with the immediately subjacent tissues, these preparations have
proven so efficient there is little question of its value as a local
anæsthetic in such cases. But its action on deeper structures, such
as involve the roots of teeth, is so uncertain as to render its
practicable benefits questionable in the operation of extraction.
In the surgical treatment of pockets caused by pyorrhea alveolaris,
the anæsthetic effect of this agent is often so great as to render
this sometimes very painful operation comparatively painless, and
its employment in such cases should rarely be dispensed with. In the
treatment of hypersensitive dentine, as well as in the removal of
tooth-pulps, its action as an anæsthetic has, under some circumstances,
seemed to be all that could be desired. But in far the greater number
of cases it has proved of little practical value. More recently,
however, a new form of cocaine, known as the citrate, has been
introduced in Germany by Merck, and is now being manufactured by
McKesson & Robbins, of New York. In a series of experiments, conducted
by Dr. John S. Marshall, of Chicago, it has been shown that for
operations on sub-mucous tissues, or in the extraction of teeth, it
seems to possess no special advantages over the preparations previously
named. But when applied to dentine or the pulp, its action--though not
always positive--seems to be more reliable, especially on the dentine,
and gives promise of better results. Under favorable conditions it
produces anæsthesia of the parts in from five to ten minutes, and the
duration of the effect is of sufficient length to afford time for
the preparation of the cavity. This effect has, in some cases been
prolonged for more than an hour. The pulp has been extirpated without
pain after the drug has been applied in from three to twelve minutes.
If the citrate of cocaine be kept in solution for more than three
or four days it decomposes and loses its active properties. As
introduced by Mr. Merck for dental purposes, it is made into pills by
incorporating it with gum tragacanth dissolved in glycerine, each pill
containing 1/8 grain of the citrate. In this form it keeps well. A pill
is applied to the sensitive cavity and covered with a cotton pledget,
moistened in tepid water. It should be allowed to remain from five to
twelve minutes, when--if at all--the desired result is produced. In
twenty per cent. of the cases where this remedy has been employed it
has proven unsuccessful, but it is hoped that this percentage will be
reduced by a better knowledge of the drug and the improved methods of
its preparation and use.
With this in view, and at the suggestion of Dr. Marshall, McKesson &
Robbins are now manufacturing granules containing one-sixteenth of
a grain of the citrate of cocaine, without glycerine or any other
saccharine excipient, so that the obtundent may act more promptly
than it can in the presence of sugar.--_Address at American Medical
Association._
Editorial, Etc.
UNIVERSITY OF MARYLAND, DENTAL DEPARTMENT.--The fourth Annual session
of this institution opened with a much larger number of matriculates
than ever before in its history, and the number is so rapidly
increasing that the present class of seniors and juniors bids fair to
be larger than any preceding one.
The reputation of this school has never been sullied by the graduation
of students for fees irrespective of professional ability, and the
consequence of such a course as has been steadily pursued since its
organization, has been to give a professional standing to its diploma
which that of no other dental school excels. The present class consists
of representatives from all parts of this country, and also Germany,
France, South America, Canada, and even Turkey. Many states of this
country are largely represented, such as New York, Georgia, Virginia,
Pennsylvania, South Carolina and Maryland especially, and also the New
England states, while nearly every other state is represented.
Students who have passed a session at other dental schools have entered
on a second session at the University of Maryland, Dental Department,
to complete their course of study and receive its diploma, and not
one of the hundreds of students who have attended a course in this
institution, has ever gone elsewhere to graduate. In matriculating the
present class, the resolutions adopted by the National Board of State
Dental Examiners have been strictly adhered to, and many applicants
of this country and Europe have been refused admission who desired to
make their attendance obligatory on graduation after ONE session's
attendance.
The Infirmary and Laboratory practice is not excelled in size if
equalled by that of any other dental school, and the records will
show hundreds of gold fillings credited to the individual practice of
students for both the regular winter and summer sessions. No other
school can offer greater facilities for practical instruction, nor
present more complete equipment as to building and appliances than
this Dental Department. Dental practitioners are cordially invited to
visit the University and inspect the specimen work of its graduating
classes deposited in the museum. Large and valuable contributions from
all parts of this country and also from Europe are almost daily being
received for the Museum, which will compare favorably with that of any
other dental school for valuable pathological specimens, which are also
utilized for illustrating the lectures of each course.
