"Fitch," 1835, recommends the treatment of the exposed pulp with Aleppo galls, scraped up, placed on the exposure and covered with wax; a few weeks or months later, caps with sheet lead or piece of gold plate and fills with gold. He relates numerous cases and complete success of this practice.
Harris, in 1840, arched his gold fillings over the exposure and continued the filling with gold, with some success. Had tried Fitch's method with indifferent success, and thought Koecker's must from necessity result in failure.
In 1841, "Lefoulon," in his work, after giving some of the methods and remedies of his predecessors and cotemporaries, says: "As for ourselves, though we be accused of being controlled by one permanent notion, truth compels us to say that the employment of our ethereal alluminous paste has enabled us to preserve the teeth of our patients, even when these organs were attacked with most intense inflammations. Its sedative and extraordinary anti-spasmodic quality does not fail to triumph over the inflammatory erytheism of the dental nervous system and its appendages to such an extent that all pain and all irritation cease at the end of some days, sometimes on the next day. Let the incredulous put us to the proof and test for themselves the truth of our words."
The above quotations will show about the status of the professional opinion as expounded by the authors of the then works on dentistry. Most of these were written by practitioners who claimed special skill, and were in a measure separated from each other and the profession.
With the exception of Hudson, Maynard and, possibly, one or two others, the practice of removing the pulps and filling the canals was not known or attempted. Harris, in 1840, speaks of their operations, but had attempted it only in a few cases, and with indifferent success.
The necessity for, at least, claiming to succeed in operations of this kind—saving pulps—was almost imperative.
In 1850, Dr. J. D. White, in theNews Letter, says: "The treatment of the exposed pulp has given rise to great difference of sentiment among well educated dentists, but mainly about the means which should be employed for that purpose, agreeing pretty generally that it is bad practice to destroy it entirely. But as well might we expect to procure a healthy function of the reto-mucosum when denuded of the epidermis by substituting one of our own invention, as to procure a healthy function of the pulp when deprived of its natural protection, the bone."
From about this time until within a comparative recent date, in all methods of capping the ultimate design has been to secure a production of secondary dentine at the exposed point of the pulp. The methods and materials made use of are almost numberless, and the successes claimed are also equally as numerous. For applications in the treatment we have recommended to us in our text-books, pure nitric acid, pure carbolic acid, pure creosote, iodoform, dilute chloride of zinc, iodine, bichloride of mercury, and in fact everything from stimulating it with the electric cautery, to feeding it upon lacto-phosphate of lime and powdered dentine. For capping: the different cements, stoppings, gums, minerals, etc.; and the cases run from the capping of the remaining third of the pulp in the root of a lower incisor upon which a pivot tooth was to be placed, an exposure in the distal surface of a third upper molar, and this suppurating, to a simple exposure from excavating a cavity for filling.
Our dental societies in their reports show that some are very successful in their endeavors to save exposed pulps: that others don't kill babies for the sake of having a funeral, and attempt to save everything: while others, whose experiences are just as extensive, whose observations and opinions are just as much to be respected, claim that an exposed pulp that has ached or been inflamed, can never become healthy by any treatment whatsoever.
There has been, without doubt, a gradual change in practice for the past fifteen years, brought about by sad experiences and the better knowledge of the tissues involved; also by the improved educational condition of the profession as a whole. Dr. Black,in theAmerican System of Dentistry, on "The Pathology of the Dental Pulp," has given us, as far as I am able to judge, by far the best and most instructive contribution upon this subject. He concludes his sixty pages of valuable observations as follows:
"PATHOLOGY OF THE DENTAL PULP—GENERAL CONSIDERATIONS."
"In the foregoing pages I have frequently alluded to the fact—which is apparent in a very large proportion of my microscopic preparations—that any of the secondary calcific formations within the pulp of the tooth, result in exhaustion and final death of the pulp. This fact is so prominent that it seems to me that it cannot well be overlooked; and yet, in the capping of exposed pulps, it seems to have been the thought of the profession that to be able to obtain a secondary deposit under such circumstances was to insure the permanence of the health of the pulp. This was my own thought some years ago, but further clinical experience, combined with closer microscopical study of the subject has convinced me that this is a mistake. Secondary deposits may, and do, insure temporary quiet, but so far from insuring health are they, that, as a matter of fact, they bring about the very conditions that we most wish to avoid—the degeneration and final destruction of the pulp.
