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Dr. Kingsley. There stands my assistant, who has seen forty of them, at least. I have been using the same principle in certain cases for many years.
'Dr. Weber. Some patients speak quite well directly after the application of this apparatus, and some, after a time, articulate perfectly.
Dr. Kingsley. Is this a case of congenital cleft-palate, or acquired?
Dr. Weber. It is acquired.
Dr. Kingsley. Then, gentlemen, I would call your attention to something which is of the utmost importance in cases of this kind: Where the patient has once had the faculty of distinct articulation, you can put in any kind of an appliance, no matter how inferior it is, and benefit the speech. I did not observe this patient's mouth until this moment. I see it is not a case of congenital cleft-palate, but one of acquired lesion, where it is not necessary to put in a bulb of this kind at all. All my previous remarks were made upon the supposition that this was a case of congenital cleft. If you will put in a simple obturator to cover this opening, you will get precisely the same result as you have now; there is not the slightest necessity in this case for this bulbous attachment. Twenty years ago, in London, I was discussing congenital cleft-plate before the Odontological Society, and when I closed my remarks, Mr. Sercombe arose and said, "I see nothing peculiar about this;" and he then went on to state a case where he had applied an instrument and distinct articulation followed immediately. For a moment it seemed as if the wind were all taken out of my sails, when Sir Edwin Saunders, who was then president of the society, inquired, "Will the gentleman be kind enough to tell us whether that was a case of congenital cleft-palate or acquired?" He then replied that it was acquired. "Then," said the president, "your case has no reference to the subject under discussion.*' It is well known that a very simple arrangement will produce the desired result in cases of acquired lesion; but if any of you suppose you can put an apparatus of this kind in the mouth of a person who has congenital cleft-palate, and produce as marked a change within a month as there is in the case before us, you will find you are mistaken. It never has been done yet. I have introduced appliances in cases of acquired lesion like this, and have found that the difficulty of speech was instantly corrected; it does not take a month. The simplest kind of an apparatus that will go back and cover the opening, although it may be as thin as paper, will restore the speech immediately. I will guarantee to take this patient and produce the same result that has been obtained here, by applying a simple obturator without any such hulb at all. I would not attempt to put in an artificial velum in a case of acquired lesion like this. I would always put in an obturator. As we are here to get light, will Br. Weber permit me to saw off the top part of the bulb, and let us see what effect, if any, it will have upon the patient's speech?
Dr. Bodecker. This is merely temporary.
Dr. Kingsley. ISTo matter; we see the effect it has, and by removing the bulb we can see whether this particular form of appliance is necessary in these cases.
Dr. Bodecker. He said it was necessary to begin with, until the patient has become accustomed to speaking.
Dr. Weber. It is made for the beginning; afterwards it is not necessary to have it on.
Dr. Kingsley. If you will allow me to cut the entire bulb off down to the sixteenth of an inch in thickness, you will find she will articulate just as well as she does with it on. If her speech is injured by it, I will make her a new piece,—either one like this, or anything else; she shall not suffer from it. Personally, I care nothing about it. It is not to satisfy myself; but I would like to remove it, in order to show others that it is of no use.
Dr. Weber declined to have the piece cut.
Incidents Of Office Practice.
Dr. W. D. Tenison. The conclusion I have arrived at, from my own and reported experiments with cocaine, is that this remedy is of little value unless injected. I have used it with the rubber-dam, drying the cavity thoroughly, and it had no effect. In other cases, the patients said they did not feel quite so much pain. I have used it in cases where the rubber-dam could not very well be applied, and where the fluids of the mouth got into the cavity of the tooth with it, and in some of those cases the patients thought the pain was very much lessened. I concluded that a good deal of that was in the imagination of the patient. We all know that when we use the rubber-dam, and the tooth is thoroughly dry, after excavating beyond a certain point, the patient does not feel as much pain as when we commenced. I am about as much at sea with regard to the value of cocaine, when applied to tooth-substance, as I was before I experimented with it.
Dr. Bodecker. I have used cocaine in a number of cases,—with good results in some, in others not. A physician informed me that in some dispensaries they have used it by injecting a drop or two in the vicinity of the inferior dental nerve, and were able to remove quite a number of roots, in different instances, without any pain whatever. I have used it a great deal in minor operations, such as opening abscesses, etc., and I have found that it generally lessened the pain very materially.
