counter foreign bodies in the left lung than in the right) at a depth of 10 in. from the teeth. All attempts at removing the tooth at this sitting failed.

A second peroral examination, eight days following the first, was a failure. The patient suddenly collapsed, and had to be restored by artificial respiration before an attempt at removal could be made.

The formation of a lung abscess forbade further delay. The third examination was in brief as follows: Under chloroform, tracheotomy was performed. This permitted the introduction of a 10 mm. Bruening tube. The tooth was found at a distance of 5 in., and was relatively easily removed with a pair of Killian's "bean forceps." The after-history was uneventful. The scar on the neck is insignificant.

[Paris Médical, June 22, 1918.] Maxillo-dental-facial Malformations. PIERRE ROBIN.

BY

By maxillo dental facial malformations, Robin means all the irregularities of the teeth and of the jaws which distort the esthetic harmony of the face, as well as the form and volume of the cavities contained therein. These malformations are considered especially in their relation to diseases of the digestive and respiratory systems, of olfaction, of audition, as well as to the vicious attitudes of the thorax so frequently assumed in the case of children. The immediate consequences of these malformations are the imperfect preparation of the food bolus and of the inspired air.

It is imperative to correct these malformations as early as possible. Robin's method can be applied as soon as the eruption of the deciduous teeth is completed. His appliance, which is not technically described in this paper, acts not upon the teeth directly, but upon the jaw-bones themselves (the alveolar processes?), which thereby are slowly expanded. The appliance is inserted totally within the mouth, is worn all night, and as much as possible during the day; it is always removed when eating. The results are to Robin very satisfactory.

A priori, this appliance seems promising. The method meets the desideratum of Bogue (DENTAL COSMOS, February 1917, p. 246) of early treatment of malocclusion, which is only

one item of Robin's maxillo-dental-facial malformations, even during the period of the deciduous teeth; apparently it is of simpler technique and of less annoyance to patients of such tender age; and finally, it is not impossible that moving a segment of the alveolar process with its teeth in toto is more logical than that of moving the teeth alone, as well as provocative of periodontal traumatism.

Robin's appliance appears to fulfil the conditions exacted by modern orthodontia. J. V. Mershon (DENTAL COSMOS, October 1918, p. 934) says "The ideal appliance is one which interferes the least with the normal functions of the tissues and organs of the mouth." The possibility of removing it whenever desired would permit the institution and inculIcation of those exercises and habits so admirably presented by A. P. Rogers (DENTAL COSMOS, October 1918).

[California State Journal of Medicine,
July 1918.]

Vincent's Angina: Report of a Case. BY
J. M. KING.

The case is unusual for (1) its long course, the patient being seriously ill for about four months; (2) death from exhaustion, no special complication occurring (no autopsy was permitted); and (3) its resistance to neosalvarsan, three maximum doses being given a week apart without staying the progress of the disease. It is interesting to compare the symptoms and findings in this case, set forth below, with those enumerated by Barker and Miller (see pp. 1160-61).

The patient was a woman of twenty-six years; complained of sore-throat, fever, cough. Temperature 103°, cervical glands slightly swollen, whole pharynx covered with a slight membranous exudate, and on upper pole of right tonsil a small superficial ulceration. Smears showed abundance of Vincent's organisms (a condition persisting to time of death). Urine at first contained a small amount of albumin, a few hyaline and an occasional granular cast, but later was normal. At all times, leucocytosis of 12,000, of polymorphonuclear nature. The blood gave a weakly positive Wassermann. In course of observation the temperature was irregular, from normal to 104°. Pulse rose from 100 to 130 Respiration mounted to 40. Anorexia

or so.

persisted. Vomiting was a rather marked feature. The local lesion before death had spread across the pharynx, involving the left tonsil, ate away the uvula, involved the soft palate, and invaded the larynx.

[British Dental Journal, June 15, 1918.] A Case of Meningitis Associated with the Presence of Bacillus Fusiformis. BY CECIL WORSTER-DROUGHT.

In this case no definite primary focus beyond dental caries and pyorrhea alveolaris could be demonstrated even at autopsy. The patient was a man of thirty-two years. Apparently no microscopic examination was made of the "well-marked pyorrhea," which may or may not have been due to a Vincent's infection. This is unfortunate, as it would afford the first link in the chain connecting the "pyorrhea" with the meningitis. spinal fluid showed numerous Gram-positive cocci, some lanceolate and in pairs, others in small chains, Gram-negative coliform bacilli, and many Gram-negative fusiform bacilli. No spirochetal forms were seen. There is nothing recorded in this report which would prove or disprove the implication that meningitis was secondary to an oral Vincent's infection.

