[Surgery, Gynecology, and Obstetrics,

Chicago, February 1918.]

Remarks on Dichloramine-T. BY EDWARD K. DUNHAM.

Dichloramine-T is an aromatic chloramine containing a little over 29 per cent. of chlo

rin.

Its systematic name is toluene parasulfon-dichloramine. It is only slightly soluble in water, but freely soluble in certain oils. This property is of essential importance in its use as an antiseptic.

Dunham prefaces his discussion of this representative of the newer antiseptics with a brief survey of the whole subject of the antiseptic treatment of wounds from the laboratory viewpoint. For successful disinfection, three conditions must be met: (1) Contact of antiseptic with infecting organisms; (2) time during which this contact is maintained, and (3) adequate mass, or concentration of the antiseptic at the points of contact. But little dependence can be placed upon the power of penetration of any known antiseptic, least of all when these are chemically unstable in the presence of substances occurring in wounds.

There are three things of prime importance that should be known about an antiseptic before it is chosen as appropriate for a given purpose, because the way in which it should be used to obtain the best results depends on such knowledge as- (1) The speed or rate of disinfection, (2) the stability of the substance under the conditions of its use, since this affects the duration of disinfection, and (3) the permissible concentration, for this determines the mass of antiseptic that can advantageously be employed.

The speed of disinfection is enormously influenced by the medium in which the antiseptic acts. In a medium of equal parts of blood serum and muscle extract, the disinfectant action of the members of the chlorin group were extremely rapid.

All the members of this group have a direct chlorinating and an indirect oxidizing power. The germicidal action of chlorin antiseptics is not specific, but is incidental to the high reactivity of this group of compounds. In other words, the efficiency of this group is a function of their chemical instability and high affinity for many other substances, and consequently to secure the best results pro

vision must be made for an adequately frequent renewal of the antiseptic. The chlorin antiseptics have a very striking detoxicating effect upon wounds, in addition to germicidal and deodorant action.

The third factor, the permissible concentration in which these antiseptics can be applied, and therefore the mass entering into the above reactions, can only be determined by clinical experience. Solutions of dichloramine-T in oil can be used in concentration up to 20 per cent. if need be, thus introducing an extraordinary mass of antiseptic at a single application. This abundant and apparently excessive mass can become effective without undue irritation. When proteins are present-and they invariably are in the secretions of wounds-the amount of active chlorin transferred from the oil solution is amply sufficient for rapid action. This action is continuous, not intermittent, and the renewal of the antiseptic coming into play in the secretions is automatic, and persists until the store in the oil has been exhausted.

[American Journal of the Medical Sciences, Philadelphia, February 1918.]

The Incidence of Chronic Focal Infection in Chronic Diseases. BY LOVELL LANG

STROTH.

This report is a brief summary of the data, pertinent to the doctrine of focal infection, afforded by the medical clinic of the University of California Hospital. The subject was of interest not only because it explained the cause of diseases whose etiology was hitherto unexplained, but also because it opened up a hopeful field in respect to therapeutics.

Langstroth summarizes his observations as follows: 84 per cent. of ulcer (gastric and duodenal) patients, 66 per cent. of acute or subacute cases of arthritis, 73 per cent. of the chronic cases of arthritis, and 100 per cent. of the gall-bladder cases, have been associated with chronic focal infections.

These figures are imposing until we realize that they are percentages based upon a totality of thirty cases of gastric and duodenal ulcer, of twelve cases of acute or subacute arthritis, of forty cases of chronic arthritis, and of four cases of chronic gall-bladder dis

ease.

In the face of this it must be granted

that "The figures do not, of course, prove any causal relation between chronic focal infection and the various chronic diseases mentioned." It is just this proof which is the crux of the whole question.

What is of special interest to the dentist in this paper follows: "In a number of cases the therapeutic results have been good; in a few cases they have been brilliant. The foci which lend themselves most readily to our work are the teeth and the prostate. On two occasions we have insisted on the removal of teeth because the [roentgen] plate showed a distinct area of rarefaction at the root-apex, and pus has not been found. Even with a positive report from the roentgen-ray department, one should rely on the judgment of a competent dental surgeon when he declares the tooth to be, nevertheless, sound."

The following is probably one of the brilliant results referred to above: One of the patients was a girl of seventeen years, with a subacute arthritis of the right foot of several months' duration. The joint improved the day after drainage of an alveolar abscess by extraction, and in ten days the patient wore a shoe for the first time in three months. An intensive and complete study of a concrete case such as this would be far more opportune and welcome than the elaborate compilation of statistics.

[Science, November 9, 1917.]

Anesthesia and Respiration. By A. R. C. HAAS.

