THE COMBINATION OF GOLD AND AMALGAM AS A THERA ence, PEUTICAL AGENT. IN the October (1882) number of the Ohio State Journal of Dental SciDr. Watt, in replying to Dr. Pease's paper on amalgam, quotes a case of a patient of his who suffered from irritation of pulp, due to galvanic action by wearing gold and amalgam in the same tooth, the filling having been inserted by an itinerant Yankee. Having systematically used gold and amalgam in combination for a number of years, with marked success, in cases where some positive therapeutic measure was demanded to stop the ravages of disease, as for instance in caries located at the cervix; in young toothstructure, or in teeth poorly calcified, I am led to believe it a specific as a prophylactic if physical and physiological laws are observed in its employment. In the case reported by Dr. Watt my diagnosis is that the patient was suffering from pulpitis, induced by thermal influences. The removal of the metallic filling and the substitution of a non-conductor like Hill's stopping prevented the irritation from thermal changes, and if a capping of oxyphosphate of zinc had been introduced under the metal, and the patient had avoided all extremes of temperature for a time, nature would have done the rest, and a cure been the result. I assume, of course, a vital condition of the pulp, though Dr. Watt does not state what was the pathological condition other than that the tooth gave the patient great pain. The Yankee may have filled over a partially or totally devitalized pulp. In cases where amalgam filling is sealed over by gold, I believe irritation might follow in certain cases, such as an acid systemic condition with an acid saliva, but where both metals are exposed to the oral secretions, I cannot conceive of any galvanic action upon the dentine. There is doubtless in such cases slight galvanic action, but it is confined to the metals. In using amalgam alone I find that, by preparing it with mercury into which has been rubbed say thirty to forty per cent. of gold-sufficient to form it into a pasty mass-heat is evolved in the first stages of its crystallization. This would seem to indicate chemical union, and I think the oral secretions can have very little corroding action upon its surface. Two years ago I read a paper and gave a demonstration before the Odontological Society of Pennsylvania, of the combination of gold and amalgam, showing how they could be used with advantage to both patient and operator in compound cavities, or in cavities in approximal and grinding-surfaces, condensing the amalgam with a light mallet, following with plain soft foil in cylinder form, until the mercury line was passed, and finishing the depth of the enamel with hard cohesive gold; or, by another plan, allowing the amalgam to crystallize and using it as a matrix, thus converting a compound into a simple cavity, and finishing with gold. Last July, at Williamsport, at a meeting of the Pennsylvania State Dental Society, I read a paper and demonstrated the advantages of combining gold and amalgam in filling large compound cavities in the approximal and grinding-surfaces of a second superior bicuspid and first molar for Dr. W. B. Miller, of Altoona, assistant secretary of the society. In reply to a recent inquiry as to his experience with these fillings, Dr. Miller says that with the exception of a slight periostitis of short duration, he has suffered no inconvenience whatever; that from his own experience and practice he is favorably impressed with the advantages of combining gold and amalgam; that he has adopted the method in his own practice; that he believes it to be not only a saving of time and of nervous force of both patient and operator, but a valuable therapeutic measure in the preservation of the natural teeth. Many who saw these operations performed upon Dr. Miller will be gratified to know that they have proved successful and that the gentleman himself, who has the reputation of being a beautiful manipulator of cohesive foil, shows by adopting the method his belief that mechanical and physiological laws do harmonize, and that, as Dr. Watt puts it, "truth and simplicity are twin sisters." The principles underlying the laws of health and life, and as well the influenees which tend toward disease and death, are still somewhat obsure, but we formulate laws as the result of experience just in proportion as we appreciate uniform results from like conditions; and, though beautiful but fallacious theories of other days are thus overturned, we must be willing to learn what experience teaches us. Teeth do not decay by chance. Inherited defects of tendencies, or personal neglect, may cause pathological conditions, but like causes operate with like disadvantage upon all the organs and tissues of animal life. All development, and