Dr. Atkinson. I have had some experience with cocaine, and I know it is no humbug. I lately made an operation in which I went into the inferior dental canal on the right side, from the site of the transverse process between the second bicuspid and first molar, tracing the entire canal back to the posterior border where it turns up and escapes from the ramus. Before applying cocaine the patient could not bear to be touched, either on the face or gums, without having a "tick," as she called it, which is a very old and significant name for the sensation. Yesterday I saw her again, and she said the "tick" was not entirely gone, but there was no heavy shock. Mr. Charles S. Tomes saw the case immediately after the operation, which consisted in rasping down the entire alveolar border to the permanent part of the bone. I put, say, ten or fifteen drops of cocaine on a piece of cotton, down into the chamber where the operation had been made, there being no dressing in it, and held it there for five minutes. I then touched it with an instrument and asked if she felt it. She said, "Yes, I feel it, but it does not hurt." I repeated the dose, using a ten per cent, solution that I made myself from distilled water and the alkaloid, and I know it was not deteriorated. The peculiar feature of the case was, that while the patient could feel the instrument there was no pain, although I burred to my satisfaction and thoroughly along the canal to get at the posterior foramen; then turned to the thin portion of the process and burred that off until I reached the soft tissues on the inside. The solution does not wholly remove sensibility. It produces insensibility to pain, but the tactile sensation seems to remain. In the case of this lady the exsection of the nerve was first made in August last, in the territory where the inferior dental nerve comes out of the mental foramen, and that territory has been numb ever since, except as to tactile sensation. She could tell when one or two points of the pliers were placed upon that locality at some distance apart as readily as she would if placed upon the well side. Therefore, the idea was suggested whether there was not an abnormal connection through some other sensory nerve with this part of the face. Wherever we can get this agent absorbed in the neighborhood of a sensory nerve, we do get local anesthesia against pain. Dr. Tenison. Do you get anesthesia in the tooth-structure? Dr. Atkinson. I have, in a case where I put it in four teeth,—two bicuspids and two molars. It operated so nicely, that the patient would not believe the excavating Jiad really been done. But I do not think we can rely on that in all constitutions. I prefer to make the operation of excavating right in the fluid. I have not used it in any case yet where I put on a rubber-dam. For removing children's teeth it is just the thing. It quiets the local trouble, so that you can pick them out without difficulty. I have not yet had a case of really exposed pulp on which to test it.
Dr. Tenison. I have extracted one tooth, for a very nervous patient, applying cocaine, and the patient said she felt no pain.
Dr. Atkinson. In regard to recovery from the effects of cocaine,—I have had no case under my own observation, and I have read of no case, in which all the sensation was'not dissipated in from fifteen minutes to two hours. It was used very vigorously in my own mouth at Springfield, and I only felt a stiffness of the right side of the tongue and the pharynx for most of the day. After I slept I do not think I noticed any unusual sensation. We have records of cases where fifteen grains have been taken by a human being, the only result being intoxication.
Dr. Northrop. I know of an instance where it has been used for nearly six weeks, in a case of uterine cancer, for the purpose of keeping the person from suffering. It has kept her quiet, and she has had no ill effects.
A paper was then read by Dr. J. L. Williams, of New Haven, Conn., entitled "Molecular Structure and Force with Eeference to Nutrition." *
Adjourned. B. 0. Nash, D.D.S., Secretary.
S0UTHEE3J DENTAL ASSOCIATION.
The Southern Dental Association will hold its seventeenth annual meeting in the city of New Orleans, at Tulane Hall, Dryades street, between Canal and Common streets, commencing the last Tuesday (31st) of March.
The Exposition, together with cheap traveling rates, will, no doubt, induce a large attendance, and the meeting will be one of unusual interest and profit.
Much of the session will be taken up with clinics, and those attending may expect a rare treat, as some of the foremost men in the profession will be present for that purpose.
The committee of arrangements will see that ample provision is made for the accommodation of visiting dentists.
Those wishing to engage rooms in advance will correspond with Dr. J. E. Walker, chairman committee of arrangements, corner Baronne and Common streets, New Orleans, La.
J. L. Fountain, Cor. Sec, Bryan, Texas.
* See page 129, current number of the Dental Cosmos.
NATIONAL ASSOCIATION OF DENTAL EXAMINEES. The third meeting of the National Association of Dental Examiners will be held at New Orleans, on Tuesday, March 31, 1885.
All State Boards not already members of this association are earnestly invited to send representatives to this meeting.
Geo. H. Cushing, Secretary.
CALIFORNIA STATE DENTAL ASSOCIATION.
The sixteenth annual meeting of the California State Dental Association will be held in San Francisco, commencing the first Tuesday in August, 1885, and continuing five days.
The following are the officers:
A. Warner, D.D.S., president; W. F. Griswold, vice-president; S. E. Goe, D.D.S., secretary; II. E. Knox, D.D.S., corresponding secretary; S. E. Knowles, M.D., D.D.S., treasurer; J. A. W. Lundborg, librarian.
YEEMONT STATE DENTAL SOCIETY. The ninth annual meeting of the Vermont State Dental Society will be held at Burlington, Vt., commencing Wednesday, March 18, 1885, and continuing three days.
A cordial invitation is extended to members of the profession in this and adjoining States to be present.
Thos. Mound, Secretary, Eutland, Vt.
VERMONT STATE BOARD OF DENTAL EXAMINERS.
The Vermont State Board of Dental Examiners will hold their third annual meeting at the Van Ness House, Burlington, Wednesday, March 18, 1885, at 10 A. M.
Applicants for license are requested to report promptly at that time. R. M. Chase, Secretary, Bethel, Vt.
IOWA STATE DENTAL SOCIETY. The twenty-third annual meeting of the Iowa State Dental Society will convene in Des Moines, on the first Tuesday in May, continuing four days. This meeting is expected to be one of the best in the history of the society. A cordial invitation is extended to members of the profession from other States.
Des Moines is centrally located, easy of access, and has splendid hotels and many attractions, which will make this a pleasant as well as profitable vacation for dentists.
J. B. Monfort, Secretary, Fairfield, Iowa. Vol. Xxvii.—12.