Suggest to your customers that they communicate now with members of the committee listed above and, also, write their Congressman and Senators at Washington.

[Extract from Miscellaneous Publication No. 402, United States Department of Agriculture. the Bureau of Home Economics, in cooperation with the Work Projects Administration, 1941] FAMILY EXPENDITURES FOR MEDICAL CARE

FIVE REGIONS

(By Helen Hollingsworth, assistant economist; Day Monroe, principal home economist; Margaret C. Klem, social statistician; Karl L. Benson, associate economist; Economics Division, Bureau of Home Economics)

DENTISTS' SERVICES

In the farm section, as in the villages, there was a striking association between income and expenditures for dentists' services. More than three-fourths of these farm families in the income classes under $500 and one-half in the class $1,250$1,499 spent nothing for dental care; but in the classes above $1,000 fewer than one-fourth of the families were without some expenditures (table 23).

Families spending for dentists' services had lower average outlays in this Pennsylvania-Ohio farm section than in the villages studied at nearly every income level. It was only in the classes above $3,000 that this average was more than $20, while in the villages it was $20 or more at all levels above $1,750. In the class $500-749, nearly seven-tenths (69 percent) of the families having expenditures spent less than $10, while in the classes above $3,000 the percentage spending as little was approximately 30. Expenditures did not, however, exceed $30 for the majority spending at most income levels.

TABLE 23.-Dentists' services: Average expenditures for dentists' services per family and per capita, and distribution of families by amount of expenditures, by income, Pennsylvania-Ohio farm analysis unit,' 1935-36

[White nonrelief families that include a husband and wife, both native-born]

1 See Glossary for definitions of terms used in this table.

2 Based on the number of families in each class (column 2), regardless of whether they had any expenditures for dentists' services.

3 Based on the number of families in each class having expenditures for dentists' services.

4 Based on the total number of year-equivalent persons in each class, regardless of whether the family had any expenditures for dentists' services.

[Extracts from the Journal of the American Dental Association]
COUNCIL ON DENTAL THERAPEUTICS

SOLUTION 58 (HANKE)-NOT ACCEPTABLE FOR A. D. R.

[Report of the Council on Dental Therapeutics of the American Dental Association, authorized for publication.]

The Council's report on Solution 58 (Hanke) was submitted to Medadent Products Company in order that the firm might have an opportunity to reply in detail to the various points brought out in the Council's consideration of the product. After some delay, the firm presented reports of toxicity studies on rats conducted by Milton Theo. Hanke. The firm has not presented any further evidence on the efficacy of Solution 58 (Hanke) in the treatment of dental diseases, nor has it offered any comments valid in the light of the Council's rules regarding the name Solution 58 (Hanke). The Council referee and two consultants have carefully examined the toxicity data on Solution 58 (Hanke). The examiners are agreed that the evidence presented, which unfortunately was obtained after the product was put on the market, goes far toward establishing the safety of the preparation. They are not agreed, however, that the evidence is conclusive, particularly in that the experimental animals were on a high protein diet during administration of the drug and also no results of microscopic examination of kidney tissues were presented. In addition, the referee and his consultants believe that the transfer of data from experiments on rats to situations in which human beings are involved is not an entirely valid procedure.

The Council concurred in the referee's recommendations, and voted to present its original report, together with the foregoing inrtoductory comments. The Council's report follows:

After publication of "Studies on the Local Factors in Dental Caries. I. Destruction of Plaques and Retardation of Bacterial Growth in the Oral Cavity," the Council received requests for information on Solution 58 (Hanka) and on sodium parahydroxymercuribenzoate. More recently, the Medadent Company of Chicago, for which Milton Theo. Hanke apparently acts as consultant, has placed a preparation called Solution 58 (Hanke) on the maraket. As far as the Council is aware, the sale of the product prepared by the Medadent Company is restricted to the State of Illinois. Apparently, a permit for interstate distribution of Solution 58 (Hauke) has not been granted by the Food and Drug Administration. It has come to the Council's attention, however, that other firms are marketing sodium parahydroxymercuribenzoate in packages labeled "Not for Drug Use." In the light of these facts, the Council has requested a referee to examine the published information on sodium parahydroxymercuribenzoate and on Solution 58 (Hanke), with a view to presenting an informative report to the dental profession.

The referee has studied the available information on sodium parahydroxymercuribenzoate and on Solution 58 (Hanke). He has also enlisted the aid of several consultants whose comments have been of value in the preparation of this report. The referee and the Council consultants are agreed that the consideration of Solution 58 (Hanke) should involve a careful study of the safety and the effectiveness of the product under conditions of use.

