Transcriber's Note.
Italic text is denoted by _underscores_.
[Illustration:
THE
ARCHIVES OF
DENTISTRY]
SUCCESSOR TO
_Missouri Dental Journal, also Consolidated with New England Journal
of Dentistry_.
VOL. VII., NO. 4.] APRIL, 1890. [NEW SERIES.
Societies.
BLEACHING TEETH.
BY DR. K. M. FULLERTON, CEDAR FALLS, IOWA.
The bleaching of teeth has, from the first introduction of a positive
method, been met with remarkable indifference and, at times, positive
prejudice. Why this should be will remain a problem. The teeth that
require bleaching belong mostly to a class condemned for all purposes
except that of mastication. The process is generally only applicable
to the six anterior teeth, while possibly an occasional bicuspid may
be treated with advantage. When these anterior teeth, especially the
incisors, are discolored, they are such a positive disfigurement that
the operator has only the choice of evils—to bleach or to excise them,
and insert an artificial crown. It would seem no difficult matter to
come to a decision, or at least to determine to give the natural tooth
a chance for future usefulness.
The fear of re-discoloration, or annoying labor, should not be taken
into consideration. All operators are liable to meet with sudden
discoloration in the regulating of teeth by the strangulation of
the pulp at the apical foramen. When this occurs, it is one of the
most humiliating of accidents, as it is one of the most annoying to
patients. Discoloration is caused by decomposition, through a slow
disintegration of the organic material and the deposit of carbonaceous
matter. It therefore follows that the products producing color are not
_necessarily_ taken into the tubes by imbibition, though doubtless,
to a limited extent, this is the case, but are produced by local
degeneration through putrefactive processes. This change, though very
slow in producing results, eventually gives to the tooth the bluish
tinge, or to a tooth long affected by decomposed matter, the dirty,
bluish-yellow. It is unnecessary to enter minutely into the more remote
causes of discoloration, but we may summarize them as follows:
1st. When death of a tooth is caused by a blow, attacks of caries, too
rapid pressure in regulating teeth, etc., the death and devitalization
are followed by imbibition of coloring matter through the largest
diameter of the tubules and local discoloration of the tube contents
in the minuter anastomosing conduits. These changes may occur in teeth
affected by caries, or without any external evidence of disease.
2d. The more aggravated cases, when this color has changed to a
bluish-yellow, involving the entire structure of the dentine.
3d. Of the latter class, there may be a further subdivision, in which
these are complicated with periosteal lesions which more or less
interfere with efforts at restoration to original color.
The necessity of making some effort to restore the color of teeth
changed by devitalization was apparent to dentists very early in
the present century. The constant destruction of pulps with the
imperfect methods of practice then prevailing, necessarily increased
this unpleasant complication to such a degree that treatment of the
anterior teeth became, so far as appearances were concerned, of no
value whatever. Under the defective modes of treating pulp canals then
prevailing, discoloration was sure to follow the filling of teeth.
Any attempt to change color is necessarily dependent for success upon
preliminary measures. Without thoroughness _here_, all subsequent
efforts will fail. The early attempts at bleaching, before the settled
practice of filling root canals was established, was not a success, and
it must ever remain a failure unless the minuter structure of dentine
be carefully considered.
It has been demonstrated by artificial injection, and still better by
sudden congestions of the pulp, that coloring matter may be carried
nearly to the final distribution of the minute ramifications of the
tubuli. This is an important point, for, without this vascularity,
bleaching would be impossible. With it, the possibility exists of
extending the whitening process to the peripheral border of the
dentine; or, in other words, to its union with the enamel on the crown,
or the cementum on the roots.
The diameter of the tubuli is so minute, always decreasing in size
until lost in final distribution, that any agent used must necessarily
require considerable time before it can penetrate to the minute tubes,
therefore you must not expect to bleach rapidly and meet with good
success. The change, if any change be made at all, is simply on the
walls of the canal, and cannot penetrate to any depth of tissue. If
the discoloration is superficial, this mode will be effected, but not
otherwise.
Color can be changed by several of the acids: notably, oxalic and
nitric. The former destroys the color, and the latter changes dark-blue
to a yellowish tinge; but as both of these are very destructive, they
should never be used except in connection with an ant-acid. The first
named will be found to give better results when used in connection with
chlorinated lime.
_Chlorine_, free, or in some of its combinations, has been and is
to-day the main reliance for bleaching, and that it is the most
effectual has been demonstrated.
Failures have _usually_ been the result of defective manipulation.
It has great penetrating power, is a thorough bleacher, is readily
applied, and if handled with care, will prove harmless.
The possibilities of chlorine were early understood in connection
with the bleaching of teeth, but the result was not satisfactory for
the reason named, and also from the fact that no practical mode had
been devised for its use. To present free chlorine to a tooth was an
impossibility, owing to its irritating character and necessarily
superficial action; and no plan had been originated to free it from its
compounds, hence, all teeth suitable for bleaching were condemned to
remain a perpetual disfigurement. The first attempt to present chlorine
free to a tooth was made by Dr. James Truman, in 1862.
Chlorine is liberated from chlorinated lime by all the acids, but more
rapidly by some than by others.
It was found that, as rapid action was not desirable, those acids that
affected this were not satisfactory. Tartaric acid was one of these.
The conclusion arrived at was that a 50 per cent. acetic acid was the
best, although later investigation seems to indicate to the contrary.
The difficulty attending the use of chlorinated lime is due to the fact
that a good article is rarely to be found.
Good chlorinated lime is in the form of a dry powder; when moist, it
is worthless. It should have a strong odor of chlorine. A rough test
can be made by adding to a solution of indigo, in a test tube, a small
quantity of chlorinated lime; to this, add strong acid, and note the
rapidity of change in color. If this is very slow, or not accomplished
at all, the chlorinated lime is unfit for use, and should be discarded.
INSTRUMENTS.—These, though very simple, require special notice, for
neglect in this particular will involve total failure. _No iron or
steel instruments should be used in any connection with the agent
employed in bleaching._ This must be impressed on the mind of every
operator. The reason for this is, that the salts of iron formed
discolor the teeth very rapidly. It would be preferable not to use any
steel instruments at any stage of the operation, but this is difficult
to avoid in the excavation of the cavity. Instruments can be made of
hard wood that will serve the purpose, but ivory, platinum or gold
can be used in place of this—either of the latter materials making
efficient instruments.
Extreme care must be used not to produce any unnecessary irritation.
The removal of all remains of decomposed pulp from the canal is
of vital importance, but this must not be done in a rough, rapid,
careless manner. It is of great importance that no inflammation of
the periosteum should supervene, as that not only complicates the
operation, but renders it more doubtful of success. The removal of the
pulp should be followed by the usual treatment given to a tooth, and
no attempt should be made to change the color of the tooth until all
evidences of putrefaction have been removed, which will be manifested
in the absence of the odor of decomposition.