not less all disease, and restoration to ease or health, is under the dominion of law,-vital, chemical, or mechanical. Aitkens defines disease to be "a deviation from the state of health, consisting for the most part in a change in the properties or structure of any tissue or organ unfit for the performance of its actions or functions according to the laws of the healthy frame;" and the same author defines therapeutics to be "the action of remedies upon the diseased economy, or the means by which nature may be aided in her return to health." If carious teeth are to be cured, it must be through a recognition of the fact that caries is a disease, and that the cure must come through therapeutic influBeautiful operations are not to be underrated, but the principal fact to be considered in the treatment of a diseased tooth is how to cure the disease. There are some conditions in which, with our present light, we are ences. The compelled to partially destroy the circulation or life of a tooth to save its body. It was demonstrated years ago that a tooth has an inside and an outside circulation, independent of each other. We destroy the nutrient supply to the inside, and by filling preserve the tooth from disintegration or decay; but caries and decay are not the same thing. Decay means to rot; caries means quite another thing. Devitalized teeth are subject to decay, but not to caries. Vitalized teeth are subject to caries, but not to decay. same conditions in the mouth may lead to both these processes, but the processes differ. In the one cese there is dissolution, and the formation of new chemical compounds; in the other we have, in addition to the former process, all the phenomena of vital tissue in relation with the arterial and nervous circulation of the organism. To cure diseased vital teeth all manipulation, whatever it may be, is therapeutic in character, even thongh it be seemingly only mechanical. When we expose the dentine of a vital tooth, we expose its circulation, for the basissubstance consists for many years of but slight partitions, while fibrille and nervous reticula pervade its every part. Under certain conditions, dentine is converted almost entirely into basissubstance, yet with wonderful recuperative energy, as has been shown in the tusk of the elephant in which bullets have been entirely inclosed. Manipulative ability is successful in the treatment of diseased teeth just in proportion as we make an intelligent diagnosis of the individual case and the application of the proper therapeutic remedy. In order to make a foreign substance held in living tissue not only bearable but beneficial, we must study individual idiosyncrasies and acquire experience by watching the curative influences of our treatment, so as to discriminate as to materials, with reference to their adaptability to different ages or stages of tooth-life. Simply to fill a hole in dentine without regard to the peculiari ties of the individual case is nothing more or less than empiricism.-H. C. REGISTER, M. D., in Dental Cosmos. UNITING GOLD TO AMALGAM BY N. W. KINGSLEY, D.D.S., OF Reported to the N. Y. Odontological Society. par I would like to refer to a use I have been making of amalgam for several years, and which I reported to the State Society some four or five years ago. I advocated at that time that in many instances of large cavities on approximal surfaces, of bicuspids and molars ticularly, they should be partly filled with amalgam, to be followed at the same sitting with gold, carrying out the filling to the grinding-surface of the tooth, if one desired to avoid a full amalgam filling. Without going into a lengthy discussion of the arguments in favor, or the objections that might be offered, let me say that I have seen a great many of those fillings, and have watched them with much solicitude and anxiety, but I have never seen a single instance where there has been any recurrence of decay at the cervical edge of the cavity. In nearly every case that I have seen, I have found the amalgam discolored on the surface, but the gold as bright as any gold filling, and the tooth preserved perfectly from further decay. I have been querying, why this result; whether it was attributable entirely to the fact that with the amalgam I got perhaps a closer adaptation to the cervical edge of the cavity than I would with gold, or whether it was owing to some galvanic condition of the different metals in contact or what? But this I do know, that sooner or later the majority of operations, under like circumstances, when made with gold, are giving out at that portion of the cavity, no matter by whom they are made. I say a majority, not because I have had an opportunity of examining all the fillings made by every operator, but because I am constantly seeing the work of the most skillful