The

[El Siglo Médico, Madrid, July 6, 1918.] Facial Paralysis in a Syphilitic. By E. F.

SANZ.

The patient, a man of forty-six years, had suffered for four years of hemiplegia with aphasia, from a cerebral syphilitic lesion. A series of injections of gray oil was given, five days after the first of which there appeared a paralysis of the left half of the face. Synchronously with this there was an exacerbation of the oral conditions, which were already in a bad state. The gums became turgid, dark red, with numerous ulcerations. Severe pain with tumefaction of the left upper jaw region was felt. The mouth was dry.

Sanz diagnosed the condition as a parotitis consecutive to mercurial stomatitis (vide infra, Barker and Miller's paper). The facial paralysis might on this assumption be attributed to a compression of the branches of the facial nerve by the inflamed parotid.

Mercurial medication was halted. A scru

pulous disinfection of the mouth was instituted. Warm external applications were made in the region of the parotid. Very soon the stomatitis ameliorated. The inflammatory reaction of the parotid receded; step by step with this the facial paralysis became less marked, confirming Sanz' diagnosis.

[Journal of Experimental Medicine, October 1, 1918.] Experimental Parotitis. BY MARTHA WOLL

STEIN.

This work is summarized by the author as follows: A new series of inoculations of the filtered, sterile [free of microscopically visible organisms?] salivary secretions derived from cases of parotitis (including the epidemic parotitis of our military camps) has been described.

Confirmatory evidence of the filterable nature of the causative agent of mumps has been obtained. It has been determined that the saliva of man and of inoculated cats, and the inoculated glands of the latter animals, contain the filterable infective agent. The "virus" of parotitis was detected most readily in the saliva during the first three days of the disease, less easily on the sixth day, and not at all on the ninth day. It was detected also in the blood of patients showing marked constitutional symptoms, and in the saliva of a case of recurrent mumps at the periods of enlargement of the parotid glands. but not two weeks after the swelling had subsided. It was not detected in the cerebrospinal fluid.

[Journal of the American Medical Association, September 7, 1918.]

Perforating Ulcer of the Hard Palate Resembling Tertiary Syphilis, but Due to a Fuso-spirillary Invasion. BY LEWELLYS F. BARKER AND SYDNEY R. MILLER.

The patient was a man of forty-seven years, who presented himself on account of an ulcer on the roof of his mouth, of the development of which he had been conscious for only a few days, and which had gradually become larger and more painful. Physical examination revealed slight anisocoria, rather marked oral sepsis and gingivitis, an unpleasant, fetid odor of the breath, and a well-defined punched-out ulcer, about the size of a dime. situated on the hard palate, covered with a

thick, creamy, easily removed exudate, and surrounded by a deep red, somewhat indurated areola. The base of the ulcer bled easily. The clinical picture justified the suspicion of syphilis, but the Wassermann was negative. The patient was afebrile, and not sick. Smears showed the fusiform bacillus and the spirochetes of Vincent. The lesion promptly healed under treatment with dichloramin-T and local applications of concentrated arsphenamin solutions.

It is well known that the organic arsenicals are almost a specific for Vincent's infections. Consequently the rapid clearing-up of the lesion is to be ascribed rather to the arsphenamin than to the dichloramin-T, which in such cases at the Evans Dental Institute School of Dentistry, University of Pennsylvania, has proved unavailing.

This single case history has served the authors merely to introduce a concise and very well proportioned review of the subject. They recognize that it has been established without a doubt that one condition above all others exerts an influence favorable for the development of this type of ulcerative stomatitis, namely, oral sepsis, periodontal gingivitis, or pyorrhea. This fact has been pointed out by Bowman (DENTAL COSMOS, June 1918, p. 534).

The symptomatology is as follows. Objectively one notes

(1) Insignificance, as a rule, of constitutional disturbances; the patient is not very ill. (For possible exceptions. see reports of cases by Worster-Drought, King, and Sanz on pp. 1059-60.)

(2) Absence of fever, rarely over 100-101°. (3) Heavy and offensive breath.

(4) Enlargement of the cervical and submaxillary glands, as a rule moderately; they are tender and never suppurate.

(5) The lesions proper.

(6) Swollen, spongy and bleeding gums, suggestive of scurvy.

Subjectively the patient complains of-
(1) Extremely bad taste in mouth.

(2) Tenderness of the gums, so that the use of a toothbrush is impossible, and mastication is so painful as to preclude eating.

(3) Pain in swallowing.

