Before closing, I should like to speak of some other mouth antiseptics that cooperate with the mouth enzymes rather than hinder them, although they do not (properly speaking) pertain to dentifrices.

Along these lines lies an interesting field for future investigation, but until the perfect enzyme is discovered, we should not fail to take advantage of the peroxide and fluoride antiseptics, since while they destroy bacteria chemically, they do not destroy the enzymes and ferments either of the mouth or of the stomach. And the fact that they do not destroy the enzymes, but seem to have a selective tendency for the pathogenic germs, may be one of the reasons they so rapidly restore inflamed oral tissues to a state of health, since instead of fighting the enzymes, they may assist them by reducing the number of bacteria against which the enzymes must contend.

In closing, let me briefly go over some of the points that might properly be emphasized. Tooth powders containing grits are harmful to both enamel and cementum and the patients should be taught to brush and cleanse the teeth without their aid. All stains that cannot be removed without the aid of toothcutting grit should be removed only by the dentist. Very finely powdered peroxide of magnesium, with 10 per cent. of soap and a suitable flavoring agent, will make a valuable antiseptic peroxide powder, and when left around the teeth at night will prove an invaluable antacid. For those who do not wish a semblance of grit in their powder, flavored perborate of soda can be used, both on the brush and in ten-grain tablet form as valuable mouth-wash tablets.

But I cannot bring this paper to a close without emphasizing the value of a saturated solution, in water, of sodium silicofluoride. It forms a 0.61 per cent. solution. This may be held in the mouth for from two to five minutes, three times a day, by patients under treatment for pyorrhea. And while in some cases it does not retard the progress of tartar on the teeth, in many cases it most emphatically does, and as a supplement to scaling of the teeth, its healing effect on

the inflamed gums is so satisfactory as to be little less than marvelous. It is nonpoisonous and cheap, being readily purchased C. P. at 75 cents a pound, which is enough to make one-half to two-thirds of a barrel of mouth wash. And, above all, being a fluoride, it has the fluoride antiseptic qualities without affecting the porcelain fillings.

In recommending these new antiseptics for the mouth I wish to emphasize the fact that my observations as to their effect on the teeth and gums have been largely clinical and macroscopic. I believe that a close study of the first stages of enamel decalcification, such as occur before the enamel is roughened or whitened, will prove that many foodstuffs and ordinary therapeutic remedies are directly responsible for much of the general tooth deterioration of the present day. These new antiseptics of which I have spoken, I believe, are therapeutically valuable as an aid in treating the oral tissues, but whether in time they may prove to have undesirable action of a less harmful nature than the grit of chalk or the acid of lemon and carbon dioxide, no one is in a position to say. Nevertheless, as my next scientific work lies along this line, I hope to give more data on this important subject in the future.

DISCUSSION.

Dr. F. E. Stewart, Philadelphia: As you know, medicine is assuming a strong tendency towards the prevention rather than cure of disease, and dentistry is rapidly advancing in the same direction. The human mouth is a fertile field for the growth of bacteria unless it be kept in a cleanly condition. It is probable that the lodgement of infectious germs in the mouth and the favorable soil there for their growth is an important factor in the production and communication of infectious diseases. Though difficult to prove, nevertheless it is perfectly reasonable to believe that the germs of diphtheria, scarlet fever, measles and tuberculosis find the mouth an excellent place for continued existence. This has indeed been demonstrated in the case of diphtheria carriers, who, themselves immune to the germs, spread them broadcast as they travel about. Another important point is the influence of the condition of the mouth on the general health. The lowered resistance to disease from disturbances of nutrition, due to oral defects, and the pernicious physical state it causes are factors which must be taken into consideration. It is believed that enlarged tonsils are a predisposing cause of diphtheria, and it is well known that tonsillar enlargement is often concurrent with defective teeth.

Cavities in the teeth are culture fields for disease-producing microbes. In the mouth there is warmth and darkness, and these, together with decomposing food and decayed teeth, are most excellent conditions for germ life. Children and young adults are peculiarly susceptible to infectious diseases, and these are the persons in whom the teeth are most neglected. Dr. Jessens, of Strasburg, has revealed the startling fact that in his own state of the German Empire about 90 per cent. of the school children have defective teeth. An examination of 187,000 children in the public schools of New York shows that defective teeth more than double all other physical defects. There are at least 600,000 children in the schools, and in these statistics the physicians making the examination recognized only gross dental conditions. In the public schools of Boston the nurses find about 75 per cent. of the cases. Examination of the teeth of the children in Brooklyn develops the surprising fact that it is an exception to find a child with sound, normal teeth. These children are dental cripples. They are unable to properly masticate their food, which interferes with digestion, and, consequently, with full nourishment and proper growth and development.

