knowing the degree of infection and without following the progressive decrease in the number of bacteria it would be impossible to know whether the technic is carried out in the proper way or when the wound should be closed. When a large number of wounds have to be watched it is found impossible to use the ordinary bacteriological methods. The only way that seems practical is to take smears and count the bacteria on the surface of the smear. This method is inaccurate but has been found to be very good from a practical standpoint. The smears are taken every two days from the back parts of the wound and the recesses in which infection would be most likely to lurk. It is important to know, not the average bacterial count, but the condition of the more badly infected part of the wounds, because it does not matter if nine-tenths of a wound be sterile, if one-tenth remains still infected. The work of counting the bacteria can be done by mere technicians. It is possible to examine 30 or 40 slides per hour, and as the examinations are made every other day a large number of wounds can be examined bacteriologically.

The bacteriological chart of every wound is plotted and gives to the surgeon the necessary information about the condition of each wound. It tells when the antiseptic is properly applied and when the wound can be closed. When the time is reached that only one bacterium is found in five or ten fields, the wound is said to be surgically sterile and may be stitched with safety. Some bacteriological charts are as characteristic as are the temperature charts in typhoid fever. In suppurating surface wounds where there is no necrotic tissue there would be a sudden drop in the number of bacteria, from a large number to one in five or one in ten fields, after 24 to 48 hours, but where there is necrotic tissue the count will remain high for two or three days. In cases of deep wounds the drop

in the bacterial count is generally slower. The curve is especially characteristic in cases of suppurating fractures, if the wound contains some foreign body. The count will be very high and will then drop to about ten per field. If one operates on these cases and removes the foreign body the count will go up to 100 or more, and after two or three days would drop to one per five or ten fields. After a few weeks' experience one may diagnose the case at first sight of the curve, determine the character of the complication, and tell the process to be followed in the treatment. When the bacteria has disappeared, it does not mean that the wound is bacteriologically aseptic. Dr. Vincent found that only about 30 per cent of the surgically aseptic eptic wounds were bacteriologically aseptic. But when the count has dropped to one in five or ten fields, the wounds can be closed. When one is dealing with a surface wound or a wound of the soft parts, the wound can frequently be closed after two days of asepsis; but in cases of fracture, one has to be very careful and study the clinical symptoms as well as the bacteriological curves. When both clinical symptoms and bacteriological chart agree, a fracture, say of the thigh, may be closed after five or six days after the wound is found surgically aseptic.

4. For the closing of the wound, which is the fourth step in the method, there is no special procedure to be used. The wounds are closed by strapping with adhesive plaster in the cases in which the wounds are sterilized in less than ten days. When there is a loss of skin the elastic traction method is used. In most of the cases the wounds are stitched. No drainage is made. When the patients are brought with already suppurating wounds, especially with fractures, the closing has to be done by following the rules studied especially by Dr. Guillot and Dr. Woimant in Compiegne. About

60 per cent. of the old suppurating fractures of the thigh can be sterilized and closed.

I can best illustrate the results of the application of the principles which I have described by means of lantern slides (Dr. Loewy then showed characteristic bacteriological curves, and demonstrated the manner in which the curve of cicatrization should follow the calculated curve in a properly treated wound, the manner of arranging the perforated tubes and the dressings, emphasizing the point that the dressing should be loosely packed about the tubes and that in changing dressings one should never touch the granulating surfaces. He showed the results obtained in fractures and stated that a great many suppurating fractures could be sterilized and closed thus avoid

ing amputation in many instances and saving much suffering.)

Our conclusion after three years' experience is that suppuration can be arrested and that no patient's wounds should be allowed to suppurate for more than three or four days after his coming to the hospital. Septicemia can almost always be prevented and a great many limbs can be saved. At least 50 per cent of the amputations performed for infection could have been avoided if sterilization of the wounds had been effected. The time required for treatment is greatly reduced. As an average it is only 33 per cent. of the ordinary time. It should be remembered that a precise method requires more care than the old methods. But more systematized work in the hospitals, by the surgeons and their assistants will most certainly yield an immense improvement in results.

MR

TR. CHAIRMAN, members of the Crown and Bridge Section of the National Dental Association; it is with great pleasure that I bring this subject before you and still with much trepidation at the undertaking.

The reading of a paper of this kind was to have been the lot of Dr. Forrest H. Orton, of St. Paul, who has given this subject a great deal of thought and attention. Unfortunately, he has been very ill and his recovery has not been very encouraging.

The purpose of this section is simple, and still very complex. Primarily, we are endeavoring to bring order and system out of chaos. No Art can become scientific without the adoption of some standard. Operative Dentistry floundered about until Dr. G. V. Black set a standard for it that made it scientific at once. His extension for Prevention, placed this branch of our profession upon a scientific basis. Crown and bridge workers have not been so fortunate as vet, but it is a hope of the officers of this section, that thru the work of the section, we may have a standard that will place this great part of the work of our profession upon a scientific basis. In other words, we are endeavoring to lead the crown and bridge workers to a point where their efforts will be based upon truly scientific principles and this will be accomplished only after

we have proven and accepted standards of operation.

A very conservative estimate of dental operations based upon investigation of a rather rigid sort, shows that 15% or more of all dentistry done is crown and bridge work and only a partial survey of the literature of the day and of the work seen, soon drives into our consciousness that the great bulk of this work is doing more harm than good, in fact, is doing more harm than any other class of work. Still no research work is being done in a beneficial way by our profession. No investigation is being made as to why the work in this great field of Dentistry is doomed to failure. What work of this sort is undertaken, is done by individuals who, unfortunately, have to struggle hard to influence the few they reach. Some serious work should be done by the Research Commission and by the National Association thru this section if need be, and I earnestly plead that this section be a permanent part of the National Association. The work, as presented at this time, can but represent a start in the proper direction. We solicit the earnest support of the members of this section as well as the officers of the National Association. A great amount of work will have to be done, much investigation undertaken, and those interested in furthering this work will of necessity give

thought that is unbiased and open-minded.