It seems necessary to establish with certainty the effect of anesthetics upon respiration before a satisfactory theory of anesthesia can be formulated. Haas has measured the change in the hydrogen-ion concentration of sea-water produced by the respiration of the marine alga, Laminaria.

Experiments were carried on with sea-water containing the following substances: Chloral hydrate, novocain, ether, caffein, ethyl bromid, formaldehyd, chloroform, acetone, and ethyl alcohol.

"It was found that whenever the concentration of anesthetic is sufficiently strong to produce any measurable result, the initial effect is always an increase of respiration, which may either remain approximately constant over a large number of periods and then gradually decline, or the increased rate of respiration may fall very rapidly below the normal when the concentrations of anesthetic are too great. No decrease is observed with low concentrations which are not toxic. These facts contradict the theory of Verworn that anesthesia is a kind of asphyxia, for his view is based on the assumption that anesthetics decrease respiration."

Vincent's Angina.-Dr. Thomas Hubbard of Toledo states that reports of fatalities, in a disease that was usually transient and curable, indicate that a large number of cases are not diagnosed. Laboratory study of all ulcers and false membranes is necessary to positive, timely diagnosis. Perborate of sodium is an efficacious local medicament. The nascent hydrogen dioxid penetrates and disintegrates necrotic tissue, and is, theoretically, an ideal inhibitor of anaerobic bacterial growth. The local treatment resolves itself into careful applications limited to the diseased tissue. The glycerol of iodin-iodid of zinc 2, iodin 3, aqua destillata 5, glycerin 10 -applied to the tonsil crypts was probably

the most efficacious antiseptic. Theoretically the arsenical group is specific in action, and the writer believes that experience is proving favorable. He reports a case which presented a hopeless condition prior to the administration of neosalvarsan, and the improvement following was comparable only to that in diphtheria cases following a proper dose of antitoxin. In cases that did not yield promptly to this treatment cacodylate of sodium should be given, 2.5 to 5 grains, repeated in twenty-four or forty-eight hours, if the kidneys are not affected. In the malignant type, not improving under the above treatments, neosalvarsan 0.6 gram is given intravenously.-N. Y. Med. Journal.

A Hint on Mixing Cement.-For the proper mixing of cement a strong. pliable, rather long-bladed spatula gives the best results. It should be used rapidly with long, strong strokes, exerting considerable downward pressure, thus compelling a thorough mechanical mixing, which is the only way to create the opportunity for an accurate chemical union, which is very necessary if the maximum density and adhesiveness is to be attained.-Oral Health.

Removing Blood Stains.-To remove blood stains use a concentrated solution of chloral hydrate, from 70 to 80 per cent. Not only recent blood stains on linen, but stains existing for from ten to twenty years, first moistened with a drop of acetic acid and then soaked for some hours in a chloral solution are said to be perfectly removed. Blood stains on white materials may also be removed by treatment with hydrogen dioxid solution. It may take some hours to act if the stain is old.-Druggists' Journal.

Annealing Lingual Bars.-In the construction of lingual bar cases for partial lower dentures where the bar is to be soldered to gold saddles, the bar should be thoroughly annealed after bending and final adjustment has been completed, otherwise the heating in soldering will cause the bar to spring, and the case will not go back to place properly on the cast, and failure will result in the mouth. This result will also obtain in vulcanite cases unless the bar is annealed before final adjustment.-VICTOR H. FUQUa, Dental Review.

Local Anesthesia for Painless Operat= ing. Because of the initial pain accompanying the insertion of the needle, because of toxic symptoms observed, because of afterpain and soreness, and because of occasional sloughing of tissue and even abscess formation occurring at the site of injection, many otherwise conscientious operators have shunned the hypodermic syringe and the local anesthetic solution, thereby inflicting untold agonies that might have been avoided had they mastered the technique of our modern methods of induction. Every dentist can do better and more thorough work if he can operate painlessly, and incidentally, patients may use up their nervous energy in much more useful pursuits than that of enduring unnecessary pain incident to the excavation of sensitive cavities, the extirpation of vital pulps, or the extraction of teeth.-P. G. PUTERBAUGH, Dental Review.

Iodin as an Antiseptic.-Iodin is one of the most widely used and most useful of antiseptics. It was introduced as a skin disinfectant by Stretton in 1909, and for this purpose is undoubtedly of great value. It has been found much too irritating for repeated application to open wounds, and it is said that severe neuritis has been observed as a result of its use. Its strong coagulating action upon protein is also an objectionable feature. "In general, it may be said that iodin will be found most useful when the conditions are such that rapid and complete sterilization may be effected by a single application, as in skin disinfection or small surface wounds."-Amer. Journ. of Clin. Medicine.