* * * * *
CORRESPONDENCE.--The following letter was received from a prominent
dental practitioner of Georgia for publication:
AUGUSTA, Sept. 30th, 1885.
EDITOR "AM. JOURNAL OF DENTAL SCIENCE":
DEAR SIR: According to my knowledge of the proceedings of the
organizations known as the "National Board of Dental Examiners," and
the "National Association of Dental Faculties," it was determined that
no dental school would be regarded as reputable that did not after
June, 1885, require TWO FULL SESSIONS OF FIVE MONTHS EACH IN SEPARATE
YEARS FOR GRADUATION. The only exceptions made being those who after
graduation in medicine had passed one year in the study and practice
of clinical dentistry, and also those who had attended a previous
session at a reputable dental school. I believe that the American
Dental Association also adopted the same rule. Am I not correct?
I therefore ask how it is that the dental school of Vanderbilt
University is permitted to offer graduation at the close of but one
session, to a student of this city who has passed one session only,
and that very irregularly, at the Georgia Medical College? I also ask
how the same school can offer similar inducements to another
student from Edgefield, South Carolina, as I understand it has done,
and yet be declared reputable? Was it for the purpose of permitting
such violations of the rules adopted by the different organizations
referred to, that the "National Association of Dental Faculties"
allowed the dental school of Vanderbilt University to abstain from
becoming a member of that Association for the present year, and
accorded to its Dean the privileges of the floor at its late meeting
in Chicago? I cannot see why some schools should be compelled to
conform to a rule that others may violate with impunity, and I think
that the State Boards of Dental Examiners of both my own state and
South Carolina should investigate the matter and act accordingly.
Respectfully, &c.,
"JUSTICE."
We can only reply to the above letter by stating that several students
who as we had learned from their preceptors, intended to matriculate
in the Dental Department of the University of Maryland, on discovering
that they would be required to attend two sessions in the institution,
had, we are informed, been induced to go to Vanderbilt by the promise
of graduation on one session's attendance.
EDITOR OF "AM. JOURNAL OF DENTAL SCIENCE."
Bibliographical.
_A Series of Questions Pertaining to the Curriculum of the Dental
Student._--Embracing Dental Histology, Dental Pathology, Dental
Surgery, Dental Prosthesis, Dental Metallurgy, Dental Materia Medica
and Therapeutics, Anatomy, Physiology and Chemistry. By Ferdinand J.
S. Gorgas, A. M., M. D., D. D. S., University of Maryland. Publishers:
W. K. Boyle & Son, Cor. Baltimore and St. Paul Streets, Baltimore, Md.
1885. Price, $1.50.
This work comprises leading questions on all the branches belonging to
the course of study pursued by the dental student, and its object is to
facilitate the study of dental science and its collateral sciences.
Some years ago the author published a small work embracing in an
abridged form, questions on Dental Science, and the favor with
which it was received by the students of his class, was such as to
rapidly exhaust the limited edition, and induce him to prepare, when
opportunity offered, a more complete series of questions embracing the
entire curriculum of the dental student, and even that of the medical
student so far as related to Anatomy, Physiology and Chemistry.
The present work, therefore, is the result of such an intention, and is
presented with the hope that it may accomplish the object for which it
has been prepared.
* * * * *
_Practical and Analytical Chemistry._--Being a Complete Course in
Chemical Analysis. By Henry Trimble, Ph. G., Professor of Analytical
Chemistry in the Philadelphia College of Pharmacy. Illustrated.
Publishers: P. Blackiston, Son & Co., Philadelphia. 1885. Price,
$1.50.
The object of this excellent work is to place before the student of
pharmacy and medicine a compact course of analytical chemistry.
The distinguished author believing that the study of Qualitative
Analysis should be preceded by some practical experience such as
relates to the preparation of the important gases and a few of the
salts, devotes Part First to the consideration of Hydrogen, Chlorine,
Hydrochloric Acid, Oxygen, Nitrogen, Ammonia, Nitric Acid, Carbon
Dioxide and the preparation of such salts as Potassium Chloride,
Potassium and Sodium Tartrate, Ammonium Nitrate and Oxalate, Calcium
Phosphate, Magnesium Sulphate, Carbonate and Oxide, Aluminium
Hydrate, Ferrous Sulphate, Ferric Sulphate and Hydrate, Copper
Sulphate and Lead Acetate. Part Second is devoted to Qualitative
Analysis, and Part Third to Quantitative Analysis, together with a
description of apparatus, and the processes of filtration, evaporation,
crystallization, ignition, etc. The work extends over nearly one
hundred pages, and is a valuable text-book for the student.