If this preliminary process has been satisfactorily conducted, the
next step will be that of filling the canal at its upper third. Gold
is claimed to be the best material for this. The question may be
asked, why fill the upper third? Because it is absolutely necessary
for success that the root should be bleached as well as the crown. It
must be remembered that the pulp chamber requires the same careful
treatment as that given to the canal. It must be thoroughly cleansed
of all debris to its fullest extent, and that, in the incisors and
cuspid teeth, is almost to the enamel line of the cutting edge. Having
proceeded thus far, the case is now prepared for the further process of
bleaching.
The next point to be considered is the insertion of the material.
Before this is attempted the canals and crown should be well washed
with a solution of ether, borax, sodium bicarbonate, or ammonia, to
remove fatty matter. It should then be well washed with distilled aqua.
The tooth is then dried, the rubber dam having been applied at the
beginning of the operation. There are several methods of bringing the
acid used in connection with the lime. This apparently simple matter is
really quite difficult. One process is, to saturate the entire canal
and pulp chamber with the acid before inserting the chlorinated lime.
Another is, to dip the instrument into the weak acid solution and then
into the lime, and pack rapidly into the cavity; and still another
is, to make a paste by the use of distilled aqua and pack this in the
tooth, and then apply a stronger acid by means of cotton wrapped around
the point used. There are difficulties attending all these modes. The
point desired must be kept constantly in view—that of having acid
sufficient and of proper strength to break up the compound and set free
the chlorine used, and to preserve as much as possible of the latter
for bleaching. Before commencing the packing, everything should be
ready, so the cavity can be sealed at once.
Convenience of adaptation must govern the choice of the material used
for closing the cavity. Gutta-percha, oxyphosphate or oxychloride of
zinc may be used with good results, but the zinc preparations are
harder to remove than the gutta-percha. After sealing the cavity, the
tooth must be left for a day or two. On the return of the patient,
remove all of the application, avoiding the use of steel instruments.
Syringe out the canal with distilled aqua. If the bleaching has not
gone far enough, a second application must be made, and this be
repeated until a satisfactory result is obtained. The importance of
using distilled water must be insisted upon. The reason for this
must be apparent, for in many waters the minerals held in solution,
especially those impregnated with iron, will defeat the desired object.
The immediate bleaching effect will be observed on the lower third of
the tooth where the dentine is the thinnest. In the majority of cases
this will be effected by one application. The greatest trouble will
be found at the gingival border. Here the dentine is very thick, and
it will be slow work, and in some cases end in failure, to restore
normal color. The great objection made to this operation is, that the
tooth will re-discolor, but if the subsequent operations are properly
performed, this danger will be reduced to a minimum. The fact that
dentine is permeated by pulp prolongations throughout the tissue,
increases the difficulty of bleaching, and also increases the liability
of a return of discoloration; but if the oxidation of the soft contents
of the tubes has been properly effected, and then an agent used to fill
the canal, and also act directly upon this microscopic tissue, there
is but little reason to fear a return of discoloration. The operation,
simple as it is, requires close attention to details and a clear
comprehension of possible results.
The tooth having been restored to a good color, the next consideration
is the proper filling to place in it. In this connection the before
mentioned fact still remains an important factor, that the tubuli are
still filled with decomposable matter. To allow this to remain without
attention to future contingencies, must result in eventual failure.
To effect any good results the antiseptic must not only operate in
the main canal, but penetrate deeply into the minuter conduits. This
quality is possessed in a remarkable degree by chloride of zinc,
and maintains the same effect when combined with the oxide of zinc,
forming the oxychloride of zinc. The canal and pulp chamber should
be thoroughly filled with this paste, or, it is better to line the
whole cavity with it, and then finish with the oxyphosphate, using
gutta-percha at the cervical margin.
Chlorine acts as a bleaching agent by reason of its strong affinity
for hydrogen. Vegetable and animal colors when brought in contact with
chlorine in the presence of water, is seized upon by the chlorine, and
the oxygen set free, oxidizes the color and destroys it. Chlorine in
this case acting indirectly as an oxidizing agent.
If you wish to try to bleach more rapidly, a solution of oxalic acid is
used to liberate the chlorine. Oxalic acid is more rapid than either
tartaric or acetic.
Sulphurous acid is said to be a good bleaching agent, and acts by an
entirely different method from chlorine. It is therefore of great
interest from a chemical point of view.
As before mentioned, chlorine acts as a bleaching agent by reason of
its strong affinity for hydrogen. Sulphurous acid, on the contrary, is
a reducing agent by reason of its affinity for oxygen, in combining
with which it becomes _sulphuric_ acid.
On the chemical character, therefore, of the coloring matter depends
the choice of the agent to be used.
Chlorine should be used when the color is an oxidizable compound,
or rich in hydrogen; while sulphurous acid should be used more
particularly in substances highly oxidized and capable of being reduced.
There are a great many different agents used for the bleaching of the
teeth, but I will not consume any more of your valuable time, as I find
that my paper is already quite lengthy.
* * * * *
DR. W. N. MORRISON is very proud of his son, who carried off the gold
medal at the Missouri Dental College.
INCIDENTS AND ACCIDENTS OF OFFICE PRACTICE.[1]
BY H. H. KEITH, D.D.S., ST. LOUIS.
There are no more useful lessons than those contained in the incidents
and accidents of office practice. If we do not communicate the
knowledge gained, the event is limited to the individual. Not alone
should we record our successes and apparent achievements, that we may
stimulate the energy of the younger members of our profession, but as
faithfully read the story of our failures.
In 1877, “S. A.,” a boy of ten years of age was presented with a
mesial corner of the right superior central incisor broken in such
a manner that the pulp, though not exposed, had died. The tooth was
much discolored, abscessed, and very loose. A few days treatment
sufficed to bring the tooth into a comfortable condition, when the
boy's visits ceased. Some time elapsed: when he next came the tooth
was elongated fully one-half the length of crown. The gums presented
a most unfavorable appearance, and extraction was at once pronounced
as the only proper treatment. At the earnest solicitation of the boy's
mother this was deferred until the next day, and such treatment applied
as the case seemed to indicate. Just here it may be well to say that
exploration showed the root was not fully developed, the canal being
quite large and funnel-shaped. So marked was the improvement the next
day, that all idea of extraction was dismissed, and the root was
finally filled with gutta-percha. A temporary filling of oxyphosphate
was then introduced, and allowed to remain for two years. Then the
contour was restored with gold. This filling was again replaced six
years later with another of gold, which remained to within a short time
ago, when a porcelain faced crown took its place. Deferring extraction
to the next day has saved this tooth for thirteen years so far, with
prospects of many years valuable service yet.
