas distends the pus cavity, and as it escapes from the orifice, it carries much of the pus with it, and its application should be repeated till all purulent accumulations are evacuated. The liberated oxygen, being in a nascent or active condition, rapidly oxidizes the products of suppuration, and destroys many of the micro organisms of suppuration.[A] Hence it is a disinfectant and anti-septic.

Finally, peroxide of hydrogen, after its decomposition, leaves no material in the system which is foreign to the system, and it is, therefore, one of the most efficient and harmless disinfectants and anti-septics that can be used, in all forms of purulent inflammation.--_Address at American Medical Association._

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ALCOHOLIC PARALYSIS.--The immediate and transient effects of an excessive quantity of alcohol upon the human nervous system, whether they are manifested in the form of drunkenness, or of delirium tremens, or of an acute attack of insanity, are well-known. Scarcely less evident are the effects produced upon the nervous system by a less excessive, but a more prolonged, abuse of alcoholic drinks. These effects may be manifested either in a general failure of physical and mental power, or in a form of disease closely resembling progressive paralytic dementia, or in various forms of chronic insanity, or in epilepsy, or in neuralgia, or in paralysis. In the acute form of alcoholic poisoning, no change in the structure of the nervous system has been found, except that the meninges in common with the internal organs and the mucous membranes are the seat of a very decided injection and slight exudation. In the chronic form of alcoholism, a number of pathological changes have been discovered in the nervous system, which, however, vary greatly in different cases.

Of late years the paralysis which results from the abuse of alcohol has been accurately described by numerous observers, and the attempt has been made to discover the lesion of the nervous system which is associated with this form of paralysis. Two cases which are reported by Dr. Henry Hun, of Albany, in the _American Journal of Medical Sciences_ for April, 1885, are typical examples of this disease, and contribute to a better understanding of it.

Dr. Hun has collected the recorded cases of alcoholic paralysis, and from their study he holds that we are justified in regarding it as a special form of disease with the following symptoms: After a number of cerebral and gastric disturbances due to the alcoholic poisoning, the symptoms of the disease proper commence with neuralgic pains and paræsthesiæ in the legs, which gradually extend to the upper extremities, and which are accompanied at first by hyperæsthesia, later by anæsthesia, and in very severe cases by retardation of conduction of pain. Along with these symptoms appears a muscular weakness, which steadily increases to an extreme degree of paralysis, and is accompanied by rapid atrophy and by great sensitiveness of the muscles to pressure and passive motion. Both the sensory and motor disturbances are symmetrically distributed, and the paralysis attacks especially the extensor muscles. In addition to these motor and sensory symptoms, there is also a decided degree of ataxia. The tendon reflexes are abolished and vaso-motor symptoms, such as ɶdema, congestion, etc., are usually present. Symptoms of mental disturbance are always present in the form of loss of memory and in transient delirium.

The lesion is in all probability a degeneration of the peripheral nerve fibres and of the nerve cells in the cerebral cortex, together with a chronic congestion or inflammation of the pia mater. This lesion explains well the symptoms, although it is curious that alcohol should not attack the spinal cord, but only the highest and lowest part of the nervous system, if one may so call the cortex of the brain and the terminal branches of the peripheral nerves.--_Detroit Lancet._

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NOURISHING THE TISSUES OF THE TEETH.--Dr. Frank Abbott says: For a number of years past I have entertained the views that there was some difficulty existing not due to an insufficiency of lime-salts, which occasions so many faulty and imperfectly formed teeth. With that idea in view I have advised exercise in the open air and other kinds of treatment for some patients which would favorably affect their digestion. That the food ordinarily taken contains sufficient lime-salts to form and to sustain the teeth I have no doubt (except in cases of extreme anemia, during gestation and lactation). I believe the fault is beyond that. There is a lack of proper nourishment of the tissues, due to imperfect digestion, which depends again on the proper "nerve tone." I believe this to be the real cause of the difficulty. It is reasonable to suppose that any _tonic_, whether taken in the form of exercise in the open air, or in any other form, which affects favorably other portions of the body, will affect the teeth favorably as well. When we have _ascertained the functions of the great nerve-centers_, and those functions are assured, then we will probably have more perfectly formed teeth.--_Items of Interest._

[Footnote A: See Gradle on "Bacteria and the Germ Theory of Disease," pp. 39 and 151.]