[Read before the Odontological Society of Pennsylvania, February 6th.] The discussion at a former meeting reminded me of a long contemplated intention, of writing a history of some of the more remarkable experiences of my professional life in the results of pulp extirpation. Believing that in such history there would be found both entertainment and material for profitable discussion, the paper having been written, is now offered for your consideration. It may be remembered, that during the discussion alluded to, it was remarked that the incidental results of root filling were frequently much more serious than most of us apprehended. Let us now see if the correctness of this position may not be amply proven by testimony which the following simple statement

of facts will reveal. Not that imminent danger must necessarily attend at all times, even the most intricate operation •needed upon a devitalized tooth, but that such results incident upon either present or subsequent circumstances, do frequently follow. root-filling. Such circumstances for instance; as removal of the patient after a recently filled root, still in pathological conditions, out of reach of proper treatment, in case of periosteal inflammation; or falling into the hands of a physician, who, however eminent or successful in general practice, may know positively nothing of the duties he assumes when undertaking those of a speciality which he has never even tried to comprehend.

The first case referred to was that of a young man for whom in the summer of 1854 I treated and removed the pulp of a superior lateral incisor, filling with gold, as was the practice of the time, as nearly as possible to the apical foramen. There was nothing apparent at its completion signifying that trouble was to be apprehended. It was with much surprise, therefore, that upon meeting the patient some days afterwards, I learned that he had been, and was still suffering from the effects of periosteal inflammation, with every indication that an abscess was forming. I advised him, as was I believe the universal practice at the time by those who undertook this kind of operating at all, to apply active fomentations with a view to hastening its termination as rapidly as possible, desiring him to report to me within the next twenty-four hours. Not hearing from him however for a number of days, and supposing that the crisis had passed, I was startled upon hearing that he was ill and under medical treatment. As I was about leaving the city, and the patient being a personal acquaintance, I called the next morning to make inquiry and was much astonished upon learning that during the night he had died of erysipelas of the stomach, as was reported by the physician in attendance. Although it was never supposed that death was caused by the treatment of the tooth of which I had every assurance by the family at the time, and again

very recently, by a brother of the patient who was with him during his illness, yet the question has frequently arisen in my own mind as to whether it was not incidently even the cause of death. In order to reach a fair standpoint from which to judge, let us review the whole train of circumstances as they occurred after the fomentations had been recommended, which advice was not followed, but instead the physician's treatment, of which we have no knowledge, but do know of the agonizing pains frequently experienced during the process of suppuration.

We may naturally suppose that in this case they were exceptionally severe; that the patient's strength was greatly reduced by the rapidly developing but unsuspecting malady; while all the trouble was attributed to the condition of the tooth. At this period the physician was called in; it may have been at the very turning-point when remedial agencies must have proven unavailing, or even to him, there may have been no suspicion of the coming disease. Here then is illustrated the means by which the filled root may have been incident to the disaster; for during all this time the smouldering, unseen fires within were gaining strength, ere while to manifest the fearful ravages, which, unresisted, had been consuming the very vitals and had already gained that force which no human agency could control. Let us remember that erysipelas is but one of many diseases which need to be recognized in their earliest stages and combatted by proper remedies if danger or even death are to be arrested; and also that many thousands of pulpless roots annually filled, many of which remain from a few hours to a number of years so filled, ere manifesting such conditions as might produce results corresponding to those of the cited case. Though the fatal result in this instance might not have been arrested had the patient continued for three days under the dentist's treatment, yet this advantage would have been gained; that he would have known familiarity with the effects of forming abscesses, that the rapidly diminishing strength of the patient was due to something fiercer and

stronger than this; and that the insidious enemy, whatever it was, must be immediately deprived of its formidable ally, even by removal of the tooth if needs be, and brought at once face to face with the skill that would have immediately discovered its nature and strength and administered timely remedies which, under God, might have worked its overthrow and saved the life of the patient.

He must be a dullard indeed, who would not profit by the experiences of such a case; as for myself, I have since approached with timidity the treatment of a threatened abscess, never omitting any possible precaution, by which it might be averted, especially where there are the slightest indications of the presence of either chronic or acute disease, which alone might prove to be all that the patient had strength to endure. A few such precautionary measures may be properly admitted here. The first of these was adopted about a year later.

The patient, an invalid, was waited on at her residence. Among the operations performed for her at the time, was one upon a bicuspid, of which the pulp was destroyed and removed and a temporary filling inserted. A few days later the tooth, seeming entirely well, was filled with gold, and for a time promised the best results. Nevertheless, about ten days later violent pains commenced, with other indications of acute periostitis. Upon visiting the patient I found her much prostrated. Whereupon the tooth was extracted and immediately returned to its place. Three days after which, with little or no suffering in the interim, it was perfectly comfortable, remaining so, I believe, until the day of her death, which occurred about twenty-five years later. We may now suppose a possible train of circumstances such as frequently do follow a series of operations resembling essentially those just described, less the extraction and replanting of the tooth, which would have been as likely to produce death, as those which followed the case first described. Supposing that this lady, already physically debilitated by protracted disease, had been visiting at Potts

ville, where the case occurred, for medical and dental treatment, from a distant region where skilled medical or dental care could not be obtained. Anxious to return to family and friends, she had hurried off immediately upon completion of the last operation, and before the inflammatory conditions appeared. Now out of reach of intelligent treatment, still weak and debilitated from long continued sickness, who, for an instant, will doubt that the added torture of a growing abscess, and possibly blood poisoning, might have shortened her life by the quarter of a century that followed.

In 1862 I was visited by the late B. V. M., merchant of this city, who was suffering from the effects of acute pulpitis of the right inferior third molar. An application of the usual arsenical preparation was made, but in half an hour he returned, suffering so intensely and manifesting symptoms so unusual, that the tooth was unhesitatingly extracted. But being found with a perfectly healthy periosteum, was, by his consent, immediately returned to its socket. Whereupon the patient left with the understanding that he was to return to have it filled as soon after the soreness ceased as convenient, but did not reappear for nearly two months; then stated that at the time of the extraction of the tooth he was actually suffering from insipient malignant typhoid fever, from which he had only just recovered. Does it not seen more than probable that the pain, experienced just at this time, in the pulp, which had doubtless been exposed for a number of months, was caused by the approaching fever? And does it not seem also more than possible, that any considerable amount of pain added to what the patient was already necessarily subjected, may have proven just so much more than he was able to live through. And is it not reasonable to suppose that, in view of the existence of many thousands of half dead or dying, capped pulps, and more thousands of fragments left in obscure canal-ends; left to rot and fester upon provocation, will, or do, so act at periods just as critical as those described in the cases under consideration.