On the other hand, it is a physiological fact that the teeth are integral portions of the body, and, as such, influenced by the state of the general health. Dr. A. Stayt Dutton in a naval paper on "The Cause and Prevention of Dental Decay," published in the Medical Press, London, England, June 7, 1911, states that from the result of his observations in England and Wales, he formed the opinion that the main cause of such a physical deterioration and decay of the teeth, as is present in British people, is due to the blood being defective in quality. He says that the likelihood of the correctness of this view is indicated by the results of the estimation of haemoglobin in the blood of the inhabitants in different urban

and rural centers, which showed that the great majority of those from whom the specimens were taken had a percentage below 90, while in a large proportion it was below 80, and in many below 70.

Moreover, the effect of constitutional factors is a causative factor of decayed teeth. Tom's Dental Surgery states that almost every tooth was attacked during a case of rheumatic fever, a complaint which quickly reduces the quality of the blood. This is said to be due to the secondary anemia which rheumatic fever occasions. Dutton believes that anemia is mainly responsible for the prevalence of caries. He also believes that unless the teeth have their normal share in the work for which they are made, they tend to atrophy or undergo degeneration, as in the case of other organs from disease. Therefore the condition of the food we eat plays an important part in the preservation of the teeth.

In this symposium we are endeavoring to place before you the subject of dentifrices and the proper care of the teeth and mouth. The exciting cause of caries is considered to be acids that are formed in the mouth by fermentation and putrefaction. These acids dissolve the enamel of the teeth, thus allowing the entrance of micro-organisms which cause disintegration. It is, therefore, assumed that the proper dentifrices should be alkaline in reaction to neutralize these acids, and also contain materials capable of scouring from the surface of the teeth the detritus from the food remaining on or between the teeth after meals. In addition to the food detritus, there is the peculiar formation known as tartar, even small deposits of which are difficult to remove from the teeth. It is believed by many that a toothpowder containing such substances as pumice, for example, should be used, at least occasionally for removing the tartar.

You have listened to two notable papers this evening, one of which clearly proves that we are not right in our ideas regarding the scouring of teeth. That it is easy to destroy the enamel by keeping it clean, and, therefore, free from decay, has been thought of by some of us a long time ago, but we have not been in position to protest. Dr. Head seems to have proved beyond all question that certain dentifrices believed to be not only harmless but beneficient, are, in fact, very deleterious. We find ourselves in the position of the Turkish brigade who mistook another brigade of the same army for the foe and made a desperate and disastrous attack upon it. In our attack upon disease-producing bacteria in the mouth, let us not make the mistake of attacking the teeth themselves. Here is an excellent field for a pharmacist to do some original work. Dr. Head outlined a plan for making tests of substances used for toothpowder that any pharmacist can employ and know that what he dispenses for cleaning the teeth will not injure them.

We have listened to Professor Broomell's paper and learned that the pharmacist has a serious responsibility in his relations to the public and the dental profession in such matters. We have learned the reason why the pharmaceutical profession should cooperate with the dental profession in the onslaught against causes of disease. When the enormous importance of the teeth as a factor in preserving the health is considered, what excuse is there left for physicians, pharmacists, and dentists to neglect their responsibilities in this matter?

It is very desirable that we should have a free discussion of this important subject of dentifrices and the proper care of the teeth and mouth from the point of view of the physician, the dentist, and the pharmacist. We speak here to an audience far greater than that actually present. Our papers and discussions are published in the JOURNAL of the American Pharmaceutical Association. Our official organ not only has a large circulation, but exercises an influence far in excess of the size of its circulation list, and in no better way can we protect the public in relation to the care of the teeth than by discussing the subject at this meeting, and thus placing before the pharmacists of this country the important data we have now under consideration.

There are in the United States about 35,000 practising dentists, about 40,000 retail druggists, and about 150,000 physicians. In spite of this army of practitioners there yet remains the fact that the masses are still woefully wanting in proper appreciation of the value of the teeth, and the majority (a very large majority) is ignorant of the dangers incident to their neglect.

The Memoirs of an American Pharmacist.

JAMES WINCHELL FORBES.
(Edited by J. H. Beal.)

CHAPTER XIX.

RUNNING A COUNTRY DRUG STORE WITH PISCATORIAL STUNTS ON THE SIDE-ENTERS THE WHOLESALE HOUSE OF STEIN-VOGELER CO.-A THEOLOGICAL DISQUISITION-ENTERS THE NEW HOUSE OF STEIN-GRAY CO.-EDITORIAL EXPERIENCES WITH

AND SUNDRIES".