Part 2

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.