The second case is that of a right inferior second molar, a root
filled with gutta-percha being allowed to fill pulp chamber, on which
was placed a gold filling, February 20, 1878. In 1887 the gentleman
complained of discomfort, but it was sometime before the cause was
ascertained. The tooth had been split through its antero-posterior
length, the fracture terminating nine-sixteenths of an inch below
the point of the crown, on the lingual side. The fractured piece was
removed, and the gum pressed out by means of gutta-percha, to give a
better view of the remaining root. It was finally decided to attempt to
restore the tooth by means of a band and crown. The fragment removed
was used as a model from which dies were made, on which was struck a
piece representing the lost part, having extensions sufficiently long
to encircle the remains of the crown. This, when adjusted in position,
was partly filled up on the inside with gutta-percha. A porcelain cusp
crown was then arranged to antagonize the superior teeth. For a time
everything seemed to go well. A little inflammation about the margin
of the gum upon the lingual side instead of decreasing, suddenly grew
worse, and pus was formed at the point of division of the roots.
This finally yielded to treatment, and now the tooth is apparently
in perfect health. The cause of this fracture appears to have been
elasticity of the gutta-percha, under the pressure of the gold filling.
Case 3:—E. W., a boy of nineteen years of age, had broken a point
off the right superior central incisor, not quite exposing the nerve,
which subsequently died. The accident occurred some five years previous
to his visit to me. The canal was found large and funnel-shaped, and
was treated in the following manner: The lower portion was enlarged a
trifle more than the diameter at the apex. A piece of lead was then
introduced, and found to extend to the top by accurate measurement. In
order to produce an accurate adaptation of the lead to the surrounding
walls at the apex, the lead was reduced with fine sandpaper, the
scratches of the sand being parallel to the long axis of the tooth.
When the lead was forced into place, these fine ridges could be seen to
be flattened when examined with a magnifying glass, and an adjustment
continued in this manner, until the lead was found to close the apical
foramen completely. The filling was completed with gutta-percha, and
a porcelain crown was mounted upon the root. This has remained in a
favorable condition up to the present time, about a year and a half.
Case 4, is that of a central incisor, pulp destroyed, canal filled, in
which a Howe screw-post was used as an anchor to secure a large contour
filling. Some time after, the tooth began to show a decidedly green
discoloration, near the neck, which gradually extended throughout the
crown. The filling was removed and replaced, however, using a screw
of silver and platinum instead. I have here two specimens of roots in
which the Howe post has been used, and have seen two other cases in the
mouth, the same green stain appearing in all.
When the Howe post was put upon the market by the White Manufacturing
Company, their agents refused to tell of what metal they were made, but
gave the impression that they were some form of platinum and iridium
alloy. They proved, however, to have been made of chrome steel. Besides
the disagreeable discoloration of all these roots, I am inclined to the
believe that the chrome salt formed, acts as a constant irritant to the
peridental or dental membrane, and will result ultimately in the loss
of the tooth.
Case 5:—In this case the left superior second bicuspid was devitalized
and became discolored. The gentleman who was the lady's dentist at
the time, desiring to improve the appearance of the tooth, removed
the dentine extensively on the labial surface, and proceeded to fill
with gold. When the tooth came into my hands for treatment, I found
the part of the filling against the lingual wall well condensed, but
that against the frail labial wall quite soft, and this portion of
the filling had leaked, and the tooth was again discolored, showing
that in order to avoid undue pressure on the thin enamel wall,
insufficient force had been applied to condense the gold. Would it not
have been better in this case, and in fact in all similar cases, to
have sacrificed somewhat the appearance of the tooth and made a more
permanent filling by the removal of all that portion of the enamel
which was liable to fracture.
Case 6, is one of those mistakes in diagnosis which are liable to occur
in almost any practice. Miss E. presented herself with every appearance
of an abscessed right superior second molar, a large sac protruding
into the mouth, opposite the palatine root. The tooth was so extremely
loose and so sore that the patient would not allow it to be opened.
The abscess sac was opened and syringed out, and two days later the
soreness of the tooth had sufficiently subsided to permit the removal
of the filling. Drilling toward the pulp chamber, a short distance,
developed the fact that the tooth contained a living nerve. The result
of this case showed that the abscess was caused by the lodgement of a
fragment of a wooden toothpick between the first and second molar.
Another case, in my own mouth. The second left superior molar had for
years stood alone, which facilitated a thorough cleansing upon all
sides: I was therefore somewhat surprised at what appeared to be the
development of a case of pyorrhoea alveolaris. The tooth continued
sore, becoming looser, until its removal was a necessity. Neuralgia,
and all the symptoms of a dying pulp had been present for three months.
On extracting the tooth the nerve was found to be alive, and not much
congested. The three roots were absorbed upon their inner surfaces.
Exploration of the socket revealed the fact that a portion of the
process enclosed by the three roots had been entirely absorbed. As the
socket did not close in the usual time, I made an examination, and the
probe revealed the presence of the missing wisdom tooth. The tooth has
still continued to come down, but has not yet reached the gum line.
Another case in my own mouth is of interest: the result of wearing a
wedge for three weeks between the first molar and the second bicuspid,
on the right side. Some time after the tooth was filled, the first
bicuspid became sensitive to heat and cold, and showed symptoms of
peridental inflammation. Had a patient come to me describing the
conditions of this tooth, I think I should have at once drilled into
it, and applied the arsenic, but as it was in my own mouth I did
nothing; and for fifteen months this tooth gave more or less trouble,
but finally these disagreeable symptoms subsided, and the tooth is now
apparently perfectly well.
* * * * *
DR. G. L. CURTIS, of Syracuse, has been acting as Dr. Garrettson's
assistant in oral surgery this winter, in Philadelphia.
CAMPHO-PHENIQUE.[2]
BY J. W. DOWNEY, M.D., STATE CENTRE, IOWA.
_Mr. President and Gentleman_:
Campho-phenique is a germicide and antiseptic or nothing,
therapeutically considered; and discussing its properties necessarily
opens the entire subject of germicides and antiseptics, a subject
fraught with peril to the writer or speaker, especially if he is not a
practical chemist, pathologist, and microscopist.
Nothing in pathology is better established than the fact that certain
microscopic germs cause disease, and no point in therapeutics is better
known than the fact that a few drugs will, within the limit of safety,
destroy these germs, and thus most effectually cure or prevent disease.
In deciding which germicide or antiseptic to use, the dentist should
enquire, 1st, which is the most effectual; 2d, which is the safest;
3d, which is the most agreeable to the patient. To answer the first
question we must inquire of the experimenter. Dr. Frank L. James,
editor of the _St. Louis Medical and Surgical Journal_, a pathologist
and microscopist of large experience, has determined, by a series of
over eighty cultures carried on during the summer time, covering a
period of two months, that campho-phenique, pure, is equal to 1 to 85
of bichloride of mercury, which is six times as strong as it can be
used even on the unbroken skin, and about 25 times as strong as is
considered safe on cut surfaces.