operators in gold giving out at the point referred to, within a few years. There is not a dentist who is not seeing this almost daily, and among his own patients, if he would but have the candor to admit it. I have been puzzled for an explanation of the success where amalgam has been used in this manner. There is no evidence of shrinkage of the amalgam that is placed in the upper part of the cavity. Whatever amalgam may do under other circumstances, that amalgam shows no shrinkage after it is put in. It remains perfectly tight, and the tooth does not discolor in contact with it. In filling a tooth in this way, the amalgam occupies a third or a half of the cavity, and the gold is immediately forced into it. For some little time the gold will absorb the mercury and take up all the excess. After that ceases, the gold shows its true gold appearance, and unites or welds in the usual way. The filling can be finished as soon as the gold is packed. The amalgam will be found sufficiently hard to be finished up to the cervical edge. We see here two results: one is that the gold has taken up all the excess of the mercury that can possibly be taken from the mass of amalgam, preventing the possibility of shrinkage; and, secondly, such a filling is in a better condition to make a perfect flush edge at the cervical border. There is little or no risk of the difficulty so often found with gold fillings, of the filling standing out and forming a lodgment for foreign matters, which will end in decay, because the amalgam has not become so hard but that it can be easily brought flush with the body of the tooth. This may be the explanation of the results that I believe will almost invariably attend such operations. I spoke of this before the State Society a few years since with some timidity, for the reason that there is such a prejudice in the minds of almost every one against amalgam,— and especially as the charge is often made that amalgam is only used by those who cannot put in a gold filling. It was not for the reason that gold could not be used, but because I saw gold fillings were constantly giving out, that I felt obliged to resort to something for the good of the patient, and the result has been so successful and uniform that I felt it a duty to give somebody else the benefit of it. CARBOLIC ACID POISONING. Dr. Inglessi, in Bulletin Général de Thérapeutique, has arrived at the following conclusions respecting this: First, the symptoms of poisoning by external application of carbolic acid are the same as those which arise from the absorption of the poison by the stomach from the gastric mucous membrane. Second, poisoning occurs certainly where the acid has been applied to the skin or injected into a serous, mucous, or abscess cavity. From the exposed surface of a wound the absorption is very slight, and the toxic effects trifling. The mucous membrane of the respiratory passages may serve as the place of introduction of the poison. Third, the effects may assume a very acute form, a less acute form or a chronic form. Fourth, there exist certain idiosyncrasies; women and children are especially liable to carbolic acid poisoning. Fifth, the toxic dose is variable. In persons predisposed, one grain of carbolic acid may be sufficient to poison. Sixth, carbolic acid as an application to contused wounds should be used with caution, and in some cases should even be substituted by a less dangerous agent. Seventh, the treatment of severe carbolic acid poisoning should consist in artificial respiration and diffusible stimulants, especially the hypodermic injection of ether. In other cases, the removal of the cause, through the discontinuance of the remedy, will suffice to remove the symptoms.-Druggists' Circular. PROFESSIONAL COURTESY. WILL the time ever come when the spirit of jealousy and personal feeling shall depart from all professions and every man shall hail every other as brother and friend? presented to the world in almost every What a spectacle is town and city where professional men most do congregate, of that petty strife and bickering spirit that results in a mutual loss of respect and frequently develops into actual hatred. It is found as often in the dental profession as in any other. Who has known two or three of the leading dentists of a town or city to be on friendly terms? Instead, we all know the common experience, of being forced to listen to slurring and derogatory remarks of one or more of the profession, sometimes of all as a whole, the manifestation of a churlish, uncharitable spirit that savors of anything but "Professional courtesy " conformity to the spirit of the "Code of Ethics." Yet these same old stagers who are frequently not on speaking terms with each other, are apt to be most chary of extending a cordial welcome, to the beginner in