A review of the available information on Solution 58 (Hanke) and on sodium parahydroxymercuribenzoate failed to furnish adequate evidence upon which a claim for safety of Solution 58 (Hanke) might be based. Apparently data on acute and chronic toxicity of the mercurial are not available. Nor does there appear to be any evidence on the rate and extent of absorption of the mercurial from the oral mucosa. These are not matters which can be dismissed lightly regardless of whether the mercurial is effective against acidogenic oral organisms. The referee is aware of Hanke's statement that "one-third ounce of Solution 58 contains only one-fiftieth grain of mercury, the major part of which is probably expectorated." Statements of this sort, which are really arithmetical assumptions, are of no value in attempting to answer the important questions relating to chronic mercurial poisoning. The mere fact that some people have used Solution 58 for a period of a few years without presenting any symptoms of mercury poisoning is only presumptive evidence and is therefore unacceptable. Statements of this kind are of no value whatever in formulating answers to such important questions as these:

What are the local and systemic effects of Solution 58 on healthy persons who may use the product over a period of twenty or thirty years or more?

What are the local and systemic effects of the product on persons whose kidneys are already damaged by disease to the extent that the kidney reserve is reduced nearly to the minimum physiologic requirements?

What effect may Solution 58 have on children and on incompetents who may swallow the product?

Cases of acute and chronic mercury poisoning have been described in the medical literature at various times. Many of these cases of poisoning have come about from excesive therapeutic use of mercurials. In other cases, mercurials have been swallowed with suicidal intent. In still others, the poisoning has been occupational in character. In a large number of instances, the poisoning has been due to metallic mercury or inorganic mercurials. The toxicity of the organic mercurials of which sodium parahydroxymercuribenzoate is an example is relatively low. But whatever type of mercury compound is used, it may give rise to mercury intoxication under favorable conditions. Moreover. it is not possible to place complete reliance upon oral symptoms for detection of chronic mercury poisoning. The symptoms may include loss of appetite, nausea and gastrointestinal conditions, pain in the bones and joints, anemia, loss of weight and general cachexia.

Metallic poisoning, including mercurial poisoning, has been discussed at length in a number of textbooks on pharmacology and in books on toxicology. The following excerpt from Cushny's "Pharmacology and Therapeutics," revised by Edmunds and Gunn (Lea & Febiger, Philadelphia, 1928), page 652, is pertinent to this discussion :

"Chronic Poisoning.-A much more frequently observed form of poisoning is that induced by the prolonged medicinal use of mercury. It may arise from any of the preparations and from any form of application, although some methods of administration are credited with being less liable to induce it than others. Thus inunction with mercurial ointment and the use of calomel internally are both more liable to cause the severer forms of stomatitis than is corrosive sublimate. A single hypodermic injection of an insoluble preparation may induce it in susceptible persons, because the mercury is only slowly ab sorbed, and passes into the tissues as gradually as if it were given by the mouth regularly for several days. This chronic poisoning, or Mercurialism, is due, not to the local action, but to the effects of the drug after absorption. It may follow the abuse of mercury in any case, but some individuals exhibit a special susceptibility from some unknown cause."

An examination of the statements in Hanke's paper relative to the effective. ness of Solution 58 (Hanke) failed to reveal adequate evidence upon which any claims might be based. In fact. the purported clinical evidence was contained in the bald statement: "Dental caries has been definitely arrested or ameliorated in fifteen patients (in an unclassified group of 95) who have used the solution consistently as indicated above and who had always heretofore been highly susceptible to this disease." The statement is worthless as evidence. It meets none of the requirements for clinical evidence.

Hanke's data on the effect of the mercurial on acid production in saliva are interesting, but require confirmation. Several tests for susceptibility to caries, based upon chemical and bacteriologic technics, have been described in the literature and most of these antedate Hanke's findings. They have been discussed concisely in the book "Dental Caries" and do not require extended discussion here. Results obtained by these tests, although helpful, are not suffi cient in themselves for an evaluation of agents used for the prevention or mitigation of dental caries. For this purpose, adequate clinical data obtained under controlled conditions are required. Other types of evidence may be valuable and research of this type should be encouraged.

It is claimed that the use of Solution 58 once or twice a day prevents formation of plaques on the teeth and that gingivitis usually disappears in a few days "except in those regions contiguous to calculus and even here the tissue tends to shrink to nearly normal." Also, it is claimed that "Solution 58 has also been used in a few cases of acute ulcerative gingivitis with very encourag ing results." Statements of this sort read like testimonials and, in the absence of supporting data, must be so considered.

It is pertinent to inquire whether Solution 58 minus the mercurial might not have yielded results upon which the same type of statement could be made. At any rate, in view of the probable alkalinity of the solution and because of

similar cleansing claims for lime water, it would appear logical to use such a solution as a control in experiments with Solution 58. In fact, why was not a suitable control used in the experiments on dental caries?

