No. 55.

VOL. IV.

PENNSYLVANIA ASSOCIATION OF DENTAL SURGEONS. (From The Dental Cosmos,' October, 1860.)

(Continued from vol. iii, p. 486.)

DENTAL medication is general medication. Several years ago I said on the floor of this room, that it would be compulsory on the part of the professors of our dental colleges to suit the curriculum of their institutions to this growing requirement. I do not forget, gentlemen, the reception my doctrines then met with. We have grown somewhat in stature since then; we are growing rapidly now from month to month. I remarked at that time, that I could not understand how the aurist and oculist could be successful without the abilities of the general practitioner. And as I entertained a respect for the dentist equal to that of any special surgeon, I could not understand how he alone, of all the specialists, could hope for the greatest success, possessed of only a local knowledge or an ability to treat a cachexia only at the point or periphery at which a cause exhibited its effect. But the good dental graduate of to-day is almost as well qualified to practise medicine as dentistry; and, gentlemen, according to my views, he should be quite as able, and I have little doubt, judging of the future by the past, that he, after a time, will be as fully qualified. You, who are as familiar with private teaching, with clinics, and hospitals, as I am, must have been struck with the number of dental students constantly met with at such places. I am sure four fifths will be found so engaged in the hours not devoted to their own lectures. Does not

this suggest that we are not even yet giving them as much as they can digest? If we look at dental classes as in the winter they assemble in the colleges, and compare them with the classes of our medical schools, we will not have to ask ourselves the second time why they thus cry for more-it is indeed due to the growing intelligence of the profession. If, gentlemen, to-morrow I should have two students enter my office, one with the intention of reading medicine, and the other dentistry, the only difference I should make would be, that when each had finished the same medical studies I would conceive my dental student ready for the manipulative or mechanical department of his profession, while the first would be ready to go forth. Theory first, practice afterwards.

Neither should we consider their education finished, for as science advances so must the practice of a profession advance with it. At this very moment Europe is divided on Virchow's new doctrine of life as the result of cell segmentation. It would now seem as nonsense to talk of a blastema and the spontaneous evolution therefrom of cytoblasts. The embryo develops by the segmentation of a single cell; the alveoli, on the extraction of teeth, are filled up by the same process of segmentation. We hereafter have nothing to do with lymph as a reparative agent; we must cure our patients by exciting one of the three functions of a neighbouring part. We attribute dental caries to acidity, and heretofore we have been satisfied in considering the acidity as we find it in the mouth. We have not, as a class, asked ourselves the nature of these acids, or to what is their production due. We

have underrated our position in giving too wide a scope to the general practitioner, and limiting too much our own. When, years back, before this association I have spoken of anæmia, chlorosis, and kindred conditions as the source of dental caries, I have been met with rebuke for travelling outside my profession. Let me now, gentlemen, add my mite to the experience of to-night by affirming that I believe I have saved more teeth by constitutional treatment than ever I have through manipulation. And if I could exhibit to you my practice, I would offer it in proof of the assertion. I could point happily to many cases where, when the patients first came into my hands, the tendency to caries seemed a cachexia; and where, under treatment, this cachexia has seemed to wear out, as does fire when unsupplied with fuel. I have the satisfaction of saying I could show you many such cases. And why not? Has not every one of us seen sets of teeth perfect up to some certain date, an attack of fever perhaps, or pregnancy, and then, under a constitutional change, at once succumb? Has not every one of us met with sets of teeth where our art seemed set at defiance? I know I may answer for all in the affirmative.

If, then, I am asked what these constitutional deteriorations are, I can only answer by referring you to the physiology of animal life, and to conditions modifying physiological action, or perverting such action to the pathological. Thus, I may allude to the circulation of the nutritive or life-supporting force, and may pronounce such circulation physiological when an equilibrium is preserved, both as concerns the relative quantities and qualities of constituent particles and pro rata distribution. Thus recognising this normal condition of blood and its office, I acknowledge a pathological condition in what Dr. Wood describes as inflammation, perverted condition of the circulation of a part, attended with heat, redness, pain, swelling, and a modification of secretion and nutrition." If I would make an analysis of its constituents, I may discover a deficiency in red corpuscles by looking in the face of my patient; I may see deficiency in or excess of fibrin, by watching the clotting blood; I may notice deficiency or excess of water as the blood flows from the cavity of an extracted tooth; I may note the excess of albumen in my strumous patient, not critically, of course, but to the practical advantage of my cases; patho

logical conditions may be induced from the fluids to the solids, or, firstly attacking the solids, may thus indirectly affect the fluids. Thus, in the one case we have dental caries as the result of a constitutional deterioration of the muco-oral secretions. And, to get an example from our peculiar domain, we have dyspepsia and its train of evil associations as a result of dental caries.

Mucus is the secretion, as we know, of numberless glands distributed through the alimentary canal. In health mucus may be denominated neutral, its capacity for deterioration may be marked by noticing the difference between the pearly and watery character of that which is eliminated by the healthy follicle and the sordes of the febrile condition. Deteriorated mucus is always more or less acid in its reaction. The effect of this acid mucus on the teeth is evident to all those who are familiar with the matter through clinical experience, or general practice. I have nothing to say of it as an entirely local condition, but shall briefly refer to it as a constitutional condition. In various of the exanthemata, in bilious remittent, in all typhoid forms of fever, the production of this watery deficient mucus gives us the sordes of the books. As I remarked, it is in itself most eroding, but there is from it an indirect effect in the formation in the mouth, through its presence, of nitric acid. You ask me to explain the manner of this production. Sordes is an organic body, having the nitrogenous element in excess; in its decomposition, which is going on so long as it continues to be produced, it liberates its nitrogen; this in turn indirectly combines with its equivalent of oxygen, yielding nitric acid as the result. Yet, if objections are urged, considering the known difficulties in the way of this union, we have only to convince ourselves, to take a portion of the sordes and fluid of a febrile mouth, and subject it, after neutralizing it by potash, to either of the tests given by Taylor in his 'Toxicology', particularly the last one, as found on page 188 of his work. You will recall the mention made by Professor Harris, in which Dr. S. R. Mitchell gets nitrous acid from the decomposing nitrogenous substance found between the teeth.

(To be continued.)