Bleaching Teeth.-One of the very best bleaching agents for discolored teeth is 25 per cent. pyrozone. The root should be filled, and a pellet of cotton saturated with the pyrozone should be placed in the cavity and sealed with cement. It may be left two or three days, and if a tooth can be bleached at all, it will be bleached by this method. The pyrozone comes in sealed glass tubes. Care must be exercised in opening the tube. It should be chilled on ice and wrapped with a towel, letting the narrow end of the tube extend from the towel. This can then be snipped off with pliers, and the contents of the tube poured into a clean glass-stoppered bottle. A second application of the pyrozone may be necessary in deeply discolored teeth. -EDITORIAL, Dental Review.

An Interesting Case of Hypertrophied Tissue.-Miss X., about forty years of age, came to my office with the roof of her mouth covered with hypertrophied tissue in the form of soft teats as big as the end of the little finger. My diagnosis was that the plate was ill-fitting and did not go up into the arch in front, but did in the back, thus forming a vacuum. As "Nature abhors a vacuum," the tissues had grown down trying to fill it up. I cocainized and removed all the large teats possible, cauterized the remaining tissue with 4 per cent. AgNO3, and applied glycerite of tannin. I then built up the plate with modeling compound until it caused an even pressure on the affected area, thus causing ab sorption. I saw the patient every few days, and cauterized and built on to the plate until I got her mouth into absolutely normal condition. Then I made a well-fitting plate without a vacuum chamber, and she has had no further trouble.-R. B. EDSON, Proc. Harriet Newell Lowell Society for Dental Research.

Atmospheric Pressure in the Retention of Dentures.-Atmospheric pressure, contrary to the opinion of many, is only a neg ligible factor in the retention of dentures, it being dependent upon a vacuum, or near-vacuum, under the plate. So long as this space remains under the plate atmospheric pressure has some bearing on the retention, depending upon the degree of vacuity obtained, fifteen pounds of pressure to the square inch being the weight of a column of air on a surface from under which all air has been excluded. But the vaccum space cannot be permanent unless it is placed over a hard, unyielding area, in which case it acts as a relief; otherwise the space is soon filled in with the yielding tissue, and the influence of atmospheric pressure is lost, leaving the denture to be retained by the true principle, adhesion by contact.-E. B. OWEN, Dental Summary.

not condemning plaster too severely, for many good dentures have been made over it, but knowing its properties of expansion and compressibility as we do, why take chances with it when such materials as Spence's plaster and Weinstein's artificial stone are to be had?" The technique of manipulating these materials is too well known for discussion here. The writer personally prefers Spence's plaster, which must be manipulated and jolted into the impression for two or three minutes in order to give a smooth cast. This jolting requires that some sort of a matrix be built around the impression to confine the cast material. This matrix serves also to preserve the contour of the impression in the cast, which is necessary if we are going to extend the denture accordingly.-E. B. OWEN, Dental Summary.

Teeth Do Not Control Mandibular Movement. When building up cusps and carving fissures it will be well to remember that the teeth do not control the mandibular movements. If a cusp or part of a crown is not in harmony with the arcs through which the mandible sweeps in its movements it will wear off, or act as a lever to loosen the tooth upon which it is found. When several teeth are malposed they will to some extent limit the movements of the mandible, but never control it. The mandible will move as freely and as far as the muscles will pull, or the patient chooses to move it, but in all these movements it sweeps through certain

arcs of circles that are in harmony with the peculiarity of the anatomics of the case, without any regard to the occlusion or the occlusal surfaces of the units that make up the two arches. If any cusp or series of cusps are so placed that they interfere with these movements, they will be reduced to a point where they are in harmony, or the tooth of which they are a part will be exfoliated, while the mandible swings merrily on in its accustomed arcs.-F. W. FRAHM, Pacific Dental Gazette.

Ionization in the Treatment of Neuralgia.-Ionization has been successfully used for the treatment of trigeminal neuralgia. The technique consists in covering the whole affected area of the face with a folded cloth pad saturated with warmed solution of two per cent. sodium salicylate. On this is fitted a metal electrode covered with felt, which is securely bandaged in position throughout the application. The indifferent electrode,

which is also well covered with lint and moistened with sodium chlorid solution, is placed on the chest, or under the shoulders. The salicylic ions are anions, they are therefore repelled from the negative pole, which is attached to the electrode on the face. The current is turned on gradually and the patient can usually bear 20 to 30 m.a.; the application should last for thirty minutes, and may be repeated three times a week.

Great care must be taken to secure the terminals, so that there is no possibility of sudden break of current.

Quinin ions have also been used successfully for trigeminal neuralgia with the same technique, but the positive pole is here necessary to introduce these cations.-E. STURRIDGE, Dental Items of Interest.