"In a large majority of cases, however, this result is brought about very slowly, and thus has escaped the notice of most observers; for if an exposed pulp is capped and the cavity filled, and the case seems to do well for a year or two, it is regarded as a success, and is lost sight of. When this returns some years later with a dead pulp, it is treated as one of the great mass of such cases that are constantly presenting themselves, and probably no note was made of the fact that it was capped at a certain time, and was one of the many successful cases.
"Very many cases of capping pass on for years without any deposit whatever, and seem to remain in a perfectly healthy condition. This we must regard as the most desirable result that can be obtained. Enough of these cases have been noted to demonstrate the possibility of rendering the conditions so nearly normal that no disturbance of the functions of the organ occurs."
From my own experience and observation, and with all due regard for the experiences and opinion of others, I will say, when there has been an exposure of the pulp, with any considerable pain as a consequence, I would in all cases destroy and remove. In cases where from the location of the cavity, or where the surroundings would not admit of a satisfactory operation otherwise, I would devitalize. With the remedies at our command, the increased facilities for destroying and removing the pulp, cleansing the canals, and the various means for hermetically filling them, thereby rendering the tooth absolutely free from painful impressions, just as serviceable, just as beautiful, and in all respects as enduring. I fail to see how we can justify ourselves, or do justice to the patient by subjecting them to a painful and, possibly, an imperfect operation, with the probabilities that they will again be obliged to seek for relief from the same offending member.
In conclusion, I would add, that accepting the reasoning of Dr. Black as the correct explanation of the conditions presented, I believe there are, comparatively, a small number of cases where we are able to so protect the exposed pulp as to leave it in a normal condition; and while we should endeavor to save the patient time and expense, we should also endeavor to secure them relief from pain and future suffering, and also protect ourselves and the profession from the criticisms following operations that are worse than failures. Since my experience has enabled me to distinguish, to a certain extent, between facts and fables, between the teachings of reasoning intelligence and egotistical statements, my practice has been most satisfactory, my ways have been those of pleasantness, and my paths those of comparative peace.
Drs. J. A. Price, Weston, Mo., J. C. Goodrich, Wentzville, Mo., J. H. Kennerly, Lebanon, Ill., P. H. Helmuth, Highland, Ill., Geo. Cameron, Carrollton, Ill., F. A. Green, New Albany, Ind., F. H. Caughell, Morrison, Mo., J. O. Eppright, Odessa, Mo., R. R. Vaughan, Fulton, Mo., visited St. Louis during the past month.
OBITUARY.
At the annual meeting of the Southern Illinois Dental Society, held in Chester, October 21st, 1890, the following resolutions, expressive of the sense of the Society, relative to the death of Dr. Homer Judd, and Dr. M. D. LaCroix were adopted.
Whereas, The Southern Illinois Dental Society having learned with profound regret of the death of Dr. Homer Judd since the last annual meeting, the members in convention assembled desire at this time, both individually and collectively, to testify to their high esteem and great love for the life and character of the deceased. Much of the success of the Society is due to his kind helping hand as one of the founders, and the admirable rules and by-laws governing it, were largely the work of his experience.
The members of the Southern Illinois Dental Society will ever hold in reverent regard the memory of Dr. Homer Judd, and extend to his family their respectful sympathy; and the Secretary is hereby requested to advise the family of this action.
C. B. Rohland, }T. W. Prichitt, }Committee.L. Betts, }
C. B. Rohland, }T. W. Prichitt, }Committee.L. Betts, }
C. B. Rohland, }T. W. Prichitt, }Committee.L. Betts, }
Whereas, We have learned with deep regret and sorrow of the death of our friend and professional brother, Dr. M. D. LaCroix of Lebanon, Illinois, in the prime of his young manhood and usefulness in the dental profession; it is hereby
Resolved, That in the death of this estimable young man, the Southern Illinois Dental Society has lost one of its most earnest and enthusiastic members, the world a useful and honorable citizen, and the social circle a faithful and beloved companion;
Resolved, That our heartfelt sympathies are hereby tendered to the family of our deceased brother, in the hour of their sad bereavement;
Resolved, That these resolutions be entered upon the records of this Society, that copies be sent to the family of the deceased, and to the dental journals for publication.
