while the legs rapidly lengthened, so that men very early became fast runners on the open plains.

In conclusion, if we compare the skull of a young anthropoid ape with that of a young human being we shall find that every bone in the ape skull may readily be identified in a slightly different form. in the human skull; the number and kinds of teeth are the same, both in the milk and permanent dentitions, and even the crown-patterns of the molar and bicuspid teeth are fundamentally similar in primitive apes and men. In spite of all the readjustments following the assumption of the fully upright gait and the change in food habits, the differences between the primitive ape skull and the

human skull are essentially differences of proportion and of degree rather than of kind.

From the paleontological viewpoint these numerous and fundamental resemblances can only mean that living apes and men have evolved from a remote and as yet undiscovered common ancestor that lived perhaps in the middle period of the age of Mammals. I believe also that the living apes, because they have stayed in the ancestral habitat, have retained the greater part of the ancestral man-ape characters, and that the ancestral pattern of the human face may still be seen in a little-changed state in the faces of young female gorillas and chimpanzees.

F not uncommon occurrence in the present war are those distressing wounds of the face and jaw which have attracted particular attention, not only on account of the disfigurement which they cause, but even more so from the difficulty that was at first encountered in dealing with them. This difficulty is the logical outcome of an attitude that regarded dentistry and surgery as two distinct and separate professions. As long as this theory was allowed to dominate practice, a man who had an extensive injury of the face and jaw-bone had about as much chance for an ideal result as had the man with an open fracture of a limb in the days when the physician and the bone-setter could find no common ground upon which to meet.

The bone-setter, and the physician who refused to recognize the surgeon, are of the past, but the surgeon and the dentist in their relation to each other only too frequently perpetuate the agnosticism of those older practitioners.

It is now accepted as axiomatic that in dealing with an open fracture of the thigh, the fixation of the bones and the treatment of exposed tissues should be concurrent, and that early treatment is one of the most important factors. It is not universally recognized that these same principles hold in the treatment of a wound involving the jaw-bone and the soft tissues, whether it be the result of an industrial accident, a removal of a tumor, or a war injury.

The surgeon has expended much study

upon making himself master of the various means of splinting an injured limb, but proper fixation of a fractured jaw can only be done by the use of dental splints. These he cannot apply himself, and he has not always sought the help that the dentist could so easily lend.

The late Von Langenbeck, after the war of 1870-71, said, "I would not care to go through another campaign without the help of skilled technicians to aid in the care of these jaw injuries."

The surgeon is not technically trained to splint these cases, yet early proper fixation is one of the most important points of the treatment. The dentist as such is not trained to care for the wounded tissues beyond fixation of the bones, yet repair of the soft tissues and proper drainage may be equally important. A few have bridged this no-man's land between surgery and dentistry, recently a much larger number have learned cooperation, but today I believe that the majority are pursuing their separate ways; that a patient with a jaw injury will be treated either by a surgeon or a dentist, neither of whom is master of all of the problems, and that either the fixation or the care of the tissues will suffer accordingly. Of the two, the dentist is the one more likely to recognize his need of help.

We

I crave pardon for injecting a personal note to the extent of begging that nothing be interpreted as the slightest criticism of the men who have been doing this work in the present war. have a grave problem, and we must analyze the circumstances with which we have to deal. Anyone who is familiar with the results that have been obtained by Kazanjian, Hayes, Davenport, Morestin, Valadier, and the other men who have been doing this work abroad, can have but one opinion of what has been accomplished, but these men have now been engaged in this work for one or more years, while we have not yet started.

It is or has been the custom to transport these cases back to special centers where qualified men were stationed. In the meantime the patients receive what

might for want of a better term be called general treatment. We have recently been told by Crile that the most important step in the preparation for the care of our wounded is to plan to give them the proper operative treatment within the first twelve hours; that if this be done, primary union may be obtained in 90 per cent., and that gas gangrene, etc., may by this means be eliminated. This may be too much to expect literally of mouth injuries, but I feel absolutely certain that in over 90 per cent. of these cases earlier treatment would accomplish even better results than late treatment, where reconstruction must overshadow conservation, and that Kazanjian, Morestin, and the others, could accomplish even better results in the individual cases with less effort and less distress to the patient if they could have their plan of treatment started in the earlier hours after the injury, rather than later when the wound is complicated by infection, muscular spasm, infiltration of the tistue, or scar contraction.

