the inflammation. This may be of carbolic acid and oil of cloves, or creosote which coagulates serum or albumen and forms a scarf-skin over the exposed nerve. Such treatment for a few days together with aconite and mercurius sol, 3rd trit, will assist very materially in reducing pulpitis. It may be necessary to use Bell or Ver vir in alternation with the mercurius. The latter has marvelous power to control either pulpitis or periostitis. It is difficult to determine, sometimes, whether we have pulpitis or periostitis to deal with. With the former condition we may have all the characteristics that belong to the latter, such as soreness, throbbing and beating, but till one carefully examines at the junction of the cementum and dentine-a sensitive spot, if the tooth is alive or discovers the tender pulp, can one know surely that it is a congested pulp, and not periostitis.

We may notice that one cannot suffer from periostitis, while a nerve is alive in a tooth. Hence it follows that it is unwise to deliberately kill a nerve in a tooth.

A tooth cannot be filled so as to stop its farther destruction if the nerve has been or is exposed. There are three things that can be done. First, extract the tooth. That is unwise in this enlightened day, especially if it be a bicuspid or molar. The incisors are of less value to a person than are the back teeth. The back teeth support the jaws, and comminute the food. The front teeth are valuable, chiefly, to give contour to the anterior portions of the face, to tear off food, and to articulate words, but do not compare in real value to the back teeth.

An exposed nerve will not tolerate any foreign substance upon it. Hence some peculiar method must be adopted to prevent the filling pressing upon the nerve. This can be done by constructing a bridge or cap, whose periphery shall rest over and beyond the opening of the pulp chamber, to the intent, that a free space shall be maintained over and above the nervous tissue, to prevent pressure. Upon this bridge, and the balance of the cavity, can be filled with some appropriate material. Usually a non-conductor of heat and cold, should be used.

One of the most important points to be remembered in regard to the teeth is, that if the nerve is kept alive and healthy in a tooth, said tooth cannot ulcerate.

If one is called upon to save a tooth whose nerve has died from thermal causes, or for some other reason, a quite different procedure is necessary. Between a dead tooth and one that is alive, there is this difference, beside others. A dead tooth-a pulpless one—is brittle and of a darker color. Such a tooth compared with one having a live nerve in it, is like a fresh green limb or branch of wood compared with another similar piece of wood that has become dried. The latter will easily

snap and break on bending, the former will stand much strain and torsion. Therefore apart from their greater liability of ulceration-unless certain treatment is resorted to a dead tooth cannot render to the owner as valuable service as one that is alive-not brittle.

Mention has been made of the difference in the density between the enamel and bone of a tooth. No one can properly examine their own

teeth. It must be done for them by some one else.

The writer has never seen a cavity in a tooth when the periphery-the edge of the enamel-was smaller than the excavation beneath, in the dentine. Quite often extensive caries will be found-especially in children's teeth-beneath a very small opening through the enamel. This is an exceedingly important fact to be remembered by all who have any teeth, as serious lesions are present, when only a " small hole" is discernible. The nerves become exposed before one is aware of it; then the extra cost of bridge and other matters to properly fill the tooth must be incurred.

It is understood by every one that the object of filling a tooth is to stop its decay in a given spot. Not else where. Too many persons assume that because they have once had their teeth filled that they will never have to consult their dentist again. If the right approximate surface of the left central incisor has decayed and been filled, that fact can have nothing to do in preventing the left approximate plane from becoming involved with caries. Even the right surface may become decayed again, unless, both preparation and filling has been most carefully attended to, and due care exercised in preventing other healthy tissue from becoming broken.

The first great important point to be attended to in filling a tooth is, to most thoroughly remove all decay around the edges of the cavity. One little weak spot any where will act like a stream running under the foundation walls of a house. Undermine the walls, then "down comes the house."

In cases where the pulp would be exposed if all the decayed tissue is removed, it can safely be allowed to remain. This is understood to apply to the inside of the cavity, and not to the edges of the same. Absolute healthy tissue must be had at this point. Decayed dentine left over the pulp is a much more benign substance than any foreign element. But one cannot put pressure over, even this substance. The pulp will not permit any unlawful intrusion upon its domains. Under certain conditions juxtaposition might be tolerated. Nothing more.

If there is any doubt about whether there will be pressure over softened dentine that is immediately over the pulp, leave the debris there, and bridge over this. But much beyond the periphery, healthy sound tissue

must be found. There can be no further decay in coats left over the pulp chamber, if all the other operations are most thoroughly performed. All the elements for further destruction have been excluded, such as air, moisture in conjunction with normal heat.

All metals are conductors of heat and cold. Iron, gold, silver, tin, cadmium, copper, and mercury. Therefore, it is unwise to bring any of these substances in a mass near an exposed pulp, or even where there is but a very thin septum; for the reason, that, thermal change will kill the nerve in the tooth about as readily as will arcenious acid. It follows then, that the filling must be of some substance that will not absorb any more heat or cold than the tooth structure itself. What shall it be? Here the devil has come in with his spear tail done up in fine cloth, and his split hoofs encased in patent leather shoes and with immense wisdom shining with incandescent brightness, says "Under certain conditions, such as we find here, I would recommend Oxy-phosphate or Oxy-chloride of zinc, as the best materials to use in your case. The exact facts are these. That oxy-phosphate, or oxy-chloride of zinc will dissolve out of a cavity in a tooth about as fast as will an alum salt, especially in the cervical portions of the excavation. Hundreds and thousands of teeth have been lost by these abominable substitutes, of nothingness. Still, there are those who will try to deny these facts, "yet he" that "abideth faithful: " . . . . "cannot deny" the truth.