I have purposely omitted comparison with other drugs of this class,
as the bichloride was by far the most effectual of any in general use
before the introduction of campho-phenique.
If these figures are correct, they answer the first question.
Certainly, if campho-phenique is from 6 to 25 times as effectual as
a safe solution of bichloride of mercury, then it should have the
preference in all cases where it is applicable. To the second point,
which is the safest germicide, we all should be competent witnesses.
The mercuric bichloride is known to be a virulent poison, and therefore
ranks lowest in this respect, with carbolic acid closely following it.
Campho-phenique is absolutely free from toxic or caustic properties.
This I have had frequent opportunity to prove, and no doubt many
gentlemen present have had a similar experience. Applied to the
unbroken skin it produces no sensation whatever. On cut surfaces
there is a slight burning sensation when first applied, followed by
anæsthesia.
Being non-poisonous, non-irritant, campho-phenique ranks first as a
safe germicide.
Now to the third point, which is the most agreeable. The brassy
metallic taste of the bichloride is intolerable, the taste and smell
of carbolic acid and creosote are disagreeable to most people, and the
odor and meagre antiseptic properties of iodoform should banish it from
the operating room. Campho-phenique has a pleasant odor and agreeable
taste, this should establish its claim as the most agreeable germicide.
I have yet to hear the first patient complain of its odor or taste.
From the foregoing data I am led to conclude—
1st. That when used pure and undiluted, campho-phenique is one of the
most efficient and reliable germicides and antiseptics.
2d. Being non-poisonous and non-irritant, it is perfectly safe.
3d. It is the most agreeable to the patient of any drug of its class.
I am glad to know that I am not alone in these conclusions. Prof.
J. Foster Flagg, writing on this subject in the July number of the
_Cosmos_, said, “When it is known that it is a notable germicide, an
efficient antiseptic, a non-irritant, a decided local anæsthetic,
non-poisonous, insoluble in water or glycerine, does not discolor or
stain, is possessed of an agreeable odor and no disagreeable taste,
and maintaining an unchanged integrity, it will at once be recognized
as wonderfully adapted to a large proportion of dento-pathological
conditions, from sensitivity of dentine through the varying conditions
of pulp irritation, pulp devitalization, pericemental irritation,
alveolar abscess, and caries and necrosis of contiguous osseous
structures, and that thus it must rank as one of the most, if not the
most valuable polychrest which dentistry possesses.”
It seems to me that this endorsement from a teacher and author of such
acknowledged ability as Dr. Flagg, ought to place campho-phenique in
the armamentarium of every dentist in the land. And now a word on its
special uses, and I am through.
First and foremost as a pulp canal dressing in the various pathological
conditions, from recent devitalization to alveolar abscess. Here it
will take the place of corrosive sublimate, carbolic acid, creosote,
oil of cassia, oil of cloves, iodoform, or any germicide heretofore
used, except peroxide of hydrogen. If thoroughly rubbed on the gum
or injected with a hypodermic syringe, it acts efficiently as a
local anæsthetic, not equal however to cocaine, but there are no
constitutional effects following its use, and there is no danger of the
tissues sloughing. It is quite efficient as an obtunder of sensitive
dentine.
The very disagreeable ache which sometimes follows the extraction of
abscessed teeth is almost instantly relieved by placing a pledget of
absorbent cotton saturated with campho-phenique deep in the painful
socket.
These are a few of the chief uses to which this new candidate for favor
can be applied; others will suggest themselves to each practitioner.
Before closing I want to mention its use for a condition which is not
in the realm of dental pathology, but which is a source of annoyance to
every dentist who uses plaster and hard water. I refer to the condition
generally known as chapped hands. It is one of the numerous forms of
eczema, and is greatly relieved by campho-phenique. I use the following
formula:
℞ Campho-Phenique, . . . . . . .
Oil of Cade, . . . . . . . . . aa ʒi
Rose Cosmoline, . . . . . . . . ℥i
M. Sig.—Apply frequently.
Campho-phenique should never be mixed with water or glycerine. It will
mix in all proportions with alcohol, ether, chloroform, and all fatty
substances. In dentistry it will seldom be necessary to dilute it at
all. Gentlemen, give it a trial, and when you have weighed it in the
balance of experience and found it wanting, we will assist you in
writing its fate upon the wall.
ETHER AS AN ANÆSTHETIC.[3]
BY DR. A. C. KELLOGG, DECORAH, IA.
For over a quarter of a century ether, as an anæsthetic, has stood
at the front of all anæsthetics, as the safest, most reliable agent
to use in all surgical operations. Being a faithful advocate of this
time-tried friend, which has done so much for humanity, a brief
description of its qualities and effects will constitute the theme of
this paper.
Sulphuric ether is prepared by distilling alcohol with sulphuric acid.
For many years after its first discovery the profession were not aware
of its anæsthetic properties, but looked upon it as a mere chemical
curiosity. Amusing incidents are related of many who inhaled it for the
exhilarating and intoxicating effects it produced. But to the late Dr.
Horace Wells is probably due the gratitude we truly feel for giving
to the profession its true anæsthetic properties, in the painless
performance of all surgical operations, no matter how severe. Since
that date it is used almost exclusively in all the leading hospitals,
medical and dental colleges throughout the land.
Very few deaths have been reported from its administration, and,
indeed, if that proper care and knowledge of the agent be used,
together with a pure article, and an intelligent understanding of the
pathological condition of the patient, the death rate would sink to a
minimum, and I doubt not that if a death should occur, after all these
precautions, its true reason might find an explanation in some other
cause.
If it is desired to anæsthetize a patient, the most important thing
to consider is the possession of a pure article of _ether_. There are
several reliable makes. Squibbs' sulphuric ether, for inhalation,
being one of the most reliable for uniform purity and freedom from
heavy oil of wine, acetic acid, fusel oil, sulphurous acid, or excess
of water and alcohol. Every operator should acquire the knowledge of
testing ether, if it contain any of these adulterations, using none for
inhalation but the purest article that can be procured. Just here it
might be well to state that pure sulphuric ether has a specific gravity
of 0.725°, boils at 96° and has a density of vapor 2.586. This latter
fact should be borne in mind, and when administered in the evening
the lamp or light should be kept away from the inhaling apparatus and
bottle, for ether is inflammable, several accidents being reported
where this precaution was not observed.
To insure the best results from ether, it should not be inhaled after a
full meal. Dr. Turnbull recommends a biscuit or cracker, and a glass of
wine or a tablespoonful of brandy, half an hour before, always avoiding
for several hours previously the annoyance of a full stomach. Serious
complications and deaths have resulted from lumps and particles of
indigested food becoming lodged in the trachea and glottis, from the
act of vomiting, as ether, with many people, produces vomiting, and a
recent meal is often reproduced.