In the light of our past clinical observation and of what we have learned from workers abroad, it is our hope to place in every evacuation base and recovery hospital men who are familiar with the problems and technique of dealing with these face and jaw injuries, so that from the very first each of these patients will receive the best that surgery has to offer.

Where are we to get the large number of trained men to do this work on the scale as planned?

There are in this country at present a large number of men who have specialized in oral surgery. These are men of dental training, many of them with medical degrees, who have gone beyond the treatment of the teeth, to devote their attention to the peridental structures. These men understand most of the oral problems, the application of splints, etc., but as a rule are not accustomed to doing the major surgery that is required for many war injuries.

The surgical principles of treating oral and face injuries are the same as those applicable to wounds of any part of the

body. Wounds of the soft parts, if seen early before infection has occurred, may frequently be immediately repaired by suture. The wound is cleaned of all blood-clots, hemorrhage is controlled, and foreign bodies are removed; with the latter are included totally detached bone fragments. Above the lower border of the body of the mandible, local and general conditions permitting, immediate closure of the wound should be made, but all shreddy and pulpefied tissue is removed by clean excision, no attached fragments of bone being removed. If the defect is too large for simple suture, then, local and general conditions permitting, undermining of the borders may be done with provision for drainage of these pockets, or the wound is closed by flap operation. If the parotid duct is severed, provision for drainage into the mouth is made. In the neck there are two particularly notable danger zones in reference to subsequent infection: (1) The lower parts of the sub-facial spaces that lead directly into the mediastina, and (2) the immediate wound area about the ligated carotid or carotid primary branches. In the first instance the danger is that of mediastinitis, whereas in the second it is the possibility of secondary fatal hemorrhage. The blood supply, and therefore the resistance to sepsis, is not so good in the neck, and drainage may be necessary. If the deep sub-facial spaces are opened, in the deepest part of the lower end of each invaded space a small strip of gauze packing is placed. If one of the primary branches of the external carotid artery is divided, this part of the wound is packed, because sepsis here predisposes to fatal secondary hemorrhage. A wound in the trachea or larynx may be sutured, the more superficial part being packed, to furnish drainage away from the tracheal lumen. wound of the pharynx or esophagus is sutured, and the line of union reinforced by some superimposed tissue, but the mediastinum is guarded by a light packing at the lowest part of the wound.

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These packs are not allowed to remain when fouled. A complete wound through the floor of the mouth, as Billroth long ago pointed out, should never be primarily sutured, on account of the danger of indurating infection and secondary hemorrhage. If the bones are involved, then the remaining portions should be splinted in their proper positions and no attached fragment removed. pocket, every open bone-cavity, and the lower end of every fracture line should have efficient dependent drainage. If this be done early, it is surprising to note the conservation and regeneration that may result. After the bony fixation and drainage have been provided for, then the soft parts may be repaired as outlined above. The necessity for late repairs will largely be in inverse ratio to the early care that the case has received. It is by associating the capable general surgeon with the dental oral surgeon and sending them out as units that we propose to furnish this skill in multiple. If any apology were needed for this plan it is to be found in the recent report in a lay journal by Dr. W. W. Keen of the operation performed upon the late President Cleveland, in which one maxilla was removed and replaced by a prosthesis so perfect as to defy detection. This was an example of co-operation of the surgeon and the dentist.

In order to correlate the work and to present the special war problems, shortcourse schools have been established by the Surgeon-general in several cities where these surgeons and the dental oral surgeons working together will be molded into working units. Until their services are needed abroad these units are co-operating with the dental surgeons in the cantonments in an attempt to eradicate peridental infections from the mouths of our soldiers. It is hoped by this to materially lessen the medical casualties on the other side.

These are the aims of the subsection of Plastic and Oral Surgery in the program of "preparedness."

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S soon as there had been published a sufficient amount of literature pertaining to dental subjects to constitute what might be termed a literature of dentistry as a special branch of the healing art, those interested in the literature of this specialty began to make definite efforts toward the compilation of bibliographical records of dental literature.

As early as 1793 there was published in Leipzig in Neues Magazin für Aerzte a list of the dental works that had been published up to that time. The next effort appeared in 1829, as an appendix to Fitch's "System of Dental Surgery," published in New York, and constituted a fairly complete list of dental books published in the United States. Following that and previous to 1851 several other lists of dental books were published, notably those by Maury, of France; Linderer and Carabelli, of Germany, and Goddard, of the United States. In 1851 there was published by Robert Arthur, in the American Journal of Dental Science, as a "Report on American Dental Literature" to the American Academy of Dental Science, a fairly comprehensive list of dental works published in America previous to that year.

