Concluding, I desire to say that I should not have ventured the foregoing observations had I not, after careful observation, become convinced of their value. My clinical experience during the past year, which embraces the time my attention has been given to the catarrhal nature of pyorrhea alveolaris, covering a record of some twenty-four cases, is as follows: Catarrh of the nasal passages, or of the pharynx and larynx,—generally combined,—in every case; in ten cases, the atropic or fetid form; in a majority of the cases breathing conducted almost entirely through the mouth, on account of stenosis of the nasal passages. In many of the cases catarrh was stoutly denied, but upon careful examination was found to be present*

Whatever the future may develop in the study of the causes of the disease we call pyorrhea alveolaris, and whatever personal observation may teach that differs from the past, yet these recent observations from my own practice have been an astonishment which has been uninterrupted by the testimony of any case presented for treatment during the period mentioned. The actual demonstration of the identity of these diseases must be left largely to the competent ability to diagnosticate the catarrhal presence. This ability cannot be made available without considerable study. The observer will find at the outset many difficulties. The history of catarrh is not yet very clear; the etiology is somewhat in dispute among those high in authority. The actual irritant in the catarrhal exudation is also a mooted question. Then, the history from the patient is often misleading. Those suffering from the disease will sometimes deny until denial is useless, that they suffer from catarrh, and not until the atrophic, hypertrophic, and fetid forms are present will they admit the truth. It is not an infrequent occurrence in any dental practice to detect the peculiar catarrhal odor known to you all (and said by Dr. Bosworth to faintly remind of crushed bed-bugs more than anything else), and yet to find the patient professedly ignorant of the least trace of catarrh, and, if admitting anything, he will relegate the trouble to a simple "coryza." These and many other difficulties confront our investigation; but if with care we can arrive at some fixed point in the etiology of dental disease, our labor will be well repaid.

PATHOLOGY, THEBAPEUTIOS, AND MATEEIA MEDIOA.

BY A. W. HARLAN, M.D., CHICAGO, ILL.

(Read before the American Dental Association, at Minneapolis, Minn.,

August 6, 1885.)

The discoveries of the past year in dental pathology are not sufficiently numerous to warrant even a summary of the contributions in this special field. The most important, the work of Miller, either

TOL. XXVII.—43.

through lack of interest in strictly scientific investigation or failure to comprehend the vastness of his labors to elucidate the causes of dental caries, has not yet been entirely accepted by the mass of the profession.

The next most noteworthy contribution in the field of pathology has been the one which attempted: to foist on the unsuspecting and guileless practitioner actinomycosis, or "lumpy " jaw, in the human subject. At least two cases have been reported during the past few months of ordinary alveolar abscess which were gravely declared to be "lumpy" jaw, and similar to that observed in cattle. Expert microscopists, after examination of the contents of the swellings, declared the micro-organisms to be veritable actinomyces.

A very exhaustive paper reviewing the work of Israel, Zollinger, Yirchow, Duncker, and others accompanied the report of the first case. The second case, after the extraction of the tooth, recovered without any treatment, showing that lumpy jaw in the human subject need not necessarily be fatal, even though actinomyces be present in the pus of an alveolar abscess. In both cases the teeth were carious and unfilled, and, as has been shown by Zeigler and others, the actinomyces are almost constantly present in the mouth, air-passages, throat, intestinal canal, and elsewhere. It were the simplest and easiest matter in the world for this organism to be found in the pus taken from an alveolar abscess without a fistulous opening. Actinomyces have been found underneath the gum overlying an erupting wisdom-tooth without producing so-called "lumpy " jaw. They are instantly destroyed the moment they are exposed to free oxygen, and may, in consequence, be styled an,serobic germs. The interest which these pseudo cases of actinomycosis have for dentists is this: Pus taken from blind abscesses should be examined under the microscope to discover if actinomyces are constantly present or only when the crown and root are unfilled; the organisms will not be found in the pus from a fistulous abscess.

Other papers, reports, and discussions on dental and oral diseases have failed to invite criticism or summarizing, on account of the paucity of ideas contained therein. The work which I have imposed upon myself in an investigation of the pathology of pyorrhea areolaris is still unfinished, and I shall have to beg, as committees are wont to say, for further time.

In the domain of materia medica and therapeutics more activity has been shown, and the mass of the profession is gradually being weaned from the empirical use of only one or two remedies, and availing themselves of a more extended and useful knowledge,—a wider selection from materia medica. Although former years have given us the uses of a numerous list of drugs, yet none have created such a widespread interest as cocaine. It is hoped that a full discussion of its merits and failures will take place here. Having used it in all operations on the mouth and teeth, especially in the extraction of pulps and as an obtunder of sensitive dentine, I have come to the conclusion that we have a vastly more efficient remedy in the stronger tincture of cannabis indica, or the normal liquid (an extract), for such purposes, than any form of cocaine that I am acquainted with. A tincture of the strength of gx of the flowering tops to alcohol Oj is sufficiently concentrated to obtund in from three to five minutes the most sensitive cavity in a tooth. The cavities should first be washed with tepid water to remove all debris, and the gums adjacent to the teeth to be operated upon painted with the fluid extract or tincture a minute before adjusting the rubber-dam. A clamp or ligature can then be adjusted without pain. I have removed the pulp from a tooth painlessly after saturating it with the stronger tincture in from five to eight minutes. The tincture of cannabis indica was first used in England about one year ago by Mr. Aronson to obtund the gums before extracting a tooth. It was used very much diluted in warm water; the gums were saturated by painting them; then the beaks of the forceps were warmed and dipped in the diluted tincture, and the patient was said to have felt no pain. My experience with cannabis indica has been as an obtunder of sensitive dentine, exposed pulps, and by injecting a weak extract into pyorrhea pockets previous to removing deposits from the roots. I have been unable to obtain good results by using cannabin, the active principle of cannabis indica. A patient should not be allowed to swallow a very large dose of the above tincture or fluid extract, as these proportions are about three times stronger than the ordinary tincture or extract. The antidote is the same as for opium.