* * * * *
_Chemical Problems._--By Dr. Karl Stammer. Translated from the second
German edition, with explanations and answers, by W. S. Hoskinson, A.
M., of Wittenberg College, Ohio. Publishers: P. Blackiston, Son & Co.,
Philadelphia. 1885. Price, 75 cents.
The text is in the form of questions to which answers are given at
the end of the volume, which comprises one hundred and nine pages.
Part First relates to the recognized elements, and Part Second to
approximate ratios, temperature, atmospheric pressure and mixed
problems, making a compact and useful text-book for the study of
chemical problems.
* * * * *
_Quiz Questions._--Course on Dental Pathological and Therapeutics,
Philadelphia Dental College. Prof. J. Foster Flagg, D. D. S.
Answered by William C. Foulks, D. D. S. Third edition, Revised and
Enlarged. Publishers: The S. S. White Dental Manufacturing Company,
Philadelphia, New York, Boston and Chicago.
This excellent series of questions and answers on Dental Pathology
and Therapeutics is again offered to the dental profession as a work
of reference in daily office practice, and is the only book that
contains in a condensed and practical form the facts and principles
of these subjects, as enunciated by Professor Flagg. Commencing with
General Principles, these questions and answers relate to Deciduous
Teeth, Pathological Dentition, Lancing, Permanent Teeth, Dental
Caries, Sensitive Dentine, Galvanic Action, Pulp Protectors, Obtunding
Applications, Pulp Capping, Pathological Conditions of Pulp, Dental
Exostosis, Malformed Teeth, Periodontitis and Alveolar Abscess, the
whole constituting a work of great value to all engaged in the practice
of dentistry. The work is interleaved with blank pages for notes, etc.,
and gotten up in a neat and excellent style. We take great pleasure
in commending this treatise as a valuable adjunct to the regular
text-books of the profession.
Monthly Summary.
PEROXIDE OF HYDROGEN.--_Dr. W. W. Allport, Chicago._--The peroxide of
hydrogen (H2 O2), though not a new remedy, has only within the last few
years gained much prominence in the treatment of surgical diseases.
One of its uses in dental and oral surgery is in blind or deep-seated
abscesses, such as arise from roots of diseased teeth. As the tendency
of pus is always downward, when these cases occur in the lower jaw it
is not infrequent that the abscess, if left to itself, and sometimes
even after the tooth is extracted, will point through the external
tissues at the lower margin of the jaw, and occasionally downward
between the muscles of the neck, and open at various points, even as
low down as the clavicle. The usual treatment is to extract the tooth
and evacuate the pus through the alveolus, but it often happens that
the formation of pus and the continuance of suppuration is not checked,
and the abscess points, or is opened through the external tissue of the
face or neck, leaving, when healed, a disfiguring scar.
By injecting peroxide of hydrogen into such abscesses before they point
through the external tissues, this serious disfigurement can usually
be averted, and the suppurative process is materially shortened. It
is also a valuable aid for the evacuation of the purulent contents of
the antrum of Highmore, in catarrhal and suppurative inflammations,
and especially where the sinuses are divided into two or more pockets
by bony septi. These cases are often protracted by the inability of
the surgeon to perfectly evacuate them. But with this preparation it
becomes a simple matter after access has been gained to the cavity
by the extraction of a tooth or the perforation of its external wall
in the proper place at the juncture of the cheek with the alveolar
border. A free opening must always be made for the escape of the
contents, in order to avoid pressure from the rapid evolution of
gas. Two or three applications of a dram each is usually sufficient to
completely empty the sac.
It is used with the most gratifying results in the treatment of
pyorrhea alveolaris, and is an invaluable agent in treating pulpless
teeth, as by its action all decomposed matter from the pulp chamber and
dentinal tubuli is readily ejected, thereby removing the most frequent
cause of discoloring of this class of teeth, of inflammation of the
peridontal membrane, as well as alveolar abscesses.
The efficacy of peroxide of hydrogen depends on the case with which
it is decomposed into oxygen and water. Pus is one of the many
substances which causes this decomposition. Hydrogen peroxide acts
first chemically and then mechanically. When the decomposition takes
place the oxygen is set free and escapes from a liquid to a gaseous
form; this expansion of the gas distends the pus cavity, and as it
escapes from the orifice, it carries much of the pus with it, and
its application should be repeated till all purulent accumulations
are evacuated. The liberated oxygen, being in a nascent or active
condition, rapidly oxidizes the products of suppuration, and destroys
many of the micro organisms of suppuration.[A] Hence it is a
disinfectant and anti-septic.