There was then a lapse of some fifteen years before any other dental bibliographer attempted to make a record of the dental literature. In 1876 Dexter published his "History of Dental and Oral Science in America," and in this was included a list of dental publications, which was, however, very incomplete; his effort being more in the nature of a review of the most important dental works published in English, together with a

record of the periodicals then published, with no particular effort at giving a complete record of the periodical literature.

In 1885 there appeared the most conspicuous effort at dental bibliography yet undertaken in America, in the publication of Crowley's "Dental Bibliography," a remarkably accurate record of the dental literature of the world, covering the period from 1536 to 1885. This today is a classic in American dental bibliographical work, and is the most authentic record we have of dental literature up to and including the year 1885.

The next most notable effort in dental bibliography was that in 1891 by Sternfeld, who published a work of excellent value, and one which ranks with Crowley's as a remarkably faithful record of the dental literature which had appeared up to and including the year of its publication.

In 1886 Taft's "Index of Dental Literature" was published, and was a fairly complete record of the periodical literature of the United States up to that time, and compiled almost entirely from the literature that was familiar to the author in his career as student, practitioner, teacher, and editor.

It was, however, left for Port, a German bibliographer, to publish the most elaborate record of periodical dental literature yet attempted. Port's work began in 1910, and the first volume included the literature, both books and periodicals, from the beginning of dental literature until 1902. This index was published in separate volumes for each year up to 1907, but we understand that further effort in the direction of bringing this bibliography up to date has been

suspended on account of the war conditions at present existing.

The two most notable efforts at the publication of monthly indexes including both book and periodical literature are those by Lamb, published in the DENTAL COSMOS from March 1889 to December 1902, and Paul de Terra, published in Archiv für Zahnheilkunde for the years 1911, 1912, and 1913.

Lamb's index was a fairly complete monthly record of book and periodical literature of the time. Paul de Terra's work, however, was more elaborate, and was a remarkably complete record of the monthly literature of the world, including the literature of almost all languages and countries of the world.

David, a French bibliographer, published in 1889 a very accurate bibliographical record of French literature, but did not include in this any dental works published in other languages.

The most recent dental bibliographical record in America comes from the Surgeon-general's office in Washington, and is a splendid historical record of the dental books and periodicals published in all countries, but is unfortunately incomplete in that it only records the publications that are on file in the Surgeongeneral's Library.

In the foregoing the writer has only attempted to give a brief history of the efforts at dental bibliography in the past as a matter of historical interest and record.

We shall devote the remainder of this article to an attempt to impress upon the reader the necessity for renewed activity in the bibliographical field, and cite some of the many apparent reasons why such records of our literature are more necessary and important today than ever in the history of our profession, in an endeavor to stimulate a more lively interest in this subject than has been exhibited in recent years by those most vitally interested in the educational development of dentistry.

The literature of a profession is the permanent historical record of its progress and advancement, and every member of that profession should be sufficiently

interested in his own advancement and progress to keep abreast of the progress made by his professional confrères. There is only one way in which the dentist can keep in touch with the advancement of his profession, and that is by constant reading of the periodical literature in which is recorded from month to month the latest improvements and suggestions in the various methods of dental procedure. As a previous writer on this subject aptly expressed it, "The periodical literature of dentistry is a serial story, ever-unfolding record of dental achievement. Each instalment, whether it be a copy of a journal, a book, a pamphlet, or a report, adds its 'incidents' to the main trend of the story."

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The dental profession has long borne the stigma of being a non-reading profession, and we regret to have to admit that in the past there has been a certain degree of justification for such a charge, but with the ever-increasing responsibilities to humanity that are devolving upon the profession because of the widening of the scope of dentistry, it is coming to be clearly recognized that we can ill afford to allow such a stigma to continue to rest upon the profession.

Dentistry has developed with such giant strides in recent years that it has become necessary for a division of the profession into numerous sub-specialties until today we have as specialties of dentistry orthodontia, prosthodontia, exodontia, periodontia, radiodontia, oral surgery, and even further specialization. in particular operative procedures.

Coincident with this broadening development of dentistry has been the development of the literature pertaining to each of the specialties, and consequently an increasing necessity for the specialist to keep abreast of the advancement in his own specialty as well as to keep himself familiar with the advancement of other specialties in their relationship to his own. In addition to this we have devolving upon dentistry larger responsibilities that have been forced upon it by the important rôles that oral sepsis and oral infections play in general systemic disturbances.