Use of the Toothbrush.-The chief benefits derived from the use of a toothbrush are that it acts as a series of fine toothpicks, thereby removing a part of the loose débris, and that the massaging produces a more healthy condition of the gums. Massaging of the gums, however, can be carried to excess. I do not like to see the gums present a hard, leathery, mottled, pink surface, for this calloused appearance is the result of severe rubbing. There is not good circulation, and infection followed by serumal deposits usually occurs sooner or later, and works rootwise under this kind of tissue. Gum tissue should lie over well-formed bony structure, and should have a good, bright, healthy color, and a network of fine capillaries showing plainly just under the surface. I do not mean hyperemia, but just a good healthy

circulation. As far as I have been able to observe, daily massaging with cotton rolls or cheesecloth napkins increases circulation, but does not cause the gums to become calloused. It is better to take toothbrushes away from patients, if they cannot learn to handle them properly, and have them depend upon the polisher, dental floss, and cotton rolls, for with these they will not injure their teeth or gums. -FRANK H. SKINNER, Dental Summary.

Leucoplakia Oris.-Sometimes the mucous membrane of the cheeks, lips, and tongue develops a tendency to take on a grayishwhite coating, which is at times irregularly diffused, or decidedly patchy or flaky in appearance. This condition is called leucoplakia oris. It bears a close resemblance to the so-called leucoplakia of syphilis, except that the mucous membrane is quite smooth, and is devoid of the scarlike irregularities of the latter process. A serological examination will establish readily the identity in doubtful cases. The cause of this simple form of leucoplakia is very obscure. Syphilis and immoderate use of tobacco are regarded as predisposing influences by many. On the other hand, leucoplakia is often observed in women who have never incurred an infection of syphilis, and who likewise are not addicted to the use of tobacco. Some of the cases probably are predisposed by chronic gastric hyperacidity, and to the local irritation incident to overindulgence in pungent, acrid, highly spiced foods and condiments. This condition may become exceedingly pronounced in extreme cases, and not infrequently becomes transformed into well-defined malignancy. recognition and significance is within the pale of dentistry, with an incurred obligation of proper care and safe conduct.-M. L. HEIDINGSFELD, Dental Summary.

Its

Reinforced Silicate Cement Filling.The future favorite filling for certain selected anterior cavities will be the filling made by grinding a piece of porcelain of proper shade to match the tooth to be filled, and then setting the porcelain with silicate cement.

The piece of porcelain need not be ground so accurately as to fit the cavity perfectly, as the silicate will fill the inequalities and give a harmonious appearance. The porcelain, however, should be large enough to give the tooth its general contour, make a perfect contact point with the approximal tooth, and should form an occlusion with the opposing teeth when the jaw is closed. The porcelain should be of sufficient size to reproduce the general contour of the tooth, so that it will not be necessary for the silicate

cement to run over the edges of the porcelain, for the reason that the thin edges will break off later.

This kind of filling has many advantages, and overcomes nearly all the weak points of the silicate filling, such as lack of strength to retain the contact point and insufficient strength to hold on incisal angles or occlusal surfaces.

The inlays are cut from the part of a porcelain tooth which corresponds to the part to be replaced. A broken tooth or a diatoric tooth, or any pieces of a tooth, may be used, just so a piece is obtained that approximately corresponds to the cavity you wish to fill.— E. E. HAVERSTICK, Dental Summary.

Indications and Contra-indications for Local Anesthesia.-Almost everyone who has seriously entered the practice of conductive anesthesia has found that with increasing experience in its use he employs it more and more, to the exclusion of the commonly practiced infiltrative type. This is accounted for by the comparative painlessness of the needle insertion and the injection, the small amount of solution required, the absence of after-pain and soreness, and the absolute anesthesia obtained. Patients upon whom it has been used for cavity preparation or surgical procedures are pleased with the results, and request its use on subsequent occasions, and that encourages one to use it with increasing fre quency as time goes on. It is not recommended over nor will it ever supplant nitrous oxid for the highly nervous, uncontrollable neurasthenic who dreads operations; for the physically exhausted individual who has been in pain for a number of days; for the child with whom it is difficult to reason, nor for extractions in acute abscess conditions. But for the preparation of the sensitive cavity that does not respond to the ordinary methods of desensitization, for the removal of vital pulps, for root amputations, for extractions, for prolonged and complicated operations such as the removal of unerupted and impacted teeth, for maxillary sinus operations, for the reduction of fractures of the mandible, and for the removal of tumors and cysts about the jaws, it gives complete anesthesia. The patient can be placed in any position in the dental chair that is most convenient to the operator; there is no aspiration or swallowing of blood or mucus, and no nausea, vomiting, or prostration after the operation is over. In fact, the anesthesia will usually last until the patient reaches home, which in itself is highly desirable.-P. G. PUTERBAUGH, Dental Review.