A similar case is on record where a Boston gentleman, thirty-three years of age, from disturbance of the pulp, became quite insane, and on removal of the tooth in that case complete recovery followed. I mentioned the case of a patient at that time in my care, who had been in my hands for nearly two years, and whom I was treating for retarded eruption of the wisdom teeth. A number of physicians diagnosed his disease as brain trouble per se, and treated him accordingly. In my remarks I said that the above cases showed that the nerves may be very seriously affected by the eruption or diseased conditions of the teeth. I was asked by a member if the gentleman was insane. I answered that he was very near it, and that the gentleman himself thought he would become insane, and that his physician, Dr. Dieffenbaeh, had said to me, " This man will be a subject for the lunatic asylum if he is not relieved of those wisdom teeth." I promised to give the Odontological Society a full history of the case at some future time. His long-protracted illness commenced with pain in the head in July, 1878.

My attention was first professionally directed to the case of Mr. W by being requested to extract a carious left superior sixthyear molar in December, 1881, but on account of the very delicate condition of the patient I did not extract it till about the 1st of February, 1882, some five weeks later The pulp had been devitalized and the tooth prepared for filling while he was in the country, but on account of the dentist attending to it having been unexpectedly called away the operation was not completed. I had filled

several teeth for Mr. W when he was twelve years old, and I

found them in good condition. I said to him, "You have lost all your wisdom teeth except one?" His reply was, " Oh, no; I have never had a wisdom tooth extracted." I made a more thorough examination a few days later, and, taking his age into consideration (he was in his twenty-seventh year), I became convinced that the real source of his long and severe illness and brain trouble was caused by the retarded eruption of the wisdom teeth. Knowing that he was at this time in the hands of a specialist, who was treating him for brain disorder, I told him at once that I did not believe that his trouble was with his brain. This surprised him greatly. I told him I was sure his brain trouble was caused by reflex nervous action from the source above stated. At this time but one of his wisdom teeth had normally erupted; this was in the right superior maxilla. Judging from the griping pains in his jaws, extending therefrom to the back of his head, and locating the non-erupted wisdom teeth, confirmed me in the opinion that my diagnosis was correct. I refused to take his case as long as he was in the hands of a specialist, being treated for brain trouble. This point being satisfactorily settled, I then undertook his case. He told me that Dr, Wm. A. Hammond concurred in my diagnosis. In each case I found it impossible to remove the wisdom tooth without first removing the twelfth-year molar. My first operation was to extract the upper left twelfth-year molar, hoping thereby to afford relief by so doing. This was accomplished in April, 1882. At the same time I endeav. ored to extract the wisdom tooth also, but on account of its position, and the patient being so weak and delicate, I did not succeed. It was not deemed advisable to administer an anesthetic, and without one the shock was to be dreaded. It was not until the following December, seven months later, that I was able to extract this left superior wisdom tooth, during all of which interval he was in very great pain and suffering constantly from excessive nervous prostration. This tooth had three diverging roots, all of them largely exostosed. The effect of the operation was almost immediate, the benefit being very marked, and he was soon able, for the first time in three years, to resume business and take part in social enjoyments. His health continued good until his return in September from the Catskills, where he had spent the summer, when he reported to me that he was again suffering in a manner similar to that which he had suffered previous to the extraction of the above-mentioned tooth. I found on examination that the right inferior wisdom tooth was giving him trouble. Previous to his going away I had told him that, at the first indication of any trouble in the lower jaw, I would advise the extraction of the twelfth-year molars at once. I now reiterated this advice and urged its immediate adoption. Hoping to relieve the pressure and mitigate the pain, the right inferior twelfth-year molar was extracted in October, 1882; but to my disappointment the operation did not afford perceptible relief. I now hoped that the wisdom tooth would erupt in the normal way, but it did not. After a few weeks the absorption of the surrounding gum-tissue revealed the exact position of the retarded tooth. I found it lying diagonally across the ramus, a position from which it was very difficult to remove it. I had much difficulty in finding an instrument that would grasp the tooth. I finally removed it on December 24, 1882, an interval of six weeks. This tooth was also bifurcated and exostosed. The effect of this operation was not what I had hoped for, the pains continuing, but changing to the left side. Owing to the very nervous and prostrated condition of the patient I was obliged to defer for a few days the extraction of the left inferior twelfth-year molar. This was done in February, 1883. At this time I did not cut to find the wisdom tooth. I could see no external evidences of it. As before, I waited, hoping relief would follow, but, as the pains continued without mitigation, shortly thereafter I made an examination and struck the wisdom tooth deeply imbedded in the ramus. It really appeared as though the tooth tried to go out through the facial side of the ramus. The patient continued to suifer intensely. I really thought he would lose his mind. One of his physicians had previously said to me that if the cause was not removed he would certainly become insane. He suffered so much that, at his urgent request, I consented to attempt the extraction of the tooth in May,—some twelve weeks later,— though feeling almost certain that the attempt would be fruitless without an anesthetic; and this proved to be true. His very delicate condition rendered it impracticable to administer an anaesthetic, or to do anything to cause a sudden shock. This factor in the case greatly hampered me all through. His eyes, too, became affected sympathetically. Sometimes he could not see at all during the spasms of pain. He would be almost delirious at times with the severe pain in the back of the head. As he described it, his head would be sore to the touch. With reference to anesthetics, Dr. Hamilton, who at one time had been his physician, had refused to sanction their use in his case. While I duly respected the high authority of this opinion, and had been governed by it, nevertheless I did not concur in it. Finally, on or about the 9th of June, I sue ceeded in extracting this tooth, the patient having been first placed completely under the influence of ether. I was assisted in this operation by his attending physician, Dr. J. F. Davis. The tooth was a very remarkable one, both as to location and formation. As to location, it was inclined, by reason of its extreme exostosed condition, to make its appearance through the maxilla on the facial side; in fact, after the extraction, the face there was extremely sore, a slight protuberance showing. As to formation, it was bifurcated, and its exostosed condition had united the bifurcation, so that the nerve-currents were, by the progress of the exostosis, partially cut off. I dressed the aperture carefully every day with a weak solution of carbolic acid, alternating with permanganate of potash and wine of opium; but on account of the terrible strain upon the parts attendant upon the great force necessary in drawing out the inverted wedge-shaped exostosed roots, there was much inflammation to contend against. By the latter part of June he had so far recovered that he was able to leave the city for the Isle of Shoals, where he remained in a comfortable condition until about the 6th of the following September. Shortly aftetr his returm home he complained to me of pain in the same side of the face. From about the second week in September he had a severe relapse, and at times, as before, was almost crazy with pain. About the 1st of November following I was obliged to use the engine bur for the purpose of re-opening the aperture made by the extraction of the wisdom tooth. This I did thoroughly, breaking down the septum between the wisdom tooth and the twelfth-year molar. Prior to this, on account of the severe prostration of the patient, I had only partially opened the cavity. After the operation he revived again, gained strength, and we both thought he was now going to be well; but, to my surprise, he was again attacked with pain in the superior right side, in the only normally-erupted wisdom tooth that he had had. As I have before stated, I had extracted the right inferior wisdom-tooth and twelfth-year molar, consequently these superior teeth had no antagonists. Elongation in both teeth was now apparent. A very slight fissure exposure was found in the wisdom tooth and the dentine exceedingly sensitive. Both teeth became very sore, and the least pressure of the finger was painful. I therefore advised the extraction of both; nevertheless, I could not persuade him to have it done without an anesthetic. During the next iive months his health was very poor and his general condition low. He was in the care of Dr. E. B. Pardee, who was at first averse to giving him any anesthetic, but finally, as he had made some improvement under his treatment, on the 30th of May he assisted me in administering the nitrous oxide gas, and I extracted these teeth. Thus, after a series of operations and treatment by me extending over a period of three years, and treatment by many physicians—some ten, I am informed—for a period of more than six years, the causes having been fully removed, the brain trouble ceased, and has not returned.