(4) Looseness of the teeth, with salivation, which is common resembling mercurial ptyalism (vide infra, laboratory finding No. 2).

(5) Anorexia.

(6) Joint pains, frequently.

(7) Lassitude-lack of "go."

(8) The most serious constitutional symptom, and one always present when the teeth and gums are affected, is severe depression.

The laboratory findings are

(1) Uniformly negative blood cultures.

(2) The Wassermann in all cases of Vincent's disease is negative in nonsyphilitic patients. The presence of a positive reaction does not exclude Vincent's disease, and experience has shown that patients with a syphilitic history, undergoing mercurial treatment, are especially prone to this form of mouth lesion. (In other words, "mercurial" stomatitis is strictly a Vincent's infection of the gingival tissues, whose resistance has been lowered by the specific treatment.) Cf. Sanz' report [opposite page].) It is acknowledged that the treament with mercury can be pushed to a far greater extent in cases with healthy mouths than in those with mouths filthy with oral sepsis. This is explicable on the views of Bowman and of Barker and Miller themselves, viz, that oral sepsis strongly favors Vincent's infection. The question of the Wassermann reaction in Vincent's infection has received some attention, and the view held by the authors is that advocated by Taylor and McKinstry (DENTAL COSMOS, May 1918, p. 449).

(3) The leucocytes are rarely increased over 10,000; anemia does not develop in the majority of cases.

(4) A transient albuminuria is common in the more severe cases.

(5) Smears from the lesions show the characteristic organisms, a fusiform bacillus and a coarse spirochete, in association with numerous other organisms.

(6) Dark-field illumination aids greatly in eliminating the treponema pallidum.

As the identity of the two organisms mentioned above in (5) is undecided, and since the postulates of Koch have in no sense been fulfilled, the crucial demonstration that these organisms are the specific cause of Vincent's disease is at present lacking. This much is known

(1) In all of the lesions under discussion the organisms are present, as a rule, in enormous numbers, and often virtually in pure

culture. The severer the infection, the greater the number of organisms.

(2) There is positive evidence both as to the infectiousness and contagiousness of Vincent's disease.

(3) Healing of the lesions goes on parallel with the disappearance of the organisms. When complete, no organisms remain.

These facts may be taken as adequate proof that if the organisms are not the only, they are certainly an essential factor in the causation of these lesions, which constitute a clinical picture distinctive enough to be considered an entity, and so regarded by the consensus of present opinion.

Two sentences are of particular interest to the dentist. The first injunction, under the heading of Treatment, is: "A good dentist is one of the best therapeutic measures; the

care of the mouth is essential." And the admonition which receives the emphatic position of concluding the article is: "Prophylaxis is better than cure; oral sepsis is inexcusable "

[Bulletin of the Johns Hopkins Hospital, October 1918.]

Multiple Primary Malignant Tumors. By R. H. MAJOR.

The single case upon which this extensive analysis of 196 similar cases throughout the literature is based, concerned a woman of sixty years, who was suffering from carcinoma involving the right side of the nose, and extending to the inner canthus of the right eye. Necropsy showed an unsuspected round-celled sarcoma of the stomach.

Relieving Pain of Devitalized Pulp.When a patient returns to the office with an aching tooth as the result of a treatment for devitalization, conduction anesthesia may be used with good results. If properly performed the aching subsides in a few minutes. after which the tooth may be thoroughly and painlessly opened up. A new treatment can then be placed in the tooth, or if sufficient anesthesia is present, the pulp can be removed at once. In either instance, a patient relieved of pain will leave the office.-ALBERT E. CONVERSE, Dental Review.

Instructions in Re-sterilizing Compound. (1) Thoroughly clean all plaster from compound, breaking any extra large pieces of compound so that there are no pieces larger than an egg.

(2) Place in a pot-a double boiler is preferable, as it prevents the compound from burning at the bottom-and cover well with a solution of glycerite of naphthol (benetol) composed of one ounce to one gallon of hot water.

(3) Bring to a boil as rapidly as possible and boil thirty minutes. Note: Be sure the water is really boiling, as the small pieces of

plaster left in the compound will cause numerous bubbles to rise.

(4) Pour the water off and pour out the compound, which should be a spongy mass. on a sheet of galvanized iron or clean planed board, previously covered with Russian oil.

(5) Knead thoroughly the same as dough, when the plaster that may have been left in will work to the surface in the form of a bubble. Be sure to keep the hands well covered with Russian oil to prevent the compound from sticking, and start kneading as soon as it can be handled. Do not use soap and water to prevent the compound from sticking, as the lye in the soap will destroy the oils in the compound.