The apparatus for administering ether is very simple, consisting in a
towel or newspaper folded in cone form, with a moistened sponge at the
apex to receive the fluid. During the first part of inhalation it is
well to hold the cone a little distance from the patient's face, that
the first few inhalations may be mixed with atmospheric air, otherwise
an oppressed, smothered feeling may possess the patient. This feeling
happily passes away in a few minutes, and the cone may be held close to
the face, bringing the patient under its influence as soon as possible;
better results are obtained, the after-effects pass away sooner, and
there is less danger of nausea than when administered slowly, taking a
long time to bring the patient under its influence.
It is well to observe that the temperature of the room be warm and well
ventilated, avoiding all draughts. The patient should be in a recumbent
position—better perfectly horizontal, all tight garments around the
waist and throat should be loosened, allowing perfect freedom to the
organs of respiration. With a finger on the pulse, an ear to the
breathing and an eye to the patient, the operator is to judge when
anæsthesia is complete.
The physiological action produced can be summed in a few words.
Observation shows that the functions of the cerebrum are affected
first; next, the anterior or motor centers soon fail to respond to
mechanical irritation, yet the functions of the medulla-oblongata (the
center of respiration) are performed. This is the proper stage to
appreciate, for, if the inhalation be still further carried on, the
sensory and finally the motor functions of the medulla-oblongata are
involved, and death ensues from paralysis of the respiratory centers.
In conclusion, I must not fail to observe that ether has a peculiar
and exciting effect on the genital organs, and a prudent operator will
not fail to have a third party present throughout all the period of
anæsthesia, otherwise his honor and reputation might be forever blasted
by the emphatic assertions of some female laboring under the unhappy
delusion of having been injured beyond reparation.
DISCUSSION OF DR. STODDARD'S PAPER: PORCELAIN FILLINGS.[4]
PRESIDENT BRIGGS:—Gentlemen, I think we all are paying more attention
to porcelain fillings than we formerly did. Since 1883 I have referred
to them in my lectures as one of the methods of preserving the teeth,
and have used them in my practice. One point particularly interesting
to me is the method Dr. Stoddard uses, of packing the clay into the
plaster impression, biscuiting it, then removing the surrounding
plaster and finishing the fusing. I presume it is because the carver I
have employed does not do this that he fails to give me good results
from irregular impressions. I imagine he tries to take them out while
they are in the clay, and of course, cannot, if the shapes are peculiar.
DR. SMITH:—My method of using porcelains is so similar to what
Dr. Stoddard has just presented that my remarks will be largely an
endorsement of his paper. I do only the operative part; the laboratory
part is done by my assistant, so I have only that part requiring the
shaping of the cavity and taking the impression. I have a number of
questions I want to ask Dr. Stoddard on working his furnace, but that
hardly comes in to what you would call discussion. I like the method
I have used, that is, taking an impression of the cavity, baking the
enamel and setting in cement or gutta-percha. I have also ground them
in, and, as Dr. Stoddard says, it is a very difficult thing to grind
them in entirely. Even a very large cavity will seem very small when
you get the porcelain between your fingers and attempt to grind it into
place. I think it is a much better way to take the impression and bake
the body and enamel it, as Dr. Stoddard has suggested. I would further
say, Mr. President, that I am using the porcelains where we find large
cavities in molars: for instance, dead teeth, where we have a compound
cavity, either the mesial or distal surfaces in connection with the
crown, and where amalgam is prohibited and the teeth too weak for gold.
I find that when an impression is taken of the cavity, and the filling
made as Dr. Stoddard says in his paper, and set in cement, that it
makes a very nice-looking filling, and one that wears exceedingly well.
I use the porcelain in that way a great deal and obtain from it success
and satisfaction.
DR. TAFT:—There is but little I can say on the subject before us, from
the fact that I have had no experience whatever in making porcelain
fillings; although so frequently do cases present themselves in my
practice, where porcelain tips and inlays would no doubt make not only
as durable but more artistic fillings, by far, than gold or any of the
plastics, that I feel encouraged to adopt this method after listening
to the interesting paper of the evening, and upon examination of the
specimens before us. In looking over the specimens I notice quite an
appreciable difference in color between the inlay and the tooth itself,
more so in some than in others. This may, of course, be due to the
fact that possibly the inlays were placed in some of them previous to
extraction. I do not yet quite understand how the doctor mixes his
material so as to get the color of the inlay as nearly like that of the
tooth as is possible, and should like to have him explain the point a
little more thoroughly.
DR. STODDARD:—I neglected to say that it was impossible to match
the color of these dry, dead teeth out of the mouth, but there is no
difficulty at all in the mouth. You have a baked sample of your body,
which you keep, and from which you select your color.
DR. BIGELOW:—Mr. President and gentlemen: I have never used any of
the porcelain fillings myself, but several cases have come under my
observation, and the greatest objection that occurred to me, at least
in those cases, was the well-defined line of demarkation between the
filling and the tooth itself; not but what the porcelain was good
color, but it was the material it was set in. A gentleman once opened
his mouth and showed me his teeth, and spoke of the great pleasure and
comfort that he had taken since his teeth were filled in that way. The
porcelain fillings were made for him by a dentist in New York City.
To me they were very much more unsightly than gold, possibly because
the material used in setting them was not a good match in color for
the natural teeth. I think I may have seen one of the cases that Dr.
Stoddard has spoken of in his paper. So far as the porcelain itself
was concerned, it was a very good match for the tooth, but the line of
demarkation was very distinct, almost as much so as if gold was used,
though perhaps the strength would be greater. I don't know, perhaps Dr.
Stoddard manufactures his own cements and gets his shades just right,
thereby overcoming this objection.
DR. TAFT:—There is one other place, Mr. President, where it seems
to me these porcelain tips or fillings may not be always practicable
that may be illustrated by a case in hand: namely, that of a patient
whose upper incisors upon examination were found to be filled with
fine fractures, extending along the surface of enamel from the biting
edge well up towards the margin of the gums. In the left superior
central I found what seemed at first to be a very small proximal
cavity, and started very carefully to excavate it from the palatal
side, when the corner of the tooth soon afterwards chipped off, and in
still further excavating,—hoping to fill with gold,—it continued,
in a most aggravating manner, to chip away more and more. To get the
smallest possible undercut or groove to retain the gold seemed an
utter impossibility, and the longer and more carefully I worked, the
more discouraging it became, until finally I was obliged to give up
altogether the attempt to fill the tooth with gold and to replace the
broken corner with oxyphosphate cement.
Now, here would have been an excellent opportunity for a porcelain
tip, provided a man had the requisite skill to get sufficient anchorage
for it without experiencing the same difficulty that I encountered in
attempting to make a gold filling. I should like to ask Dr. Stoddard
what his own experience has been with this class of teeth: if it is
possible to adapt porcelain tips in such cases, and if so, how long
they would be likely to remain. They are the most discouraging sort of
teeth, I think, we have to deal with, but fortunately, cases as bad as
the one just cited do not confront us very often.
