from a pinhead to a total destruction. of the crown of the tooth; eight or ten holes filled with rotten, decaying food, sometimes weeks old, with additional fragments lodged between many of the other teeth, constituting almost a teaspoonful of fetid matter, and they are actually mixing this decomposing mass with all the food and drink that they take.

Dr. Kirk says that this constant drain of poison into the intestinal tract in child life causes an intestinal indigestion in which bacterial products are absorbed into the system, and produce fevers, headaches, eye-strain, anemia, malaise, and constipation. Nature finally takes away the child's appetite and forces it to bed until a good house-cleaning can be accomplished. The poisons from the mouth are insidious and slow in action; many can and do withstand them for years, but as the constant dropping of water will wear away the stone, so will the products of decomposing food in the mouth soon destroy a good digestion and undermine the system.

IMPORTANCE OF CARING FOR THE TEETH OF SCHOOL CHILDREN.

It is unfortunate that the teeth of children, just at the age when thorough mastication is of greatest importance, are allowed to decay to such an extent that it becomes a painful operation for the child to masticate food at all. It is during this age that the greatest develop ment should take place, but most of the children are dental cripples by this time. A child cannot be expected to develop into a healthy adult with a strong mind if it is deprived of efficient means of chewing its food properly, or if the food must pass through in infected and uncared-for mouth that is more like a cesspool than a receptacle for the transmission of food to the human body, every ounce of which must pass through this disease-breeding area, and naturally becomes burdened with numerous colonies of bacteria. No wonder such children are sickly and lacking in strength to resist disease, or that they are not con

sidered bright and intelligent, figuring many times as members of our mentally deficient class in school work. No child can grow in grace, mentality, or stature with a body that is not properly nourished, with organs seeking to grow and develop but with nothing to grow or develop on, and these are the exact conditions present in many cases.

Diseased teeth are usually aching teeth, and a child with toothache is not able to meet the requirements of our modern educational systems. Eating is a process to be avoided, and it is practically impossible for the child to sleep. Weakened by the loss of sleep and the lack of nourishment, he becomes discouraged in everything that he undertakes, is lacking in ambition, and is pessimistic. His standard of self-respect and respect for his teachers and classmates is lowered, his judgment is clouded, and his ability to discriminate between right and wrong is greatly handicapped. His associates are in keeping with his lowered ideals, and we are permitting a child to start on the downward path through no fault of his own.

UNCLEAN MOUTHS A MENACE TO PUBLIC HEALTH.

Forgetting for a moment the effect that an unclean mouth has upon an individual, let us turn our attention to the result it has upon the public. Today everybody feels that the condition of their children's mouths is their own private affair. We must get away from this selfish, erroneous, and dangerous attitude, for with every breath from an unclean mouth millions of pathogenic bacteria, easily capable of inoculating another person with a virulent organism, are expelled from one to ten feet, and a filthy mouth becomes as much a public menace as the unswatted fly, filthy streets or garbage cans.

Miller claimed to have isolated about sixty kinds of bacteria from the juices. and deposits in the mouth, a great many of which were disease-producing.

The mouth is an ideal incubator, for here we find all of the essentials for

the propagation and development of these organisms-the right temperature, sufficient moisture, darkness, and a menu to choose from that would tempt any member of this large family.

An unclean mouth means an increased number of bacteria, and with increased numbers come increased dangers from infection. The bacteria which cause tuberculosis, pneumonia, measles, scarlet fever, diphtheria, erysipelas, influenza, cerebro-spinal meningitis, and many other diseases, have the mouth as their happy hunting-ground, and are ready to set up their specific disease whenever the bodily resistance becomes lowered.

Children with defective teeth are more susceptible to all contagious diseases, and are apt to pass them on by means of borrowed pencils, rulers, and handkerchiefs, making the condition of their mouths one of concern to all parents.

During an epidemic of scarlet fever in Chicago those affected were of course sent away, quarantined, and the other usual precautions taken, and were not allowed to return to school until well. Their return was frequently followed by a fresh outbreak of the disease, the cause of which could not be determined for a long time. After the enforcement of a regulation requiring each child having the disease to have the mouth cleaned and every cavity in the teeth filled before returning to school, the epidemic was stopped. Similar results were also obtained at St. Vincent's Orphan Asylum in Boston. The average number of contagious diseases in that institution was about 100; this was reduced to two cases after the establishment of a dental infirmary. These illustrations show what can be accomplished by proper dental attention, and since it is the state that has to pay so dearly for these epidemics, the condition of the child's mouth should be one of interest to all.