J. J. Jennelle, }C. C. Corbett, }Committee.R. H. Canine. }
J. J. Jennelle, }C. C. Corbett, }Committee.R. H. Canine. }
J. J. Jennelle, }C. C. Corbett, }Committee.R. H. Canine. }
NORTHERN OHIO DENTAL ASSOCIATION.
The thirty-second annual meeting will be held in Oberlin, Ohio, Tuesday, May 12th, 1891, at ten o'clockA.M., and continue its sessions three days.
Subjects for Discussion.—"Development of the Teeth." Paper by Dr. W. H. Whitslar, Youngstown. Discussion opened by Dr. A. J. Dowds, Canton.
"The Recurrence of Decay in Teeth." Paper by Dr. J. G. Templeton, Pittsburgh, Pa., and "Hind Sight." Paper by Dr. W. H. Atkinson, New York. Discussion opened by Dr. C. R. Butler, Cleveland, and Dr. E. J. Waye, Sandusky.
"The Sanitary Condition of the Mouth, and How Best to Maintain It." Paper by Dr. J. F. Dougherty, Canton. Discussion opened by Dr. W. T. Jackman, Cleveland and Dr. J. H. Wible, Canton.
DEPOSIT PLATES.
Editor Archives:—Please allow me a word in regard to the electric deposit plate. Mr. E. E. Clark, the owner and manager, has been absent in the West in its interest most of the year, and I have, in his absence, undertaken to look after the making of the plates. For a considerable time past, the plates have been sadly deficient in gold, sometimes not enough being put on to properly vulcanize over.
I was unable to account for it, knowing that full quantity of gold was supplied. The secret has been discovered, and the thief lined his pockets instead of coating the plates with gold, and is now in jail awaiting trial for larceny.
The plates as now made are all right in every respect, and it is hoped that all its former friends will again come back to its use.
Yours, etc.,
C. S. Stockton.
Newark, Nov. 17th, '90.
PEROXIDE OF HYDROGEN AND OZONE.THEIR ANTISEPTIC PROPERTIES.[4]
BY DR. PAUL GIBIER,
Director of the Pasteur Institute of New York.
Gentlemen:—Since the discovery of the peroxide of hydrogen by Thenard, in 1818, the therapeutical applications of this oxygenated compound seem to have been neglected both by the medical and surgical professions; and it is only in the last twenty years that a few bacteriologists have demonstrated the germicidal potency of this chemical.
Among the most elaborate reports on the use of this compound may be mentioned those of Paul Bert and Regnard, Baldy, Péan and Larrivé.
Dr. Miguel places peroxide of hydrogen at the head of a long list of antiseptics, and close to the silver salts.
Dr. Bouchut has demonstrated the antiseptic action of peroxide of hydrogen, when applied to diphtheritic exudations.
Prof. Nocart, of Alfort, attenuates the virulence of the symptomatic microbe of carbuncle before he destroys it, by using the same antiseptic.
Dr. E. R. Squibb,[5]of Brooklyn, has also reported the satisfactory results which he obtained with peroxide of hydrogen in the treatment of infectious diseases.
Although the above-mentioned scientists have demonstrated by their experiments that peroxide of hydrogen is one of the most powerful destroyers of pathogenic microbes, its use in therapeutics has not been as extensive as it deserves to be.
In my opinion, the reason for its not being in universal use is the difficulty of procuring it free from hurtful impurities. Another objection is the unstableness of the compound, which gives off nascent oxygen when brought in contact with organic substances.[6]
Besides the foregoing objections the surgical instruments decompose the peroxide, hence, if an operation is to be performed, the surgeon uses some other antiseptic during the procedure, and is apt to continue the application of the same antiseptic in the subsequent dressings.
Nevertheless, the satisfactory results which I have obtained at the Pasteur Institute of New York with peroxide of hydrogen, in the treatment of wounds resulting from deep bites, and those which I have observed at the French clinic of New York, in the treatment of phagedenic chancres, varicose ulcers, parasitic diseases of the skin, and also in the treatment of other affections caused by germs, justify me in adding my statement as to the value of the drug.
But, it is not from a clinical standpoint that I now direct attention to the antiseptic value of peroxide of hydrogen. What I now wish is merely to give a full report of the experiments which I have made on the effects of peroxide of hydrogen upon cultures of the following species of pathogenic microbes: Bacillus anthracis, bacillus pyocyaneous, the bacilli of typhoid fever, of Asiatic cholera, and of yellow fever, streptococcus pyogenes, micro-bacillus prodigiosus, bacillus megaterium, and the bacillus of osteomyelites.