DR. STODDARD:—I should think that that was a case where it would be
scarcely practicable to put in a porcelain filling, unless the tooth
could be backed with platinum and the filling held that way, rather
than by pins running into the tooth substance.
DR. ALLEN:—Mr. President and gentlemen: I have had no practical
experience with porcelain fillings, but I was much interested in
the paper just read. While I was abroad last summer I met Mr. Dall,
the gentleman referred to by Dr. Stoddard, and he showed me some
very beautiful specimens of porcelain fillings in teeth which he
had prepared out of the mouth. His method in dealing with proximate
cavities in superior front teeth, where the lingual, proximal and
labial edges are involved, is to build up the lingual, cervical,
and half of the proximal walls with gold, leaving a cavity for the
insertion of porcelain, which, when finished, is a great success from
an artistic point of view, as it does away with the objectionable
display of a large gold filling. Mr. Dall cuts his porcelain inlays
from teeth manufactured by C. Ash & Sons.
DR. MERIAM:—Mr. President, the body referred to is Ash's Tube tooth
body. Ash, I believe, has always refused to sell it in bulk. I know
that a number of American gentlemen have wished to experiment with it.
Either the Harwood or the Thompson blow-pipe will bake it; of course,
it would be very easy to bake in the Stoddard furnace. I do not know
that it has ever been imitated or reproduced in this country. Of
course, we often hear of Dr. Herbst's glass fillings.
There is one question I would like to ask Dr. Stoddard, which he can
answer after I have finished, and that is, how far his body corresponds
with the body usually used for the porcelain teeth of the shops? Does
it have to fuse at a lower heat, or is it substantially the same?
It seems to me that, going further than this, an effort should be made,
before they are entirely lost, to preserve the old formulas that are
in the hands of the older dentists. I believe that the most successful
manufacturers to-day are manufacturing teeth from the formulas of
these men, and if they are available they will be useful to add to
our directory, that they may go on record. I think this is a very
interesting study, and it is certainly carrying us back to the older
days of dentistry in some ways.
DR. ALLEN:—I have in my pocket a tooth which Mr. Dall prepared. He
takes one of Ash's inlay teeth, cuts a groove in it and cuts them off
in sections.
DR. STODDARD:—In reply to Dr. Meriam's question, the body that we
use is Dr. Daniel Harwood's, and is harder than the ordinary bodies.
There has been some effort, I believe, to preserve the old formulas.
Dr. Preston has presented his to the school, and Dr. Chandler has some
which he is preserving.
DR. MERIAM:—I think, seeing this specimen that Dr. Allen has passed
around, that some years ago in France a porcelain was made in the form
of a pencil, so that the end could be ground and fitted to a cavity,
and then cut off and polished. I also believe they use the long teeth
used for continuous gum work.
DR. SHEPHERD:—I noticed that some of the specimens, especially a tip
for a central, were a little larger than necessary. I would like to ask
Dr. Stoddard if the porcelain could be dressed down to give the proper
contour to the filling.
DR. STODDARD:—Yes, it can be ground down and polished; and when it is
wet in the mouth it looks just as well as English porcelain.
DR. CLAPP:—I have had very little experience in inlay fillings, but
I find that the process of grinding in the piece of artificial tooth,
when that is used, can be considerably facilitated by cementing the
piece of porcelain into the end of a small stick with cements the same
as is used by lapidaries who cut precious stones. I would like to ask
Dr. Stoddard about the Ash teeth, they being softer and more easily
fused than the bodies that we have, would it be possible to take those
teeth and pound them up the same as the body is made now, and then use
them as the body?
DR. STODDARD:—That never occurred to me, but I think very likely it
could be done. The only question it seems to me is in the coloring
material, whether it would bleach or not.
DR. MERIAM:—I think we should make a distinction between the Ash
ordinary tooth and the Ash Tube tooth. The tube tooth fuses at a
lower temperature, and in soldering this tube tooth I found that it
would change color and once, for a man with teeth very yellow, I took
advantage of that fact and secured a very good match.
DR. CLAPP:—I would like to mention a case that came under my
observation a short time ago. It was in the right superior lateral,
the mesial portion being turned outwardly a very little. I noticed
that there was a slight defect extending a little above and below the
enamel, but no decay. I think I examined this tooth two or three times
before I discovered that there was a porcelain inlay at that point.
On questioning the patient, I learned that it had been put in by Dr.
Rollins, eight or nine years ago. I find diamond disks the best for
grinding inlays.
DR. MERIAM:—I remember hearing of a dentist standing by the chair of
Dr. Perry, in New York, and his showing an operation he had done of
that kind; it is now probably seventeen or eighteen years ago. The
dentist pointed out that there was a check in his tooth, when it was a
tip Dr. Perry had put on.
PRESENTATION OF SPECIMENS.
DR. COOKE:—I wish to present a piece of steel which was sent me by Dr.
Wetzel, of Germany. He got it from Geneva. It is very thin, and is a
first-rate thing to use for a matrix, &c., and for passing in between
the teeth where something very thin is needed.
A method of casting a plaster model where you take a bite and desire
to get a model very quickly: First, cast one side, turn the impression
over, place a double piece of bibulous paper over the plaster that is
to form the tail piece and cast the other side. It comes apart without
any trouble, doing away with shellac and oil, and is done with one mix
of plaster.
DR. CLAPP:—A bit of vaseline will accomplish the same thing.
DR. COOKE:—I have never tried the vaseline. I have a rather
interesting case, an extensive piece of bridge and crown work which
the patient received some years ago from a firm who make a specialty
of this work. The bridge on the right side had broken away, several
abscesses had formed, and the condition of the mouth was far from
satisfactory.
DR. SMITH:—Mr. President, right here, after Dr. Cooke's remarks in
presenting this case of bridge-work, and knowing that he himself has
performed some operations in bridge-work, I would like to ask if the
result of his experience places him on record as universally condemning
bridge-work.
DR. COOKE:—Far from it. I simply presented that as a specimen of
bridge-work as performed in the nineteenth century. It was done by a
firm that makes bridge-work a specialty.
DR. MERIAM:—These instruments, I think, have never been made in
America. I had them copied by Mr. Schmidt. I present first the set of
groove cutters or chisels for molars and bicuspids. I think you will
find them about page 122, Appendix to Ash's Catalogue, 1886. They are
of the well-known chisel form, and I will send around with them two
made on my own curve. I like the Whitten Approximal Trimmers very much
as a trimmer and also as a scaler, but I wanted something with a little
suggestion of Dr. Lord's added to Dr. Whitten's, and in these the blade
is flat and passes easily between the teeth.