Finally, peroxide of hydrogen, after its decomposition, leaves no
material in the system which is foreign to the system, and it is,
therefore, one of the most efficient and harmless disinfectants
and anti-septics that can be used, in all forms of purulent
inflammation.--_Address at American Medical Association._
* * * * *
ALCOHOLIC PARALYSIS.--The immediate and transient effects of an
excessive quantity of alcohol upon the human nervous system, whether
they are manifested in the form of drunkenness, or of delirium tremens,
or of an acute attack of insanity, are well-known. Scarcely less
evident are the effects produced upon the nervous system by a less
excessive, but a more prolonged, abuse of alcoholic drinks. These
effects may be manifested either in a general failure of physical and
mental power, or in a form of disease closely resembling progressive
paralytic dementia, or in various forms of chronic insanity, or in
epilepsy, or in neuralgia, or in paralysis. In the acute form of
alcoholic poisoning, no change in the structure of the nervous system
has been found, except that the meninges in common with the internal
organs and the mucous membranes are the seat of a very decided
injection and slight exudation. In the chronic form of alcoholism, a
number of pathological changes have been discovered in the nervous
system, which, however, vary greatly in different cases.
Of late years the paralysis which results from the abuse of alcohol
has been accurately described by numerous observers, and the attempt
has been made to discover the lesion of the nervous system which is
associated with this form of paralysis. Two cases which are reported by
Dr. Henry Hun, of Albany, in the _American Journal of Medical Sciences_
for April, 1885, are typical examples of this disease, and contribute
to a better understanding of it.
Dr. Hun has collected the recorded cases of alcoholic paralysis, and
from their study he holds that we are justified in regarding it as a
special form of disease with the following symptoms: After a number
of cerebral and gastric disturbances due to the alcoholic poisoning,
the symptoms of the disease proper commence with neuralgic pains
and paræsthesiæ in the legs, which gradually extend to the upper
extremities, and which are accompanied at first by hyperæsthesia, later
by anæsthesia, and in very severe cases by retardation of conduction
of pain. Along with these symptoms appears a muscular weakness,
which steadily increases to an extreme degree of paralysis, and is
accompanied by rapid atrophy and by great sensitiveness of the muscles
to pressure and passive motion. Both the sensory and motor disturbances
are symmetrically distributed, and the paralysis attacks especially
the extensor muscles. In addition to these motor and sensory symptoms,
there is also a decided degree of ataxia. The tendon reflexes are
abolished and vaso-motor symptoms, such as ɶdema, congestion, etc., are
usually present. Symptoms of mental disturbance are always present in
the form of loss of memory and in transient delirium.
The lesion is in all probability a degeneration of the peripheral nerve
fibres and of the nerve cells in the cerebral cortex, together with
a chronic congestion or inflammation of the pia mater. This lesion
explains well the symptoms, although it is curious that alcohol should
not attack the spinal cord, but only the highest and lowest part of
the nervous system, if one may so call the cortex of the brain and the
terminal branches of the peripheral nerves.--_Detroit Lancet._
* * * * *
NOURISHING THE TISSUES OF THE TEETH.--Dr. Frank Abbott says: For a
number of years past I have entertained the views that there was
some difficulty existing not due to an insufficiency of lime-salts,
which occasions so many faulty and imperfectly formed teeth. With
that idea in view I have advised exercise in the open air and other
kinds of treatment for some patients which would favorably affect
their digestion. That the food ordinarily taken contains sufficient
lime-salts to form and to sustain the teeth I have no doubt (except in
cases of extreme anemia, during gestation and lactation). I believe
the fault is beyond that. There is a lack of proper nourishment of the
tissues, due to imperfect digestion, which depends again on the proper
"nerve tone." I believe this to be the real cause of the difficulty. It
is reasonable to suppose that any _tonic_, whether taken in the form of
exercise in the open air, or in any other form, which affects favorably
other portions of the body, will affect the teeth favorably as well.
When we have _ascertained the functions of the great nerve-centers_,
and those functions are assured, then we will probably have more
perfectly formed teeth.--_Items of Interest._
[Footnote A: See Gradle on "Bacteria and the Germ Theory of Disease,"
pp. 39 and 151.]