ECONOMIC VALUE OF CLEAN MOUTHS TO

THE COMMUNITY.

In Cleveland, Ohio, 97 per cent. of the school children had defective mouths. In the prosecution of the clinical work

to improve the mouth conditions twentyseven of the children selected as having the greatest amount of oral defects in a school of 846 pupils showed after proper dental attention an average increase in their efficiency in school work of 99.8 per cent. This was apparently due wholly to the correction of their oral conditions and teaching them the proper care and use of their mouths. The improvement in their physical and moral standards was quite as marked as that in their mental activity. These results are in keeping with other statistics in this field, and we could produce similar results in every community. Every school has a certain percentage of retarded pupils, pupils who have failed to pass to higher grades. The cost of having the child make up this work amounts to millions of dollars throughout the country, a large percentage of which could be saved by giving the children proper dental attention. Two or more decayed molars will keep a child back six months in school during the first eight grades, which means an extra cost of from $25 to $50. In New York City a few years ago 67,000 children failed to be promoted to higher. grades because of absence, 80 per cent. of which was laid either directly or indirectly to defective teeth, costing the city of New York $1,037,696. It has been clearly demonstrated that the worse the condition of the teeth, the worse the school standing of the child.

You have seen scores of pupils absent from school on account of the toothache, and you realize that the anemic, ill-nourished, stupid, retarded child is almost always one with a foul, unclean mouth. "What is the use," says a noted educator, "of trying to teach arithmetic to a child whose capabilities are only half their maximum, due to a grossly neglected oral cavity."

When you see a child who is from one to three years behind his proper grade, is pale, listless, apathetic, gives a history of headaches, and is unable to cope with his studies, you can take it for granted that you will find upon examination actually repulsive conditions of the mouth.

These unfortunates are being deprived of this measure of education, besides endangering the health of other children. by reason of their susceptibility to infectious disease, simply because the pub:

lic does not realize that the condition of the child's mouth is a part of their business, and does not insist upon having this condition remedied.

DR. OSLER ON DEFECTIVE TEETH.

Dr. Osler, the noted physician, says, "If I were asked to say whether more physical deterioration was produced by alcohol or defective teeth, I should unhesitatingly say, Defective teeth," which is the light in which it is viewed by the medical profession at the present time.

Taking, then, this specific knowledge as to the deleterious effect of a diseased mouth upon the child, school, state, and nation, into consideration, it becomes a great economic and sociological problem that should appeal in the highest degree

to all teachers who are interested in the welfare of the child.

Summing up, then, oral cleanliness means less disease. It means fewer physicians' and dentists' bills. It means more work and play and less discomfort and pain. It means more attractiveness and greater self-respect, more aggressiveness and greater initiative, more of the rose-tint of health and less of the wanness of disease. It means stronger bodies and brighter minds, greater vitality and less physical and moral insufficiency and renders the child better able to choose between right and wrong.

In conclusion, to say that most of the ills of the human family are due to the lack of proper care during the period of childhood is not saying more than is generally conceded by those who are most competent to judge; and statistics show that the teeth are directly or indirectly responsible for from 80 to 90 per cent. of all these ills.

Ulceration may become thickened, and when detached around the edges new membrane forms. This ulcerative tissue is necrotic tissue. In color it may be of the soft gray, yellowish gray, or greenish variety. There is a distinct fetid odor to the breath which is different from that of any other form of stomatitis.

In differentiating this from syphilitic chancre the following features are useful: (1) Angina ulceration is more tender to touch, (2) more superficial, (3) with granular enlargement in the region of the angle of the jaw, and (4) examination of the microscopic smear will determine the diagnosis.

I have treated several cases received in the Philadelphia General Hospital (Oral Surgical Department) and obtained excellent results.

The following record of a case will serve as an illustration:

Patient, a colored girl of twenty-eight, admitted January 4, 1917. At the Philadelphia General Hospital oral surgical clinic held January 6, 1917, by Dr. Carlton N. Russell, the case was diagnosed as Vincent's angina.