While I am on the subject, I will show some of Dr. Lord's excavators
that I have had made quite small, smaller than he has made himself, and
for a simple proximal cavity where only one instrument is to be used, I
think they are admirable. Dr. Lord only orders them in hatchet forms.
Here are some hoes that I directed Mr. Schmidt to make for me; some of
them have been rubbed down thinner.
H. L. UPHAM, D.M.D.,
_Editor Harvard Odontological Society_.
* * * * *
Send subscriptions to the ARCHIVES to Dr. DeCoursey Lindsley, 321 N.
Grand Avenue, St. Louis, Mo.
DISCUSSION OF DR. PARR'S PAPER:
IMMEDIATE SEPARATION OF THE TEETH.[5]
DR. J. G. PALMER:—I do not think I have anything in particular to
say concerning rapid separation. I have the separator that Dr. Parr
describes in his paper, and I also have a set of Dr. Perry's. The
latter is, perhaps, the most nearly universal in its application of
any. I cannot say that I agree with the doctor in regard to separating
so rapidly in all cases: in some cases it is probably advisable to do
it, but I would rather follow the lead of Dr. Faught's paper, and go a
little slow. I think going slowly in separating teeth is as useful as
it is in some other cases cited in the paper.
DR. C. A. MEEKER:—I have used Dr. Parr's separator for three years,
and prefer it to any of the others that I have used.
DR. PINNEY:—Sometimes, when you have a couple of nice little teeth
to fill, and you want to get to work and get it done, and you know
your patient is going to be so nervous for a week after, if you put
rubber between the teeth, that you cannot treat them, it is a great
pleasure then to put on your separator and slowly and gradually get
those teeth apart, with just one little squeal, so that you can put in
your two fillings. This little instrument is one of the best things
we have: it does not work in all cases, but it will in nearly all. It
should be used carefully; you should not move the teeth in a second,
or in a minute, but work carefully with it and you will be surprised
to find how many times you can use a separator to advantage. Patients
are better satisfied to have their teeth separated in this way, than
be compelled to wear rubber or tape, or something of that kind, in the
mouth—they say those things tire them.
DR. FAUGHT:—I would like to say a word about that one little squeal
that has been spoken of. I do not think we dentists quite appreciate
what that one little squeal means. I think it means a feeling of fear
and distrust in our patients for years afterwards. I believe also that
when we avoid giving pain to a patient, or stop a slight pain, it pays
in our dealings with the patient in future years. They never forget
it, but we forget them because we see so many of them, but each patient
remembers that somewhere in his or her mouth there was one little turn
given that caused intense pain, and they remember that _you_ did it.
It always causes a feeling of dread when they sit in our chairs again
for another operation. I believe that we should, more than we do, try
to protect our patients from every annoyance, however slight, even at
the expense of a little more time. There are many cases where the use
of mechanical separators is unobjectionable, and when it facilitates
such work. I wish to call your attention to a method of separating
not my own. It is the use of a little piece of tape. I hand a little
piece of tape to my patient with instructions how to use it, and in
the course of four or five days the necessary space is obtained, and
quite painlessly. When they return the mouth is in condition for the
operation, and they do not seem to have hurt themselves, and _you_ have
not hurt them.
DR. PINNEY:—After you have gained the beautiful space by the use of
tape or some other appliance, do you not have sore teeth. One good
point in favor of the separator is, that after you get these teeth
separated, the pressure of the instrument is so positive that there is
no pain whatever during the operation of filling. But when you separate
them with tape, the teeth are loose and sore, and a little pressure
upon them causes intense pain. The pain is so much greater than that
which caused the little squeal in immediate separation, that almost any
one would prefer the squeal.
DR. FAUGHT:—I would suggest the use of a little cocaine just before
the operation.
DR. JENNISON:—I do not like to disagree with my friend, Dr. Parr,
because he has given us a great many valuable things. I have not had
much experience in the use of separators, for the reason that I cannot
get my patients to submit to them. The moment I put one on and begin
to turn the screw, the patient exclaims: “Take that off; I cannot
stand it,” and I am compelled to take it off. Then in the use of the
separator, I am always fearful of crushing the enamel, which I think
is a very important thing to consider. With regard to separating
immediately, it would be very desirable if we could do it under all
conditions, or even under some conditions. I would like to see a
separator of some sort for immediate use, and I have no doubt Dr. Parr
can devise one, having plates not made of metal, and which will do the
work of separating teeth without possible injury to the enamel. That,
to my mind, is a very important point, and I agree with the essayist
of the evening most emphatically that it is best to go slow in this
matter. It has been said that teeth are sometimes so situated that you
cannot pass anything through between them for the purpose of gaining
space. When I find teeth in that condition, I introduce a piece of
rubber dam; you can always get that in, and leave it there until the
next day, and then I am usually able to put in something else, such as
a bit of wood, which I generally use. I take time to separate. After I
get space, if the teeth are still sensitive, I fill with gutta-percha
and leave it for a few days, and soon the soreness is all gone.
DR. J. A. OSMUN:—I think it always best to be perfectly frank with
your patients. If you must inflict pain, tell them you are going to
do it, and why, but that you will be as careful as you possibly can,
and you will find they will stand an immense amount of pain, and be
satisfied when you are through.
DR. ADDLEBURG:—If you speak to the patients and tell them the
operations will be painful, but that by inflicting pain you can serve
them better, in most cases they will allow you to apply the separator,
and they say it is much preferable to the old way of separating. I have
some patients who will not allow me to use it, but most of them prefer
the separator. Ladies especially say they prefer it, rather than have
something between their teeth, when going into society; they would
rather bear the little pain than the annoyance. I have used it for two
years. After the teeth are separated I find them to be obtunded to such
an extent that there is little pain in excavating and filling.
DR. EATON:—I want to add a word in favor of quick separation. For
the last four or five years I have followed the practice of quick
separation. If the separator fits property, and you use it with care,
it does not cause much pain. As soon as you find you are inflicting
pain, stop and rest a minute or two, and then you will be able to gain
a little more space. The separator should not extend up to, or impinge
upon the gum. A little gutta-percha under the bows of the separator
will tend to keep it out of the gum and will also steady the separator.
In some cases, where it is very difficult to keep the separator on the
teeth, the placing of a little gutta-percha on the bows will overcome
the difficulty, and the separator will stay in place, you can gain
all the space required, and then the teeth are held firmly while you
perform the operation of filling. Another thing: I have a number of
dead laterals in my patients' mouths which I cannot account for in any
other way than by slow separation. The pulps were not exposed at the
time of filling, and yet a few months afterwards I found them dead. I
believe the blood vessels were strangulated by holding the teeth in one
position for so long a time.