The most important wall in all the borders of a cavity, in a tooth, is the cervical one. Here is where failure comes in. In those cases where a phosphate or a chloride of zinc have been used, the saliva, bathing this portion of the tooth so thoroughly and constantly, soon, very soon, dissolves out these tramps, these aliens, in so short a time as to make them practically worthless. The lower portion of the filling may be quite hard and apparently "all right" but above there is being bored a small hole to let the swamp angels" in, and they soon find the sensitive pulp, and devitilize him, with all the promptitude of educated devils! This is not a matter that will permit of smiles or laughter, but tears! Whether it shall please the reader to believe these facts or not, he has had them faithfully presented to him, and experience—if he desires it will prove the exact truth!

But what is to be done to meet the necessities of the case? Simply, Exclude the thermal agent, and fill the cavity with something that cannot be dissolved out by the secretion of the mouth, whether of an alkaline or an acid reaction.

This can be found in bleached Gutta-Percha, into which has been rubbed plaster of Paris, or some form of silicious matter. vical portions of the cavity are safe from intrusion !

The cer

But, if the grinding surface of the tooth has become involved to any great extent, it will be found that the gutta-percha filling is not quite hard enough to wear as well as one could wish. It will not dissolve out under any circumstances, but after a while will wear out, cup-shape. If the patient will consult his dentist three times a year, as is his boun den duty-that is if he is interested in saving his teeth in the best possible condition-then, without any extra excavation a little more of the filling can be added and his tooth made safe for some time longer. Or, a slight excavation can be made in the gutta-percha filling, and an amalgam filled into this, or a capping of Guilloi's cement can be used, a very different compound from these effeminate zincs.

Is it wise to permit teeth to so far decay as to make the above difficult operations necessary?

If a tooth is worth saving at all, it is worth saving just as near its original condition as it is possible to have it. If there is one part of the human body that is more neglected or more outrageously-outrageously is just the adverb-treated than are the teeth-as a whole-then the writer does not know where to find such maltreatment. It has always been so, but is growing daily less. I am assured that no intelligent physician can take exception, to my suggestion, of the propriety of his professional advice, to his patients, to pay greater and more prompt attention to their teeth.

There are many other interesting points, about how and in what manner to have one's teeth filled, so as to make them useful, and valuable, but this obtuse paper is too long already. We should like to notice some facts about contour work, that is, restoring lost parts of dental tissue, so as to return the diseased tooth into a reasonable physiological condition again. It is possible that it may be done at some future time, but, there is pressing need of some considerations as to dental tissue building, to the intent that there will be less necessity of having teeth filled-" poorly stuffed" as is too often the case-and extracted.

It's the babies, the youths, then the grown men or women that are to be benefitted in this direction. And it is upon you medical men and women that this duty falls; though not a hundredth part of your arduous duties are properly compensated for, and too frequently unappreciated.

89 South Portland Avenue, Brooklyn. N. Y.

REPORT OF PROGRESS IN EYE AND EAR DISEASES.

BY

F. F. CASSEDAY, M. D.

It

ULCAMARA IN DISEASES OF THE EAR.-(Dr. W. P. Fowler, Trans. N. Y. State Hom. Med. Soc. 1886.) Very useful in catarrhal conditions of the ear, the Eustachian tube and pharynx. Is especially called for in cold, damp weather or in diseases resulting from damp weather. It is useful in both sub-acute and chronic cases. acts somewhat as a preventitive of colds. In some cases of sub-acute catarrh where dulcamara is indicated there is slight transient pain in and around the ear, usually of a shooting or twinging character and aggravated by moving the jaw. Frequently the membrana tympani is somewhat congested, dull and depressed and the Eustachian tubes. closed. The skin of the dulcamara patient is usually dry and inactive.

NEW METHOD OF TREATING CHRONIC AURAL CATARRH.-(Dr. R. W. Seiss, Med. News, Feb. 5, 1887.) It consists of Eustachian catheter closed at the point and having the sides of the curved portion perforated with numerous very minute openings. A small syringe is fitted with a metallic nozzle on the ground joint principle and slips into the end of the catheter. The instrument may be made of German silver but is preferably made of pure silver. The best average diameter is that of the ordinary Eustachian tube, three or four milometers, and the length from fourteen to sixteen centi-meters. When the beak of the instrument is fixed in the Eustachian tube suitable solutions can be injected through it, watching it and medicating the lower part of the canal without any of the fluid entering the middle ear or ascending high up in the tube, the fluid being thrown wholly in a lateral direction. through the minute perforations. Care must be observed that the moment the fluid is thrown in the instrument must be withdrawn, or the patient will be choked by the fluid deluging his larynx as soon as the palate is relaxed.

TREATMENT OF DEAFNESS.-(Dr. Robert T. Cooper. Paper read before British Hom. Society). Condemns the use of Politzer bag inflation in all cases of deafness as being unscientific. The different varieties of aural disease should be carefully differentiated. The first variety which Dr. C. speaks of is obstructed ear, resulting most frequently from obstruction of the Eustachian tube and meatus. The former can be relieved by the Politzer bag; the latter by the syringe. Nervous deafness was next mentioned, and a case cited which occurred in a lady,