I have personally felt the need of this work as I made a survey of my own too many failures and tried to analyze them. The profession is very much at sea, largely because so much has been left undone in a connected way. The teachings of some one man or group of men has been followed, only to be torn down and ridiculed by another man or group of men. The profession has been swayed too easily by professional likes or dislikes and the true merit of much, has been overlooked by the failure to be open-minded. We should know first what bridge work is, what should be accomplished by its use, what it should be and what it should not be. This requires also a standard of criticism. We should know what the essential principles are and, by all means, have a classification of favorable and unfavorable conditions. This can be undertaken by our section and be of everlasting benefit to workers in this field.

There must be radical changes in the teaching of this great subject, for much blame for the failures can be traced to the Dental Colleges. A survey of work done in the majority of the colleges of this country proves that here we have the source of much that retards advancement along proper lines. The student is instilled with a mass of detailed technic and little attention is paid to the essentials. This is retained and the practitioner goes forth to enter this field with a mind unable to think along other than the presented lines. There are exceptions to this and we have men rising out of this condition to be individual leaders, but unfortunately, whose efforts are isolated and of less avail than those of the teacher in a college who directs the minds of a class of students varying in number every year.

The teaching in our colleges, for the

most part, is done by men who have developed a certain technic and rarely is a man found who recognizes the fundamental principles involved or who will place them above the technic that he has developed.

Crown and bridge work is taught very largely as a side issue or a part of the course in Prosthetics. The subject is a large one and we know it is too important to be combined with that of another of equal importance, namely, Prosthetics. These two subjects should be taught separately and by men who can give sufficient time to do justice to the subjects. No man can give the proper instruction, to a class of one hundred men, in the essentials of crown and bridgework, by a series of lectures and turn the control of technic work as well as practical work, over to a set of Demonstrators drawn from the classes previously so trained. Little attention is given to Dental Anatomy, Dental Physiology, occlusion or articulation. To open the door thru which much truth and light may enter, allow me to advance the following thoughts: Dr. Orton has advanced a definition of bridge work that I will submit at this time,-"A method of correcting or perfecting malocclusion in an arch mutilated by the loss of one or more teeth."

This may require changes; but as it stands, is short and to the point. We realize that the malocclusion brought about by the break in a perfect arch following the loss of one or more teeth, produces many degenerative changes. It interferes with the functions of the organ of mastication and with the specialized functions of the individual teeth. Thus,

we see that the primary purpose of crown and bridge work is the necessity of preserving the normal functions of the organ and of the individual teeth.

Let us present the essential principles that we believe should become the foun

dation upon which crown and bridge work should be based, and take them up in an indiscriminate order and we shall see that one predominates the others. In other words, we have several essentials that contribute to a principle.

First of all, let us take Dental Anatomy and emphasize its importance. Dental Anatomy receives some attention as such, and then seems to be entirely forgotten when it comes to our Crown and Bridge work. Men who give a great deal of attention to Dental Anatomy in their foil, amalgam or inlay operations, forget it all when constructing a Crown or a Bridge.

When we speak of Dental Anatomy, we mean not only the occlusal restoration but the restoration of all tooth shape contours, etc. This is seldom done, and I will admit, is very hard to do by even the most skilled technician.

The results following the preaching of Dr. J. Lowe Young, on occlussal restorations, have been remarkable and farreaching. The occlussal restoration is of vital importance possibly of greatest importance, in maintaining normal functions, but is only a part of the reproduction of tooth anatomy. The Gingwal contours, the contacts, the embrasures, the Buccal and Lingual contours, which if overlooked, allow food to pack against the Gingwal tissues producing inflammatory changes, must all receive proper attention if we wish to have our work function properly and fail to be an agent of destruction.

Next, let us take up occlusion. While not of greatest importance, it has been. emphasized very much. Perfect occlusion is very vital in order to maintain the proper balance of stress, etc., necessary for proper function of the organ of mastication. However, we may have a perfect occlusion but a very imperfect articulation, and our perfect occlusion stands for little. This may occur in mouths

where a great amount of wear has interfered with a proper articulation and still worn itself to a perfect occlusion.

It is unfortunate that while we may have so-called articulation, that they will not give us perfect articulation while they may give us perfect occlusion. This is easily demonstrated by taking a set of casts of normal teeth and try mounting them in any articulator. They will never produce movements necessary to follow the facets showing normal wear during the movements of the jaw in mastication.

There is being made, however, by Dr. Munson, of St. Paul, an articulator built on an entirely new principle, that I believe will revolutionize our theories with which it is possible to so mount cast of jaws, that all the movements of the jaw can be followed accurately. This promises to be of great aid to us in our bridge work in attaining perfect articulation.

In summing up, we find that all of the foregoing, all of our efforts in obtaining occlusion, articulation point to the maintenance of normal function. The reason that a tooth with a perfect occlusal reproduction is of great service, while one without is of little service and produces changes that soon become degenerative, is that it functions properly. We know that teeth have certain contours as for instance, the marginal ridge preventing the packing of food thru the contact point. The lingual and buccal contours that direct the food out into the mouth and away from the gingwal supporting tissues. This is definitely a function of the tooth as much as is mastication, so that our tooth form our Dental Anatomy has its reason in maintaining normal function of the organ as well as the especialized function of the individual teeth.

So it all points to normal function. We may have many things contributing