(6) As soon as the compound begins to show signs of stiffening, roll out on an oiled surface, and just before hardening run a knife across the same, marking off squares of desired size.

An excess of Russian oil incorporated in the compound will seriously retard its setting qualities. An excess of oil may be extracted by again bringing the compound to a boil. Only enough oil should be used to keep the compound from sticking to the table and hands.-W. E. CUMMER, Oral Health.

Removing Bad Lateral Root.-An upper lateral root which the X-ray showed to be infected as well as crooked, absolutely resisted all usual methods of removal.

At a hardware store a very small "machine screw tap" was purchased, also one or two short machine screws to fit the thread which this screw would cut. With a large fissure bur the canal was carefully enlarged, and a real screw-thread carefully cut in the sound dentin of the tooth. The tap was then removed, and one of the machine screws firmly set up tight in this threaded root. truding head of the screw offered a splendid hold for the, ordinary forceps, and the root came out entire and without fracture.ARTHUR G. SMITH, Dental Review.

The pro

Removing Plaster from Vulcanite Dentures. The dental laboratory worker sometimes finds, on removing a plate from the flask after vulcanization, that the mold or model plaster has formed a hard and strongly adherent layer of crystals on the surface of the vulcanite. Prevention is, of course, better than cure, and one ought not to be so careless as to leave the flask in water for some hours after vulcanization. In cases where one can afford to wait for the gradual action of a slow solvent, the following method will be found very satisfactory: The well-washed plate should be immersed in a strong or saturated solution of sodium hyposulfite-photographers' "hypo"-and left in this solution overnight. On removal from the solution, it will be found that in many instances the incrustation has been entirely dissolved. Should some crystals remain on the plate, they no longer adhere closely, and they can be readily brushed away, leaving the vulcanite surface quite clean. Oral Health.

How to Fit and Apply Angle's Ribbon Arch. All bands are to be fitted and soldered at the chair. Make anchor bands out of coin gold, 32-gage, soldering buccal tubes thereto. A more accurate fit can be obtained by following this procedure than by using ready-made bands. Place anchor and bracket bands on the teeth, and take a plaster impression. Put on two coats of shellac and one of sandarac varnish, let the impression stand over night, then run a model in Weinstein's artificial stone.

Place one end of the ribbon arch in the buccal tube, and by careful annealing and bending it can be sprung to place in each bracket. Remove from the brackets and place the other end of arch in the buccal tube. Loosen up the nuts and anneal with blowpipe.

Iron-bending wire should be used to hold the arch in the brackets, for the reason that it will not sweat the parts together. The ribbon arch treated in this way will fit perfectly, and will not put a strain upon any part until manipulated by the operator.-J. BERTRAM STEVENS, Internat. Journ. of Orthodontia.

Matrices for Amalgam Fillings.-In my opinion the method of fastening matrices with a ligature is sloppy and uncertain. The ligature is liable to slip off and give way. Besides, the 36-gage copper advocated is unnecessarily thick. A better way is to use a soldered steel matrix, which can be made of thinner material and is secure, as well as quickly and easily made. You can make up a stock of them of all sizes you may need, as follows: Get one of the stands used for holding seamless caps, which consists of an oblong flat piece of wood with numbered upright cylindrical blocks. Get a sheet of the thinnest matrix steel. The S. S. White Co. has it of a thinness almost of writing paper. Cut the steel into strips of convenient length, pinch around the blocks, remove, hold the pinched portion in appropriate pliers, flux the joint with solution of zinc chlorid made by dropping a piece of zinc into hydrochloric acid, apply a small piece of soft solder, and solder over alcohol lamp. Do not trim the soldered portion flush, but leave quite a little projection to give plenty of strength. You will, after a short experience, be able to pick a matrix which will fit or approximately fit the tooth you are working on. If the one you selected does not fit the tooth, find which of the cylindrical blocks it does fit. From that you can determine the exact size you want. You can then trim it if necessary to avoid irritation of the gum; place on the tooth, shape the end of a stick of orange-wood to fit between the teeth, and hold the cervical part of the matrix against the gingival wall, preventing overhang of filling. Do not cut your orange-wood wedge to interfere with contour. With the wedge in place, you are ready, after drying, etc., to fill. You will need about twelve sizes. Of those about six are most frequently used. You may rarely need a size larger than the largest of the blocks, which of course is easily made. It may sometimes be necessary to cut the matrix before removing after hardening of the filling. Generally I am able to remove without cutting after the filling has been left to harden sufficiently.

The matrix can then be washed, sterilized in flame or boiling water, and used several times. VINCENT FISCHER, Dental Review.