The referee does not believe that it is necessary to discuss Hanke's statements on the dental plaque beyond expressing the opinion that they do not constitute a significant addition to the dental literature. The same may be said of his qualitative experiments on the effect of acids on dental enamel and on the hydrogen ion concentration of plaques. More adequate studies on these topics have been presented elsewhere.

The referee cannot agree with the designation Solution 58 (Hanke) is appropriate or desirable. The name fails to comply with Rule 8 in that it does not indicate the chemical composition of the solution. Also, it is difficult to see how such a name would be in the interest of public. welfare. Apparently, the only advantage in the name is a commercial one.

It is not the referee's intention to imply that no oral antiseptics of the mouth wash variety will ever be of value in the prevention or mitigation of dental caries. Indeed, some of the numerous findings in the literature could lend encouragement to the thought that a remedy of this sort may eventually be developed. Of course, there are other findings in the literature of a contrary nature. The only sound basis upon which products of this type should be offered the dental profession and the public is that of adequate scientific evidence.

In summary, the referee finds that the evidence regarding the safety and effectiveness of Solution 58 (Hanke) is inadequate and that the name of the product is in conflict with the provisions of Rule 8. He therefore recommends that the product be held not acceptable for A. D. R. and that this report be published for the information of the dental profession.

The Council on Dental Therapeutics of the American Dental Association announces the inclusion of the following articles in the list of Accepted Dental Remedies.

Sheffield Tooth Powder.-Composition: Each hundred grams is stated to contain precipitated calcium carbonate (Snow Top Light), 90.40 gm.; Conti's castile soap powder, 7.30 gm.; saccharin soluble, U. S. P., 0.15 gm.; methyl salicylate, 2.05 gm.; oil of cloves, U. S. P., 0.05 gm.; menthol, 0.05 gm.

Abrasiveness: 0.00025 mg. loss on silver block under weight of 4,536 gm. in 400 revolutions.

Manufactured by the Sheffield Company, New London, Conn.

2 CALCIUM COMPOUNDS

Non-Fer-Al Brand Calcium Carbonate.-Non-Fer-Al Brand Calcium Carbonate complies with U. S. P. XI. It is used in the manufacture of dentifrices.

Manufactured by Diamond Alkali Company, Pure Calcium Products Division, Painesville, Ohio.

Chemical Analysis: 98.15 percent calcium carbonate.

Physical Properties.

Specific gravity: 2.65.

Particle size: Diameter in microns:

Less than 5 microns, 44%.

5-10 microns, 30%.

10-20 microns, 20%.

20-30 microns, 6%.

Maximum size particle observed: 25 microns-single particle. 50 microns-aggregate.

1 A. D. R. Ed. 7, p. 102.

2 A. D. R. Ed. 7, p. 87.

Most of the particles over 5 microns in diameter appear to be aggregates not dispersed by the liquid used in the test.

Abrasiveness: The abrasiveness of Non-Fer-Al Brand Calcium Carbonate was determined by rotating a polished surface of antimony in a slurry of chalk and water under a weight of 63 gm. for 6,240 revolutions on a test machine (details filed with Council). The area of the metal specimens exposed was 53 square millimeters and the Bierbaum hardness was 236 units for antimony. The weight loss was 5.9 mg.

Admission of an article to the list of Accepted Dental Remedies does not imply a recommendation. Information regarding the rules and work of the Council will be sent on request. HAROLD L. HANSEN, Secretary.

RESEARCH COMMISSION

LIST OF CERTIFIED DENTAL IMPRESSION COMPOUNDS

(A. D. A. Specification No. 3--First Revision 1939)

THE impression compounds listed below have been certified to the Research Commission by their respective manufacturers, tested at the National Bureau of Standards and found to comply with the requirements of American Dental Association Specification No. 3, first revision.

Mr. BOREN. Mr. Chairman, I want to ask about five questions which have occurred to me. I do not necessarily want the answers today, but I want them in the record.

Mr. BULWINKLE. Do you want to ask them of Dr. Mead?

Mr. BOREN. Yes.

Dr. Mead, it has occurred to me that it would be valuable to the committee to have some estimate of the percentage of complaints from patients of dentists with reference to dentures.

We have here a very complete record of 8 percent which these people who make mail order dentures have returned, and I feel if there is any way of giving us that information as to the percentage of dissatisfied patients who have dentures made by the dentists, it would be helpful.

Now, No. 2. I would like a break-down of the cost of these plates if that is possible as an average matter, among the dentists of the country; a comparative analysis between the cost to the patient under the dentist's care, with the cost of purchasing the plate by mail.

No. 3. I would like an answer, if you care to attempt to discuss it, of the reasons why a person who has been to a dentist to get his teeth extracted-and I presume that is the universal case-why he