Physical examination showed ulcerations about the regions of the second and third molar teeth, also upon the buccomucosal reflection and posteriorly toward the tonsil region.

Symptoms. The patient complained that the teeth were all sore to touch; she could not eat, suffered with headache and malaise, and had difficulty in swallowing. There were present enlarged glands and swelling about the region of the angle of the jaw.

Two smears on glass slides were sent

to the laboratory and returned with a positive diagnosis of Vincent's angina. The patient's temperature ran normal. Treatment. The patient was given a laxative, and ordered to use three times daily potassium permanganate (solution of 1:3000) with cotton upon applicators. Some of the ulcerative tissue was removed and the region swabbed with a 5 per cent. solution of hydrargyri nitras. The swollen region around the angle of the jaw was painted with 10 per cent. tincture of iodin. This treatment was continued, and the patient's condition cleared up in about eight days. This is only one of the many cases of Vincent's angina similarly treated with success.

Another antiseptic treatment used and from which I have obtained results is swabbing the parts with one of the following preparations: Copper sulfate 10 per cent., Lugol's iodin, phenol in glycerin 5 per cent., saturated solution of potassium permanganate.

In connection with the above I prescribe the use of a good germicidal mouthwash, such as potassium permanganate (solution 1:3000) or potassium chlorate.

Vincent's angina should be diagnosed and treated by all dentists, as it is a mouth condition which clearly falls within their scope of practice, especially as it is most likely to be presented first to the dental practitioner in its intial stages, when treatment should be promptly instituted to avert its extension and the loss of tissue by necrosis which

results from its later and more extensive development.

1809 CHESTNUT ST.

A

T this time, when American chemical ingenuity is so sorely needed and its products are so carefully watched, I cannot refrain from reporting my observations of and conclusions from a series of over 700 oral operations under local anesthesia induced by the new American synthetic local anesthetic -apothesine. These operations were performed at the Vanderbilt Clinic of the College of Physicians and Surgeons, New York, during a period of two months, between November 9, 1917, and January 11, 1918. In a series of 380 cases, 703 extractions were done, 151 of which were anesthetized by infiltration by subperiosteal and peridental injections, the remaining 229 by conduction through perineural injection of the pterygo-mandibular nerve. There were also sixteen minor operations, including root amputations, removal of small cysts, fibrous tumors, and plastic operation to close the palate. In another series of

cases

there were twenty-five double pterygo-mandibular injections. The anesthetic solution in each case consisted of apothesine 2 per cent. and adrenalin. 1:50,000. The solutions were prepared by dissolving one tablet of apothesine combined with adrenalin for every 2 cc. of Ringer solution used, and boiling the solution over an alcohol flame for sterilization. Profound anesthesia was induced in one minute when infiltration was the method employed, and it is even more noteworthy that when conduction was resorted to, the average time in which complete anesthesia resulted was. eight minutes. Untoward symptoms such as pallor, syncope, or palpitation

were conspicuously absent during the whole series. The anesthesia in each case was absolute, and in those cases that were observed an hour and a half after injection (impacted third molars) sensation had not yet returned. My observations with regard to the toxicity of apothesine and its non-interference with primary wound healing coincide entirely. with those of Prof. Arthur Dean Bevan, president-elect of the American Medical Association, which he records in the Chicago Surgical Clinics of February 1917, in the following language: "I have recently used apothesine in twenty-five operations, including removal of inguinal glands, resection of rib, and drainage of lung abscess, circumcision, inguinal and femoral hernia, carcinoma of the face, synovial cyst on the back of the wrist, ligation of thyroid vessels, gastroenterostomy, resection of rib, and draining subphrenic abscess, a very extensive. thyroidectomy, removal of bullet from the thigh, removal of infected cyst of the neck, and removal of tumor of the breast. We have used as large an amount as five and one-half ounces of a half of one per cent. solution. We have not noticed any toxic effects of any kind, and no interference with primary wound healing." Owing to apothesine's entire freedom from habit-forming properties, its purchase and sale is not restricted by any of the provisions of the Harrison narcotic law.

CHEMICAL COMPOSITION OF APOTHESINE.

To discuss technically the chemistry of apothesine is beyond the scope of this