Your attention is called for a moment to a consideration of resorcin and tereben, both antiseptics of great value to the dental surgeon. Resorcin is no new drug, as experimental therapeutists would testify; but its merits are little understood by dentists, and its use has been limited, even in general practice. It may be used in all conditions where carbolic acid has been indicated without the danger of the latter, as it is neither poisonous, except in very large doses, nor escharotic, except when used in crystals or powder. Tereben is the active principle of the oleum terebinthinse, and has for composition C10 H16. It is a transparent, limpid liquid, with no unpleasant odor or taste, and is a ready absorbent of oxygen. It is disinfectant, antiseptic, and stimulant. It may be used in and around the roots of teeth for ail the usual purposes of disinfection and stimulation, and is especially useful for the destruction of anaerobic germs, such as are found in closed abscesses. It is not an obtunder of sensitive dentine, and is not used as a dressing for exposed pulps. It will destroy the foulest odor which proceeds from the decomposition of a pulp. It does not irritate the most sensitive surface, and it is especially useful as a dressing for root-canals when they are particularly mal-odorous. It dissolves readily in all the essential oils, and is a solvent for gutta-percha, iodine, various resins, and is soluble in alcohol, one part to ten. Its merits in the abovementioned cases are undoubted, and a few trials will convince the most skeptical of its great efficiency.

CLINICAL REPORTS.

HOSPITAL OF OEAL SUBGEBY.

CLINIC OF PROFESSOR JAMES E. GARRETSON, M.I>.

Bemoval Of Incisor Branches Of Inferior Maxillary Nerves.

The patient, a young gentleman, was brought into the amphitheater etherized. The "dis" in the case, as Prof. Garretson uses the word to express cause, or meaning, of lesion, was diagnosed to lie with injury of the incisive branches of the two inferior maxillary nerves, resulting from the kick of a horse. The person was a sufferer from convulsions, An inference, arrived at through the process of exclusion, both by Prof. Waugh and Dr. Garretson, attributed tjiese convulsions to reflex disturbance arising out of the local condition. The proposition being to remove the involved nerves, a line was drawn around and below the chin reaching the mental foramina of either side. This line had the meaning of an operation which should be without sear, and which was not in a future to show evidence when the head was in an upright position with the face directed toward a vis-a-vis. Next, this line was drawn upward upon the bone, and the point of a catling-shaped blade was sunk to the jaw just in front of the mental foramen of the left side, the blade, with a sweep, being carried around the chin until an exactly opposite position was reached upon the right side. A succeeding step was the ligation of two arteries, while immediately following this the chin tissues were dissected from the jaw, care being taken not to disturb the inside mucous membrane, with a view to avoid entrance of blood into the mouth. The bone, freely exposed to view by this performance, was seen to be deformed through nodulated hypertrophy j the attention of the class being called to the condition.

Following the exposure was the use of a raspatory, a strip of periosteum, four lines in breadth, being scraped away from foramen to foramen. The flap being, at this stage of the operation, held

fairly clear of the bone by means of retractors, and all oozing of blood controlled, the convex-faced exposure of jaw was seen to be fully ready for the bur.

Prof. Garretson uses in all bone operations the surgical engine. In the present case a bur found to be dull was quickly replaced by a second of oblong form, new and exquisitely sharp, and it was not longer than five minutes when the canal underlying the anterior teeth from cuspis to cuspis lay open its entire length, with its contents wholly removed.

In concluding the operation stress was laid on the necessity for rounding and smoothing the cut surfaces of bone, and a free syringing of the parts with a view to getting clear of debris. These points being here attended to, the soft parts were brought into place, stitched, and compressed, with a view to securing union by first intention.

The line of incision was so perfectly suited to the intention that, when the flap bad been stitched back to its place in the neck, and the head of the patient was lifted, nothing at all was to be seen indicating that an operation had been performed. Prof. Garretson was assisted as usual by his chief of clinic, Dr. Cryer, and by Dr. Shimwell.

Bony Anchylosis Of Thirty Years' Standing.—Cure By OperaTion Oe Exsection.

The patient is a lady thirty-five years of age. Jaws immovably locked. The condition had its origin in an attack of scarlet fever, occurring in the fifth year of her age. At a previous clinic this person had been brought before the class, and had, with a view of securing absolute accuracy of diagnosis, been profoundly etherized, a result being confirmation of an opinion previously expressed, that the lesion lay with the right tempero-maxillary articulation, and that here was a complete osseous union of the two bones.

The patient being laid on the revolving table and re-anesthetized, the proposed operation was commenced, which considered the removal of a wedge of bone from the angle of the lower jaw, which wedge was to measure an inch across at its base, and four lines at its apex.

First, a shade line was made upon the neck just below the jaw, the object of which was to secure a position for the incision that would avoid an observable scar. Second, this line was drawn upward so that the knife, when laying it open, should reach and rest upon the bone. Third, attention was directed to the anatomy of the part, as this considered the relations of the parotid gland, facial artery, and action of the masseter and pterygoid muscles.

The point of the bistoury was sunk to the bone at a point midway