DR. PALMER:—I fear I did not express myself very clearly in regard
to the different separators. I have frequently used Dr. Perry's
separators, and have taken them off and put on Dr. Parr's; and I want
to say, that while I do not find Dr. Parr's separator universal, as
claimed, it is more nearly so than any other: and I can do with it what
I cannot do with any other. But I have failed to find any patients
like those Dr. Pinney speaks of, who prefer the separator to slower
methods of separating. Many ask me never to use one again. I have found
best results from using pieces of rubber and keeping them there until
sufficient space is gained. I think the difficulty in Dr. Eaton's case
was that the teeth were not kept sufficiently solid: if they had been
held firmly, the difficulty would not have occurred.
TEETH A COMBINATION OF CONES.
At the usual monthly meeting of the Manchester (Eng.) Odontological
Society, on December 10th, Mr. W. A. Hooton showed a collection
of bones and specimens of ancient implements and pottery recently
discovered in a limestone cavern at Deepdale, near Buxton, including
remains of a brown bear, Celtic ox, deer, wild boar, fox, sheep, horse,
and other animals.
The skull of the bear, which was in fine preservation, was found
imbedded in a mass of stalagmite more than a foot thick. The specimen
was an old one, and the teeth had been subjected to very rough usage,
being excessively worn down and many of the pulp cavities exposed. The
canines had all been fractured and afterwards worn smooth, with the
exception of the right upper, which was of full length and encircled by
a band of erosion. There was no trace of the second premolars.
The skull of a Celtic ox (_bos longifrons_) showed portions of skin in
a petrified condition still adherent, and there was also half the lower
jaw of a calf.
In the clay were found portions of a stag's antlers of great size,
somewhat softened by exposure to moisture.
Although no human bones have so far been met with, the signs of man's
presence were conclusive, and that probably during the ancient British
and Roman periods. One antler had been divided, and the tip smoothed
and sharply-pointed; another was shaped, apparently for use as a spear
head; and close at hand a small carved bone ornament, much blackened,
and some bits of bronze were found.
We know that fires were made in the cave, for fragments of charcoal are
preserved in the stalagmite.
The specimens of pottery are unfortunately much broken, but examples
of Romano-British and also of Samia ware have been identified by Prof.
Boyd-Dawkins, also pieces of hand-made pottery.
Dr. Shaw said that what had been exhibited by Mr. Hooton referred us
back to that almost eternity of the past when the limestone was formed
in which these caves are now found—a time before the appearance of
vertebrate animals. And even when, inconceivable ages after it was
formed, the limestone had risen from the shallow seas and became a
part of the dry land, these caves must have been formed in it at a
date so remote as to be almost incomprehensible to our mental grasp.
And they had undoubtedly been, from a time of which we have no record
down to clearly historical times, the homes of animals—man included.
Many of these animals have, in only comparatively recent times, become
extinct. In many of these caves, however, are to be found remains that
show they have been the homes of animals now only to be found in hot
climates, but were able to roam far north of their present habitations
at that period when this island formed part of a great continent which
was connected with Africa, and possessed an altogether different
temperature than at present. The ruder kind of pottery to which Mr.
Hooton referred are probably of Neolithic origin. In regard to the
ornaments and better class of pottery found in these caves, it shows
they have been at some time inhabited by a race greatly superior to
the ancient riverdrift and cave-men, and their still later Neolithic
inhabitants; and there can be no doubt they were the places in which
the Celtic and Roman element sought refuge at the time of the fierce
Saxon invasion.
Referring to the inferior jaw of a wild boar in which there was, at the
extreme posterior portion, a fully-formed molar tooth which had not yet
erupted, and consequently, had not any of its cusps in the slightest
degree worn down by mastication, he (Dr. Shaw) said that he had read
a paper some years since before the Manchester Microscopical Society,
in which he had vaguely hinted at a theory which he had not since had
time to work out, but which he would now distinctly state and leave
it to younger men to consider. Mr. Hooton had also exhibited a most
interesting specimen of a young, partly-formed and unerupted horse
tooth in which also there had not been any wearing down of the cusps.
He (Dr. Shaw) had several specimens of the same sort. Now, this molar
horse tooth was in reality a combination of five teeth with projecting
cones of various heights. As soon as the tooth appeared in the mouth
these cones began to be worn down in mastication, and the tooth
eventually presented a flat surface with alternate layers of enamel,
dentine and cementum, so arranged that the occlusion formed a veritable
mill for grinding the food. Although the molars of the bear and boar
are not made up in the same way as those of the horse, the wearing down
can be seen to have taken place in the teeth of the bear and the boar
exhibited; and if gentlemen will kindly examine this unerupted tooth
at the extreme posterior portion of the inferior jaw of the boar, it
will be seen what this animal's molars are like when first formed, and
before they are put to any use. _They are ummistakably made up of a
great number of cones._ Therefore, it was his (Dr. Shaw's) opinion
that, while in the primitive manner dentine and eventually teeth first
appeared there were no signs of cones, when this form did, in the long
process of time, make its appearance, it became a starting point from
which has been derived, by a great variety of combinations, the forms
of the teeth of the higher animals.
THE TACOMA DENTAL SOCIETY.
We are in receipt of a copy of the constitution and by-laws of the
above Society, which indicates that the dentists of the new State of
Washington are abreast of the times.
“The object of this Society shall be to cultivate the science
and art of dentistry, to promote among dentists mutual improvement,
social intercourse and good feeling, and to collectively
represent and have cognizance of the common interests of the
dental profession in our city.”
We take pleasure in giving to our readers the code of ethics of this
new Society as being something new and original.
CODE OF ETHICS.
The members of the Tacoma Dental Society in the fulfillment of their
duties to the profession, to the public and to each other, declare
and accept as binding the following code of ethics as embracing
such principles of honor, fairness and gentlemanly bearing as every
gentleman of honor and self-respect should most willingly adopt.
ARTICLE I.
SECTION 1. It is the duty of every dentist to maintain the honor,
respectability and good name of the dental profession, and by a manly
and dignified bearing, by studious habits and mental improvement, as
well as by a conscientious earnestness in the employment of his skill
for the welfare of mankind, to aim at securing a general recognition of
the worthiness of the dental profession to rank among the honored and
learned professions.
SEC. 2. He should so practice his profession that the community will
esteem it above the art of a mere mechanican and above traffic wherein
shrewdness and cunning are an essential part of the stock in trade.
SEC. 3. He should therefore regard it as unprofessional and beneath
the dignity of his calling to offer the products of his skill in
competition at fairs, or to make sale of his services as does the
shop-keeper of his goods, or resort to public advertisement such as
cards, hand-bills, posters, or signs calling attention to peculiar
styles of business, lowness of price, special modes of operating, or to
claim superiority over neighboring practitioners, to go from house to
house soliciting or performing operations, or to do other similar acts;
but nothing in the above shall be so construed as to prevent any member
from inserting simply his or her name, occupation and place of business
in the public prints, or giving notice in the same of his removal,
absence from or return to business, or issuing appointment cards with
his fee bill thereon.
ARTICLE II.