President Jarvie. In regard to the case which I reported about two years ago, and which is referred to by Dr. La Eoche, I would say that there has been no improvement in the condition of the patient since that time.

E. T. Payne, D.D.S., Secretary,

SOUTHEBN DENTAL ASSOCIATION-SEVENTEENTH ANNUAL

SESSION. (Continued from page 289.) Second Day.—Morning Session. The association was called to order by Yice-President Catching. On motion of Dr. McKellops, a half-hour of each day, at the close of the morning session, was set apart for the exhibition and explanation of appliances.

Several committees were called and passed. When the Committee on Operative Dentistry was reached, Dr. W. N. Morrison, St. Louis, read a paper protesting against the unnecessary sacrifice of dentine in devitalized teeth, and detailing his method of dealing with such cases. Following is a synopsis:

Dr. Morrison wished to call attention to the reckless sacrifice of tooth-substance in devitalized teeth. We have been instructed when opening dead teeth to cut freely and to make the openingslarge, so that we can see into every part of the cavity, and in many instances to drill out the individual root-canals, removing solid dentine from the best part of the crown of the tooth, unnecessarily weakening it in the place where it should have the most strength. In many instances the roots are filled with cotton, and the cavity with whatever material is used, leaving only a thin, frail shell of dentine between the filling and the enamel. Soon follows the breaking down of these walls by the ordinary use of the jaw in mastication. He has always felt that there was no excuse for this wholesale destruction of so important a part of the teeth, and has been working to save all the crown substance of dead teeth possible. With the method of root-filling which he has used for many years, with pure gold wire, of size to correspond to the sizes of the different canals, it is possible for almost any operator to fill the canals of the molars through an opening not to exceed one-sixteenth of an inch in diameter, made directly in the center of the crown with a drill, the sharp angle at the lower end of this hole being slightly funnelled with a round or truncated cone bur. Access is had with small steel broaches for the removal of the dead pulp, and the cleansing and treatment, if necessary, of the canals. He protested against the over-treatment of canals where the pulp-tissue is entirely removed. When certain of this, and that there is no inflammation in the peridental membrane, he fills the canals immediately.

He recently had a case of a lower first molar, with a very large mesial cavity of black decay, the patient being a gentleman about fortyfive years of age. Being uncertain as to whether the pulp was healthy enough to live, he put in a large filling. The tooth remained comfortable for several weeks, but finally i|rjbegan to have neuralgic disturbances, with flashes of pain and extreme sensitiveness to thermal changes, both of the air and food, the pain recurring nearly always at night. The gentleman was anxious to keep the pulp alive, but one morning he said he could endure it no longer. An opening not exceeding one-sixteenth of an inch in diameter was made into the pulp through the top of the crown, without removing the mesial filling, and the vessels were removed from one of the roots without much pain. Those of the other being exceedingly sensitive, were devitalized with arsenious acid. In removing the pulp, a nodule of secondary dentine, about the size of a quail shot, was discovered in the pulp-chamber. With a small, sharp barbed broach the pulp-tissue was torn from this nodule, which was perfectly smooth. The nodule was then rolled forward over the orifice into the mesial