The peroxide of hydrogen which I used was a 3.2% solution, yielding fifteen times its volume of oxygen; but this strength reduced to about 1.5%, corresponding to about eight volumes of oxygen, by adding the fresh culture containing the microbe upon which I was experimenting. I have also experimented upon old cultures loaded with a large number of the spores of the bacillus anthracis. In all cases my experiments were made with a few cubic centimetres of the culture in sterilized test-tubes, in order to obtain accurate results.
The destructive action of peroxide of hydrogen, even diluted in the above proportions, is almost instantaneous. After a contact of a few minutes, I have tried to cultivate the microbes which were submitted to the peroxide, but unsuccessfully, owing to the fact that the germs had been completely destroyed.
My next experiments were made on the hydrophobic virus in the following manner:
I mixed with sterilized water a small quantity of the medulla that had been taken from a rabbit that had died of hydrophobia, and to this mixture added a small quantity of peroxide of hydrogen. Abundant effervescence took place, and, as soon as it ceased, having previously trephined a rabbit, I injected a large dose of the mixture under the dura mater. Slight effervescence immediately took place, and lasted a few moments, but the animal was not more disturbed than when an injection of the ordinary virus is given. This rabbit is still alive, two months after the inoculation.
A second rabbit was inoculated with the same hydrophobic virus, which had not been submitted to the action of the peroxide, and this animal died at the expiration of the eleventh day, with the symptoms of hydrophobia.
I am now experimenting in the same manner upon the bacillus tuberculosis, and if I am not deceived in my expectation, I will be able to impart to the profession some interesting results.
It is worthy of notice that water charged, under pressure, with fifteen times its volume of pure oxygen has not the antiseptic properties of peroxide of hydrogen. This is due to the fact that when the peroxide is decomposed nascent oxygen separates in that most active and potent of its conditions next to the condition, or allotropic form, known as "ozone." Therefore, it is not illogical to conclude that ozone is the active element of peroxide of hydrogen.
Although peroxide of hydrogen decomposes rapidly in the presence of organic substances, I have observed that its decomposition is checked to some extent by the addition of a sufficient quantity of glycerin; such a mixture, however, cannot be kept for a long time, owing to the slow but constant formation of secondary products, having irritating properties.
Before concluding, I wish to call attention to a new oxygenated compound, or rather ozonized compound, which has been recently discovered, and called "glycozone," by Mr. Marchand.
This glycozone results from the reaction which takes place when glycerin is exposed to the action of ozone, under pressure—one volume of glycerin with fifteen volumes of ozone produces glycozone.
By submitting the bacillus anthracis, pyocyaneous, prodigiosus, and megaterium to the action of glycozone, they were almost immediately destroyed.
I have observed that the action of glycozone upon the typhoid fever bacillus, and some other germs, is much slower than the influence of peroxide of hydrogen.
In dressing of wounds, ulcers, etc., the antiseptic influence of glycozone is rather slow if compared with that of peroxide of hydrogen, with which it may, however, be mixed at the time of using.
It has been demonstrated in Pasteur's laboratory that glycerin has no appreciable antiseptic influence upon the virus of hydrophobia; therefore, I mixed the virus of hydrophobia with glycerin, and at the expiration of several weeks all the animals which I inoculated with this mixture died with the symptoms of hydrophobia.
On the contrary, when glycerin has been combined with ozone to form glycozone, the compound destroys the hydrophobic virus almost instantaneously.
Two months ago, a rabbit was inoculated with the hydrophobic virus, which had been submitted to the action of this new compound, and the animal is still alive.
I believe that the practitioner will meet with very satisfactory results with the use of peroxide of hydrogen for the following reasons:
1. This chemical seems to have no injurious effect upon animal cells.
2. It has a very energetic destructive action upon vegetable cells—microbes.
3. It has no toxic properties; five cubic centimetres injected beneath the skin of a guinea-pig do not produce any serious result, and it is also harmless when given by the mouth.
As an immediate conclusion resulting from my experiments, my opinion is, that peroxide of hydrogen should be used in the treatment of diseases caused by germs, if the microbian element is directly accessible; and it is particularly useful in the treatment of infectious diseases of the throat and mouth.