practice, and watch with jealous eye his every move, and are quick to condemn anything they may consider "unprofessional." or a Now this is not as it should be, and while it is an unpleasant truth, yet it should receive consideration, and sober thought from every dentist who loves his profession and is jealous (in the right spirit) of its honor. Let us strive to lay aside our personal feeling more and be governed by that broad spirit of honorable dealing and true courtesy that refuses to speak ill of any man, and especi ally of a professional brother, to not only do that, but make an effort to be friendly, and extend the fraternal hand to every one. To whom shall the beginner in practice look for encouragement if not to the older members of the profession? Is it apt to increase his respect for the profession at large or for its leaders, when he sees manifested that unprofessional feeling of jealousy so often exhibitid? I fear not. We all can call to mind a few dentists who seem to feel that every other dentist is a natural enemy, to be treated accordingly. However, I am glad to know that their number is not legion. But I appeal for the honor of our calling when I say, let us cultivate more and more the virtues of forbearance, mutual respect and that unity of effort that shall place us, as a profession, on somewhat higher ground in this respect.-Vindex, in Dental Headlight. THE PLANTAIN AS A STYPTIC. THE following abstract of a paper read by Dr. Quinlan at the recent British Pharmaceutical Congress, may prove of interest to medical readers in this country, where the plant mentioned is a common weed: "About a year ago Dr. Quinlan had seen the chewed leaves of the Plantago lanceolata successfully used to stop a dangerous hemorrhage from leech-bites in a situation where pressure could not be employed. He had searched out the literature of the subject, and found that, although this herb is highly spoken of by Culpepper and other old writers as a styptic, and alluded to as such in the plays of Shakespeare, its employment seems to have died out. Professor Quinlan described the suitable varieties of plantain,and exhibited preparations which had been made for him by Dr. J. Evans, of Dublin, State apothecary. They dried leaves and powdered leaves, conserved with glycerine, for external use; juice preserved by alcohol, as also by glycerine, for internal use; and a green extract. He gave an account of the chemistry of the juice, from which it appeared that it was not a member of the tannin the series; and also described its physiological effect in causing a tendency to stasia in the capillaries of the tail of a goldfish, examined with a microscopic power of 400 X. He regarded its styptic power as partly mechanical and partly physiological. The juice, in large doses, he had found useful in internal hemorrhages.The knowledge of the properties of this plant he thought would be useful in cases of emergency, because it could be obtained in any field and by the most uninstructed persons."-Scientific American. --CEMENT FOR REPAIRING GLASS. -Dissolve fine glue in strong acetic acid to form a thin paste. NEW PUBLICATION. "DIAGRAM OF AN INCISOR TOOTH," by Prof. Frank Abbott, M.D., New York. Published by request of the Dental Society of New York. Price, $1.00. This is a six colored lithographic diagram of the longitudinal section of an upper incisor, and gives a remarkably clear and distinct representation of the minute anatomy of a tooth and its immediate surroundings. Dr. Abbott deserves much credit for the production of this, the best illustration of dental histology it has been our fortune to examine. No student of dentistry should be without it, and by its aid the practitioner can answer in a quick and comprehensive manner the many questions propounded by patients with regard to tooth structure, etc. THE CURSE OF CHLORAL. "A sad glimpse into the life of the late Dante Rosetti, over whose newly-closed the lovers of the two arts are grave mourning, is afforded by the brief memoir of Theodore Watts. The curse of chloral upon any life is disastrous enough, but its features are brought into terrible salience when it falls upon the gifts of genius. No man ever lived who was so generous as he in symathizing with other men's work, save only when the cruel fumes of chloral turned him against everything. The dependence on its influence which chloral habitually taken inevitably causes, the nervous prostration which it gradually induces, the irritability which follows chloral sleep, and follows equally the sleepless nights of abstinence, the slowly sapping of the nervous energyall these are only too familiar, and over and over again during the past ten years we have pointed out their moral."-Lan cet. "No wrath of men or rage of seas Can shake a just man's purposes; -Herrick. |